CMS Flashcards
Regs (40 cards)
Deposit of funds
In general: Except as set out in paragraph (f)( 10)(ii)(B) of this section, the facility must deposit any residents’ personal funds in excess of $100 in an interest bearing account (or accounts) that is separate from any of the facility’s operating accounts, and that credits all interest earned on resident’s funds to that account.
(In pooled accounts, there must be a separate accounting for each resident’s share.)
The facility must maintain a resident’s personal funds that do not exceed $100 in a non-interest bearing account, interest-bearing account, or petty cash fund.
medicaid trust fund
Residents whose care is funded by Medicaid: The facility must deposit the residents’ personal funds in excess of $50 in an interest bearing account (or accounts) that is separate from any of the facility’s operating accounts, and that credits all interest earned on resident’s funds to that account. (In pooled accounts, there must be a separate accounting for each resident’s share.)
medicaid trust fund
The facility must maintain personal funds that do not exceed $50 in a noninterest bearing account, interest-bearing account, or petty cash fund.
how often must the facility as a fiduciary report the status of a residence trust fund account?
“Hold, safeguard, manage, and account for” means that the facility must act as fiduciary of the resident’s funds and report at least quarterly on the status of these funds in a clear and understandable manner. Managing the resident’s financial affairs includes money that an individual gives to the facility for the sake of providing a resident with a non-covered service. In these instances, the facility will provide a receipt to the gift giver and retain a copy.
total health status includes?
“Total health status” includes functional status, nutritional status, rehabilitation and restorative
potential, ability to participate in activities, cognitive status, oral health status, psychosocial
status, and sensory and physical impairments.
initial comprehensive assessment
Discussion and documentation of the resident’s choices regarding future health care may take
place during the development of the initial comprehensive assessment and care plan and
periodically thereafter.
The right administer self medication’s
The right to self-administer medications if the interdisciplinary team, as
defined by §483.21(b)(2)(ii), has determined that this practice is clinically appropriate.
GUIDANCE §483.10(c)(7)
If a resident requests to self-administer medication(s), it is the responsibility of the
interdisciplinary team (IDT) (as defined in §483.21(b), F657, Comprehensive Care Plans) to
determine that it is safe before the resident exercises that right. A resident may only self-
administer medications after the IDT has determined which medications may be self-administered
How do staff determine if a resident is able to safely self-administer medications?
When determining if self-administration is clinically appropriate for a resident, the IDT should at
a minimum consider the following:
* The medications appropriate and safe for self-administration;
* The resident’s physical capacity to swallow without difficulty and to open medication
bottles;
* The resident’s cognitive status, including their ability to correctly name their medications
and know what conditions they are taken for;
* The resident’s capability to follow directions and tell time to know when medications
need to be taken;
* The resident’s comprehension of instructions for the medications they are taking,
including the dose, timing, and signs of side effects, and when to report to facility staff.
* The resident’s ability to understand what refusal of medication is, and appropriate steps
taken by staff to educate when this occurs.
* The resident’s ability to ensure that medication is stored safely and securely.
A resident may only request a self administer medication after the IDT has?
If a resident requests to self-administer medication(s), it is the responsibility of the
interdisciplinary team (IDT) (as defined in §483.21(b), F657, Comprehensive Care Plans) to
determine that it is safe before the resident exercises that right. A resident may only self-
administer medications after the IDT has determined which medications may be self-
administered.
documenting If resident is self administering medication
Appropriate notation of these determinations must be documented in the resident’s medical
record and care plan. If a resident is self-administering medication, review the resident’s record
to verify that this decision was made by the IDT, including the resident. The decision that a
resident has the ability to self-administer medication is subject to periodic assessment by the
IDT, based on changes in the resident’s medical and decision-making status. If self-
administration is determined not to be safe, the IDT should consider, based on the assessment of
the resident’s abilities, options that allow the resident to actively participate in the administration
of their medications to the extent that is safe (i.e., the resident may be assessed as not able to
self-administer their medications because they are not able to manage a locked box in their room,
but they may be able to get the medications from the nurse at a designated location and then
safely self-administer them).
IDT?
In a nursing home Interdisciplinary Team (IDT), the core members typically include the resident or patient, family and/or personal care partners, the facility’s Medical Director, nursing staff, therapists (physical, occupational, speech), a social worker, the dietary department, a life enrichment coordinator (for activities), and the billing office. Other professionals may be involved depending on the individual resident’s needs, such as a dentist, pharmacist, or other specialists
IDT break down
Resident/Patient: The individual receiving care is at the center of the IDT.
Family and/or Personal Care Partners: Individuals who provide care and support, and who are involved in the resident’s care decisions.
Medical Director: The physician responsible for the overall medical direction and care of residents.
Nursing Staff: Registered nurses and licensed practical nurses who provide direct care to residents.
Therapists (Physical, Occupational, Speech): Professionals who help residents regain or improve their mobility, daily living skills, and communication.
Social Worker: A professional who addresses the resident’s social, emotional, and environmental needs.
Dietary Department: Provides dietary assessment and planning for the resident.
Life Enrichment Coordinator: Plans and coordinates activities and programs for residents.
Billing Office: Responsible for managing the resident’s billing and payment.
