IHCA
MLN Matters posted an article September 11, 2015 regarding the related change request for CR 9340. This change is intended for physicians, other providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Home Health & Hospice (HH&H) MACs and Durable Medical Equipment (DME) MACs, for services provided to Medicare beneficiaries who are in a Part A covered Skilled Nursing Facility (SNF) stay. This change request is scheduled to be implemented January 4, 2015. To read the entire article, please click here.
MLN Matters posted another article on September 11, 2015 revising SE0434. The revision is to reflect the updated regulation reference in the first paragraph of the Background section of the article and to update several Web addresses. All other information remains the same. To read the revision, please click here.
Thursday, October 8, 2015
ASPE Compendium of Residential Care & Assisted Living Regulations and Policy
The Office of the Assistant Secretary for Planning and Evaluation (ASPE) has published its 2015 Compendium of Residential Care and Assisted Living Regulations and Policy. The report provides an overview of state approaches to residential care policy, including assisted living, and provides state summaries for the 50 states and the District of Columbia.
Links to the compendium are as follows:
• Executive Summary: http://aspe.hhs.gov/execsum/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition-executive-summary
• Full Compendium: http://aspe.hhs.gov/pdf-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition
• State Summaries: http://aspe.hhs.gov/pdf-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition-continuation
Links to the compendium are as follows:
• Executive Summary: http://aspe.hhs.gov/execsum/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition-executive-summary
• Full Compendium: http://aspe.hhs.gov/pdf-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition
• State Summaries: http://aspe.hhs.gov/pdf-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition-continuation
August Residential Tags
In August 2015 the ISDH issued 6 offense tags and 26 deficiency tags totaling 32 citations to Residential Care Facilities. Five citations were issued to tag 0273 concerning maintenance of food preparation and service areas in accordance with state and local sanitation standards. The total for this tag is now 55, making it the highest cited tag in 2015. Tag 0241 (Offense tag) concerning the administration of medications by licensed nurses or QMAs, was also cited five times this month. This tag has been cited every month this year. Tag 0144 concerning proper maintenance of the building and grounds was issued three times. In the past six months this tag has been cited every month.
A few tags have been frequently cited this year. Tag 0154 concerning maintenance of good and clean kitchen and dining areas and equipment and tag 0217 concerning have trained staff complete a resident’s evaluation, have both been cited every month in 2015. Tag 0090 regarding failure to ensure administrator maintained management of the overall facility has been cited seven out of the past eight months as has tag 0117. Tag 0117 is failure to ensure staff is sufficient in numbers, qualifications, and training. Tag 0214 concerning the evaluation prior to admission and upon admission by a license nurse evaluating each resident’s need for nursing care, has been cited six of the last seven months. Five of the last six months tag 0246 regarding proper authorization and documentation when administering PRN medications by a QMA, has been cited. Tag 0414 concerning staff washing hands after contact with each resident has been cited four of the past five months. In the past four months offensive tag 0242 concerning observation of resident for the effect(s) of medications, documentation of effects, notification to physician, and documentation of notifying physician in resident’s clinical record, has been cited. Prior to this current trend this tag had not been cited since October 2014. For the second time this year tag 0191 concerning inadequate kitchen in complying with 410 IAC 7-24 (Sanitary Standards for the Operation of Retail Food Establishments), was cited. This tag popped up for the first time in IHCA history in June.
Click here to review a summary of August’s Residential Care Facility citations.
A few tags have been frequently cited this year. Tag 0154 concerning maintenance of good and clean kitchen and dining areas and equipment and tag 0217 concerning have trained staff complete a resident’s evaluation, have both been cited every month in 2015. Tag 0090 regarding failure to ensure administrator maintained management of the overall facility has been cited seven out of the past eight months as has tag 0117. Tag 0117 is failure to ensure staff is sufficient in numbers, qualifications, and training. Tag 0214 concerning the evaluation prior to admission and upon admission by a license nurse evaluating each resident’s need for nursing care, has been cited six of the last seven months. Five of the last six months tag 0246 regarding proper authorization and documentation when administering PRN medications by a QMA, has been cited. Tag 0414 concerning staff washing hands after contact with each resident has been cited four of the past five months. In the past four months offensive tag 0242 concerning observation of resident for the effect(s) of medications, documentation of effects, notification to physician, and documentation of notifying physician in resident’s clinical record, has been cited. Prior to this current trend this tag had not been cited since October 2014. For the second time this year tag 0191 concerning inadequate kitchen in complying with 410 IAC 7-24 (Sanitary Standards for the Operation of Retail Food Establishments), was cited. This tag popped up for the first time in IHCA history in June.
Click here to review a summary of August’s Residential Care Facility citations.
IJ/SSQC Citation Update
There was one IJ citation issued by the ISHD in August. F 155 was issued for failure to have a system in place to determine code status and failure to perform CPR on a resident in full code. The facility also failed to ensure advanced directive/code status that was clearly and consistently documented for 4 of 6 residents reviewed with advanced directives. This is the fourth time F 155 has been cited as the IJ level in 2015, and the sixth time in the last 7 months that a citation has been issued at the IJ level for failures surrounding advance directives and administration of CPR.
In the August event, a resident was found deceased in her bed by a CNA. The CNA immediately got an RN, who determined that the resident was cold, stiff, and mottled half way up and deemed calling the ambulance unnecessary as it would just result in the EMTs telling the RN to contact the coroner. The RN indicated the resident had no pulse, no respirations, and no blood pressure. The POST for this resident was to administer CPR even if pulse and breathing are not detected.
The other event documented was the facility failed to ensure clear and consistent documentation of advanced directives, 4 of 6 residents were affected by this. The inconsistent documentation included not updating current POST, no updating proper stickers that indicate directives, miscommunication between the POST and the computerized profile, and RN not being CPR certified. The immediate jeopardy began on 4/5/15 and was removed on 8/10/15 when the facility began to in-service staff on CPR and how to determine resident’s codes. The facility has also mention discussion of replacing the stickers with a sheet of colored paper for a quick reference on resident’s proper POST.
To review a summary of the 2015 IJ/SSQCs and the August 2567, click here.
In the August event, a resident was found deceased in her bed by a CNA. The CNA immediately got an RN, who determined that the resident was cold, stiff, and mottled half way up and deemed calling the ambulance unnecessary as it would just result in the EMTs telling the RN to contact the coroner. The RN indicated the resident had no pulse, no respirations, and no blood pressure. The POST for this resident was to administer CPR even if pulse and breathing are not detected.
The other event documented was the facility failed to ensure clear and consistent documentation of advanced directives, 4 of 6 residents were affected by this. The inconsistent documentation included not updating current POST, no updating proper stickers that indicate directives, miscommunication between the POST and the computerized profile, and RN not being CPR certified. The immediate jeopardy began on 4/5/15 and was removed on 8/10/15 when the facility began to in-service staff on CPR and how to determine resident’s codes. The facility has also mention discussion of replacing the stickers with a sheet of colored paper for a quick reference on resident’s proper POST.
To review a summary of the 2015 IJ/SSQCs and the August 2567, click here.
HEA 1391 Final Report
Since the passage of House Enrolled Act 1391 by the 2014 General Assembly, the Office of the Secretary of Family and Social Services, in conjunction with the State Department of Health, and the Office of Management and Budget have been working on a written report regarding various issues concerning delivery of long term services and support in Indiana. That final report has been be submitted to the Indiana General Assembly as of October 1, 2015. To view the final report, please click here. You can also find previous drafts for HEA 1391 under the Newsletter Materials section on the website. For more information or any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
NF Capacity Reduction Update
Throughout the year 2015 IHCA has been in discussion with the Indiana Family and Social Services Administration (FSSA), as well as the two other nursing facility trade associations Leading Age Indiana (LAI) and Hoosier Owners and Providers for the Elderly (HOPE), concerning the future of Long Term Care in Indiana. FSSA has emphasized the rebalancing of spending between institutional care and home and community based services (HCBS) using a 5 to 8 year plan. The effort to rebalance is driven by future budgetary concern and because the current Indiana ratio of spending is 67% on institutional and 33% on HCBS, whereas nationally spending is 51% institutional and 49% HCBS.
Although this conversation has been going on for many months, in recent weeks FSSA has included a proposal to incentive the closure of nursing facilities as a method for increasing overall operational efficiency and save long term dollars. The proposed incentive plan is to withhold some amount of the supplemental payments county hospitals currently receive and only give that withheld amount back if a targeted number of nursing facilities close. The proposal would be effectuated by changing the quarterly agreements that each county hospital signs with Indiana Medicaid when drawing down supplemental payments.
According to a report released by the Indiana State Department of Health (ISDH) in July 2015, there are 540 facilities with a total of 52,624 comprehensive beds in the state of Indiana, averaging 97 beds per facility. The report also found that statewide occupancy is at 75%. FSSA has a target statewide occupancy rate of 85-90%, which means the closure of 54-81 facilities total and about 15-25 facilities annually. IHCA agrees that there is a need to increase the occupancy rate and that reduction in capacity could be a part of that, but the FSSA proposal is very complicated and has generated many concerns from IHCA members and partners.
IHCA and LAI sent a letter to Chris Fletcher, OMPP Reimbursement Section Director of FSSA, on September 18, 2015 concerning the 5-8 year plan and the state’s idea concerning facility closure. The letter explained concerns with the FSSA proposal, as well as providing a proposed 5 to 8 year plan timeline and alternative concepts. To read the entire letter, please click here.
The state’s plan to rebalance is progressing rapidly after months of little action. This rebalancing plan will have a major impact to the LTC community, please remain engaged for updates. Please contact Zach Cattell at zcattell@ihca.org or 317-616-9001 for more information.
Although this conversation has been going on for many months, in recent weeks FSSA has included a proposal to incentive the closure of nursing facilities as a method for increasing overall operational efficiency and save long term dollars. The proposed incentive plan is to withhold some amount of the supplemental payments county hospitals currently receive and only give that withheld amount back if a targeted number of nursing facilities close. The proposal would be effectuated by changing the quarterly agreements that each county hospital signs with Indiana Medicaid when drawing down supplemental payments.
According to a report released by the Indiana State Department of Health (ISDH) in July 2015, there are 540 facilities with a total of 52,624 comprehensive beds in the state of Indiana, averaging 97 beds per facility. The report also found that statewide occupancy is at 75%. FSSA has a target statewide occupancy rate of 85-90%, which means the closure of 54-81 facilities total and about 15-25 facilities annually. IHCA agrees that there is a need to increase the occupancy rate and that reduction in capacity could be a part of that, but the FSSA proposal is very complicated and has generated many concerns from IHCA members and partners.
IHCA and LAI sent a letter to Chris Fletcher, OMPP Reimbursement Section Director of FSSA, on September 18, 2015 concerning the 5-8 year plan and the state’s idea concerning facility closure. The letter explained concerns with the FSSA proposal, as well as providing a proposed 5 to 8 year plan timeline and alternative concepts. To read the entire letter, please click here.
The state’s plan to rebalance is progressing rapidly after months of little action. This rebalancing plan will have a major impact to the LTC community, please remain engaged for updates. Please contact Zach Cattell at zcattell@ihca.org or 317-616-9001 for more information.
IHCA Presents to Indiana House Ways & Means Committee Concerning Nursing Facility Policy
On September 29, 2015, the Indiana House Ways & Means Committee held a briefing for a select group of committee members with the aim to better understand the funding of and reimbursement for nursing facility services, as well as issues surrounding efforts to rebalance Indiana Medicaid’s Long Term Services and Supports spend. Representatives from the Indiana Family and Social Services Administration (FSSA), IHCA, LeadingAge Indiana, and HOPE were invited to make presentations to the committee. The briefing resulted in an open conversation concerning current NF Medicaid reimbursement, the State’s policy objectives in rebalancing Long Term Services and Supports (LTSS) spending, and the NF trade associations’ perspectives on these issues.
The FSSA’s presentation began by discussing the agency’s desire to rebalance the LTSS spend towards more spending on Home and Community Based Services (HCBS) and less spending on institutional services. The agency, through its contractor Myers & Stauffer, provided a detailed explanation of the Medicaid rate setting system, as well as an overview of the supplemental payment program that county hospitals have engaged in by being licensed to operate nursing facilities across Indiana. The presentation continued with financial projections of Indiana’s Medicaid program based on current spending levels for institutional and HCBS service spending, with reference of managed care as an often utilized method to achieve LTSS rebalancing. FSSA also discussed an idea related to reducing nursing facility capacity that implicates the supplemental payment program. The State’s discussion ended with the topic of HCBS waiver redesign to serve more Medicaid members in the community.
