IHCA
IHCA has chosen Silverchair Learning Systems as its partner to provide effective online training solutions that will help improve operations and reduce costs to members.
“We are very excited about the vast resources and experience that Silverchair will bring to our members through high-quality and cutting-edge online training,” said Scott Tittle, President of IHCA.
This partnership gives IHCA members access to a highly effective and affordable turn-key learning program that delivers, tracks, and reports on educational programs for their entire organization. Silverchair’s training program provides a complete curriculum of in-service and regulatory courses required by CMS and OSHA, as well as important resident care topics that specifically address the needs of senior care providers and their employees. The program can also be customized to include material specific to an organization.
“As a native Hoosier, I’m especially glad to have the opportunity to partner back home again in Indiana,” said Mike Mutka, President and COO of Silverchair Learning Systems. “We are excited to see how Silverchair will enhance the training of members at the more than 200 facilities that are partnered with IHCA.”
IHCA joins eight other American Health Care Association state chapters who have chosen Silverchair as their online learning partner. IHCA has negotiated exclusive pricing with Silverchair, making the learning management and online training system available to its members at a substantial discount.
Please visit the IHCA website for details on free courses and other benefits of this new partnership!
Tuesday, January 24, 2012
Wednesday, January 4, 2012
ISDH Establishes a New Independent Informal Dispute Resolution Process for Long Term Care Facilities
by Zach Cattell, JD, IHCA General Counsel
On December 30, 2011 the ISDH issued a new ISDH Division of Long Term Care Policy and Procedure implementing the Federal requirement to establish an Independent Informal Dispute Resolution (IIDR) process for long term care facilities. The new IIDR process has been established to provide long term care facilities an opportunity, without cost to facilities, for an entity independent of the State Survey Agency to review certain aspects of survey deficiencies.
The ISDH IIDR Policy and Procedure includes two attachments, one with contact information for the ISDH IIDR lead and one with a timeline of the IIDR process (click here for the documents: IIDR Policy and Procedure; Attachment A – Contact Information; Attachment B – Timeline). The ISDH has also established a Informal Dispute Resolution Information Center at http://www.in.gov/isdh/25304.htm.
Applicability of the New IIDR Process
The new IIDR process is an option for facilities to elect if the facility is the subject of a Civil Money Penalty (CMP) that may be collected and placed in an escrow account. Until further notice from Federal and State regulators only those deficiencies that cite actual harm or immediate jeopardy (G or above) will be subject to the CMP collection and escrow and only those deficiencies will trigger the opportunity for IIDR. Any CMPs imposed for D, E and F deficiencies will be collected under the current informal dispute resolution process run by the ISDH and are not subject to the new IIDR process.
In the December 30, 2011 ISDH Newsletter, the ISDH provided the following key components to the ISDH-developed IIDR process:
1. The new ISDH Informal Dispute Resolution Policy and Procedure is effective January 1, 2012.
2. The ISDH will continue to offer traditional informal dispute resolution for all licensing and certification surveys conducted at comprehensive care facilities. The "informal dispute resolution" process refers to the review process conducted by ISDH Long Term Care Supervisors. The informal dispute resolution process may be either a paper review or a face-to-face review as requested by the facility. There is no fee to the facility for the informal dispute resolution process.
3. Effective January 1, 2012, an independent informal dispute resolution process is available to skilled nursing facilities (SNF) and nursing facilities (NF) that meet certain requirements related to a civil money penalty (CMP) imposed by the Centers for Medicare and Medicaid Services (CMS). The process is conducted by a CMS-approved "independent entity" that has contracted with the ISDH to provide this service. There is no fee to the facility for the independent informal dispute resolution process.
4. The Independent Informal Dispute Resolution process will only apply to standard (annual) and/or complaint surveys begun on or after January 1, 2012, that initiate an enforcement action for which a civil money penalty is imposed and subject to being placed in escrow. Any revisit survey conducted on or after January 1, 2012, that is associated with standard or complaint surveys begun prior to January 1, 2012, will not be subject to the Independent Informal Dispute Resolution Process.
5. Only civil money penalties which are imposed based on a deficiency or deficiencies cited for actual harm or immediate jeopardy to resident health or safety (i.e., at a scope and severity level of G or above) will be subject to civil money penalty collection and escrow provisions. Those deficiencies which result in the imposition of such civil money penalties will trigger a facility's opportunity to participate in the independent informal dispute resolution process. CMS will provide notice of the opportunity to participate in the independent informal dispute resolution process. The facility will request an independent informal dispute resolution through the ISDH.
