Ftag of the Week – F621 Equal Practices Regardless of Payment Source

Next up on CMSCG’s “Ftag of the Week” blog series, we will be reviewing F621, which is the regulatory requirement for providers to ensure all nursing home residents are treated equally regarding provision of services, transfer and discharge, regardless of their payment source. This includes all services which are mandated by law to be provided to facility residents to meet their needs, as determined by their assessments and care plans, including nursing, specialized rehab, behavioral health, dietary, pharmacy and activities. F621 requires facilities to have “identical” practices related to these services as required by law, and thus prohibits providers from providing different services based on the resident’s payment source. The regulation also notes that a State is not required to provide a resident services which are beyond the services of the State plan.

The regulation at F621 includes two additional requirements:

Notice Requirements

F621 states that a facility may charge any amount for services furnished to non-Medicaid residents unless otherwise limited by State law and consistent with the notice requirements for the description of charges, including timeliness of notification for changes in service coverage. Information related to charges for services is included in F571 Limitations on Charges to Personal Funds.

Room Changes

Room changes in a facility that is a composite distinct part are subject to the requirements under F560 Right to Refuse Certain Transfers. These room changes must be limited to moves within the same building that the resident resides in unless the resident voluntarily agrees to move to another composite distinct part’s location. This provision would not apply to a facility that does not have a composite distinct part.

On Survey

F621 isn’t widely cited, but it’s worth reviewing the probes for surveyors to understand how a facility could be cited at F621. If a surveyor observes residents being grouped into separate units/ wings/ floors for reasons other than care need and the quality of care is different between those different areas, then the surveyor will need to do some digging. The surveyor is directed to speak with the Administrator and others to understand the factors that led to these groupings and if there are factors other than medical or nursing needs that impact where a resident is placed.

The surveyor should also discuss with the State LTC Ombudsman if they have any information which could indicate that the facility handles covered services, transfer or discharge differently depending on a resident’s payment source.

If the surveyor identifies a concern related to equal access to care, he is then expected to interview the resident/ representative. Here’s the part where perception could validate a concern – when the surveyor asks the resident/ representative if they noticed there are fewer staff available to meet their needs when their payor source changed or was due to change. The resident/ representative will also be asked if notices for charges for services were provided by the facility and if they were asked to move/actually moved to a different location in the building when their payor source changed.

About the Firm

CMS Compliance Group, Inc. is a regulatory compliance and quality improvement consulting firm. CMSCG works with skilled nursing facilities and other post-acute providers to help them improve quality across their organizations. Learn more about our nursing home consulting services or contact us to discuss how we can work together.

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