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.
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