6. The ISDH will be contracting with an independent entity for the independent informal dispute resolution process. The ISDH will provide contact and process information for that entity when a facility requests the independent process.
Independent Informal Dispute Resolution Entity
As noted by the ISDH in item #6 above and in the December 30, 2011 ISDH Newsletter, the State has not yet awarded a contract as proposals to the State were due on January 5, 2012. The ISDH believes that the independent entity will be in place in time for use by facilities.
Additional Considerations
The new IIDR process, with its requirements and timing limitations, is untested in Indiana or anywhere else in the country and there will undoubtedly be questions that arise. Due to the timing limitations (the process must be completed within 60 days from a facility’s request for IIDR), the new IIDR process for Indiana facilities will be entirely paper-based and no in-person meetings will occur. For the traditional ISDH-led informal dispute resolution process, a facility can choose either paper-based review or in-person review.
Because the ISDH will continue to administer the ISDH-led informal dispute resolution process and because facilities will not be able to go through both the ISDH-led process and the new IIDR process for the same deficiencies, the ISDH will not schedule an ISDH-led informal dispute resolution process, if requested, until a determination of whether CMP will be imposed that can trigger a facility’s right to the new IIDR. It will be key that a facility submit all supporting documentation to the ISDH through the ISDH Survey Report System when electing the ISDH-led process as requests for that process will not be considered until all documentation is submitted. Once it is known whether CMP is to be imposed for a deficiency, then a facility can choose either the ISDH-led process or the new IIDR process.
In addition, facilities and their counsel should consider how the IIDR process will impact any decision to request or waive a formal hearing on cited deficiencies. CMS and ISDH have been clear that the new IIDR process is not and will not be used to delay timing of the formal hearing process. Request for a formal hearing will likely have to occur near the same time that an IIDR is requested due to timing requirements.
IHCA will continue to monitor the development of Indiana’s IIDR process. For additional information please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
On December 30, 2011 the ISDH issued a new ISDH Division of Long Term Care Policy and Procedure implementing the Federal requirement to establish an Independent Informal Dispute Resolution (IIDR) process for long term care facilities. The new IIDR process has been established to provide long term care facilities an opportunity, without cost to facilities, for an entity independent of the State Survey Agency to review certain aspects of survey deficiencies.
The ISDH IIDR Policy and Procedure includes two attachments, one with contact information for the ISDH IIDR lead and one with a timeline of the IIDR process (click here for the documents: IIDR Policy and Procedure; Attachment A – Contact Information; Attachment B – Timeline). The ISDH has also established a Informal Dispute Resolution Information Center at http://www.in.gov/isdh/25304.htm.
Applicability of the New IIDR Process
The new IIDR process is an option for facilities to elect if the facility is the subject of a Civil Money Penalty (CMP) that may be collected and placed in an escrow account. Until further notice from Federal and State regulators only those deficiencies that cite actual harm or immediate jeopardy (G or above) will be subject to the CMP collection and escrow and only those deficiencies will trigger the opportunity for IIDR. Any CMPs imposed for D, E and F deficiencies will be collected under the current informal dispute resolution process run by the ISDH and are not subject to the new IIDR process.
In the December 30, 2011 ISDH Newsletter, the ISDH provided the following key components to the ISDH-developed IIDR process:
1. The new ISDH Informal Dispute Resolution Policy and Procedure is effective January 1, 2012.
2. The ISDH will continue to offer traditional informal dispute resolution for all licensing and certification surveys conducted at comprehensive care facilities. The "informal dispute resolution" process refers to the review process conducted by ISDH Long Term Care Supervisors. The informal dispute resolution process may be either a paper review or a face-to-face review as requested by the facility. There is no fee to the facility for the informal dispute resolution process.
3. Effective January 1, 2012, an independent informal dispute resolution process is available to skilled nursing facilities (SNF) and nursing facilities (NF) that meet certain requirements related to a civil money penalty (CMP) imposed by the Centers for Medicare and Medicaid Services (CMS). The process is conducted by a CMS-approved "independent entity" that has contracted with the ISDH to provide this service. There is no fee to the facility for the independent informal dispute resolution process.
4. The Independent Informal Dispute Resolution process will only apply to standard (annual) and/or complaint surveys begun on or after January 1, 2012, that initiate an enforcement action for which a civil money penalty is imposed and subject to being placed in escrow. Any revisit survey conducted on or after January 1, 2012, that is associated with standard or complaint surveys begun prior to January 1, 2012, will not be subject to the Independent Informal Dispute Resolution Process.
