F-tag Law only Flashcards
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The resident has a right to manage his or her financial affairs. Medicare / Medicaid
x personal funds in excess of $100 in an interest bearing account
x 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
x personal funds in excess of $50 in an interest bearing account
x personal funds that do not exceed $50 in a noninterest bearing account, interest-bearing account, or petty cash fund.
Accounting and Records
resident through quarterly statements and upon request
Notice of certain balances
When the amount in the resident’s account reaches $200 less than the SSI ( Supplemental Security Income ) resource limit for one person,
Assurance of financial security
surety bond,
Conveyance upon discharge, eviction, or death.
facility must convey within 30 days the resident’s funds, and a final accounting of those funds, to the resident, or in the case of death, the individual or probate jurisdiction administering the resident’s estate, in accordance with State law
The resident has the right to access personal and medical records pertaining to him or herself.
x upon an oral or written request
x in the form and format requested by the individual
x within 24 hours (excluding weekends and holidays)
The facility must allow the resident to obtain a copy of the records or any portions thereof
upon request and 2 working days advance notice to the facility
The resident has the right to receive notices orally and
in writing (including Braille) in a format and a language he or she understands
The facility must post, in a form and manner accessible and understandable to
x residents, resident representatives
x A list of names, addresses (mailing and email), and telephone numbers of all pertinent State agencies and advocacy groups, such as the State Survey Agency, the State licensure office, adult protective services where state law provides for jurisdiction in long-term care facilities, the Office of the State Long-Term Care Ombudsman program, the protection and advocacy network, home and community based service programs, and the Medicaid Fraud Control Unit
Have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the
x 3 preceding years, and any plan of correction in effect with respect to the facility, available for any individual to review upon request; and
x Post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public
Comfortable and safe temperature levels
must maintain a temperature range of 71 to 81°F
Before a facility transfers or discharges a resident, the facility must—
x at least 30 days before the resident is transferred or discharged
Admission orders
Resident Assessment
The facility must conduct initially and periodically a comprehensive, accurate, standardized reproducible assessment of each resident’s functional capacity
Admission orders
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 CM
Admission orders
a facility must conduct a comprehensive assessment of a resident in accordance with the timeframes
(i) Within 14 calendar days after admission, excluding readmissions in which there is no significant change in the resident’s physical or mental condition.
iii) Not less than once every 12 months.
Admission orders
Within 14 days after the facility determines, or should have determined, that there has been a significant change in the resident’s physical or mental condition.
significant change” means a major decline or improvement in the resident’s status that will not normally resolve itself without further intervention
Admission orders
Quarterly Review Assessment
A facility must assess a resident using the quarterly review instrument specified by the State and approved by CMS not less frequently than
once every 3 months.
Admission orders
A facility must maintain all resident assessments completed within the previous
15 months in the resident’s active record and use the results of the assessments to develop, review and revise the resident’s comprehensive care plan.
Admission orders
At the time each resident is admitted, the facility must have physician orders for the resident’s immediate care.
Automated data processing requirement-
Within 7 days after a facility completes a resident’s assessment, a facility must encode the following information for each resident in the facility:
Transmitting data
a facility completes a resident’s assessment, a facility must be capable of transmitting to the CMS System information for each resident contained in the MDS in a format that conforms to standard record layouts and data dictionaries, and that passes standardized edits defined by CMS and the State.
Within 7 days after
Transmittal requirements
a facility completes a resident’s assessment, a facility must electronically transmit encoded, accurate, and complete MDS data to the CMS System
Within 14 days after
x Admission assessment.
x Annual assessment.
x Significant change in status assessment.
x Significant correction of prior full assessment.
x Significant correction of prior quarterly assessment.
x Quarterly review.
x A subset of items upon a resident’s transfer, reentry, discharge, and death.
x Background (face-sheet) information, for an initial transmission of MDS data on resident that does not have an admission assessment.
Coordination.
A registered nurse must conduct or coordinate each assessment with the appropriate participation of health professionals.
Coordination.
Certification.
A registered nurse must sign and certify that the assessment is completed.
Certification.
Each individual who completes a portion of the assessment must sign and certify the accuracy of that portion of the assessment.
correct
pre-admission screening and resident review
(PASARR)
Baseline Care Plans
Be developed within 48 hours of a resident’s admission
Initial goals based on admission orders. Physician orders. Dietary orders. Therapy services. Social services. PASARR recommendation, if applicable.
A comprehensive care plan must be—
Developed within 7 days after completion of the comprehensive assessment
The physician must—
Sign and date all orders with the exception of influenza and pneumococcal vaccines,
Frequency of physician visits
The residents must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 thereafter.
Availability of physicians for emergency care
The facility must provide or arrange for the provision of physician services 24 hours a day, in case of emergency
Data requirements
The facility must post the following information on a daily basis:
Facility name.
The current date.
The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift:
Registered nurses.
Licensed practical nurses or licensed vocational nurses (as defined under State law).
