IHCA
The IHCA is beginning its QIS educational programs for members and non-members in 2011 by offering three, one-day training sessions on the QIS process across the state in January. The sessions will guide participants through the fundamentals of the Quality Indicator Survey.
January 25, 2011 - Holiday Inn, Indianapolis
January 26, 2011 - Courtyard by Marriott Chicago Southeast/Hammond
January 27, 2011 - Jasper Inn and Convention Center
For more information or to register, click here.
Friday, January 7, 2011
Wednesday, January 5, 2011
Tracking RAC Info Made Easy
The American Health Care Association (AHCA) recently announced the launch of a new website which will make it easier for health care providers to track new information in the realm of Recovery Audit Contractor (RAC) activity. It is important for long term care providers, such as skilled nursing facilities, to keep track of the new issues being reviewed by the RAC. To view the latest RAC postings coming out of the Centers for Medicare and Medicaid Services (CMS) visit the AHCA Medicare RAC website, http://www.ahcancal.org/facility_operations/MedicareRAC/Pages/default.aspx.
If you have questions or require additional information, please contact Susan Ziel at 317-238-6244 or sziel@kdlegal.com.
If you have questions or require additional information, please contact Susan Ziel at 317-238-6244 or sziel@kdlegal.com.
Indiana Medicaid Reduces Payment for Transportation Services and Limits Therapy Visits
On December 8, 2010, Indiana Medicaid published two bulletins reducing Medicaid payment for transportation services and limiting the number of therapy visits reimbursable by Indiana Medicaid beginning January 1, 2011. For transportation services (IHCP Bulletin 201057), reimbursement for ambulance transportation services will be reduced by 5 percent and reimbursement for non-ambulance transportation services will be reduced by 10 percent. For therapy services (IHCP Bulletin 201058), reimbursement for speech, occupational and physical therapies will be limited to 25 therapy visits for each type of therapy per rolling 12-month period to all members age 21 or older.
If you have questions or require additional information, please contact Susan Ziel at 317-238-6244 or sziel@kdlegal.com.
If you have questions or require additional information, please contact Susan Ziel at 317-238-6244 or sziel@kdlegal.com.
AHCA Submits Comments on Proposed LTC/Hospice Contract Rule
In October, the Department of Health and Human Services published a proposed rule which would require that a written agreement be established between a long term care (LTC) facility in which a Medicare beneficiary is residing, and a Medicare-certified hospice program that is providing care to the resident. Specifically, the proposed rule states that when an LTC facility chooses to arrange for hospice services for its residents through an agreement with a Medicare-certified hospice program, the two entities must have in place a written agreement which must "clearly identify the responsibilities of each entity when arranging for the provision of hospice services to an LTC resident who elects the hospice benefit. This agreement would be required even if the Medicare-certified hospice and the LTC facility were under common control and/or ownership." In casesof an LTC facility that chooses not to formally arrange hospice care for its residents, the proposed rule will require that such facilities assist residents in transferring toa different LTC facility that would arrange for hospice care services to be provided to the resident.
On December 21, 2010, the American Health Care Association (“AHCA”) submitted its formal comments on the proposed rule to HHS. Among its comments, the AHCA raised concern over a provision of the proposed rule which places on nursing facilities a responsibility to ensure that the contracted hospice provider meets certain professional standards,and that services are timely provided. The AHCA contended that it is not possible or reasonable for the nursing facility to ensure that the hospice meets these requirements.The AHCA also noted and requested clarification of an inconsistency between the proposed contract requirements and the conditions of participation for hospices relating to certain notice requirements. Additionally, in response to the proposed rule’s requirement that the written agreements ensure that a resident’s plan of care include services furnished by the LTC facility to attain or maintain the resident’s highest possible physical, mental, and psychosocial well-being, the AHCA commented that due to the changes likely to take place for residents once they choose hospice care, confusion may arise as to what constitutes the resident’s highest practicable well-being. Therefore, the AHCA suggested that the proposed rule be amended to clarify that the determination of highest practicable well-being should be made in consideration of changes in the resident’s health status and choices relating to the type of care the resident wishes to receive.