5. Only civil money penalties which are imposed based on a deficiency or deficiencies cited for actual harm or immediate jeopardy to resident health or safety (i.e., at a scope and severity level of G or above) will be subject to civil money penalty collection and escrow provisions. Those deficiencies which result in the imposition of such civil money penalties will trigger a facility's opportunity to participate in the independent informal dispute resolution process. CMS will provide notice of the opportunity to participate in the independent informal dispute resolution process. The facility will request an independent informal dispute resolution through the ISDH.
6. The ISDH will be contracting with an independent entity for the independent informal dispute resolution process. The ISDH will provide contact and process information for that entity when a facility requests the independent process.
Independent Informal Dispute Resolution Entity
As noted by the ISDH in item #6 above and in the December 30, 2011 ISDH Newsletter, the State has not yet awarded a contract as proposals to the State were due on January 5, 2012. The ISDH believes that the independent entity will be in place in time for use by facilities.
Additional Considerations
The new IIDR process, with its requirements and timing limitations, is untested in Indiana or anywhere else in the country and there will undoubtedly be questions that arise. Due to the timing limitations (the process must be completed within 60 days from a facility’s request for IIDR), the new IIDR process for Indiana facilities will be entirely paper-based and no in-person meetings will occur. For the traditional ISDH-led informal dispute resolution process, a facility can choose either paper-based review or in-person review.
Because the ISDH will continue to administer the ISDH-led informal dispute resolution process and because facilities will not be able to go through both the ISDH-led process and the new IIDR process for the same deficiencies, the ISDH will not schedule an ISDH-led informal dispute resolution process, if requested, until a determination of whether CMP will be imposed that can trigger a facility’s right to the new IIDR. It will be key that a facility submit all supporting documentation to the ISDH through the ISDH Survey Report System when electing the ISDH-led process as requests for that process will not be considered until all documentation is submitted. Once it is known whether CMP is to be imposed for a deficiency, then a facility can choose either the ISDH-led process or the new IIDR process.
In addition, facilities and their counsel should consider how the IIDR process will impact any decision to request or waive a formal hearing on cited deficiencies. CMS and ISDH have been clear that the new IIDR process is not and will not be used to delay timing of the formal hearing process. Request for a formal hearing will likely have to occur near the same time that an IIDR is requested due to timing requirements.
IHCA will continue to monitor the development of Indiana’s IIDR process. For additional information please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
Tuesday, January 3, 2012
Congress Agrees on Two-Month Extension to Payroll Tax Cut and Extended Unemployment Compensation: "Doc Fix" and Outpatient Therapy Caps Exceptions Process Receive Similar Reprieve
The U.S. Congress passed a two-month payroll tax cut extension just eight days before its scheduled January 1, 2012 expiration after House Republicans dropped their objections under growing political pressure. President Obama signed the extension, guaranteeing that 160 million workers will continue to receive a two percent cut in their social security payroll taxes. Also included in the package was a freeze in physician Medicare payments, which avoided a massive 27.4% cut set for January 1, 2012; an extension of expanded unemployment compensation benefits; and an extension of the Medicare Part B outpatient therapy cap exceptions process under which SNFs and other providers can avoid therapy caps for certain patient diagnoses.
Congress will use the two-month reprieve to try to come to a full year agreement on the “extenders” package. The Senate and the President had supported a one-year extension, but the House had originally balked at the idea, accusing them of “kicking the can down the road” and failing to enact any long range deficit reduction legislation. A one or two-year extension will hinge on the ability of Congress to come to an agreement about how to pay for the various program extensions. Congress has appointed a conference committee to resolve the controversy. The committee has until March 1 to decide what to fix, for how long, and how to pay for it. None of the conferees named to date are from Indiana.
The original House version of the “extenders” package had called for a cut in federal reimbursement for public and private Medicare “bad debts” to 55 percent. Such a cut would have had a huge impact in states, like Indiana, whose Medicaid programs do not reimburse SNFs for Medicare Part A co-payments. We understand in this two month review, our industry is once again in Congress’ sights as potential “pay for” solution. Our national affiliate, the American Health Care Association, is following the issue closely and advocating for alternative funding sources such as savings from reduced re-hospitalizations.
We will bring you more information on the issue as it becomes available. Meanwhile, members with questions may call (317-616-9031) or email IHCA President Scott Tittle at stittle@ihca.org for additional information.
Congress will use the two-month reprieve to try to come to a full year agreement on the “extenders” package. The Senate and the President had supported a one-year extension, but the House had originally balked at the idea, accusing them of “kicking the can down the road” and failing to enact any long range deficit reduction legislation. A one or two-year extension will hinge on the ability of Congress to come to an agreement about how to pay for the various program extensions. Congress has appointed a conference committee to resolve the controversy. The committee has until March 1 to decide what to fix, for how long, and how to pay for it. None of the conferees named to date are from Indiana.