IHCA collaborated with LeadingAge Indiana and HOPE on the presentation made to the committee. Zach Cattell, IHCA President, began the presentation by discussing patient care and providing specific clinical examples of the types of patients that nursing facilities care for. Jim Leich, LeadingAge Indiana President, then provided an overview of the challenges that nursing facilities face with Medicare and discussed the importance of taking these challenges into consideration when discussing the rebalancing of LTSS spending. Terry Milller, HOPE President, provided insight on the changes of resident acuity and payment policy over the past 30 years. Zach Cattell from IHCA finished the presentation by explaining that a thorough plan is needed in order to correctly rebalance the system. The plan must focus on the needs of Hoosiers, and not simply on a budget target. IHCA focused on three key issues: 1) maintaining a direct relationship with the State for provision of NF services; 2) helping rebalance LTSS; and 3) stabilizing reimbursement and addressing nursing facility capacity.
The meeting was very productive for all that attended. It is clear that FSSA is serious about moving the needle on LTSS spending towards more Home and Community Based Services. It is also clear that the nursing facility profession must be proactive in providing the right solutions to this challenge. Sometime in October FSSA will be finalizing its LTSS rebalancing plan, so be on the lookout for that as the month continues. To access the two presentations from the State and the PowerPoint from IHCA, LeadingAge Indiana and HOPE, click here. For more information or any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
The FSSA’s presentation began by discussing the agency’s desire to rebalance the LTSS spend towards more spending on Home and Community Based Services (HCBS) and less spending on institutional services. The agency, through its contractor Myers & Stauffer, provided a detailed explanation of the Medicaid rate setting system, as well as an overview of the supplemental payment program that county hospitals have engaged in by being licensed to operate nursing facilities across Indiana. The presentation continued with financial projections of Indiana’s Medicaid program based on current spending levels for institutional and HCBS service spending, with reference of managed care as an often utilized method to achieve LTSS rebalancing. FSSA also discussed an idea related to reducing nursing facility capacity that implicates the supplemental payment program. The State’s discussion ended with the topic of HCBS waiver redesign to serve more Medicaid members in the community.
IHCA collaborated with LeadingAge Indiana and HOPE on the presentation made to the committee. Zach Cattell, IHCA President, began the presentation by discussing patient care and providing specific clinical examples of the types of patients that nursing facilities care for. Jim Leich, LeadingAge Indiana President, then provided an overview of the challenges that nursing facilities face with Medicare and discussed the importance of taking these challenges into consideration when discussing the rebalancing of LTSS spending. Terry Milller, HOPE President, provided insight on the changes of resident acuity and payment policy over the past 30 years. Zach Cattell from IHCA finished the presentation by explaining that a thorough plan is needed in order to correctly rebalance the system. The plan must focus on the needs of Hoosiers, and not simply on a budget target. IHCA focused on three key issues: 1) maintaining a direct relationship with the State for provision of NF services; 2) helping rebalance LTSS; and 3) stabilizing reimbursement and addressing nursing facility capacity.
The meeting was very productive for all that attended. It is clear that FSSA is serious about moving the needle on LTSS spending towards more Home and Community Based Services. It is also clear that the nursing facility profession must be proactive in providing the right solutions to this challenge. Sometime in October FSSA will be finalizing its LTSS rebalancing plan, so be on the lookout for that as the month continues. To access the two presentations from the State and the PowerPoint from IHCA, LeadingAge Indiana and HOPE, click here. For more information or any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
July 1, 2015 Medicaid Rate Update
On October 2, 2015 Myers & Stauffer began to issue the 7/1/2015 Medicaid rates. As of October 8, 2015 there are 187 facilities that have yet to receive their annual Medicaid rate and there are several reasons for the delay. For a majority of these facilities (100+), a request for information was sent and the provider has not yet responded to this request. Once the response is received, the information will be reviewed and the rates will be established. The remainder of the facilities are either on hold due to a pending change of ownership transaction review, the annual rate was delayed due to failure to timely file the cost report, the facility is newly Medicaid certified and still in the initial rate process, or the facility does not have the necessary data to establish an individual facility Total Quality Score (TQS). When a facility does not have the necessary data for an individual facility TQS, a Statewide Average Total Quality Score would be used in the calculation. With over 100 facilities still waiting information, establishing the Statewide Average Total Quality Score is not feasible at this time. Once more of the 7/1/15 rates have been established, the TQS averages can be determined and subsequently the 7/1/15 rates awaiting these averages can be established. To see the current Cumulative Rate Listing, please click here.
For more information or any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
For more information or any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
CMS Call - Implementation of the IMPACT Act
On October 21, 2015, CMS is hosting a provider call to discuss the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The call will cover:
CMS suggests that the call will be “more meaningful” if the audience read the entire bill text prior to session. For details, including a link to the registration page, see https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2015-10-21-Post-Acute-Care.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending.
- Legislative requirements of the IMPACT Act related to the use of standardized data, quality measures, and resource use and other measures for skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals, and home health agencies;
- Participation in the quality measure and assessment instrument development process; and
- Opportunities for stakeholder engagement and input.
CMS suggests that the call will be “more meaningful” if the audience read the entire bill text prior to session. For details, including a link to the registration page, see https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2015-10-21-Post-Acute-Care.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending.
Ombudsman Acting Director
Karen Gardner Gilliland has been appointed Acting Director of the State Long Term Care Ombudsman Program. Karen has been with the Division of Aging for eight years and most recently served as Deputy Director for Policy and Planning. As a gerontologist, she has 40 years in services for the older adults, having served as an Area Agency on Aging Director in Muncie, President/CEO of a joint venture with Parkview and Lutheran Hospitals and the Visiting Nurse Services and Hospice of Fort Wayne, and as LTC Program Development Director for Mercy Health System in Cincinnati. In May of 2015, Karen was awarded the "Advocate of the Year" award by the Indiana Association of Home and Hospice Care for client advocacy.
The Ombudsman program serves to advocate for the needs of long term care residents by investigating and resolving their problems and complaints. The program provides information and education on long term care services, programs and advocacy on regulations and policies affecting long term care. Karen will oversee twenty-two full and part time Ombudsman located throughout the state.
The Ombudsman program serves to advocate for the needs of long term care residents by investigating and resolving their problems and complaints. The program provides information and education on long term care services, programs and advocacy on regulations and policies affecting long term care. Karen will oversee twenty-two full and part time Ombudsman located throughout the state.
Meeting with CMS
On September 15, 2015, AHCA had a meeting with CMS and participated in a stakeholder meeting convened by CMS. The first meeting included AHCA, LeadingAge and CMS. The second was a larger, invitation only Stakeholder Meeting on Future Changes to Five Star and Nursing Home Compare. Discussion points include issues concerning the Payroll Based Journal, anti-psychotic use rate, “focused surveys” not being categorized as complaint surveys, and coming changes to Five Star/Nursing Home Compare. Notes from both meetings can be accessed by clicking here. For more information or any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.
Tuesday, September 1, 2015
CMS Midwest Division of Survey and Certification LTC Update
CMS has made revisions to the QIS training procedures for State Survey Agencies (SA) and Regional Offices (RO). There are four revisions for the QIS to follow. 1) Eliminate the mock survey and replace it with a survey for record; 2) Eliminate the T3.5 process formerly called “The Trainer Instructor Training”; 3) Update the compliance process and associated tool used for evaluating surveyors; and, 4) Clarify the role of Certified Trainers. Please note that these revisions do not replace the structure programs each SA and RO is required to have as outlined in Exhibit 42 of the State Operations Manuel (SOM). To read the entire revision, please click here.
CMS has also sent a guidance to clarify policies regarding SA release of data and documents to Medical Fraud Control Units (MFCU). The guidance reiterates the legal requirements SA has in regards to share Automated Survey Processing Environment (ASPEN) Complaint Tracking System (ACTS) data, Long-Term Care Minimum Data Set (MDS) data, and survey documents with their state MFCU upon receipt of a written request. The CMS new guidance memorandum and MFCU letter to SA can be found by clicking here.
CMS has also sent a guidance to clarify policies regarding SA release of data and documents to Medical Fraud Control Units (MFCU). The guidance reiterates the legal requirements SA has in regards to share Automated Survey Processing Environment (ASPEN) Complaint Tracking System (ACTS) data, Long-Term Care Minimum Data Set (MDS) data, and survey documents with their state MFCU upon receipt of a written request. The CMS new guidance memorandum and MFCU letter to SA can be found by clicking here.
Nursing Facility and Residential Care Facility Occupancy
As mandated by legislature as part of the recent moratorium bill, ISDH must determine occupancy rates for January 1 and July 1 of each year. The ISDH did a test run of the system for this past July 1, 2015 and those results are attached in five reports. The first official count from which additional nursing facility beds/facilities could be added in a county that exceeds 90% will be this coming January 1.
Statewide NF occupancy as of July 1, 2015 was 75%. Residential care facility occupancy was 63% (residential care is not impacted by the moratorium, but the ISDH decided to collect data anyway). The five reports are:
• Comprehensive Care Facility Bed Count Report 7-1-2015.pdf
• Comprehensive Care Facility Occupancy Report 7-1-2015.pdf
• Residential Care Facility Bed Count Report 7-1-2015.pdf
• Residential Care Facility Occupancy Report 7-1-2015.pdf
• Comprehensive Care Facility Count Report 7-1-2015.pdf
The ISDH has dedicated the page Reports on Health Care Facilities to serve as a central site for all facility reports. To access this page, please click here.
Statewide NF occupancy as of July 1, 2015 was 75%. Residential care facility occupancy was 63% (residential care is not impacted by the moratorium, but the ISDH decided to collect data anyway). The five reports are:
• Comprehensive Care Facility Bed Count Report 7-1-2015.pdf
• Comprehensive Care Facility Occupancy Report 7-1-2015.pdf
• Residential Care Facility Bed Count Report 7-1-2015.pdf
• Residential Care Facility Occupancy Report 7-1-2015.pdf
• Comprehensive Care Facility Count Report 7-1-2015.pdf
The ISDH has dedicated the page Reports on Health Care Facilities to serve as a central site for all facility reports. To access this page, please click here.
Monday, August 31, 2015
CRE Case Reporting in Marion County
Effective July 1st 2015, all nursing facilities in Marion County will be required to immediately report confirmed or suspected cases of Carbapenem-resistant Enterobacteriaceae (CRE) to the Marion County Public Health Department. The new requirement stems from an amendment to The Health and Hospital Corporation of Marion County code that adds CRE as a reportable communicable disease. Section 7-201 requires any physician or other health care provider who has knowledge of or diagnoses or treats a communicable disease case, and every manager of an extended care facility in which there is a communicable disease case to report that case or suspected case to Marion County Public Health Department in accordance with Section 7-202. Section 7-202 requires CRE to be reported immediately. Laboratories are also required to report evidence of a communicable disease under Section 7-301. Section 7-601 states failure to properly report could be up to a $1,000 fine, upon conviction. In addition to the fine, The Health and Hospital Corporation of Marion County may seek to abate the public health nuisance or violation of this ordinance in any court of competent jurisdiction. The code can be found at https://www.hhcorp.org/hhc/images/HHCcode/codechapter7.pdf
Nursing Facilities are required to report when they know there is a case or a suspected case in the facility. Consulting with clinicians to know what the signs of CRE and all other communicable diseases, as defined in the ordinance, would be necessary to properly suspect cases. In terms of known CRE cases the facility should still report even if the laboratory has already reported to be safe, to avoid penalty. IHCA expects the Indiana State Department of Health to amend its communicable disease rule later this year to require this same reporting statewide.
Marion County Public Health Department sent a letter to All Marion County Medical Providers and Infection Preventionists about CRE Reporting. That letter can be found by clicking here.
The CRE report form that needs to be submitted per patient per admission within 72 hours and faxed to Marion County Public Health Department Infectious Disease at (317)221-2076 can be found by clicking here.
Nursing Facilities are required to report when they know there is a case or a suspected case in the facility. Consulting with clinicians to know what the signs of CRE and all other communicable diseases, as defined in the ordinance, would be necessary to properly suspect cases. In terms of known CRE cases the facility should still report even if the laboratory has already reported to be safe, to avoid penalty. IHCA expects the Indiana State Department of Health to amend its communicable disease rule later this year to require this same reporting statewide.
Marion County Public Health Department sent a letter to All Marion County Medical Providers and Infection Preventionists about CRE Reporting. That letter can be found by clicking here.
The CRE report form that needs to be submitted per patient per admission within 72 hours and faxed to Marion County Public Health Department Infectious Disease at (317)221-2076 can be found by clicking here.
Division of Aging Introduces Email Address and Hyperlink to Address Duplicate e450B Requests
The Division of Aging (DA) continues to receive many emails from the same nursing facility regarding the same issue. This results in multiple DA staff researching the same information, which is very inefficient for response time between the DA and the facility. In an attempt to improve response time, the DA has created an email specifically designed for e450b and/or SADE process questions/concerns only. The email is DA.NFinforequest@fssa.in.gov and is effective immediately.
