The Centers for Medicare and Medicaid Services (CMS) recently adopted a definition for "distinct part" nursing facilities that may force resident transfers and violate residents' rights of financial privacy, according to the National Senior Citizens Law Center (NSCLC).
The concept of "distinct part" is clarified in final rules issued on Medicare's Prospective Payment System for skilled nursing facilities. See 68 Fed. Reg. 46036 (2003).
The federal Nursing Home Reform Law defines a federally certified nursing facility as "an institution (or a distinct part of an institution) which" meets the standards of federal law. 42 U.S.C. §§ 1395i-3(a) (Medicare certification), 1396r(a) (Medicaid certification). A "distinct part" may be a nursing facility within a hospital complex or, more commonly, a limited number of beds within a nursing facility building.
Problems can arise for Medicaid-eligible nursing home residents when a "distinct part" is in a freestanding nursing facility. As was demonstrated in the case of Lemons v. Westminster Village North, Inc. (Preliminary Injunction Order, Marion Sup. Ct., Div. 7, No. 49D07-0303-PL-000604, April 16, 2003), a resident may be subjected to a disorienting move to another part of a facility to access Medicaid reimbursement.
Rather than heed suggestions to limit the "distinct part" concept only to those nursing facilities that are a "distinct part" of a hospital complex, or to allow nursing facilities to sprinkle "distinct part" beds throughout a facility so that residents would not be segregated by payment source, CMS adopted a definition that enshrines the idea of a physically-distinguishable "distinct part" in regulations.
"The new regulations are a step backwards for most nursing facility residents," the NSCLC writes in the Aug. 22 issue of its Washington Weekly. The group has pointed out that the federal Nursing Home Reform Law explicitly prohibits nursing homes from discriminating against Medicaid residents in the provision of services, and that the law also requires nursing homes to protect the privacy of residents' financial information, which would appear to be violated when all the residents of a segregated unit have one payment source.
To go to the pages of the Federal Register containing the new definition, click here and scroll down to section "K: Distinct Part Definition".
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