Other Professionals: Depending on individual needs, other specialists like a dentist, pharmacist, or other healthcare professionals may be involve
illegal substances
it is important for facility staff to have knowledge of signs, symptoms, and triggers of possible
illegal substance use; such as changes in resident behavior, increased unexplained drowsiness,
lack of coordination, slurred speech, mood changes, and/or loss of consciousness, etc. This may
include asking residents, who appear to have used an illegal substance (e.g., cocaine,
hallucinogens, heroin), whether or not they possess or have used an illegal substance.
procedures for illegal substances
If the facility determines through observation that a resident may have access to illegal
substances that they have brought into the facility or secured from an outside source, the facility
should not act as an arm of law enforcement. Rather, in accordance with state laws, these cases
may warrant a referral to local law enforcement. To protect the health and safety of residents,
facilities may need to provide additional monitoring and supervision. If facility staff identify
items or substances that pose risks to residents’ health and safety and are in plain view, they may
confiscate them. But, facility staff should not conduct searches of a resident or their personal
belongings, unless the resident, or resident representative agrees to a voluntary search and
understands the reason for the search. For concerns related to the identification of risk and the
provision of supervision to prevent accidental overdose, investigate potential non-compliance at
F689, §483.25(d) – Accidents.
For concerns related to the behavioral health services that are provided, investigate potential non-
compliance at F740, §483.40 – Behavioral Health Services.
Resident Room change
A resident can decline relocation from a room in one institution’s distinct part SNF or NF to a
room in another institution’s distinct part SNF or NF for purposes of obtaining Medicare or
Medicaid eligibility. Facility staff are responsible for notifying the resident or resident
representative of changes in eligibility for Medicare or Medicaid covered services and of what
the resident’s financial responsibility may be. If the resident is unable to pay for those services,
then after giving the resident a discharge notice, the resident may be transferred or discharged
under the provisions of §483.15(b), F621, Equal Access to Quality Care.
Did facility staff give the resident the opportunity to refuse the transfer?
A resident also has the right to refuse transfer if that transfer is solely for the convenience of
staff. For example, a resident may experience a change in condition that requires additional care.
Facility staff may wish to move the resident to another room with other residents who require a
similar level of services, because it is easier for staff to care for residents with similar needs. The
resident would have the right to stay in his or her room and refuse this transfer.
Visitors and residents roommate
If these familial visitation rights infringe upon the rights of other residents, facility staff must
find a location other than a resident’s room for visits. For example, if a resident’s family visits in
the late evening when the resident’s roommate is asleep, then the visit should take place
somewhere other than their shared room so that the roommate is not disturbed.
can a facility discharge a resident for not consenting to a room change?
while a room change may be necessary for a resident’s well-being, a nursing home cannot force a resident to move if they refuse, and a refusal to move cannot be grounds for discharge
beneficiary notices notice of non-medical coverage (NOMNC)
Notice of Medicare Non-Coverage (NOMNC)
The NOMNC, Form CMS-10123, is given by the facility to all Medicare beneficiaries at
least two days before the end of a Medicare covered Part A stay or when all of Part B
therapies are ending. The NOMNC informs the beneficiaries of the right to an expedited
review by a Quality Improvement Organization. See also 42 CFR 405.1200 and 422.624.
The NOMNC is not given if:
* The beneficiary exhausts the SNF benefits coverage (100 days), thus exhausting their
Medicare Part A SNF benefit.
* The beneficiary initiates the discharge from the SNF.
* The beneficiary elects the hospice benefit or decides to revoke the hospice benefit and
return to standard Medicare coverage.
admission orders
At the time each resident is admitted, the facility must have physician orders for the
resident’s immediate care.
INTENT §483.20(a)
To ensure each resident receives necessary care and services upon admission.
GUIDANCE §483.20(a)
“Physician orders for immediate care” are those written and/or verbal orders facility staff need to
provide essential care to the resident, consistent with the resident’s mental and physical status
upon admission to the facility. These orders should, at a minimum, include dietary, medications
(if necessary) and routine care to maintain or improve the resident’s functional abilities until staff
can conduct a comprehensive assessment and develop an interdisciplinary care plan.
residence assessment
The facility must conduct initially and periodically a comprehensive, accurate,
standardized reproducible assessment of each resident’s functional capacity.
comprehensive assessment
1) Resident Assessment Instrument. A facility must make a comprehensive
assessment of a resident’s needs, strengths, goals, life history and preferences, using the
resident assessment instrument (RAI) specified by CMS. The assessment must include at
least the following:
(i) Identification and demographic information
(ii) Customary routine.
(iii) Cognitive patterns.
(iv) Communication.
(v) Vision.
(vi) Mood and behavior patterns.
(vii) Psychological well-being.
(viii) Physical functioning and structural problems.
(ix) Continence.
(x) Disease diagnosis and health conditions.
(xi) Dental and nutritional status.
(xii) Skin Conditions.
(xiii) Activity pursuit.
(xiv) Medications.
(xv) Special treatments and procedures.
(xvi) Discharge planning.
(xvii) Documentation of summary information regarding the additional assessment
performed on the care areas triggered by the completion of the Minimum Data Set
(MDS).
(xviii) Documentation of participation in assessment. The assessment process must
include direct observation and communication with the resident, as well as
communication with licensed and nonlicensed direct care staff members on all
shifts.
A facility must conduct a comprehensive assessment of a resident in accordance
with the timeframes
Within 14 calendar days after admission,
excluding readmissions in which there is no
significant change in the resident’s physical or mental condition. (For purposes of
this section, “readmission” means a return to the facility following a temporary
absence for hospitalization or therapeutic leave.)
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(iii)Not less than once every 12 months.
RAI-resident assessment instrument
To ensure that the Resident Assessment Instrument (RAI) is used, in accordance with specified
format and timeframes, in conducting comprehensive assessments as part of anongoing process
through which the facility identifies each resident’s preferences and goals of care, functional and
health status, strengths and needs, as well as offering guidance for further assessment once
problems have been identified.