As you are aware, an authorized e450b is available for download for up to thirty (30) days from Da’s authorization. If the nursing facility does not complete the download in that time period or the download is interrupted/not completed, the nursing facility must contact the DA to re-download the authorized e450b. There has also been a high demand for additional downloads, so the e450b web page now contains a hyperlink to request addition downloads for e450b’s that have previously been downloaded. The hyperlink, NEW Request a duplicate Form 450B ONLINE, is located just above the reference material section on the e450b webpage.
Hopefully the enhancements listed above will be helpful for all nursing facilities as well as improve the DA’s response time to the facilities.
As you are aware, an authorized e450b is available for download for up to thirty (30) days from Da’s authorization. If the nursing facility does not complete the download in that time period or the download is interrupted/not completed, the nursing facility must contact the DA to re-download the authorized e450b. There has also been a high demand for additional downloads, so the e450b web page now contains a hyperlink to request addition downloads for e450b’s that have previously been downloaded. The hyperlink, NEW Request a duplicate Form 450B ONLINE, is located just above the reference material section on the e450b webpage.
Hopefully the enhancements listed above will be helpful for all nursing facilities as well as improve the DA’s response time to the facilities.
CMS Releases Phase Two of Initiative to Reduce Avoidable Hospitalization Among Nursing Facility Residents
Since September 2012, under Phase One of theInitiative to Reduce Avoidable Hospitalization Among Nursing Facility Residents, CMS has partnered with seven Enhanced Care and Coordinator Providers (ECCP) organizations in seven states, as an effort to improve care for nursing facility’s long-term residents. Indiana is one of those seven states included in this initiative. In conjunction with Phase One, Indiana University created OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical quality, and Improving Symptoms: Transforming Institutional Care), which includes the deployment of Registered Nurses (RNs) and Advanced Practice Nurses (APNs) to be on-site at nursing facilities, allowing for enhanced recognition and management of acute changes in medical conditions. IHCA has learned that OPTIMISTIC is currently evaluating Phase Two of the initiative. To read about Phase One, click here.
On August 27, 2015 CMS release Phase Two, which includes the four-year funding opportunity that will be implemented in current ECCP facilities and newly recruited facilities. The payment model incentivizes nursing facilities to expand internal resources to treat and/or manage residents in six defined acute conditions (Pneumonia, Dehydration, Congestive Heart Failure (CHF), Urinary Tract Infection (UTI), Skin Ulcers/Cellulitis, and COPD/Asthma). This would allow facilities to treat residents on site, rather than sending them to a hospital.
Successful ECCP applicants will implement the new payment model with both their existing facilities and newly recruited facilities in October 2016. This payment structure is intended to allow CMS to continue to 1) Identify the impact of the clinical interventions, 2) evaluate the impact of a new payment model, and 3) Assess the impact of both these models combined. Relative dates and time for application process are below.
· Notice of Intent to Apply: September 9, 2015
· Electronic Application Due Date: October 29, 2015, by 5:00 p.m. Eastern Time
· Anticipated Notice of Award: January 15, 2016
· Anticipated Project Period of Performance: January 15, 2016 to October 23, 2020
To read about Phase Two, click here.
Indiana Division of Aging Update for HEA 1391
In 2014, the General Assembly passed House Enrolled Act 1391. Section 7 of the bill requires the Office of the Secretary of Family and Social Services, in conjunction with the State Department of Health, and the Office of Management and Budget, to provide a written report to the Indiana General Assembly before October 1, 2015, regarding various issues concerning delivery of long term services and support in Indiana (click here for details). The report is not yet complete, but there have been multiple drafts, and the latest draft was just released for review.
The latest draft supports reliance on a two-year CHOICE (Community and Home Options to Institutional Care for the Elderly and Disabled) pilot program, for which will be available in 2017. The CHOICE pilot program is a two-year program implemented in four regions of the state, Ares 1, 4, 13 and 14. The pilot program is intended to evaluate the impact of changes in the CHOICE program. The changes include lessening eligibility requirements to one Activity of Daily Living (ADL) impairment, which will allow individuals to receive services before their needs become extensive. The asset limit is reduced to $250,000 and an increase in cost share participation by basing it on assets as well as income in an attempt to be applicable to more individuals. The pilot program also puts focus on a needs based assessment process to identify community and personal resources for the individual’s needs, potentially without the use of public dollars. There is also more flexibility in the utilization of case management dollars for the initial assessment and screening stages. This pilot program could potentially change performance metrics such as: nursing facility admission rate in pilots versus non-pilots; reduction of wait lists or time spent on wait list; reduction of expenditures per person served; increased informal supports; and improved quality of life as measured in a new survey tool. The draft does address the issue of low occupancy rate in nursing facilities and credits the passage of the moratorium to help occupancy rates rise. The draft also discusses the FSSA’s perspective that Indiana needs to rebalance long term services and supports spending towards more Home and Community Based services. Tennessee’s managed care was used as a positive example for how nursing facility and long-term care costs can be contained relative to growth in the population over age 65. There is also an entire section dedicated to telemedicine physician coverage in nursing facilities. Telemedicine provides numerous ways in which to improve health outcomes through the use of two-way, real-time interactive communication between the patient and a remotely located physician or medical practitioner using audio and video equipment. Although Telemedicine is being used in some nursing facilities, it is not yet required, but possibly could be in the future. To see the entire draft please click here.
The latest draft supports reliance on a two-year CHOICE (Community and Home Options to Institutional Care for the Elderly and Disabled) pilot program, for which will be available in 2017. The CHOICE pilot program is a two-year program implemented in four regions of the state, Ares 1, 4, 13 and 14. The pilot program is intended to evaluate the impact of changes in the CHOICE program. The changes include lessening eligibility requirements to one Activity of Daily Living (ADL) impairment, which will allow individuals to receive services before their needs become extensive. The asset limit is reduced to $250,000 and an increase in cost share participation by basing it on assets as well as income in an attempt to be applicable to more individuals. The pilot program also puts focus on a needs based assessment process to identify community and personal resources for the individual’s needs, potentially without the use of public dollars. There is also more flexibility in the utilization of case management dollars for the initial assessment and screening stages. This pilot program could potentially change performance metrics such as: nursing facility admission rate in pilots versus non-pilots; reduction of wait lists or time spent on wait list; reduction of expenditures per person served; increased informal supports; and improved quality of life as measured in a new survey tool. The draft does address the issue of low occupancy rate in nursing facilities and credits the passage of the moratorium to help occupancy rates rise. The draft also discusses the FSSA’s perspective that Indiana needs to rebalance long term services and supports spending towards more Home and Community Based services. Tennessee’s managed care was used as a positive example for how nursing facility and long-term care costs can be contained relative to growth in the population over age 65. There is also an entire section dedicated to telemedicine physician coverage in nursing facilities. Telemedicine provides numerous ways in which to improve health outcomes through the use of two-way, real-time interactive communication between the patient and a remotely located physician or medical practitioner using audio and video equipment. Although Telemedicine is being used in some nursing facilities, it is not yet required, but possibly could be in the future. To see the entire draft please click here.
Residential Care Citation Update
The ISDH issued 12 offense tags and 71 deficiency tags totaling 83 citations to Residential Care Facilities in the month of July. This is the highest month of citations issued, it’s even higher than when ISDH was only issuing Residential Tags due to the government shutting down in October 2013. Ten citations were issued to tag 0273 concerning maintenance of food preparation and service areas in accordance with state and local sanitation standards. This marks the second time in 2015 that this Tag received ten citations, creating a total of 50 citations issued this year. Tag 0241 (Offense tag) concerning the administration of medications by licensed nurses or QMAs, was the second highest citation issued in July with nine citations. It has been cited every month with a total of 26 citations for 2015. Tag 0217 concerning resident evaluation and services plan was cited eight times. This citation has been issued every month in the year 2015 for a total of 23 citations. Tag 0148, Tag 0154, and Tag 0272 were issued five citations making it the highest month for those Tags to be cited in 2015.
There were three Tags that were issued for the first time in 2015: Tag 0058 for Patients’ Rights when a facility fails to grant immediate access for authorized public personnel or an individual’s physician; Tag 0149 for Sanitation & Safety Standards for failure to comply with 410 IAC 7-24 requiring a pest control program; Tag 0193 for Physical Plan Standards in failure to have proper laundry services. There was also a new Tag issued that had not been reported before, Tag 0179. This involves failure for an adequate air conditioning system in compliance with 675 IAC (Fire Prevention and Building Safety Commission).
Click here to review a summary of July’s Residential Care Facility citations.
There were three Tags that were issued for the first time in 2015: Tag 0058 for Patients’ Rights when a facility fails to grant immediate access for authorized public personnel or an individual’s physician; Tag 0149 for Sanitation & Safety Standards for failure to comply with 410 IAC 7-24 requiring a pest control program; Tag 0193 for Physical Plan Standards in failure to have proper laundry services. There was also a new Tag issued that had not been reported before, Tag 0179. This involves failure for an adequate air conditioning system in compliance with 675 IAC (Fire Prevention and Building Safety Commission).
Click here to review a summary of July’s Residential Care Facility citations.
Tuesday, August 4, 2015
CMS Issues Two Survey & Certification Memos Related to LTC
On July 17, 2015 CMS issued one new Survey & Certification memo and updated a previously released memo.
• CMS S&C 15-47 - Medication-Related Adverse Events in Nursing Homes
CMS states that adverse events related to high risk medications can have devastating effects on nursing home residents, and is concerned with the prevalence of adverse drug events. CMS has begun pilot testing a Focused Survey on Medication Safety Systems to look at nursing home systems around high risk and problem-prone medications using an Adverse Drug Event Trigger Tool. The CMS is making the draft tool available to assist surveyors in investigating medication related adverse events and to nursing home providers as a risk management tool. Click here to access the memo and an attachment.
• CMS S&C 14-42 - Release of Learning Tool on Building Respect for Lesbian, Gay, Bisexual, Transgender (LGBT) Older Adults (NH – Original version released 8/22/14; Revised version released 7/17/15)
The original memo announced the release of a free learning tool on Building Respect for LGBT Older Adults. The revised memo updates the Training Tool website link. Click here to see the revised memo.
• CMS S&C 15-47 - Medication-Related Adverse Events in Nursing Homes
CMS states that adverse events related to high risk medications can have devastating effects on nursing home residents, and is concerned with the prevalence of adverse drug events. CMS has begun pilot testing a Focused Survey on Medication Safety Systems to look at nursing home systems around high risk and problem-prone medications using an Adverse Drug Event Trigger Tool. The CMS is making the draft tool available to assist surveyors in investigating medication related adverse events and to nursing home providers as a risk management tool. Click here to access the memo and an attachment.
• CMS S&C 14-42 - Release of Learning Tool on Building Respect for Lesbian, Gay, Bisexual, Transgender (LGBT) Older Adults (NH – Original version released 8/22/14; Revised version released 7/17/15)
The original memo announced the release of a free learning tool on Building Respect for LGBT Older Adults. The revised memo updates the Training Tool website link. Click here to see the revised memo.
CMS Releases the FY 2016 SNF PPS Final Rule
On July 30th, 2015, CMS released the FY 2016 SNF PPS final rule, which also included language on value-based purchasing (VBP) as well as the recently-enacted IMPACT law. AHCA will provide additional details in the coming days. For now, please see below for an outline of the specifics behind the market basket update.
SNF payments to increase $430 million
CMS projects within the final rule that aggregate SNF payments in FY 2016 will increase by $430 million - or 1.2 percent - from payments in FY 2015.
This final increase is 0.2 percent less than what was outlined in the proposed FY 2016 rule released earlier in April, which included a 1.4 percent net market basket increase ($500 million) for SNFs beginning on October 1 of this year.
CMS justifies the reduction via a caveat in the FY 2016 proposed rule that if more recent data became available and was appropriate to consider, the agency would use such data to determine the final FY 2016 SNF rate. That explains the change from the original $500 million estimate to $430 million. CMS used more recent data from the second quarter 2015 IHS Global Insight forecast of the FY 2010-based SNF market basket to calculate the reduced market basket increase of 1.2 percent.
Tables 1 and 2 below reflect the updated components of the unadjusted federal rates for FY 2016 prior to adjustment for case-mix. CMS further adjusts the rates by a wage index budget neutrality factor.
Table 1 - FY 2016 Unadjusted Federal Rate Per Diem
Urban
Table 2 - FY 2016 Unadjusted Federal Rate Per Diem
Rural
Quality Measures Finalized
CMS also finalized the rehospitalization measure to be used in the SNF VBP program that applies a 2 percent withhold to all SNF Part A payments. SNFs can "earn" some of the withhold back based on its rehospitalization rate. The measure, which was unchanged from the proposed rule, will use the SNF RM, a National Quality Forum-endorsed risk adjusted measure based on SNF and Hospital Part A claims.
