Long-Term Care Survey Alert

Expect closer inspection of your policies on deposit fees and promissory notes. The Centers for Medicare & Medicaid Services recently sent a letter to nursing home surveyors reminding them that federal law prohibits providers of inpatient services from requiring an individual entitled to Medicare to prepay the nursing home for Medicare-covered services as a condition of admission.

The law also prohibits facilities from accepting money or other consideration as a condition of admission or continued stay, the letter notes. However, regulations do not prohibit facilities from charging a deposit fee or requiring promissory notes from individuals whose stays are not covered by Medicare or Medicaid.

Facilities may charge a resident whose Medicaid eligibility is pending, but they must be prepared to follow the rules for refunding the money (minus the state's determination of any resident's share) once the resident's Medicaid kicks in retroactively (for details, read the letter at www.cms.hhs.gov/medicaid/survey-cert/sc0417.pdf). Your facility must "prominently display" written information in the facility and provide "oral and written explanation" to applicants or residents about applying for Medicaid, the letter states, including how to use Medicaid benefits, and how to receive refunds for previous payments covered by Medicaid.

Looking for ways to stave off functional losses in patients with Alzheimer's? Combining a standard Alzheimer's treatment with a recently approved medication may produce better outcomes for some patients, according to a study that appears in a recent issue of the Journal of the American Medical Association. Adding the new drug memantine to donepezil (Aricept) for patients with moderate to severe Alzheimer's resulted in significantly better outcomes than a placebo on measures of cognition, activities of daily living, global outcome and behavior, the study authors report. Unlike Aricept, which boosts brain levels of the neurotransmitter acetylcholine, memantine exerts a "neuroprotective" effect on brain cells.