The original House version of the “extenders” package had called for a cut in federal reimbursement for public and private Medicare “bad debts” to 55 percent. Such a cut would have had a huge impact in states, like Indiana, whose Medicaid programs do not reimburse SNFs for Medicare Part A co-payments. We understand in this two month review, our industry is once again in Congress’ sights as potential “pay for” solution. Our national affiliate, the American Health Care Association, is following the issue closely and advocating for alternative funding sources such as savings from reduced re-hospitalizations.
We will bring you more information on the issue as it becomes available. Meanwhile, members with questions may call (317-616-9031) or email IHCA President Scott Tittle at stittle@ihca.org for additional information.
CMS Region V Updates
by Zach Cattell, IHCA General Counsel
IHCA recently had the opportunity, along with several other states’ long term care associations, to meet with the survey and certification staff of CMS Region V. The following information was discussed:
• Citation patterns by state and by region. See attached charts that summarize the top ten citations for Region V as well as a total deficiencies cited by severity level. F441, F371, F323 and F279 were in the top ten for all states in Region V.
• QIS will continue to be implemented in the states where training has started, but no new states will begin QIS training until further funding is identified. In addition, QIS will continue to only apply to annual surveys and there is no word at the current time as to if or when QIS will apply to complaint surveys.
• Elder Justice Act – Crimes Reporting
1. Unfortunately, no new guidance or insights were discussed by CMS as to the rollout of the reporting requirement. CMS stands by its last issued guidance
2. The Region V staff was unsure as to when CMS Central Office would be issuing any additional guidance or promulgating regulation to implement the CMP and excluded individual provisions of the law
3. Facilities should continue to follow the guidance issued by CMS and the ISDH to implement the crimes reporting requirement
• Independent Informal Dispute Resolution (IIDR)
1. A new CMS S&C Memorandum was published on December 2, 2011 that superseded the October 14, 2011 memorandum on the implementation of IIDR. The new Memorandum is attached and includes the Interim Advance Guidelines that will be placed in the State Operations Manual regarding the IIDR process.
2. The ISDH is working on its own guidance regarding IIDR since it is required by CMS to implement the IIDR program for Indiana. The ISDH is expected to release guidance when the new IIDR process goes into effect on January 1, 2012.
3. The new IIDR process will only apply to all standard or complaint surveys begun on or after January 1, 2012 and include enforcement action on a G-level deficiency or higher for which Civil Money Penalty may be assessed and escrowed.
4. IHCA is analyzing the CMS and ISDH guidance.
• Life Safety Code citation history for 2011. See attached charts regarding Life Safety Code citations for Region V states, comparisons of the top ten citations from 2010 to 2011, as well as CMS’s tips on how to avoid the top ten deficiencies. Indiana’s #1 Life Safety Code deficiency was K144 – Emergency Generators for the second year in a row.
Please contact Zach Cattell at zcattell@ihca.org or 317-616-9001 with any questions.
IHCA recently had the opportunity, along with several other states’ long term care associations, to meet with the survey and certification staff of CMS Region V. The following information was discussed:
• Citation patterns by state and by region. See attached charts that summarize the top ten citations for Region V as well as a total deficiencies cited by severity level. F441, F371, F323 and F279 were in the top ten for all states in Region V.
• QIS will continue to be implemented in the states where training has started, but no new states will begin QIS training until further funding is identified. In addition, QIS will continue to only apply to annual surveys and there is no word at the current time as to if or when QIS will apply to complaint surveys.
• Elder Justice Act – Crimes Reporting
1. Unfortunately, no new guidance or insights were discussed by CMS as to the rollout of the reporting requirement. CMS stands by its last issued guidance
2. The Region V staff was unsure as to when CMS Central Office would be issuing any additional guidance or promulgating regulation to implement the CMP and excluded individual provisions of the law
3. Facilities should continue to follow the guidance issued by CMS and the ISDH to implement the crimes reporting requirement
• Independent Informal Dispute Resolution (IIDR)
1. A new CMS S&C Memorandum was published on December 2, 2011 that superseded the October 14, 2011 memorandum on the implementation of IIDR. The new Memorandum is attached and includes the Interim Advance Guidelines that will be placed in the State Operations Manual regarding the IIDR process.
2. The ISDH is working on its own guidance regarding IIDR since it is required by CMS to implement the IIDR program for Indiana. The ISDH is expected to release guidance when the new IIDR process goes into effect on January 1, 2012.