In addition, CMS finalized the specifications for three quality measures to comply with the IMPACT Act. In the coming days, AHCA will release a more detailed summary of the final rule, including the VBP language as well as details on the quality reporting and staff reporting measures found in IMPACT. You are encouraged to review the final rule, as well as the CMS fact sheet.
AHCA will continue to advocate on your behalf as we meet with CMS in the coming weeks about the provisions in the final rule.
SNF payments to increase $430 million
CMS projects within the final rule that aggregate SNF payments in FY 2016 will increase by $430 million - or 1.2 percent - from payments in FY 2015.
This final increase is 0.2 percent less than what was outlined in the proposed FY 2016 rule released earlier in April, which included a 1.4 percent net market basket increase ($500 million) for SNFs beginning on October 1 of this year.
CMS justifies the reduction via a caveat in the FY 2016 proposed rule that if more recent data became available and was appropriate to consider, the agency would use such data to determine the final FY 2016 SNF rate. That explains the change from the original $500 million estimate to $430 million. CMS used more recent data from the second quarter 2015 IHS Global Insight forecast of the FY 2010-based SNF market basket to calculate the reduced market basket increase of 1.2 percent.
Tables 1 and 2 below reflect the updated components of the unadjusted federal rates for FY 2016 prior to adjustment for case-mix. CMS further adjusts the rates by a wage index budget neutrality factor.
Table 1 - FY 2016 Unadjusted Federal Rate Per Diem
Urban
Table 2 - FY 2016 Unadjusted Federal Rate Per Diem
Rural
Quality Measures Finalized
CMS also finalized the rehospitalization measure to be used in the SNF VBP program that applies a 2 percent withhold to all SNF Part A payments. SNFs can "earn" some of the withhold back based on its rehospitalization rate. The measure, which was unchanged from the proposed rule, will use the SNF RM, a National Quality Forum-endorsed risk adjusted measure based on SNF and Hospital Part A claims.
In addition, CMS finalized the specifications for three quality measures to comply with the IMPACT Act. In the coming days, AHCA will release a more detailed summary of the final rule, including the VBP language as well as details on the quality reporting and staff reporting measures found in IMPACT. You are encouraged to review the final rule, as well as the CMS fact sheet.
AHCA will continue to advocate on your behalf as we meet with CMS in the coming weeks about the provisions in the final rule.
RUGs IV 48 Grouper
IHCA has received a number of questions about the RUGs IV 48 grouper change that is set to occur on July 1, 2016. Many questions are being generated by the recent release of CMI rosters with the residents converted to the RUGs IV 48, and many facilities are seeing drops in both the all facility and Medicaid only CMIs. In discussions with the State and Myers & Stauffer, the projections given to providers in late 2014 are still on track in that the RUGs IV 48 grouper will add a small amount of reimbursement to the overall system (approx. $6.9M). Projected Medians for the RUGs IV 48 grouper are due to be released by August 31st, and once released payment modeling will be able to be performed more accurately.
ISDH Report Card Score Proposed Changes
IHCA met with the ISDH last month to continue discussions about the proposed changes to the ISDH Report Card Score methodology. After receiving positive and negative feedback, the ISDH is going to revise the proposal by examining the point allocation for each tag cited. Under the original proposal, points were assigned to each tag only with respect to the severity component and did not take into consideration the scope component. In addition, ISDH is ensuring that tags are not double counted when a complaint survey is conducted at the same time an annual survey is conducted. A new data run on the proposed methodology should be available soon, and IHCA will get that out to members asap.
QIO Nursing Home Change Package
The March 2015 v.2.0 Change Packages from the National Nursing Home Quality Care Collaborative released the Change Packages in bite-size strategies and with change bundles to help facilities use the resources available. The National Nursing Home Change Package shares and organizes best practices into seven strategies. Now, you can download each bite-sized strategy of the change package, along with supporting action items, to share with your teams to create measurable change in your facilities. Click here for more information.
Learn More About Proposed Changes to the Requirements of Participation and Submitting Comments to CMS
CMS issued a proposed rule change for the SNF/NF Medicare and Medicaid Requirements for Participation on Monday July 13th 2015. The rule is very large in scope and contains both new requirements and some requirements that have already been issued by CMS via Survey & Certification memoranda. The formatted version of the NPRM proposing changes to the SNF Requirements for Participation is available in the Federal Register, with a deadline for comments submission of 5:00 pm on September 14, 2015.
To provide you with a "Cliff's Notes" version, as well as AHCA comments regarding some of the changes, AHCA has developed a summary of all the proposed changes. Click HERE to view the summary. The actual language in the Requirements for Participation CMS is proposing are contained on pages 42246 to page 42269. Although CMS will review comments on all components of the rule, CMS has requested specific "solicitation for comments" from stakeholders for areas that CMS has not made a specific proposal or recommendation about implementation timelines. These requests appear on pages 10-11 of the summary.
Some of the proposed changes/requirements that stand out:
1. Quality Assurance and Performance Improvement (QAPI) programs;
2. Baseline care plan for each resident within 48 hours of admission;
3. Compliance and ethics programs;
4. Discharge planning;
5. Facility assessment which aims to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies; and
6. A more comprehensive Infection Prevention and Control Program including an Infection Prevention and Control Officer.
7. Comments on the use of arbitration agreements.
Given the impact these changes will have on nursing centers, members are encouraged to submit comments themselves to show the importance and concerns raised by CMS. Tips on how to submit comments are below.
Additionally, members are encouraged to send their concerns and any suggested changes to this rule no later than August 6th to Lyn Bentley, so they can be considered for inclusion in AHCA's comments to CMS.
If you send comments directly to Lyn, please copy Zach Cattell at zcattell@ihca.org. You can also submit comments to IHCA to Zach's email as well. IHCA has engaged its Regulatory/Clinical committee and Board of Directors to consider submitting comments in addition to those submitted by AHCA.
Tips to Submit Comments to CMS
* When submitting comments you need to refer to file code CMS-3260-P.
* Organize your comments by major section heading in the proposed rule (see below for list) and then by the outline format used in the rule. For example if you wanted to comment on part of the proposed changes to Resident Rights you would say: "In section Residents Rights (483.10), we have comments about the proposed language in (a) 3. (i.) about "The resident representative has the right to exercise the resident's rights to the extent those rights are delegated to the resident representative."
* Organize each of your comments in into three sections: First site the section of the proposed rule change, followed by your comments/discussion about the rule change, followed by your recommendation or suggested changes to CMS's proposed changes.
* Section of proposed rule (site Federal Registry page number and section headings - see list of section headings below). It is also ok to copy specific language you are commenting on.
* Comments/Discussion
* Recommendations/suggestions
* General comments about the changes in general or that do not contain recommended changes often have little impact on the final rule issued by CMS.
Section Reference of the Proposed Rule
* Resident rights (§483.10)
* Facility responsibilities (§483.11)
* Freedom from abuse, neglect, and exploitation (§483.12)
* Transitions of care (§483.15)
* Resident assessments (§483.20)
* Comprehensive resident-centered care plans (§483.21)
* Quality of care and quality of life (§483.25)
* Physician services (§483.30)
* Nursing services (§483.35)
* Behavioral health services (§483.40)
* Pharmacy services (§483.45)
* Laboratory, radiology, and other diagnostic services (§483.50)
* Dental services (§483.55)
* Food and nutrition services (§483.60)
* Specialized rehabilitative services (§483.65)
* Administration (§483.70)
* Quality assurance and performance improvement (§483.75)
* Infection control (§483.80)
* Compliance and ethics program (§483.85)
* Physical environment (§483.90)
* Training requirements (§483.95)
Where and How to submit your comments:
* When submitting comments you need to refer to file code CMS-3260-P.
* CMS will NOT accept comments by facsimile (FAX) transmission.
* You may submit comments in any one of three ways but only need to use one method (we recommend submitting comments electronically):
1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the ''Submit a comment'' instructions.
2. By regular mail. You must allow sufficient time for mailed comments to be received before the close of the comment period (NOT postmarked). You can mail written comments to the following address:
3. By express or overnight mail. You must allow sufficient time for mailed comments to be received before the close of the comment period (NOT postmarked). You may send written comments to the following address only:
To provide you with a "Cliff's Notes" version, as well as AHCA comments regarding some of the changes, AHCA has developed a summary of all the proposed changes. Click HERE to view the summary. The actual language in the Requirements for Participation CMS is proposing are contained on pages 42246 to page 42269. Although CMS will review comments on all components of the rule, CMS has requested specific "solicitation for comments" from stakeholders for areas that CMS has not made a specific proposal or recommendation about implementation timelines. These requests appear on pages 10-11 of the summary.
Some of the proposed changes/requirements that stand out:
1. Quality Assurance and Performance Improvement (QAPI) programs;
2. Baseline care plan for each resident within 48 hours of admission;
3. Compliance and ethics programs;
4. Discharge planning;
5. Facility assessment which aims to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies; and
6. A more comprehensive Infection Prevention and Control Program including an Infection Prevention and Control Officer.
7. Comments on the use of arbitration agreements.
Given the impact these changes will have on nursing centers, members are encouraged to submit comments themselves to show the importance and concerns raised by CMS. Tips on how to submit comments are below.
Additionally, members are encouraged to send their concerns and any suggested changes to this rule no later than August 6th to Lyn Bentley, so they can be considered for inclusion in AHCA's comments to CMS.
If you send comments directly to Lyn, please copy Zach Cattell at zcattell@ihca.org. You can also submit comments to IHCA to Zach's email as well. IHCA has engaged its Regulatory/Clinical committee and Board of Directors to consider submitting comments in addition to those submitted by AHCA.
Tips to Submit Comments to CMS
* When submitting comments you need to refer to file code CMS-3260-P.
* Organize your comments by major section heading in the proposed rule (see below for list) and then by the outline format used in the rule. For example if you wanted to comment on part of the proposed changes to Resident Rights you would say: "In section Residents Rights (483.10), we have comments about the proposed language in (a) 3. (i.) about "The resident representative has the right to exercise the resident's rights to the extent those rights are delegated to the resident representative."
* Organize each of your comments in into three sections: First site the section of the proposed rule change, followed by your comments/discussion about the rule change, followed by your recommendation or suggested changes to CMS's proposed changes.
* Section of proposed rule (site Federal Registry page number and section headings - see list of section headings below). It is also ok to copy specific language you are commenting on.
* Comments/Discussion
* Recommendations/suggestions
* General comments about the changes in general or that do not contain recommended changes often have little impact on the final rule issued by CMS.
Section Reference of the Proposed Rule
* Resident rights (§483.10)
* Facility responsibilities (§483.11)
* Freedom from abuse, neglect, and exploitation (§483.12)
* Transitions of care (§483.15)
* Resident assessments (§483.20)
* Comprehensive resident-centered care plans (§483.21)
* Quality of care and quality of life (§483.25)
* Physician services (§483.30)
* Nursing services (§483.35)
* Behavioral health services (§483.40)
* Pharmacy services (§483.45)
* Laboratory, radiology, and other diagnostic services (§483.50)
* Dental services (§483.55)
* Food and nutrition services (§483.60)
* Specialized rehabilitative services (§483.65)
* Administration (§483.70)
* Quality assurance and performance improvement (§483.75)
* Infection control (§483.80)
* Compliance and ethics program (§483.85)
* Physical environment (§483.90)
* Training requirements (§483.95)
Where and How to submit your comments:
* When submitting comments you need to refer to file code CMS-3260-P.
* CMS will NOT accept comments by facsimile (FAX) transmission.
* You may submit comments in any one of three ways but only need to use one method (we recommend submitting comments electronically):
1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the ''Submit a comment'' instructions.
2. By regular mail. You must allow sufficient time for mailed comments to be received before the close of the comment period (NOT postmarked). You can mail written comments to the following address:
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-3260-P
P.O. Box 8010
Baltimore, MD 21244.
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-3260-P
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, MD 21244-1850.
CRE Case Reporting in Marion County
Effective July 1, 2015, all nursing facilities in Marion County will be required to immediately report confirmed or suspected cases of Carbapenem-resistant Enterobacteriaceae (CRE) to the Marion County Public Health Department. The new requirement stems from an amendment to The Health and Hospital Corporation of Marion County code that adds CRE as a reportable communicable disease. Section 7-201 requires any physician or other health care provider who has knowledge of, diagnoses or treats a communicable disease case and every manager of an extended care facility in which there is a communicable disease case to report that case or suspected case to the Marion County Public Health Department. Section 7-202 requires CRE be immediately reported. Laboratories are also required to report evidence of a communicable disease. Failure to properly report could be up to a $1,000 fine, upon conviction. Additionally, The Health and Hospital Corporation of Marion County may seek to abate the public health nuisance or violation of this ordinance in any court of competent jurisdiction. The code can be found at https://www.hhcorp.org/hhc/images/HHCcode/codechapter7.pdf.