If you have questions about the proposed rule or the AHCA’s comments thereto, please contact Susan Ziel at 317-238-6244 or sziel@kdlegal.com.
On December 21, 2010, the American Health Care Association (“AHCA”) submitted its formal comments on the proposed rule to HHS. Among its comments, the AHCA raised concern over a provision of the proposed rule which places on nursing facilities a responsibility to ensure that the contracted hospice provider meets certain professional standards,and that services are timely provided. The AHCA contended that it is not possible or reasonable for the nursing facility to ensure that the hospice meets these requirements.The AHCA also noted and requested clarification of an inconsistency between the proposed contract requirements and the conditions of participation for hospices relating to certain notice requirements. Additionally, in response to the proposed rule’s requirement that the written agreements ensure that a resident’s plan of care include services furnished by the LTC facility to attain or maintain the resident’s highest possible physical, mental, and psychosocial well-being, the AHCA commented that due to the changes likely to take place for residents once they choose hospice care, confusion may arise as to what constitutes the resident’s highest practicable well-being. Therefore, the AHCA suggested that the proposed rule be amended to clarify that the determination of highest practicable well-being should be made in consideration of changes in the resident’s health status and choices relating to the type of care the resident wishes to receive.
If you have questions about the proposed rule or the AHCA’s comments thereto, please contact Susan Ziel at 317-238-6244 or sziel@kdlegal.com.
OIG Releases Report on Long Term Care Payments
On December 22, 2010, the Office of Inspector General ("OIG") released a report which examined billing trends of skilled nursing facilities ("SNFs") from 2006-2008. The purpose of the report was to determine if certain services had higher utilization rates over the span of the 2 years, to see if ownership differences existed from 2006 to 2008, and to identify SNFs with questionable billing practices in 2008.
Among its findings, the OIG determined that higher-paying rehabilitation-related resource utilization groups ("RUGs") were billed in 2008 than in 2006, and that this trend correlated positively with for-profit status, whereas not-for-profit or government-owned SNFs were less likely to bill for the higher-paying RUGs. The OIG also found that for-profit SNFs had longer lengths of stay than other SNFs, and that the longer lengths of stay were not related to the types of populations in the various different types of SNFs.
For a copy of the OIG Report, go to http://oig.hhs.gov/oei/reports/oei-02-09-00202.pdf. If you have questions or require additional information, contact Susan Ziel at (317) 238-6244 or sziel@kdlegal.com.
Among its findings, the OIG determined that higher-paying rehabilitation-related resource utilization groups ("RUGs") were billed in 2008 than in 2006, and that this trend correlated positively with for-profit status, whereas not-for-profit or government-owned SNFs were less likely to bill for the higher-paying RUGs. The OIG also found that for-profit SNFs had longer lengths of stay than other SNFs, and that the longer lengths of stay were not related to the types of populations in the various different types of SNFs.
For a copy of the OIG Report, go to http://oig.hhs.gov/oei/reports/oei-02-09-00202.pdf. If you have questions or require additional information, contact Susan Ziel at (317) 238-6244 or sziel@kdlegal.com.
Yet Another HIPAA Security Breach...
Detroit, Michigan hospital -- Henry Ford Health Systems -- had one of its laptops stolen out of an unlocked physician's office in September. The laptop contained certain individually identifiable patient information protected under HIPAA. The Hospital acknowledged that although the laptop was "password protected," this did not represent a health data protection standard required by the Hospital under its updated health information privacy and security policies.