3. The new IIDR process will only apply to all standard or complaint surveys begun on or after January 1, 2012 and include enforcement action on a G-level deficiency or higher for which Civil Money Penalty may be assessed and escrowed.
4. IHCA is analyzing the CMS and ISDH guidance.
• Life Safety Code citation history for 2011. See attached charts regarding Life Safety Code citations for Region V states, comparisons of the top ten citations from 2010 to 2011, as well as CMS’s tips on how to avoid the top ten deficiencies. Indiana’s #1 Life Safety Code deficiency was K144 – Emergency Generators for the second year in a row.
Please contact Zach Cattell at zcattell@ihca.org or 317-616-9001 with any questions.
Thursday, December 1, 2011
ISDH Long Term Care Bed and Personnel Tracking System
by Katie Eller, IHCA Director of Education and Member Services
The ISDH has created a Long Term Care Bed and Personnel Tracking System that will be effective on
December 1, 2011. The ISDH has several purposes behind the implementation of tracking system. This system will be used to track available beds in long term care facilities and track key facility personnel.
The following are the purposes behind this system.
1. EMERGENCY PREPAREDNESS: The purpose behind the system is to improve state
emergency preparedness. In the case of emergencies, there is a need to know the location of
available beds in case there is a need for evacuation. This system is intended to provide reliable
current information on available nursing home beds.
The ISDH currently tracks the number of licensed and certified beds for each facility. That
information is recorded at the time of licensing and does not reflect the number of occupied beds.
The ISDH obtains a bed census at the time of a survey. Because surveys may not occur for up to
fifteen months apart, that data is not current and therefore not reliable in an emergency. It also
does not provide the detail as to type of available beds that is needed for appropriate placement
determinations.
In the mid-2000’s, the ISDH created an online system to track available hospital beds throughout
the State. That system, in partnership with the Indiana Department of Homeland Security, was
intended to provide improved information for emergency responders in emergency situations.That system was implemented and has been a valuable asset in emergency situations.
As a next preparedness step, the Centers for Medicare and Medicaid Services (CMS) included
the development of a bed tracking system for long term care facilities as one of its priorities to be
implemented by state survey agencies by July 2009. CMS developed a pilot tracking system for
that purpose but did not implement the system. In 2011, the ISDH therefore began development
of a state system.
The need for such a system can be readily demonstrated by recent emergency situations in
Indiana. In the summer of 2009, Indiana experienced significant flooding. One nursing home that
had to be totally evacuated had planned to evacuate to sister facilities. Those facilities were no
longer accessible because of the flood waters. The facility therefore needed to know where there
were nearby available beds. There was no ready source for current bed availability information
and local communications were out. Had this system existed, the ISDH could have provided the
information to local emergency responders through the state emergency communications system.
Another large facility had to evacuate nearly 200 residents. The nursing homes in the area were
at capacity so there was a need to find appropriate beds in surrounding counties. There again
was no ready source for current bed availability information. Because phone lines were
accessible, the ISDH wound up calling facilities to determine bed availability but that resulted in
delays in getting residents placed. The ISDH also learned that there was a need to know not only
the availability of a bed but the classification and purpose of the bed.
Earthquakes, tornadoes, and flooding are all realistic potential emergency situations in Indiana.
The ISDH believes that reliable bed tracking data is essential to improving the state’s emergency
preparedness and response capacity. This new bed tracking system has been designed to meet
those emergency preparedness needs.
2. FACILITY CLOSINGS AND ROUTINE PLACEMENTS: One of the challenges faced by families, facilities, and the State is the appropriate placement of residents. When families or State
Ombudsman are trying to find available beds in an area, they often spend lots of time calling
facilities trying to identify available beds. Even more critical is when a facility is closing and there
is a need to place a large number of residents. The bed tracking system is intended to be an
efficient resource to assist in the appropriate placement of residents.
3. DETERMINATION OF STATE OCCUPANCY RATES: The ISDH is required to determine
nursing home occupancy rates. The Indiana General Assembly adopted statutes that refer to
nursing home occupancy rates. For instance, Indiana Code 16-28-16 states that the ISDH may
not approve the certification of new or converted comprehensive beds for participation in the state
Medicaid program unless the statewide comprehensive care bed occupancy rate is more than
ninety-five percent as calculated annually on January 1 by the ISDH. Other legislative proposals
have referred to a monthly occupancy rate by county and the legislature has requested that the
ISDH be able to provide monthly occupancy rates.
In order to implement state statutory requirements, the ISDH must be able to determine accurate
nursing home occupancy rates. At the present time, the ISDH is unable to comply with the
statute because the ISDH does not have a data source that provides occupancy on a given date.