Nursing facilities are required to report a case or suspected case of CRE. Consulting with clinicians to learn the signs of CRE and other communicable diseases, as defined in the ordinance, is necessary to properly identify cases. The facility should still report known CRE cases even if the laboratory has already reported them to avoid any possibility of penalty. IHCA expects the Indiana State Department of Health to amend its communicable disease rule later this year to require this same reporting statewide.
Nursing facilities are required to report a case or suspected case of CRE. Consulting with clinicians to learn the signs of CRE and other communicable diseases, as defined in the ordinance, is necessary to properly identify cases. The facility should still report known CRE cases even if the laboratory has already reported them to avoid any possibility of penalty. IHCA expects the Indiana State Department of Health to amend its communicable disease rule later this year to require this same reporting statewide.
Residential Care Citation Update
The ISDH issued 5 Offense Tags and 31 Deficiency Tags to Residential Care Facilities in June. Tag 0273, which involves maintenance of food preparation and service areas in accordance with state and local sanitation standards, was cited five times. Tag 0273 has been cited 40 times so far in 2015. Additionally, Tag 0241, which deals with the administration of medications by licensed nurses or QMAs, was cited 4 times in June, raising the total number of times this citation has been issued in 2015 to 17.
Four citations were issued for Tag 0144 which involves building and grounds maintenance. Tag 0144 has been cited in five of the past six months, with June receiving the highest number of this particular citation since October 2013. One citation for Tag 0217 was issued in June, for a total of 15 citations in 2015. Tag 0217 concerns resident evaluation and services plan.
A citation was issued for Tag 0191 which deals with inadequate kitchen in complying with 410 IAC 7-24 (Sanitary Standards for the Operation of Retail Food Establishments). Tag 0191 has not been cited before.
To review a summary of the June citations, click here.
IJ/SSQC Citation Update
Following IJ citation issued in May, no IJs were cited in June. There was one SSQC citation cited for the month of June. The event involved failing to properly report and implement abuse policy for several allegations. The administrator was not in the building at the time of the incident. The DON was present and followed all proper steps to report the incident but failed to fully report it by sending it to the ISDH. It is important to know who is responsible for filing reports in case the administrator or second in command is not currently there.
Another situation occurred where the administrator filed the abuse allegation, yet failed to alert law enforcement until several days later. There was also a report made by a surveyor who allegedly witnessed an RN become verbally aggressive with a patient when attempting to administer medication. To review a summary of the 2015 IJ/SSQCs and the June 2567, click here.
Another situation occurred where the administrator filed the abuse allegation, yet failed to alert law enforcement until several days later. There was also a report made by a surveyor who allegedly witnessed an RN become verbally aggressive with a patient when attempting to administer medication. To review a summary of the 2015 IJ/SSQCs and the June 2567, click here.
Monday, July 6, 2015
Healthy Indiana 2.0: “HIP Link” Information for Employers
Following Governor Pence's approval of HIP 2.0 earlier this year, the program has grown to include more than 293,000 Hoosiers. There are still hundreds of thousands more Hoosiers out there that can benefit from HIP 2.0. The Healthy Indiana Plan (HIP) is a program for low income Hoosiers and was modeled after consumer-driven healthcare. HIP offers members a High Deductible Health Plan (HDHP) with a Personal Wellness and Responsibility (POWER) account to which members contribute. Indiana replaced traditional Medicaid and expanded HIP to all non-disabled Hoosier age 19-64 with household incomes at or below approximately 138% of the federal poverty level. Hoosiers with incomes of up to $16,436.80 annually for an individual, $22,246.25 for a couple are generally eligible to participate in HIP. HIP 2.0 includes HIP Link, a new premium assistance program for eligible individuals with access to employer-sponsored insurance.
What is HIP Link?
HIP Info For Employers
For more information regarding Eligibility, Key Concepts and FAQs, please click here.
To download the new kit and begin using its materials immediately, please click here.
What is HIP Link?
- A new State program that is part of Indiana’s nationally recognized Health Indiana Plan model. The Health Indiana Plan or “HIP” was expanded to provide health coverage to eligible Hoosiers with household incomes at or below approximately 138% of the federal poverty level.
- HIP Link offer premium assistance for HIP participants age 21 and older who choose to participate in their employers’ sponsored health plans. Employees must meet HIP eligibility requirements.
- Spouses and/or eligible adults may also receive coverage if HIP-eligible.
- Employers that employ Indiana residents who are HIP eligible, agree to contribute at least 50% to the premium cost and offer plans that meet minimum benefits and cost requirements within the program’s limit.
- More employees may be able to take advantage of commercial health insurance benefits.
o An increase in employees may help to meet industry and marketplace participation rates or lower group premium rates. - Employees can better manage healthcare costs with their HIP Link POWER Account and Health Reimbursement Account (HRA), if offered by employer.
- Potential to expand employee base and increase retention by being listed as an approved HIP Link Employer.
- Possible tax benefits for small employers using the Health Insurance Marketplace.
- HIP Link does not disrupt current employer-sponsored health insurance and can be incorporated at any time.
HIP Info For Employers
For more information regarding Eligibility, Key Concepts and FAQs, please click here.
To download the new kit and begin using its materials immediately, please click here.
Indiana Division of Aging Announces Dates for Long Term Services and Supports Public Forums
In 2014 the Indiana General Assembly passed House Enrolled Act (HEA) 1391 that charges the Office of the Secretary of the Family and Social Services Administration, in conjunction with the State Department of Health, and the Office of Management and Budget, with providing a written report to the general assembly before October 1, 2015, addressing a variety of issues concerning delivery of long term services and supports in Indiana (click here to read the list of items to be addressed). The report was split into two parts, the first part of which has already been delivered to the general assembly and addressed nursing facility occupancy and the extent to which low occupancy is damaging to the state Medicaid program and quality of care. The second part of the report, due this October 1st, is being developed now and a series of public hearings have been set to gather input from the public.
The Indiana Division of Aging has set up a website for the work on the 1391 Report, and that site includes past reports and versions of the current draft due October 1st. An update draft is being released later this week and will be the foundation for the below scheduled public hearings. We encourage you to participate.
Indianapolis
July 22, 2015, 1:00-3:00
Crossroads Center, 4756 Kingsway Drive (Across from CICOA)
Batesville
July 31, 2015, 2:00-4:00
Public Library
131 N. Walnut Street 47006
Vincennes
August 4, 2015, 1:00-3:00
Vincennes University, ICAT Building, Room 142
Valpariso
August 5, 2015, 1:00-3:00 CT
Pines Village Auditorium, Valparaiso
Fort Wayne
August 19, 2015, 1:00-3:00
Public Library, 900 Lirbary Plaza, 46802
New Albany
August 21, 2015, 1:00-3:00
Public Library, 180 W. Spring Street, 47150
The Indiana Division of Aging has set up a website for the work on the 1391 Report, and that site includes past reports and versions of the current draft due October 1st. An update draft is being released later this week and will be the foundation for the below scheduled public hearings. We encourage you to participate.
Indianapolis
July 22, 2015, 1:00-3:00
Crossroads Center, 4756 Kingsway Drive (Across from CICOA)
Batesville
July 31, 2015, 2:00-4:00
Public Library
131 N. Walnut Street 47006
Vincennes
August 4, 2015, 1:00-3:00
Vincennes University, ICAT Building, Room 142
Valpariso
August 5, 2015, 1:00-3:00 CT
Pines Village Auditorium, Valparaiso
Fort Wayne
August 19, 2015, 1:00-3:00
Public Library, 900 Lirbary Plaza, 46802
New Albany
August 21, 2015, 1:00-3:00
Public Library, 180 W. Spring Street, 47150
CMS Issues Additional Guidance on Home and Community Based Service Setting Requirements
As you are aware CMS issued a new regulation more than a year ago that will change the landscape of home and community based services funded through Medicaid. IHCA has reported on this in the past (click here). Part of these changes include ensuring that recipients of home and community based services are in settings that are not “institutions” or have qualities of institutionalization. Certain settings are presumed to have qualities of institutions, and while those settings are not permanently excluded from participating in HCBS Medicaid programs, they will have to meet a “heightened scrutiny” process. CMS’s new guidance speaks directly to that heightened scrutiny process (click here to review).
IHCA is continually engaging the Indiana Medicaid program and Division of Aging on how it will change Indiana’s HCBS waivers to comply, and how those changes will impact Indiana providers.
IHCA is continually engaging the Indiana Medicaid program and Division of Aging on how it will change Indiana’s HCBS waivers to comply, and how those changes will impact Indiana providers.
AHCA Submits Comments to CMS on the 2016 SNF PPS Rule
Click here to view the comments submitted by AHCA to CMS on the 2016 SNF PPS Rule. The comments cover a wide range of issues included int his year’s rule including the Market Basket adjustment, Wage Index, SNF Value Based Purchasing Program, Health Information Exchanges, SNF Quality Reporting Program, and Staff Reporting Requirements.
CMS Issues Medicare Shared Savings Program Rule
CMS issued a final rule to update the Medicare Shared Savings Program (MSSP), which governs the activities of more than 400 ACOs across the country. This rule represents the first significant update to the Medicare ACO program since the first rules were finalized in November of 2011. The 592-page rule makes numerous modifications to the ACO program, including:
• Creates a new "Track 3" for MSSP ACOs that looks very similar to the Pioneer ACO program model, including higher rates of shared savings, prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
• Streamlines data sharing between CMS and ACOs, which will allow ACOs to more easily access data on their patients;
• Establishes a waiver of the SNF 3-day stay requirement for those ACOs who opt into Track 3; and
• Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings.
• Creates a new "Track 3" for MSSP ACOs that looks very similar to the Pioneer ACO program model, including higher rates of shared savings, prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
• Streamlines data sharing between CMS and ACOs, which will allow ACOs to more easily access data on their patients;
• Establishes a waiver of the SNF 3-day stay requirement for those ACOs who opt into Track 3; and
• Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings.
ISDH Requires Census Reporting as of July 1, 2015
ISDH sent out a newsletter on June 29, 2015 indicating that it intends to require nursing facilities to report their actual facility census as of July 1, 2015 through the ISDH Gateway no later than July 15, 2015. The data is needed as of each January 1 and July 1 to determine county and statewide occupancy in order to implement a portion of the nursing facility moratorium legislation. This announcement is a surprise in terms of timing, but not in terms of substance. Since the passage of the nursing facility moratorium legislation IHCA knew that the ISDH was going to require mandatory reporting of census, was under the impression it would not begin this until January 1, 2016 since the law is not even effective on July 1, 2015 (but becomes effective on July 2, 2015). The ISDH is also, apparently, requiring this data for residential care facilities as well. It is unknown right now what penalty/citation, if any, would follow if a facility did not report this data.
ISDH Proposing Changes to the Report Card Score
IHCA was recently informed that the ISDH wants to change the way Report Card Scores (RCS) are calculated. In short, the ISDH use a higher score to indicate better regulatory compliance (today, the lower score equals better compliance). The scoring would start all facilities would with 300 points then points would be deducted based on each tag received during any survey. The ISDH wants to score to reflect all tags and from all surveys over the past 30 month period, excluding life safety code tags and substantial compliance tags (A, B and C). No extra points would be deducted for IJs or SSQC tags. Click here for a description from the ISDH.
IHCA has obtained a facility by facility breakdown of the current scores and the proposed scores (click here to access that report). This breakdown is very preliminary and IHCA is examining the data sources for this report. We are concerned with a few items within this concept, and have found a few examples that validate those concerns. First, in some cases tags get cited twice during a complaint investigation that is done during an annual survey. Said another way, two 2567s are generated, one for the complaint and one for the annual survey, and the same tags cited in the complaint get cited in the annual. This improperly penalizes the facility, especially if all tags will be used in a new report card score methodology. Next, we are concerned with the point allocation proposed by the ISDH, D-E-F citations get 3 points, then the scale jumps to 20 points for any G-H-I citations. We think this is confusion and we want the ISDH to look at both scope and severity when allocating points, like in the current system. There are a couple of other issues and questions within ISDH’s process that we are examining, such as frequency of scores being updated and how to account for geographic variation in surveys. That said, we are encouraged by the new system’s design that only looks back at the most current 30 months of surveys, thereby allowing facilities to improve in their scores without having to wait for the next annual survey to be completed, as in the current system.
As you may be aware, the ISDH RCS is used by Indiana Medicaid to determine a large portion of the Value Based Purchasing Add-on within the Medicaid rate. There have not been any discussions as of yet on how this newly proposed RCS would or would not be used in the add-on. IHCA is meeting with Indiana Medicaid representatives on an ongoing basis regarding the Medicaid rate setting methodology and will be discussing this issue very soon with Indiana Medicaid. In addition, IHCA’s Payment/Reimbursement Committee will discuss this at its next meeting on June 17th.
