AHCA Submits Comments on the CMS SNF PPS Proposed Rule

On July 1, 2013, AHCA President and CEO Mark Parkinson submitted comments to CMS concerning the SNF PPS Proposed Rule. Click here to read AHCA’s comments.  AHCA addressed key components of the proposed rule including SNF market basket weights, CMS cost category weight methodology,   price proxies, the forecast error adjustment, and the reporting of distinct days of therapy.  If you have any questions, please contact Peter Gruhn (pgruhn@ahca.org, 202-898-2819) or Elise Smith (esmith@ahca.org, 202-898-6305).

Indiana Medicaid Publishes Proposed NF Rates Due to Continued and Reduced Rate Cuts

As reported in June, Indiana Medicaid announced that the existing 5% NF reimbursement rate cut would continue until December 31, 2013.  However, beginning January 1, 2014, the rate cut would be reduced from 5% to 3%.  This reduction in the rate cut is directly attributable to the advocacy efforts of the IHCA.  While Indiana Medicaid has not yet released official 7/1/13 NF rates, they did publish an estimate of the 7/1/13 rates with the 5% reduction and also the projected rates as of 1/1/14 with the 3% reduction.  Click here for the proposed rates.

Please contact Zach Cattell, zcattell@ihca.org, with any questions.

Indiana Medicaid Publishes Final Rule Concerning Value Based Purchasing

OnJune 26th, 2013, the final rule to implement the long-awaited Indiana Medicaid Value Based Purchasing program (VBP) was published in the Indiana Register. Click here to read the rule.  The VBP program is now the legal standard for NF reimbursement, however it still must be approved by CMS prior to implementation.  Indiana Medicaid submitted a State Plan Amendment to CMS on May 18, 2013, and approval should take place yet this year.  To read more details about the VBP program, click here.

The final rule also makes other changes to the Indiana NF reimbursement regulation, including changes to field audit procedures, administrative reconsideration and appeal processes, and the addition of new allowable costs in the direct care, in-direct care, and administrative components of the NF reimbursement rate.

Please contact Zach Cattell, zcattell@ihca.org, with any questions.

CMS Reminds Nursing Facilities of Resident’s Access and Visitation Rights

CMS issued S&C 13-42-NH to remind SNFs and NFs of the access and visitation rights held by nursing facility residents.  This reminder emphasizes that residents must be notified of their rights to have visitors on a 24-hour basis, who could include, but are not limited to, spouses (including same-sex spouses), domestic partners (including same-sex domestic partners), other family members, or friends.  Click here to read the memo.

CMS Releases Five-Star Quality Rating System Three-year Report

CMS issued S&C 13-44-NH containing the three-year review of the Five Star Rating System.  Click here to read the report. The report contains the results of an analysis that examined trends in the first three years of the Five-Star Quality Rating System. (2009-2011).  The report states:  “Since implementation of the Five-Star Quality Rating System, there have been improvements in nursing facility performance in all three domains of quality that the system utilizes: health inspection surveys, quality measures (QMs) and staffing levels.”

CMS Publishes LTC Hospice Requirements Final Rule

 On June 27th, 2013, CMS published the final rule establishing new requirements for the provision of hospice care in SNFs/NFs, and specifically focuses on certain information that must be in an agreement between a hospice and a nursing center.  The Final Rule is effective August 26th, 2013.  Please click here to access a copy.  The CMS summary of the rule is below:
We are adopting the provisions of this final rule as proposed, with the following changes:

• We originally proposed the standard regarding LTC facility/Hospice cooperation at §483.75(r); however, during the process of finalizing this rule, CMS published a separate interim final rule, Requirements for Long- Term Care (LTC) Facilities; Notice of Facility Closure (76 FR 9503). The interim final rule added standards §483.75(r) and (s). Since the standards at §483.75(r) and (s) are now in use, we are finalizing this standard at §483.75(t).

• In consideration of public comments, we are making three substantive changes in this final rule. We have made a revision at 483.75(t)(3) to clarify that the LTC representative must have a clinical background, function within their State scope of practice act, and have the ability to assess the resident or have access to someone that has the skills and capabilities to assess the resident. We have also made a revision to the requirement at §483.75(t)(3)(iii) removing the phrase “other physicians” and replacing it with “other practitioners.” Lastly, we have made a revision to the requirement at §483.75(t)(2)(ii)(E)(3) by removing the phrase “that is not related to the terminal condition.”

Technical Correction
• We are finalizing the proposed technical correction which would fix an incorrect citation at §483.10(n). In §483.10(n), we are revising the reference “§483.20(d)(2)(ii)” to read “§483.20(k)(2)(ii).”
• We are also finalizing the proposed technical correction which would fix an incorrect citation at proposed §483.75(r)(4). In §483.75(t)(4), we are revising the reference “483.20(k)” to read “483.25.”

Indiana Division of Aging Issues Memo Concerning Delays with e450B Processing

As has been reported to the IHCA, the Indiana Division of Aging (Division) has experienced some delays in processing the new electronic 450B, or e450B, that became effective statewide February 1, 2013.  The IHCA contacted the Division in June to discuss what the reasons for the delays were and how we could help resolve the issues.  The Division has responded with a memo. Click here to read the Division’s response.

The Division indicates that the sheer volume of e450Bs has slowed their processing, but also that a number of e450Bs are having to be returned to the provider due to incorrect or missing information that must be completed in order to process the e450B.    The most common issues appear to be missing resident Medicaid identification number, facility provider number, missing admission date, and missing documentation.  A complete list of all issues is included in the memo.

The Division has re-assigned staff to help clear the backlog and hope that with additional staff, and additional attention from providers, that delays in processing e450Bs can be avoided in the future.  The Division understands that with any change some process issues will come up and they do appreciate the hard work all have put into making this system change.