Healthcare Settings, Reimbursement, and Regulatory Compliance Flashcards

Which federal law established nursing home reform, including requirements for an ongoing resident activities program and comprehensive assessments?

Answer: OBRA 1987

The Omnibus Budget Reconciliation Act of 1987 set federal nursing home standards, including resident assessment and activities requirements.

In long-term care, which standardized assessment includes a section on a resident's activity preferences and customary routine?

Answer: Minimum Data Set (MDS)

The MDS 3.0 includes Section F, Preferences for Customary Routine and Activities.

Since October 2019, Medicare Part A skilled nursing facility payment has been based on which model?

Answer: Patient Driven Payment Model (PDPM)

PDPM replaced RUG-IV on October 1, 2019, basing SNF payment on patient characteristics rather than therapy minutes.

Under federal nursing home regulations, an activities program director may be qualified by being:

Answer: A therapeutic recreation specialist eligible for certification

CMS requirements list eligibility for certification as a therapeutic recreation specialist or activities professional among the director qualifications.

After a qualifying hospital stay, Medicare Part A covers SNF care for up to how many days per benefit period?

Answer: 100 days

Medicare covers up to 100 SNF days per benefit period, with days 1–20 fully covered and a daily coinsurance for days 21–100.

Which agency typically conducts the federal certification surveys of nursing homes on behalf of CMS?

Answer: The state survey agency

CMS contracts with state survey agencies to inspect nursing homes for compliance with federal requirements.

To qualify for the Medicare hospice benefit, a physician must certify that the patient:

Answer: Has a life expectancy of 6 months or less if the illness runs its normal course

Hospice eligibility requires certification of a terminal illness with a prognosis of 6 months or less.