IHCA has obtained a facility by facility breakdown of the current scores and the proposed scores (click here to access that report). This breakdown is very preliminary and IHCA is examining the data sources for this report. We are concerned with a few items within this concept, and have found a few examples that validate those concerns. First, in some cases tags get cited twice during a complaint investigation that is done during an annual survey. Said another way, two 2567s are generated, one for the complaint and one for the annual survey, and the same tags cited in the complaint get cited in the annual. This improperly penalizes the facility, especially if all tags will be used in a new report card score methodology. Next, we are concerned with the point allocation proposed by the ISDH, D-E-F citations get 3 points, then the scale jumps to 20 points for any G-H-I citations. We think this is confusion and we want the ISDH to look at both scope and severity when allocating points, like in the current system. There are a couple of other issues and questions within ISDH’s process that we are examining, such as frequency of scores being updated and how to account for geographic variation in surveys. That said, we are encouraged by the new system’s design that only looks back at the most current 30 months of surveys, thereby allowing facilities to improve in their scores without having to wait for the next annual survey to be completed, as in the current system.
As you may be aware, the ISDH RCS is used by Indiana Medicaid to determine a large portion of the Value Based Purchasing Add-on within the Medicaid rate. There have not been any discussions as of yet on how this newly proposed RCS would or would not be used in the add-on. IHCA is meeting with Indiana Medicaid representatives on an ongoing basis regarding the Medicaid rate setting methodology and will be discussing this issue very soon with Indiana Medicaid. In addition, IHCA’s Payment/Reimbursement Committee will discuss this at its next meeting on June 17th.
ISDH Revising the Incident Reporting Policy
IHCA sent out a member alert in June concerning the ISDH’s draft revisions to the Incident Reporting Policy. With the great work from the IHCA Regulatory/Clinical Committee, IHCA joined with LeadingAge and HOPE to submit comments to the ISDH’s original draft (click here to view those comments). IHCA has met with the ISDH since submission of those comments and we are pleased to report that the latest draft of the policy incorporated nearly all of the suggestions we made (click here to see revisions). Subsequently, IHCA submitted a second set of comments on the revised draft (click here for the second set of comments). The revised draft is not the final version of the policy and is included here for your information only.
ISDH continues to work on finalizing the policy. IHCA understands that the ISDH is working towards a release date for a final policy on or around July 15, 2015 with a 30-day implementation window for an effective date of August 15, 2015. Stay tuned for more!
ISDH continues to work on finalizing the policy. IHCA understands that the ISDH is working towards a release date for a final policy on or around July 15, 2015 with a 30-day implementation window for an effective date of August 15, 2015. Stay tuned for more!
Mandated Use of ISDH Gateway for Incident Reporting Effective July 1, 2015
As previously reported, and announced again by the ISDH on June 30, 2015, incident reporting to the ISDH is required to go through the ISDH Gateway System. This is the same system used for survey reports. The linked ISDH newsletter link you to a instructions on how to use the system and well as FAQs.
The ISDH newsletter includes instructions for reporting that will be part of a new Incident Reporting Policy that is still being revised and is likely to be released later in July. Even though the revised policy is not final and released, the instructions in the ISDH newsletter are valid and to be followed.
The ISDH newsletter includes instructions for reporting that will be part of a new Incident Reporting Policy that is still being revised and is likely to be released later in July. Even though the revised policy is not final and released, the instructions in the ISDH newsletter are valid and to be followed.
Residential Care Citation Update
The ISDH issued 37 tags at the Deficiency level and 3 tags at the Offense level to Residential Care Facilities in May. No new trends emerged in May, but the normal patterns seen for a past few years continue with citation for Tag 0273 (Food prep and service areas), Tag 0241 (Medication administration by licensed nursing or QMA), Tag 0217 (Qualified staff conducting service planning and resident/representative signing and dating the plan), and Tag 0217 (Sufficient staff to provide for 24 hour needs of residents).
To review a summary of the May citations, click here.
To review a summary of the May citations, click here.
IJ/SSQC Citation Update
There was one IJ citation issued by the ISHD in May. F 155 was issued for failure to ensure a resident’s right in self-determination regarding implementation of the formulated advance directive and staff failed to initiate CPR as indicated. This is the third time F 155 has been cited as the IJ level in 2015, and the fifth time in the last 7 months that a citation has been issued at the IJ level for failures surrounding advance directives and administration of CPR. In the May event, the resident was found lying on the floor and had clearly passed on. The resident was totally purple in the upper body and was still slightly warm to the touch. No pulse, blood pressure or respirations were noted. However, the resident was full code. The RN in charge at the time indicated that the chart was not checked for code status as she felt there was no effort that could bring the resident back. Even if the resident was not full code, which she was, the facility has a policy that requires resuscitation efforts, via an AED, unless a valid Advance Directive or DNR order states not to. This citation was past-noncompliance and the IJ was lifted after a complete audit for code status was performed, all staff were inserviced on code response, two mock drills were performed, staff involved in resuscitative efforts were CPR certified, and education and disciplinary action were taken with the RN.
To review a summary of the 2015 IJ/SSQCs and the May 2567, click here.
To review a summary of the 2015 IJ/SSQCs and the May 2567, click here.
Wednesday, June 10, 2015
Indiana Health Care Association Names Zach Cattell as New President
The Indiana Health Care Association (IHCA) has named Zach Cattell as its new president, effective June 13, 2015. Cattell joined IHCA in September 2010 as the association’s general counsel and director of regulatory affairs and reimbursement services. In that role, he advised the IHCA Board of Directors on issues confronting the long term care profession and represented the association and its members in matters before the Indiana General Assembly, the Indiana State Department of Health, FSSA, IPLA, and other Indiana state agencies.
Zach replaces outgoing president Scott Tittle who was recently chosen to lead the National Center for Assisted Living (NCAL) in Washington, D.C. During Tittle’s five-year tenure at IHCA, the association achieved greater financial stability, increased offerings to members, and affected positive legislation and regulatory matters for the long term care profession in Indiana.
“IHCA will continue to thrive under Zach’s leadership well into the future,” said Tittle. “He has been an invaluable member of the IHCA team and brings a wealth of organizational knowledge as well as exceptional regulatory and reimbursement experience to the position.”
Previously, Cattell practiced law at Indianapolis-based firms Faegre Baker Daniels and Krieg DeVault. He also has deep government affairs experience having served as Director of Government Relations for the Indiana State Medical Association, the Indiana Academy of Family Physicians, and the Indiana State Department of Health. He obtained his Juris Doctor at the Indiana University Robert H. McKinney School of Law and his Bachelors of Arts in Political Science at West Chester University of Pennsylvania.
“I am grateful to have this opportunity to serve as president of the Indiana Health Care Association,” said Cattell. “The long term care profession is deeply rewarding and challenging. The profession’s staff throughout Indiana, and across the nation, care for our most frail in their greatest time of need. I look forward to continuing to advocate on behalf of the long term care profession across the state so they have the tools and resources necessary to provide quality care.”
The Indiana Health Care Association is the state’s largest trade association and advocacy group representing for-profit and not-for-profit nursing homes, as well as assisted living communities, adult foster care and adult day services. The IHCA provides education, information, and advocacy for health care providers, consumers, and the workforce on behalf of its members.
“Over the last several years, IHCA has restored itself as an effective advocate and resource for our members, thanks in large part to the dedicated and hard-working IHCA staff,” said Doug Shuck, Chairman of the IHCA Board of Directors. “Zach has been there every step of the way, and we are confident he is the right person to lead this association through all the challenges and opportunities that lie ahead for our industry.”
For additional information, contact Kate Vaulter, Director of Public Affairs, at kvaulter@ihca.org or at 317-616-9002.
Zach replaces outgoing president Scott Tittle who was recently chosen to lead the National Center for Assisted Living (NCAL) in Washington, D.C. During Tittle’s five-year tenure at IHCA, the association achieved greater financial stability, increased offerings to members, and affected positive legislation and regulatory matters for the long term care profession in Indiana.
“IHCA will continue to thrive under Zach’s leadership well into the future,” said Tittle. “He has been an invaluable member of the IHCA team and brings a wealth of organizational knowledge as well as exceptional regulatory and reimbursement experience to the position.”
Previously, Cattell practiced law at Indianapolis-based firms Faegre Baker Daniels and Krieg DeVault. He also has deep government affairs experience having served as Director of Government Relations for the Indiana State Medical Association, the Indiana Academy of Family Physicians, and the Indiana State Department of Health. He obtained his Juris Doctor at the Indiana University Robert H. McKinney School of Law and his Bachelors of Arts in Political Science at West Chester University of Pennsylvania.
“I am grateful to have this opportunity to serve as president of the Indiana Health Care Association,” said Cattell. “The long term care profession is deeply rewarding and challenging. The profession’s staff throughout Indiana, and across the nation, care for our most frail in their greatest time of need. I look forward to continuing to advocate on behalf of the long term care profession across the state so they have the tools and resources necessary to provide quality care.”
The Indiana Health Care Association is the state’s largest trade association and advocacy group representing for-profit and not-for-profit nursing homes, as well as assisted living communities, adult foster care and adult day services. The IHCA provides education, information, and advocacy for health care providers, consumers, and the workforce on behalf of its members.
“Over the last several years, IHCA has restored itself as an effective advocate and resource for our members, thanks in large part to the dedicated and hard-working IHCA staff,” said Doug Shuck, Chairman of the IHCA Board of Directors. “Zach has been there every step of the way, and we are confident he is the right person to lead this association through all the challenges and opportunities that lie ahead for our industry.”
For additional information, contact Kate Vaulter, Director of Public Affairs, at kvaulter@ihca.org or at 317-616-9002.
Wednesday, June 3, 2015
MDS Case Mix Audit Changes – July 1, 2015
Beginning July 1, 2015, Myers and Stauffer will be assuming the Minimum Data Set (MDS) Case Mix Audit (Review) responsibilities. There are no current plans to make any modifications to the process in order to assure a smooth transition. Myers & Stauffer will host four teleconferences as outlined below:
June 23, 2015 June 25, 2015
9:00 AM and 2:00 PM 9:00 AM and 2:00 PM
No registration is required. All four teleconferences include the same discussion information.
The teleconference number is: 888-506-9354
The teleconference code is: 9507667#
In preparation for RUG-IV transition, Myers and Stauffer will be providing seminars during the month of September. Assessments with an ARD of 1/1/2016 and after will be subject to a RUG-IV case mix review for rates effective July 1, 2016. New supporting documentation guidelines will be presented. More information for this RUG-IV 48 group seminar will be posted to your web portal and Indiana.mslc.com for registration when the details become available.
Patty Padula is the contact at Myers & Stauffer that is heading up the transition. She can be reached at 317-815-2962.
June 23, 2015 June 25, 2015
9:00 AM and 2:00 PM 9:00 AM and 2:00 PM
No registration is required. All four teleconferences include the same discussion information.
The teleconference number is: 888-506-9354
The teleconference code is: 9507667#
In preparation for RUG-IV transition, Myers and Stauffer will be providing seminars during the month of September. Assessments with an ARD of 1/1/2016 and after will be subject to a RUG-IV case mix review for rates effective July 1, 2016. New supporting documentation guidelines will be presented. More information for this RUG-IV 48 group seminar will be posted to your web portal and Indiana.mslc.com for registration when the details become available.
Patty Padula is the contact at Myers & Stauffer that is heading up the transition. She can be reached at 317-815-2962.
Monday, June 1, 2015
CMS Issues Memorandum Regarding Survey Process
The Centers for Medicare and Medicaid Services (CMS) and the States have used two standard survey processes that assess the quality of care and quality of life for nursing home residents. CMS issued S&C 15-40-NH on May 22nd to discuss the survey processes and improvements made and planned. CMS expects to continue to make improvements so that the States currently participating in the Quality Indicator Survey (QIS) process have the support necessary to conduct surveys as effectively as possible and to realize the benefits of the QIS process. At the same time, CMS continues to evaluate both the traditional and the QIS processes to identify, in both quantitative and qualitative terms, the strengths and limitations of each system. These efforts involve considerable data analysis from survey results, user feedback from CMS Regional Offices and State Survey Agencies, technical expert panels, reviews of CMS Form 2567 statements of deficiencies, and observational reviews of the survey processes. The purpose of this Memorandum is simply to provide an overview of the current status of our reviews.
The attached S&C Memo also provides a high-level summary of the work done to examine nursing home survey methodologies for efficiency and effectiveness, as well as the actions that were taken to improve the processes, with particular emphasis on the QIS process. This program brief is focused on the standard recertification survey.
The attached S&C Memo also provides a high-level summary of the work done to examine nursing home survey methodologies for efficiency and effectiveness, as well as the actions that were taken to improve the processes, with particular emphasis on the QIS process. This program brief is focused on the standard recertification survey.