While the ISDH collects occupancy data at the time of licensing surveys, the data does not allow
for determination of an occupancy rate on a given date because surveys may occur up to fifteen
months apart for a given facility.
The bed tracking portion of the new system will allow the ISDH to track bed occupancies on a
monthly basis in fulfillment of state statutory requirements. The database will also allow for
further study of occupancy rates by various criteria as requested by legislative studies.
4. EDUCATION AND TRAINING: The ISDH periodically provides education and training on
healthcare quality of care issues. Examples include state leadership conferences as well as the
pressure ulcer and healthcare associated infection initiatives. As part of these initiatives, the
ISDH often provides resource materials or information on educational opportunities.
The ISDH does not currently have contact information for key healthcare providers related to
topics in their area of expertise and responsibility. The result is that healthcare quality
improvement information often does not reach the relevant healthcare providers.
For example, there has been interest in developing programs to improve care coordination.
While the ISDH tracks the name of the facility medical director, we do not necessarily have
contact information for those individuals. Furthermore, the ISDH does not have any contact
information for attending physicians. With improved contact information for key healthcare
providers, the goal of the ISDH is to use this information to improve dissemination of information
to appropriate sources and create improved partnerships towards quality improvement.
5. SURVEY EFFICIENCY: The ISDH is always looking for ways to improve survey efficiency.
When the ISDH begins a survey, surveyors spend time identifying beds and key facility staff.
With the new tracking system, surveyors will have a copy of the facility’s bed census and key
staff. Surveyors will simply verify the list with the facility at the time of entrance. Surveyors often
spend time trying to identify the key staff not a part of current reporting. For instance, many
health care facilities are required to have an Alzheimer’s Director. The ISDH does not currently
track that information so having the information in the system assist surveyors in identifying
required staff and thus reduce survey time.
6. IMPROVED ACCURACY OF PERSONNEL TRACKING: Healthcare rules require facilities to
provide the ISDH with a change of the facility’s administrator, director of nursing, and medical
director. An example of a regulatory reporting requirement is 42 CFR 483.75(p). The ISDH
frequently finds that information is out of date and has not been appropriately updated. The
system is intended to improve the accuracy of tracking.
The system will be housed and accessed through the same ISDH Gateway System as the new
Survey Report System that was implemented earlier in 2011. The facility should expect to receive
an email on or about November 30 requesting the facility to submit their monthly report. The email
will be sent to the same email address used in the Survey Report System. The facility should then
log in to the system and provide the requested information. The facility will then subsequently
receive a reminder each month via email to update their data.
What Information Will be Tracked
The following available bed information will be tracked on a monthly basis:
• Facility census on last day of month
• Total bed occupancy
• Subcategories of bed availability
• Bed availability: male and female
• Bed availability: Alzheimer's Unit
• Ventilator beds available
Facilities will be asked to provide contact information for the following individuals:
• Administrator(s)
• Director(s) of Nursing
• Medical Director(s)
• Attending Physicians
• Nurse Practitioners
• Physician Assistants
• Minimum Data Set (MDS) Coordinator
• Wound Care Specialist(s)
• Alzheimer's/Dementia Unit Director(s)
• Social Services Director(s)
For More Details
For more details about the tracking system and the facility’s responsibility, please review:
ISDH LTC Advisory Letter LTC-2011-02
ISDH LTC Advisory Letter LTC-2011-02 Attachment A
The ISDH has created a Long Term Care Bed and Personnel Tracking System that will be effective on
December 1, 2011. The ISDH has several purposes behind the implementation of tracking system. This system will be used to track available beds in long term care facilities and track key facility personnel.
The following are the purposes behind this system.
1. EMERGENCY PREPAREDNESS: The purpose behind the system is to improve state
emergency preparedness. In the case of emergencies, there is a need to know the location of
available beds in case there is a need for evacuation. This system is intended to provide reliable
current information on available nursing home beds.
The ISDH currently tracks the number of licensed and certified beds for each facility. That
information is recorded at the time of licensing and does not reflect the number of occupied beds.
The ISDH obtains a bed census at the time of a survey. Because surveys may not occur for up to
fifteen months apart, that data is not current and therefore not reliable in an emergency. It also
does not provide the detail as to type of available beds that is needed for appropriate placement
determinations.
In the mid-2000’s, the ISDH created an online system to track available hospital beds throughout
the State. That system, in partnership with the Indiana Department of Homeland Security, was
intended to provide improved information for emergency responders in emergency situations.That system was implemented and has been a valuable asset in emergency situations.