Certified nurse aides.
Resident census.
Data requirements
Facility data retention requirements
The facility must maintain the posted daily nurse staffing data for a minimum of 18 months, or as required by State law, whichever is greater.
Drug Regimen Review
The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.
The pharmacist must report any
irregularities to the attending physician and the facility’s medical director and director of nursing, and these reports must be acted upon.
Any irregularities noted by the pharmacist during this review must be documented on a separate, written report that is sent to the
attending physician and the facility’s medical director and director of nursing and lists, at a minimum, the resident’s name, the relevant drug, and the irregularity the pharmacist identified.
he attending physician must document in the resident’s medical record that the identified irregularity has been reviewed and
what, if any, action has been taken to address it.
Unnecessary Drugs—General.
Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used—
(1) In excessive dose (including duplicate drug therapy); or
(2) For excessive duration; or
(3) Without adequate monitoring; or
(4) Without adequate indications for its use; or
(5) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or
(6) Any combinations of the reasons stated in paragraphs (d)(1) through (5) of this section.
A psychotropic drug is any drug that affects brain activities associated with mental processes and behavior. These drugs include, but are not limited to, drugs in the following categories:
Anti-psychotic;
Anti-depressant;
Anti-anxiety; and
Hypnotic
Medication Errors. The facility must ensure that its
Medication error rates are not 5 percent or greater; and Residents are free of any significant medication errors
Labeling of Drugs and Biologicals
Storage of Drugs and Biologicals
facility must store all drugs and biologicals in locked compartments under proper temperature controls
The facility must provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976
quantity stored is minimal
The facility must—
Provide or obtain laboratory services only when
ordered by a physician; physician assistant; nurse practitioner or clinical nurse specialist in accordance with State law, including scope of practice laws
Promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of laboratory results that
fall outside of clinical
reference ranges in accordance with facility policies and procedures for notification of a practitioner or per the ordering physician’s orders
___________ refer residents with lost or damaged dentures for dental services.
Must promptly, within 3 days
If a referral does not occur within
3 days, the facility must provide documentation of what they did to ensure the resident could still eat and drink adequately while awaiting dental services and the extenuating circumstances that led to the delay;
Therapeutic Diets
Therapeutic diets must be prescribed by the attending physician.
The attending physician may delegate to a registered or licensed dietitian the task of prescribing a resident’s diet, including
a therapeutic diet, to the extent allowed by State law.
Frequency of Meals
facility must provide at least three meals daily, at regular times comparable to normal mealtimes
There must be no more than________
14 hours between a substantial evening meal and breakfast the following day
when a nourishing snack is served at bedtime,
up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span
Medical director.
The facility must designate a physician to serve as medical director.
The medical director is responsible for________
Implementation of resident care policies; and
The coordination of medical care in the facility
Medical records.
Complete;
Accurately documented;
Readily accessible; and
Systematically organized
Medical records must be retained for—
Five years from the date of discharge when there is no requirement in State law;
or For a minor, 3 years after a resident reaches legal age under State law.
Facility closure-Administrator.
Any individual who is the administrator of the facility must:
Submit to the State Survey Agency, the State LTC ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties, written notification of an impending closure:
At least 60 days prior to the date of closure
Facility closure.
The facility must have in place policies and procedures to ensure that the administrator’s duties and responsibilities involve providing the appropriate notices in the event of a facility closure
Social worker.
Any facility with more than 120 beds must employ a qualified social worker on a full- time basis.
Quality assessment and assurance.
A facility must maintain a quality assessment and assurance committee consisting at a minimum of:
The director of nursing services;
The Medical Director or his/her designee;
At least three other members of the facility’s staff, at least one of who must be the administrator, owner, a board member or other individual in a leadership role; and
The infection preventionist.
QAPI program required
Meet at least quarterly and as needed to coordinate and evaluate activities under the QAPI program,
Influenza and pneumococcal immunizations
Before offering the influenza immunization, each resident or the resident’s representative receives education regarding the benefits and potential side effects of the immunization;
October 1 through March 31 annually
Compliance and ethics program
Required components for all facilities
Physical Environment.
Life safety from fire.
A long term care facility must:
Install, at least, battery-operated single station smoke alarms in accordance with the manufacturer’s recommendations in resident sleeping rooms and common areas.
When a sprinkler system is shut down for more than
10 hours, the LTC facility must:
Evacuate the building or portion of the building affected by the system outage until the system is back in service, or
Establish a fire watch until the system is back in service
Emergency Power
at least for lighting all entrances and exits
life support systems
Dining and Resident Activities
The facility must provide one or more rooms designated for resident dining and activities.
These rooms must–
(1) Be well lighted;
(2) Be well ventilated;
(3) Be adequately furnished; and
(4) Have sufficient space to accommodate all activities.
Required in-service training for nurse aides. In-service training must—
Be sufficient to ensure the continuing competence of nurse aides, but must be no less than 12 hours per year