New Indiana Law Concerning Service of Alcohol in Senior Residence Facilities
As you may be aware, the Indiana General Assembly passed House Bill 1542 this year, which was signed into law by Governor Pence on May 5, 2015. HB 1542 included a provision that exempts senior residence facilities from obtaining an alcohol permit from the Indiana Alcohol Tobacco Commission (ATC) when serving residents and their guests on the campus of the senior residence facility. The IHCA issued guidance in 2014 concerning the need to obtain a permit from the ATC in order to serve alcohol to residents of nursing facilities, residential care facilities, or other senior residence facilities. With the change in the law, IHCA has issued additional guidance for your review.
CMS Releases Proposed Rule Addressing Medicaid Managed Care
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule addressing managed care regulations; this is the first update to the regulations governing Medicaid managed care organizations (MCOs) since 2002. The impact of this regulation is significant given the size and scope of Medicaid managed care programs nationwide. According to CMS, 39 states have contracts with comprehensive managed care organizations, and 20 states have implemented managed care programs that incorporate long term services and supports. To review an AHCA overview of first impressions of the rule, click here for the AHCA PowerPoint on the proposed rule.
Agency officials have indicated that the proposed rule includes additional guidelines for states on how to set rates for MCOs, strengthened network adequacy standards, and further alignment of Medicaid managed care regulations "with existing commercial, Marketplace, and Medicare Advantage regulations." In addition, the proposed rule addresses requirements concerning delivery of Medicaid managed long term services and supports (MLTSS), which has not been included in previous version of the regulation. Highlights of the proposed rule include:
Managed Long-term Services and Supports (MLTSS) Programs
The proposed regulation would implement best practices identified in existing MLTSS programs and create requirements specifically tailored for MLTSS populations. For example, CMS proposes that states establish time and distance standards specifically for MLTSS programs as part of the Agency's efforts to strengthen network adequacy requirements.
Beneficiary Experience
The proposed regulation includes provisions that would improve the beneficiary's experience in enrollment, communications from the state and managed care plans, care coordination, and the availability and accessibility of covered services.
State Delivery System Reform
The proposed regulation supports states' efforts to encourage delivery system reform initiatives within managed care programs that strive to improve health care outcomes and beneficiary experience while controlling costs.
Quality Improvement
The proposed regulation sets forth a quality framework focused on transparency, alignment with other systems of care, and consumer and stakeholder engagement. The proposed rule would require a quality strategy for a state's entire Medicaid program and also establish a Medicaid managed care quality rating system that would include performance information on all health plans and align with the existing rating systems in Medicare Advantage and the Marketplace.
Program and Fiscal Integrity
The proposed regulation includes provisions that would strengthen the fiscal and programmatic integrity of Medicaid managed care programs and rate setting by clarifying actuarial soundness requirements.
Alignment with Medicare Advantage and Private Coverage Plans
By aligning standards, where appropriate, the proposed rule would improve operational efficiencies for states and health plans, which in turn will improve the experience of care for individuals who transition between health care coverage options.
CHIP
The proposed rule would align the CHIP managed care regulations, where appropriate, with the proposed revisions to the Medicaid managed care rules in order to ensure CHIP beneficiaries the same quality and access in managed care programs.
Agency officials have indicated that the proposed rule includes additional guidelines for states on how to set rates for MCOs, strengthened network adequacy standards, and further alignment of Medicaid managed care regulations "with existing commercial, Marketplace, and Medicare Advantage regulations." In addition, the proposed rule addresses requirements concerning delivery of Medicaid managed long term services and supports (MLTSS), which has not been included in previous version of the regulation. Highlights of the proposed rule include:
Managed Long-term Services and Supports (MLTSS) Programs
The proposed regulation would implement best practices identified in existing MLTSS programs and create requirements specifically tailored for MLTSS populations. For example, CMS proposes that states establish time and distance standards specifically for MLTSS programs as part of the Agency's efforts to strengthen network adequacy requirements.
Beneficiary Experience
The proposed regulation includes provisions that would improve the beneficiary's experience in enrollment, communications from the state and managed care plans, care coordination, and the availability and accessibility of covered services.
State Delivery System Reform
The proposed regulation supports states' efforts to encourage delivery system reform initiatives within managed care programs that strive to improve health care outcomes and beneficiary experience while controlling costs.
Quality Improvement
The proposed regulation sets forth a quality framework focused on transparency, alignment with other systems of care, and consumer and stakeholder engagement. The proposed rule would require a quality strategy for a state's entire Medicaid program and also establish a Medicaid managed care quality rating system that would include performance information on all health plans and align with the existing rating systems in Medicare Advantage and the Marketplace.
Program and Fiscal Integrity
The proposed regulation includes provisions that would strengthen the fiscal and programmatic integrity of Medicaid managed care programs and rate setting by clarifying actuarial soundness requirements.
Alignment with Medicare Advantage and Private Coverage Plans
By aligning standards, where appropriate, the proposed rule would improve operational efficiencies for states and health plans, which in turn will improve the experience of care for individuals who transition between health care coverage options.
CHIP
The proposed rule would align the CHIP managed care regulations, where appropriate, with the proposed revisions to the Medicaid managed care rules in order to ensure CHIP beneficiaries the same quality and access in managed care programs.
Indiana Medicaid Appeals Reduction Process Restarting
Indiana Medicaid is restarting the appeals reduction process that was originally started back in 2012 in an effort to clear the slate on old, sometimes decades old, rate and audit appeals. Indiana Medicaid is sending out this memo to facilities that are licensed to the these entities. OMPP is focusing on all of the chain providers that have outstanding rate and audit appeals for rate effective dates prior to Oct. 1, 2011 (for rate appeals( and July 1, 2011 (for audit appeals). The memo is addressed to Nursing Facility Owners, but you may want to read that as Nursing Facility Licensee. At the end of the day, this memo and the appeal documentation will be sent to the licensee, in many cases a county hospital.
Since appeal within chain organizations are often times consolidated into one cause number covering multiple facilities, different county hospitals will receive withdrawal paperwork for the same cause number. It is important to remember that the appeal will not be withdrawn until all licensees have signed off on the withdrawal. In addition, OMPP wants to hear back from each licensee within 30 days of receiving the withdrawal paperwork that the licensee is interested in pursuing a withdraw. This notice is just that, notice of a desire to move forward and is not acceptance of the withdrawal (but it can be if the licensee desires to move that fast).
Since appeal within chain organizations are often times consolidated into one cause number covering multiple facilities, different county hospitals will receive withdrawal paperwork for the same cause number. It is important to remember that the appeal will not be withdrawn until all licensees have signed off on the withdrawal. In addition, OMPP wants to hear back from each licensee within 30 days of receiving the withdrawal paperwork that the licensee is interested in pursuing a withdraw. This notice is just that, notice of a desire to move forward and is not acceptance of the withdrawal (but it can be if the licensee desires to move that fast).
Clinical Expert Panel – Meetings Continue
On a parallel track with the LTC Planning Process, the Division of Aging and Indiana Medicaid are meeting with the re-assembled Clinical Expert Panel to discuss and recommend changes to Indiana Medicaid Nursing Facility Value Based Purchasing methodology. So far the meetings have centered around the satisfaction survey process that has been conducted for the past two summers and is entering the third summer. IHCA expects the panel to take up issues concerning inclusion of QM performance and other clinical measures as part of its evaluation process.
Indiana Medicaid LTC Planning Process
Meetings with officials from Indiana Medicaid continue on a monthly basis to develop some framework for a rebalancing of the long term care services and supports system in Indiana. Of the four workgroups created for this effort, two of them have met several times and two of them are yet to meet. The AL Workgroup and Reimbursement Workgroup have each met twice, with third meetings each coming up in the next several weeks. IHCA is posting all materials and notes from these minutes to our Members Only website, so please check in there for additional detail. Of most interest, read the meeting notes from each of the workgroup meetings. There are not a lot of specifics to report on just yet as most meetings are brainstorming sessions, but we expect that to change as the meetings progress.
CMS Issues Guidance to LTC Facilities Concerning Medicare Advantage Disenrollment
CMS released a memorandum concerning beneficiary disenrollment from Medicare Advantage (MA) plans and alleges that LTC facilities are inappropriately encouraging Medicare beneficiaries to dis-enroll from MA plans and dual demonstrations. Click here for AHCA’s summary of the CMS memorandum.
CMS stresses that any change in a beneficiary’s health care coverage must be initiated by the beneficiary or his/her representative. If the facility is asked to assist in changing the beneficiary’s health coverage, the facility must take specific steps to ensure compliance with regulations concerning enrollment/disenrollment and resident rights. Facilities must:
1. Explain both orally and in writing the impact to the beneficiaries if they change to a stand-alone drug plan and Original Medicare. Additional information on what to include can be found on CMS’s site, click here.
2. Develop written policies and procedures regarding the process of assisting beneficiaries with changing their health care coverage. Additional information on what to include can be found on CMS’s site, click here.
AHCA is reviewing the CMS memo and has reached out to CMS to initiate a dialogue on this subject.
CMS stresses that any change in a beneficiary’s health care coverage must be initiated by the beneficiary or his/her representative. If the facility is asked to assist in changing the beneficiary’s health coverage, the facility must take specific steps to ensure compliance with regulations concerning enrollment/disenrollment and resident rights. Facilities must:
1. Explain both orally and in writing the impact to the beneficiaries if they change to a stand-alone drug plan and Original Medicare. Additional information on what to include can be found on CMS’s site, click here.
2. Develop written policies and procedures regarding the process of assisting beneficiaries with changing their health care coverage. Additional information on what to include can be found on CMS’s site, click here.
AHCA is reviewing the CMS memo and has reached out to CMS to initiate a dialogue on this subject.
Future Changes to Pre-Admission Screening and Pre-Admissions Screening Resident Review
• Indiana PAS Update
Last year IHCA formed a PAS Task Force at the request of the Division of Aging (DA) in order to help the DA with ideas to reform the PAS process. With the passage of Senate Bill 465 in the 2015 Legislative Session we are on our way to reforming the PAS process as we know it today. That law requires that the current PAS statute expire next July 1, 2016. The DA intends to put in place of PAS an options counseling process for a portion of the population that may be admitted to a nursing facility. The law requires the DA to issue a report to the legislature by November 1st that addresses the replacement of PAS with options counseling and any necessary changes to PASRR.
• PASRR Technical Assistance Session
The DA is first focusing on reforming the PASRR process, looking to an electronic solution that is much faster than the current process Indiana has today. The DA has engaged the PASRR Technical Assistance Center (PTAC, http://www.pasrrassist.org/http://www.pasrrassist.org/) for help with this process. PTAC has scheduled provider/industry-focused moderated sessions for June 4th. The objective of that session is to get down to the specifics of each provider/industry groups issues with the current process and how the DA’s path forward can solve those issues. Members of the IHCA PAS Task Force will be attending the session on June 4th and we will report back to the IHCA membership.
Last year IHCA formed a PAS Task Force at the request of the Division of Aging (DA) in order to help the DA with ideas to reform the PAS process. With the passage of Senate Bill 465 in the 2015 Legislative Session we are on our way to reforming the PAS process as we know it today. That law requires that the current PAS statute expire next July 1, 2016. The DA intends to put in place of PAS an options counseling process for a portion of the population that may be admitted to a nursing facility. The law requires the DA to issue a report to the legislature by November 1st that addresses the replacement of PAS with options counseling and any necessary changes to PASRR.
• PASRR Technical Assistance Session
The DA is first focusing on reforming the PASRR process, looking to an electronic solution that is much faster than the current process Indiana has today. The DA has engaged the PASRR Technical Assistance Center (PTAC, http://www.pasrrassist.org/http://www.pasrrassist.org/) for help with this process. PTAC has scheduled provider/industry-focused moderated sessions for June 4th. The objective of that session is to get down to the specifics of each provider/industry groups issues with the current process and how the DA’s path forward can solve those issues. Members of the IHCA PAS Task Force will be attending the session on June 4th and we will report back to the IHCA membership.
Focused MDS Surveys
Mum’s the word when it comes to what is expected for the coming MDS Focused Surveys, which were announced in April 2014. MDS coding practice and care planning are set to be the focus of those surveys, but not much information has been released about the surveys since last April. A few weeks ago, however, the ISDH was authorized to share with the IHCA this Focused Survey Facility Worksheet that will be given to facilities upon survey entrance. The facility undergoing a MDS focused survey will not fill out a CMS 672 we are told, but will fill this form out instead. As more information becomes available, we will be sure to report it to our IHCA membership.
ISDH Incident Reporting – Changes Ahead
The ISDH will be unveiling changes to both the way and under what circumstances Incident Reports are to be made. As reported earlier in the year, and via the ISDH Long Term Care Newsletter from May 1, 2015, the ISDH is making the online Incident Reporting System mandatory as of July 1, 2015. The online system has been available and optional since May of 2014 and many improvements have been made over that year. IHCA encourages you to read the above linked ISDH newsletter for detail regarding the online system.