As a next preparedness step, the Centers for Medicare and Medicaid Services (CMS) included
the development of a bed tracking system for long term care facilities as one of its priorities to be
implemented by state survey agencies by July 2009. CMS developed a pilot tracking system for
that purpose but did not implement the system. In 2011, the ISDH therefore began development
of a state system.
The need for such a system can be readily demonstrated by recent emergency situations in
Indiana. In the summer of 2009, Indiana experienced significant flooding. One nursing home that
had to be totally evacuated had planned to evacuate to sister facilities. Those facilities were no
longer accessible because of the flood waters. The facility therefore needed to know where there
were nearby available beds. There was no ready source for current bed availability information
and local communications were out. Had this system existed, the ISDH could have provided the
information to local emergency responders through the state emergency communications system.
Another large facility had to evacuate nearly 200 residents. The nursing homes in the area were
at capacity so there was a need to find appropriate beds in surrounding counties. There again
was no ready source for current bed availability information. Because phone lines were
accessible, the ISDH wound up calling facilities to determine bed availability but that resulted in
delays in getting residents placed. The ISDH also learned that there was a need to know not only
the availability of a bed but the classification and purpose of the bed.
Earthquakes, tornadoes, and flooding are all realistic potential emergency situations in Indiana.
The ISDH believes that reliable bed tracking data is essential to improving the state’s emergency
preparedness and response capacity. This new bed tracking system has been designed to meet
those emergency preparedness needs.
2. FACILITY CLOSINGS AND ROUTINE PLACEMENTS: One of the challenges faced by families, facilities, and the State is the appropriate placement of residents. When families or State
Ombudsman are trying to find available beds in an area, they often spend lots of time calling
facilities trying to identify available beds. Even more critical is when a facility is closing and there
is a need to place a large number of residents. The bed tracking system is intended to be an
efficient resource to assist in the appropriate placement of residents.
3. DETERMINATION OF STATE OCCUPANCY RATES: The ISDH is required to determine
nursing home occupancy rates. The Indiana General Assembly adopted statutes that refer to
nursing home occupancy rates. For instance, Indiana Code 16-28-16 states that the ISDH may
not approve the certification of new or converted comprehensive beds for participation in the state
Medicaid program unless the statewide comprehensive care bed occupancy rate is more than
ninety-five percent as calculated annually on January 1 by the ISDH. Other legislative proposals
have referred to a monthly occupancy rate by county and the legislature has requested that the
ISDH be able to provide monthly occupancy rates.
In order to implement state statutory requirements, the ISDH must be able to determine accurate
nursing home occupancy rates. At the present time, the ISDH is unable to comply with the
statute because the ISDH does not have a data source that provides occupancy on a given date.
While the ISDH collects occupancy data at the time of licensing surveys, the data does not allow
for determination of an occupancy rate on a given date because surveys may occur up to fifteen
months apart for a given facility.
The bed tracking portion of the new system will allow the ISDH to track bed occupancies on a
monthly basis in fulfillment of state statutory requirements. The database will also allow for
further study of occupancy rates by various criteria as requested by legislative studies.
4. EDUCATION AND TRAINING: The ISDH periodically provides education and training on
healthcare quality of care issues. Examples include state leadership conferences as well as the
pressure ulcer and healthcare associated infection initiatives. As part of these initiatives, the
ISDH often provides resource materials or information on educational opportunities.
The ISDH does not currently have contact information for key healthcare providers related to
topics in their area of expertise and responsibility. The result is that healthcare quality
improvement information often does not reach the relevant healthcare providers.
For example, there has been interest in developing programs to improve care coordination.
While the ISDH tracks the name of the facility medical director, we do not necessarily have
contact information for those individuals. Furthermore, the ISDH does not have any contact
information for attending physicians. With improved contact information for key healthcare
providers, the goal of the ISDH is to use this information to improve dissemination of information
to appropriate sources and create improved partnerships towards quality improvement.
5. SURVEY EFFICIENCY: The ISDH is always looking for ways to improve survey efficiency.
When the ISDH begins a survey, surveyors spend time identifying beds and key facility staff.
With the new tracking system, surveyors will have a copy of the facility’s bed census and key
staff. Surveyors will simply verify the list with the facility at the time of entrance. Surveyors often
spend time trying to identify the key staff not a part of current reporting. For instance, many
health care facilities are required to have an Alzheimer’s Director. The ISDH does not currently
track that information so having the information in the system assist surveyors in identifying
required staff and thus reduce survey time.