As required by the HITECH Act amendments to HIPAA, the Hospital was required to notify the subject patients within 60 days of the breach. The Hospital is also obligated to notify HHS' Office of Civil Rights (OCR). A recent review of the OCR database of breaches involving 500 or more individuals, which can be accessed at http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html, reveals that many of the reported breaches to date involve the the loss or theft of laptops and other types of portable electronic devices that had not otherwise been properly secured by way of "encryption" in accordance with the new HITECH Act amendments to HIPAA.
If you would like additional information, please contact Susan Ziel at sziel@kdlegal.com or (317) 238-6244.
As required by the HITECH Act amendments to HIPAA, the Hospital was required to notify the subject patients within 60 days of the breach. The Hospital is also obligated to notify HHS' Office of Civil Rights (OCR). A recent review of the OCR database of breaches involving 500 or more individuals, which can be accessed at http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html, reveals that many of the reported breaches to date involve the the loss or theft of laptops and other types of portable electronic devices that had not otherwise been properly secured by way of "encryption" in accordance with the new HITECH Act amendments to HIPAA.
If you would like additional information, please contact Susan Ziel at sziel@kdlegal.com or (317) 238-6244.
Tuesday, January 4, 2011
"Bed Hold" Reimbursement Update
IHCA previously issued an alert to members in late December regarding the Indiana Office of Medicaid Policy and Planning (“OMPP”) posting of BT 201061, which provides formal notice of the elimination of reimbursement for bed-hold days on nursing facilities effective as of February 1, 2011. For a copy of this bulletin, click here. This change willspecifically eliminate reimbursement for the following codes: 180 (leave days), 183 (for therapeutic purposes), and 185 (from nursing homes for hospitalizations).
Since OMPP’s announcement, IHCA has received many questions from members about the impact of this reimbursement change on bed-hold policies and billing/cost-report procedures.IHCA has been in communication with OMPP, the Indiana State Department of Health (“ISDH”) and the Division of Aging (“DA”) regarding these questions and has requested that theagencies, either individually or collectively, issue guidance to the long term care profession to clarify what is or is not required of comprehensive care facilities as a result of this reimbursement change.
Several IHCA members have asked whether comprehensive care facilities will be “required” to hold beds for Medicaid residents after elimination of Medicaid reimbursement for bed-hold days. Under the current law, and the law as it will exist on February 1, 2011 when Medicaid bed-hold reimbursement is eliminated, there is no requirement that facilities hold beds for Medicaid residents (unless, of course, Medicaid reimbursement is being paid or the individual resident is paying the facility in order to hold the bed).
Under ISDH regulations, however, each facility must have a policy and provide written information to residents regarding bed-holds that is consistent with the Medicaid State Plan. The language in the Medicaid State Plan regarding bed-holds for comprehensive care facilities states “Although it is not mandatory for facilities to reserve beds, Medicaid will reimburse” facilities that meet the occupancy criteria and for 15 or 30 day periods for hospital and therapeutic leaves, respectively. That language gives facilities a choice as to whether it wants to hold beds for Medicaid residents, and if the facility chose to do so then the facility’s policy on bed-hold had to take into account the Medicaid State Plan. At the time of this publication, it is unclear whether the ISDH will be amending its rule (410 IAC 16.2-3.1-12(25) and (27)) in light of the Medicaid reimbursement change. Even if ISDH does not amend its rule to reflect the lack of a bed-hold policy under Medicaid, each comprehensive care facility must still have a policy in place and provide information to residents regarding bed-holds.
Other questions that IHCA has received relate to the discharge and re-admission process with Medicaid residents who have been on hospital or therapeutic leave. When the bed-hold reimbursement rule was adopted in 2002, OMPP published BT200204 that walked through the bed-hold reimbursement rule, the occupancy calculation and impacts of the reimbursement change on the 450B process and claims and financial reporting processes. Since publication of that bulletin, OMPP further clarified discharge, re-admission andthe 450B processes in the Medicaid Provider Manual. At the time of this publication, IHCA is aware that OMPP is analyzing the impact of the reimbursement change on each of the above discharge, re-admissions and claims issues and has offered to assist OMPP in issuing guidance to the long term care profession to clarify these processes going forward.