In addition, the ISDH Incident Reporting Policy (formerly the Unusual Occurrences Policy) is undergoing major revision (click here for a DRAFT, which is not to be taken or used as the final version). IHCA received this draft on May 22nd and has distributed it to the IHCA Regulatory/Clinical committee for comment, which were due to the ISDH on May 29th. The draft revisions, which will be made final in June, signal a significant increase in reporting for nursing facilities and residential care facilities. The revisions address many questions and uncertainties from the past policies, in terms of what is and what isn’t reportable, and err on the side of reporting more than reporting less. Many facilities in the past few years have erred toward reporting “everything” rather than get caught for not reporting an issue that didn’t appear to be reportable at the time, but after complaint was found to be a reportable that was not made. The draft revisions include information for residential care facilities as well, for the first time in one document. In addition, the draft signals not only mandatory use of the online Incident Reporting System, but sole use of the online system except for cases of evacuation or events involving the Emergency Management Agency.
In addition, the ISDH Incident Reporting Policy (formerly the Unusual Occurrences Policy) is undergoing major revision (click here for a DRAFT, which is not to be taken or used as the final version). IHCA received this draft on May 22nd and has distributed it to the IHCA Regulatory/Clinical committee for comment, which were due to the ISDH on May 29th. The draft revisions, which will be made final in June, signal a significant increase in reporting for nursing facilities and residential care facilities. The revisions address many questions and uncertainties from the past policies, in terms of what is and what isn’t reportable, and err on the side of reporting more than reporting less. Many facilities in the past few years have erred toward reporting “everything” rather than get caught for not reporting an issue that didn’t appear to be reportable at the time, but after complaint was found to be a reportable that was not made. The draft revisions include information for residential care facilities as well, for the first time in one document. In addition, the draft signals not only mandatory use of the online Incident Reporting System, but sole use of the online system except for cases of evacuation or events involving the Emergency Management Agency.
Residential Care Citation Update
The month of April was the ISDH’s most active month in 2015 with deficiency and offense citation of Residential Care Facilities. The agency issued 51 citations in April, 47 at the deficiency level and 4 at the offense level. The breadth of citations was interesting to see, and you can see too in the below linked summary. The month saw citations of tags that don’t get cited very often, such as Tag0006 (Scope of Care), Tag0029 (Resident’s Rights), Tag0155 (Sanitation & Safety), Tag0302 (Pharmacy), and Tag0406 (Infection Control). On the other hand, frequently cited tags didn’t get a break in April as 9 facilities were issued Tag0273 concerning maintenance of food preparation and service areas and 3 facilities were issued Tag0241 for failing to have medications administered by licensed nursing or a QMA. One trend that has been noticed in 2015 is that Tag0304 concerning medication cabinets/rooms being locked at all times and storage of Schedule II drugs has been cited 3 times in 2015. Tag0304 was not cited at all in 2014 and only 4 times in 2013 at the deficiency level.
For a summary of the April Residential Care citations, click here.
For a summary of the April Residential Care citations, click here.
ISDH IJ/SSQC Update
There were two events in April that resulted in one IJ citation and two SSQC citations. The first event involved the failure by an LPN to recognize the code status of a resident after the resident was found without pulse or respirations, leading to a F155 citation at the IJ level. The resident had elected to be Full Code and all records and documentation was correct that the resident was Full Code, however the LPN did not recognize this code status. This particular citation, F155, marks the 4th time in the past 6 months that a citation, either F155 or F309, has been issued for failure to properly follow a resident’s election for to be Full Code. The second event in April involved a series of abuse and misappropriation allegations that the ISHD found to not have been properly reported internally or to authorities and that were not thoroughly investigated. These events resulted in citation of F225 and F226, both at the SSQC level. Several of the issues cited by the ISDH involved alleged abuse, verbal and physical, that could also be described as rude behavior and rough treatment or handling of residents. There was also an allegation of misappropriation of resident property that took place 3 months prior to the citation being issued. The details of these particular issues are important to read as many of them could be mistaken or thought to be poor customer service rather than patient abuse and neglect.
To read the April 2567s and a summary of the 2015 IJs and SSQCs, click here.
To read the April 2567s and a summary of the 2015 IJs and SSQCs, click here.
Thursday, April 30, 2015
2015 National Nursing Home Change Package Released
The atom Alliance will be working with Indiana nursing facilities on the new NNHQCC change package that was recently released. The change package, updated from its initial 2013 release, was created for nursing homes participating in the National Nursing Home Quality Care Collaborative led by the Centers for Medicare & Medicaid Services (CMS) and the Medicare Quality Innovation Net¬work-Quality Improvement Organizations (QIN-QIOs) like atom Alliance.
The Collaborative works actively to instill quality and performance improvement practices (QAPI), eliminate Healthcare-Acquired Conditions (HACs) and dramatically improve resident satisfaction by focusing on the systems that impact quality:
• staffing
• operations
• communication
• leadership
• compliance
• clinical models
• quality of life indicators and specific
• clinical outcomes
The change package, developed from a series of ten site visits to nursing homes across the country, focuses on the successful practices of high-performing nursing homes. The change package is a menu of strategies, change concepts, and specific actionable items that any nursing home can choose from to begin testing for purposes of improving residents’ quality of life and care.
Download your change package today! Go here to learn more about how atom Alliance is helping nursing homes in Alabama, Indiana, Kentucky, Mississippi and Tennesse implement these best practices.
The Collaborative works actively to instill quality and performance improvement practices (QAPI), eliminate Healthcare-Acquired Conditions (HACs) and dramatically improve resident satisfaction by focusing on the systems that impact quality:
• staffing
• operations
• communication
• leadership
• compliance
• clinical models
• quality of life indicators and specific
• clinical outcomes
The change package, developed from a series of ten site visits to nursing homes across the country, focuses on the successful practices of high-performing nursing homes. The change package is a menu of strategies, change concepts, and specific actionable items that any nursing home can choose from to begin testing for purposes of improving residents’ quality of life and care.
Download your change package today! Go here to learn more about how atom Alliance is helping nursing homes in Alabama, Indiana, Kentucky, Mississippi and Tennesse implement these best practices.
Atom Alliance Announces CMS’ 2014 QIO Program Progress Report
atom Alliance is pleased to share the Centers for Medicare & Medicaid Services’ (CMS) 2014 QIO Program Progress Report, which highlights how Quality Innovation Network-QIOs (QIN-QIOs) nationwide are bringing together providers, partners and other stakeholders to achieve rapid improvements in health quality.
The report, which can be viewed at http://qioprogram.org/progress-report, features the following:
• Information about the QIO Program’s new organizational structure, its goals and national partnerships;
• Real-life examples of how healthcare providers like yours have addressed quality improvement challenges;
• Takeaways from CMS’ 2014 QualityNet Conference, which was attended by providers, beneficiary advocacy groups, federal agencies, nationwide health care quality improvement organizations and others.
By participating in quality improvement initiatives with atom, your organization can benefit from our ability to help you make sense of key health quality data, improve your performance in Value-Based Purchasing programs and national quality ratings, and help publicize our joint successes in improving the quality of care for Medicare beneficiaries.
The report, which can be viewed at http://qioprogram.org/progress-report, features the following:
• Information about the QIO Program’s new organizational structure, its goals and national partnerships;
• Real-life examples of how healthcare providers like yours have addressed quality improvement challenges;
• Takeaways from CMS’ 2014 QualityNet Conference, which was attended by providers, beneficiary advocacy groups, federal agencies, nationwide health care quality improvement organizations and others.
By participating in quality improvement initiatives with atom, your organization can benefit from our ability to help you make sense of key health quality data, improve your performance in Value-Based Purchasing programs and national quality ratings, and help publicize our joint successes in improving the quality of care for Medicare beneficiaries.
Congress Passes Permanent Fix for Physician Medicare Payments
With the Senate passage of the Medicare Access and CHIP Reauthorization Act of 2015 (also referred to as the SGR bill or the Doc Fix), certain risks related to the billing of Medicare Part B services will have been resolved. The -21.2 percent rate adjustment that was to be applied for Part B procedures as of April 1, 2015, including therapy services, was eliminated. Provider fee schedule rates will remain unchanged until July 1, 2015 when a 0.5 percent rate adjustment will be applied. The hard $1,940 Part B therapy cap without exceptions that would have applied for rehabilitation services as of April 1, 2015 was also eliminated. The process to request exceptions to the cap has been extended through December 31, 2017.
AHCA sent a letter with FAQs and conducted member calls on March 30 to provide an update on the status of the SGR bill legislative delay that described two specific risks operators faced from April 1 until the date of enactment of the Doc Fix. At the time, AHCA provided two specific recommendations to consider: 1) "Operators hold any Part B claims with dates of services on or after April 1 until it is clearer what will happen in the Senate" and 2) "Operators issue Advance Beneficiary Notices (ABNs) to beneficiaries needing Part B therapy services beyond the $1,940 threshold as of April 1, 2015." With the passage and enactment of the Doc Fix, these recommendations no longer apply.
AHCA is updating its recommendations to operators and encourages a return to normal operating procedures related to these two soon-to-be resolved risks:
1. AHCA recommends that operators submit claims on the usual schedule, as the Centers for Medicare and Medicaid Services (CMS) has indicated that Medicare Part B claims with dates of service on or after April 1, 2015 will be paid per the provisions of the SGR Bill. Note, however, that CMS has explained that "[w]hile the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate."
2. AHCA recommends that it will no longer be appropriate for providers to issue advance beneficiary notices (ABNs) to beneficiaries receiving medically-necessary services above the $1,940 therapy caps since providers can use the exceptions process for therapy services above the threshold. More information about therapy cap related ABNs when exceptions apply can be found on the CMS website.
AHCA sent a letter with FAQs and conducted member calls on March 30 to provide an update on the status of the SGR bill legislative delay that described two specific risks operators faced from April 1 until the date of enactment of the Doc Fix. At the time, AHCA provided two specific recommendations to consider: 1) "Operators hold any Part B claims with dates of services on or after April 1 until it is clearer what will happen in the Senate" and 2) "Operators issue Advance Beneficiary Notices (ABNs) to beneficiaries needing Part B therapy services beyond the $1,940 threshold as of April 1, 2015." With the passage and enactment of the Doc Fix, these recommendations no longer apply.
AHCA is updating its recommendations to operators and encourages a return to normal operating procedures related to these two soon-to-be resolved risks:
1. AHCA recommends that operators submit claims on the usual schedule, as the Centers for Medicare and Medicaid Services (CMS) has indicated that Medicare Part B claims with dates of service on or after April 1, 2015 will be paid per the provisions of the SGR Bill. Note, however, that CMS has explained that "[w]hile the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate."
2. AHCA recommends that it will no longer be appropriate for providers to issue advance beneficiary notices (ABNs) to beneficiaries receiving medically-necessary services above the $1,940 therapy caps since providers can use the exceptions process for therapy services above the threshold. More information about therapy cap related ABNs when exceptions apply can be found on the CMS website.
CMS Releases SNF PPS Proposed Rule
In mid-April the Centers for Medicare and Medicaid Services (CMS) released the Skilled Nursing Facility Prospective Payment System (SNF PPS) notice of proposed rulemaking (NPRM). The FY 2016 NPRM release is significantly earlier than its usual practice. While the projected market basket growth rate of 1.4 percent is less than the profession had hoped, the reimbursement provisions of the rule contain no unexpected proposals. Of note, however, the FY 2016 NPRM marks the first year in which the profession will begin to see value-based purchasing provisions, quality reporting requirements, and health information technology sections in its annual NPRM.
Specifically, the FY 2016 NPRM discusses CMS' proposed plans to implement:
• Protecting Access to Medicare Act of 2014 (PAMA) SNF Rehospitalization Value-Based Purchasing Program;
• Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) Quality Reporting Measures;
• Preliminary IMPACT Act health information technology data interoperability proposals; and
• Finally, the NPRM discusses proposed new staff reporting requirements.
AHCA has prepared a summary of the 150-plus page rule. To view the summary, which includes staff contacts by section, click here. Additionally, AHCA/NCAL has updated its SNF PPS Medicare rate calculator based on the FY 2016 NPRM. To view and utilize the calculator, please click here.
We hope you find this information helpful and look forward to your comments and feedback as we begin developing our response to CMS.
Specifically, the FY 2016 NPRM discusses CMS' proposed plans to implement:
• Protecting Access to Medicare Act of 2014 (PAMA) SNF Rehospitalization Value-Based Purchasing Program;
• Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) Quality Reporting Measures;
• Preliminary IMPACT Act health information technology data interoperability proposals; and
• Finally, the NPRM discusses proposed new staff reporting requirements.
AHCA has prepared a summary of the 150-plus page rule. To view the summary, which includes staff contacts by section, click here. Additionally, AHCA/NCAL has updated its SNF PPS Medicare rate calculator based on the FY 2016 NPRM. To view and utilize the calculator, please click here.
We hope you find this information helpful and look forward to your comments and feedback as we begin developing our response to CMS.
Subscribe to:
Posts (Atom)
