This week’s “Ftag of the Week” on the CMSCG Blog is part of the Resident Rights regulatory group, F579 Posting/Notice of Medicare/Medicaid on Admission. F579 is not widely cited across the US, but some CMS regions like to cite this more than others. First, let’s review the regulatory requirements for this Ftag and we’ll look at a survey citation that pretty much sums up how deficient practices are identified on survey.
F579 – What’s Required
This regulation is all about ensuring that nursing home residents and those who are applying for admission have the necessary information regarding how to apply for/use their Medicare and Medicaid benefits. Per Appendix PP of the State Operations Manual, the facility must do the following:
- Display written information about how to apply for and use Medicare/Medicaid benefits and how to request refunds that are due after eligibility has been retroactively determined.
On CMSCG mock surveys, we always check to ensure this posting is in place since it’s a regulatory requirement. This is the most frequent way F579 is cited – time to take a quick stroll around your building and see what’s posted.
Remember to take this same stroll whenever you redecorate or paint the walls in public areas. It is amazing what informational documents don’t get reposted due to staff not remembering where all the signage was put or who wants that frayed document posted in the shiny new glass display case.
Standard Survey Citation – F579 S/S: F
After reviewing all public areas of the facility, the surveyor was unable to identify posted information regarding how to apply for and use Medicare and Medicaid benefits and how to receive refunds when prior payments were covered by the available benefits.
The posting isn’t the only written requirement, though. Nursing homes also must provide applicants for admission and patients/residents with written information about how to use their benefits and request refunds. Per the Interpretive Guidance (IG), nursing homes can meet the requirements for compliance with F579 by using written materials provided by the State Medicaid agency or by the Federal government. This information is a great addition to your admission packet if it is not already there.
In addition to providing this information in written form, facilities also need to provide this information orally to prospective and current residents. This is not typically something that is identified during the survey process, but it’s part of the requirements, so it’s something to be aware of. The IG notes that providers can meet the requirement to orally provide this information by informing prospective/current residents about the process for applying for Medicaid or Medicare and assisting them in coordinating with Social Security or the State Medicaid agency. However, the IG also states that simply providing the phone number isn’t considered sufficient assistance, but providers do not need to go as far as explaining eligibility rules orally to be compliant with this part of the regulation.
