MI

To Whom It May Concern: I am writing in regard to the proposed changes to the Medicare and Medicaid Programs Requirements for Long Term Care Facilities and Hospice Services; file code CMS-3140-P. The summary indicates “this proposed rule would revise the requirements that an institution would have to meet in order to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or as a nursing facility (NF) in the Medicaid program. We are proposing these requirements to ensure that long-term care (LTC) facilities (that is, SNFs and NFs) that chose to arrange for the provision of hospice care through an agreement with one or more Medicare-certified hospice providers would have in place a written agreement with the hospice that specified the roles and responsibilities of each entity”. The proposed changes note the concern for a lack of clear regulatory direction regarding the responsibilities of providers in caring for LTC facility and/or Hospice residents. Although we agree, that a written agreement would help ensure that required services are provided to beneficiaries and protect beneficiary health and safety, a major concern remains regarding “who has the lead.” By dividing medical care duties and services between two facilities will open the door for further neglect of health care and safety and continue to exacerbate the lack of coordination between hospice and LTC providers. For example, what regulations are in place to ensure that LTC facilities do not fail to make the appropriate referrals to the hospice facility? In addition, this division of responsibilities may cause undue harm to the patient, who has to wait while the two facilities argue over who is responsible for which services. This division will also create the potential for medical malpractice, in the confusion of having multiple medical personnel, from two different facilities, involved in the care and treatment of the patient. This complicated division of services could be eliminated by designating a trained professional to work as the liaison between the two facilities to protect the patient’s rights and quality of care. Although we agree with the proposal that LTC facilities need to arrange for the provision of hospice services through an agreement with one or more Medicare-certified hospices, we propose that all hospices create a neutral position for a staff member to oversee the safety and rights of the patient. By requiring that all Medicare-certified hospices have an on on-staff medically trained professional, who is designated to work as the liaison between hospice and LTC facilities, will help to ensure that all appropriate medical care, safety precautions, and patient’s rights are being observed and provided. Thank you very much for providing the draft policy directive for our timely review, and for taking our recommendations into consideration. Sincerely Kimberly Richards