IHCA recommends that each comprehensive care facility examine its bed-hold policy and be prepared to amend the policies in order to take into account the elimination of Medicaid reimbursement for bed-holds and the facility’s operational needs. Each comprehensive care facility must, by ISDH rule, maintain these policies and information.
IHCA will continue to research and work on this issue in the coming weeks and will issue additional guidance at the appropriate time. IHCA is hopeful that guidance will become available prior to the February 1, 2011 effective date of the reimbursement change.
Please contact Zach Cattell at zcattell@ihca.org or 317-616-9001 with questions, comments, examples or other information about the bed-hold reimbursement change.
Since OMPP’s announcement, IHCA has received many questions from members about the impact of this reimbursement change on bed-hold policies and billing/cost-report procedures.IHCA has been in communication with OMPP, the Indiana State Department of Health (“ISDH”) and the Division of Aging (“DA”) regarding these questions and has requested that theagencies, either individually or collectively, issue guidance to the long term care profession to clarify what is or is not required of comprehensive care facilities as a result of this reimbursement change.
Several IHCA members have asked whether comprehensive care facilities will be “required” to hold beds for Medicaid residents after elimination of Medicaid reimbursement for bed-hold days. Under the current law, and the law as it will exist on February 1, 2011 when Medicaid bed-hold reimbursement is eliminated, there is no requirement that facilities hold beds for Medicaid residents (unless, of course, Medicaid reimbursement is being paid or the individual resident is paying the facility in order to hold the bed).
Under ISDH regulations, however, each facility must have a policy and provide written information to residents regarding bed-holds that is consistent with the Medicaid State Plan. The language in the Medicaid State Plan regarding bed-holds for comprehensive care facilities states “Although it is not mandatory for facilities to reserve beds, Medicaid will reimburse” facilities that meet the occupancy criteria and for 15 or 30 day periods for hospital and therapeutic leaves, respectively. That language gives facilities a choice as to whether it wants to hold beds for Medicaid residents, and if the facility chose to do so then the facility’s policy on bed-hold had to take into account the Medicaid State Plan. At the time of this publication, it is unclear whether the ISDH will be amending its rule (410 IAC 16.2-3.1-12(25) and (27)) in light of the Medicaid reimbursement change. Even if ISDH does not amend its rule to reflect the lack of a bed-hold policy under Medicaid, each comprehensive care facility must still have a policy in place and provide information to residents regarding bed-holds.
Other questions that IHCA has received relate to the discharge and re-admission process with Medicaid residents who have been on hospital or therapeutic leave. When the bed-hold reimbursement rule was adopted in 2002, OMPP published BT200204 that walked through the bed-hold reimbursement rule, the occupancy calculation and impacts of the reimbursement change on the 450B process and claims and financial reporting processes. Since publication of that bulletin, OMPP further clarified discharge, re-admission andthe 450B processes in the Medicaid Provider Manual. At the time of this publication, IHCA is aware that OMPP is analyzing the impact of the reimbursement change on each of the above discharge, re-admissions and claims issues and has offered to assist OMPP in issuing guidance to the long term care profession to clarify these processes going forward.
IHCA recommends that each comprehensive care facility examine its bed-hold policy and be prepared to amend the policies in order to take into account the elimination of Medicaid reimbursement for bed-holds and the facility’s operational needs. Each comprehensive care facility must, by ISDH rule, maintain these policies and information.
IHCA will continue to research and work on this issue in the coming weeks and will issue additional guidance at the appropriate time. IHCA is hopeful that guidance will become available prior to the February 1, 2011 effective date of the reimbursement change.
Please contact Zach Cattell at zcattell@ihca.org or 317-616-9001 with questions, comments, examples or other information about the bed-hold reimbursement change.
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