6. IMPROVED ACCURACY OF PERSONNEL TRACKING: Healthcare rules require facilities to
provide the ISDH with a change of the facility’s administrator, director of nursing, and medical
director. An example of a regulatory reporting requirement is 42 CFR 483.75(p). The ISDH
frequently finds that information is out of date and has not been appropriately updated. The
system is intended to improve the accuracy of tracking.
The system will be housed and accessed through the same ISDH Gateway System as the new
Survey Report System that was implemented earlier in 2011. The facility should expect to receive
an email on or about November 30 requesting the facility to submit their monthly report. The email
will be sent to the same email address used in the Survey Report System. The facility should then
log in to the system and provide the requested information. The facility will then subsequently
receive a reminder each month via email to update their data.
What Information Will be Tracked
The following available bed information will be tracked on a monthly basis:
• Facility census on last day of month
• Total bed occupancy
• Subcategories of bed availability
• Bed availability: male and female
• Bed availability: Alzheimer's Unit
• Ventilator beds available
Facilities will be asked to provide contact information for the following individuals:
• Administrator(s)
• Director(s) of Nursing
• Medical Director(s)
• Attending Physicians
• Nurse Practitioners
• Physician Assistants
• Minimum Data Set (MDS) Coordinator
• Wound Care Specialist(s)
• Alzheimer's/Dementia Unit Director(s)
• Social Services Director(s)
For More Details
For more details about the tracking system and the facility’s responsibility, please review:
ISDH LTC Advisory Letter LTC-2011-02
ISDH LTC Advisory Letter LTC-2011-02 Attachment A
Thursday, November 3, 2011
CMS Retracts Guidance on F322 - Feeding Tubes
by Zach Cattell, JD, IHCA General Counsel
Guidance issued by CMS this past September that was to be effective this November has been retracted. Survey & Certification Memorandum 11-37-NH is no longer valid and CMS is revising the guidance to incorporate information from the Quality Indicator Survey process. CMS anticipates releasing revised guidance during the first six months of 2012.
If you have any questions about this topic, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
Guidance issued by CMS this past September that was to be effective this November has been retracted. Survey & Certification Memorandum 11-37-NH is no longer valid and CMS is revising the guidance to incorporate information from the Quality Indicator Survey process. CMS anticipates releasing revised guidance during the first six months of 2012.
If you have any questions about this topic, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
Wednesday, November 2, 2011
Physician Signatures Not Required for Clinical Labs Under Clinical Laboratory Fee Schedule
by Zach Cattell, JD, IHCA General Counsel
CMS released its final rule making Revisions to Payment Policies to the Physician Fee Schedule for CY 2012 and CMS has officially retracted the proposed physician or non physician practitioner signature requirement on clinical lab test requisition policy. CMS had proposed for January 1, 2011 implementation of a rule which would have required a physician’s or qualified non physician practitioner’s signature on all requisitions for clinical diagnostic laboratory tests paid for on the basis of the Clinical Laboratory Fee Schedule (CLFS). The American Health Care Association, along with State affiliates, fought the proposal. CMS had first delayed the implementation and then had indicated that it would eliminate the requirement. The release of the final rule confirms the elimination of the proposal.
The final rule states “After consideration of the public comments received, we are finalizing our proposal to retract the policy that was finalized in the CY 2011 PFS final rule with comment period, which required a physician's or NPP's signature on a requisition for clinical diagnostic laboratory tests paid under the CLFS (75 FR 73483) and to reinstate our prior policy that the signature of the physician or NPP is not required on a requisition for a clinical diagnostic laboratory test paid under the CLFS for Medicare purposes.”
If you have any questions or for additional information, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
CMS released its final rule making Revisions to Payment Policies to the Physician Fee Schedule for CY 2012 and CMS has officially retracted the proposed physician or non physician practitioner signature requirement on clinical lab test requisition policy. CMS had proposed for January 1, 2011 implementation of a rule which would have required a physician’s or qualified non physician practitioner’s signature on all requisitions for clinical diagnostic laboratory tests paid for on the basis of the Clinical Laboratory Fee Schedule (CLFS). The American Health Care Association, along with State affiliates, fought the proposal. CMS had first delayed the implementation and then had indicated that it would eliminate the requirement. The release of the final rule confirms the elimination of the proposal.
The final rule states “After consideration of the public comments received, we are finalizing our proposal to retract the policy that was finalized in the CY 2011 PFS final rule with comment period, which required a physician's or NPP's signature on a requisition for clinical diagnostic laboratory tests paid under the CLFS (75 FR 73483) and to reinstate our prior policy that the signature of the physician or NPP is not required on a requisition for a clinical diagnostic laboratory test paid under the CLFS for Medicare purposes.”
If you have any questions or for additional information, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
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