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.         

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.

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.

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.

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).

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.

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.

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.

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.

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.