IHCAMonday, March 2, 2015
CMS Approves Indiana Medicaid State Plan Amendment Extending the QAF
OMPP notified IHCA on February 4th this afternoon that CMS approved the State Plan Amendment (SPA) to extend the effective date of the QAF to July 1, 2017. You can access approval packet from CMS by clicking here. The SPA changes various dates within rate setting formula to the July 1, 2017 date, and make some non-material formatting changes. Also, the approved SPA implements a 10% rate penalty for untimely filing of the Checklist Management Representations as part of the Change of Ownership process, adds to the direct care definition reimbursement for PRN skin protectants, and adds the end date for the current 3% rate cut of June 30, 2015 (this end date was omitted in a prior filing with CMS).
Indiana Medicaid 5-8 Year Long Term Care Plan
Following up on the February 3rd meeting with OMPP, IHCA met with OMPP and Division of Aging to further discuss the four work groups that are being established to being the detail work on formation of the plan. The agencies will utilize existing work that has already begun within OMPP and the Division of Aging concerning changes to the Pre-Admissions Screening process (for the Entry Point workgroup), and reach out to the agencies that oversee development of affordable housing (for the Supportive Housing workgroup). The Assisted Living and Reimbursement work groups will essentially start from scratch, although both of those topics have been part of ongoing meetings that IHCA has with OMPP and the Division of Aging on a monthly basis. No specific timelines have been set as of yet as we await further direction from the State.
If you have any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001
If you have any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001
RUGs IV Transition for Medicaid Reimbursement
The Indiana Office of Medicaid Policy and Planning (OMPP) accepted the proposal made by IHCA, HOPE, and LeadingAge Indiana concerning a transition to RUVs IV. Effective July 1, 2016 Indiana Medicaid nursing facility rates will be calculated using the 48 grouper under RUGs IV. OMPP had been pressing for use of the 66 grouper. The 48 grouper that will be used will spend approximately $6.9M more than the current RUGs III 34 grouper. In order to cover that cost unspent dollars from the Quality Assessment Fee will be used. Approximately $5.8M dollars, which becomes $17.2M once leveraged with federal match, are unspent QAF.
OMPP has accepted this proposal with one caveat. The use of the 48 grouper will be for at least 1 year, and potentially more. OMPP will not commit to using the 48 grouper beyond 1 year (July 1, 2016 to June 30, 2017) until additional discussions and progress is made on the 5-8 year long term care plan occurs. That plan, reported on last month, is focused on rebalancing OMPP’s long term supports and services spend from institutional care to home and community based services.
Additional details from OMPP concerning the RUGs IV 48 grouper transition are expected in the coming weeks and IHCA will report those to members as they become available.
If you have any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001
OMPP has accepted this proposal with one caveat. The use of the 48 grouper will be for at least 1 year, and potentially more. OMPP will not commit to using the 48 grouper beyond 1 year (July 1, 2016 to June 30, 2017) until additional discussions and progress is made on the 5-8 year long term care plan occurs. That plan, reported on last month, is focused on rebalancing OMPP’s long term supports and services spend from institutional care to home and community based services.
Additional details from OMPP concerning the RUGs IV 48 grouper transition are expected in the coming weeks and IHCA will report those to members as they become available.
If you have any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001
Five Star Quality Rating System Changes
On February 12, CMS announced changes to the Five-Star Quality Rating System that will impact how CMS assigns stars for both the Staffing and Quality Measure components, which may impact a skilled nursing center's Overall rating. These changes were made public and are posted on February 20, 2015. CMS also will add two new measures to the Quality Measure component: the short-stay antipsychotic measure and the long-stay antipsychotic measure that CMS has been using on Nursing Home Compare for the past several years. Following is a summary of the changes to the Five-Star components:
Overall Five-Star rating
No changes to methodology but changes to Staffing and Quality Measure (QM) components will impact your overall rating
Survey component
No changes
Staffing component
Changed how 3- and 4-Star ratings are determined on Staffing component.
Quality Measure component
Added two new Quality Measures to the current nine QMs:
- Short-Stay use of antipsychotics
- Long-Stay use of antipsychotics
Rescaled the Cut Points
For each star level on the Quality Measure component, the cut points were moved. CMS did not provide the new cut points on the call but will release this information in the new technical user's manual. This will result in many members losing one or two stars on the Quality Measure component. Since the QM component contributes to the Overall rating, a sizable number of centers may also lose a star on their Overall rating.
• Resources
AHCA has been working to put together a number of resources on these changes for its members and state associations. AHCA has a dedicated website for this information at www.ahcancal.org/FiveStar. IHCA has taken this information and placed it in our member’s only website as well. Click here to access that information. For either the AHCA or IHCA websites, you will need a member ID and login. The resources are:
• A PowerPoint explaining the Five Star Changes
• Instructions on How to access Five Star Preview Reports
• Sample Letter to Payers Regarding Five Star Changes
• Templates for Communications to Families and Media, as well as general talking points
• Overview of Five Star revisions for the Nation and Indiana
• An Excel spreadsheet of all Indiana NFs with estimated impacts, comparing January 2015 under the old system with February 2015 under the new system.
IHCA and AHCA will continue to monitor and analyze the changes to the Five Star system and keep you updated.
Overall Five-Star rating
No changes to methodology but changes to Staffing and Quality Measure (QM) components will impact your overall rating
Survey component
No changes
Staffing component
Changed how 3- and 4-Star ratings are determined on Staffing component.
Quality Measure component
Added two new Quality Measures to the current nine QMs:
- Short-Stay use of antipsychotics
- Long-Stay use of antipsychotics
Rescaled the Cut Points
For each star level on the Quality Measure component, the cut points were moved. CMS did not provide the new cut points on the call but will release this information in the new technical user's manual. This will result in many members losing one or two stars on the Quality Measure component. Since the QM component contributes to the Overall rating, a sizable number of centers may also lose a star on their Overall rating.
• Resources
AHCA has been working to put together a number of resources on these changes for its members and state associations. AHCA has a dedicated website for this information at www.ahcancal.org/FiveStar. IHCA has taken this information and placed it in our member’s only website as well. Click here to access that information. For either the AHCA or IHCA websites, you will need a member ID and login. The resources are:
• A PowerPoint explaining the Five Star Changes
• Instructions on How to access Five Star Preview Reports
• Sample Letter to Payers Regarding Five Star Changes
• Templates for Communications to Families and Media, as well as general talking points
• Overview of Five Star revisions for the Nation and Indiana
• An Excel spreadsheet of all Indiana NFs with estimated impacts, comparing January 2015 under the old system with February 2015 under the new system.
IHCA and AHCA will continue to monitor and analyze the changes to the Five Star system and keep you updated.
Residential Care Facility Citation Update
There were 3 Offense citations and 15 Deficiency citations issued to Residential Care facilities in January 2015. Bucking a trend that had been prominent in 2014 and in years past Tag 273, concerning maintenance of food preparation areas in accordance with state and local standards, was only cited twice. In 2014, Tag 273 was cited an average of 5.75 times per month. The leading tag for January 2015 was Tag 217, which was cited 4 times. Tag 217 requires use appropriately trained staff to complete an evaluation that identified and documented the scope, frequently, need, and resident’s preference for the services to be provided by the facility, and have the resident sign and date the plan. At the time of this writing of this writing only 1 of the 4 surveys was publicly available. The survey that was available indicated the tag was issued due to service plans not having been signed by the resident or their legal representative. The residents reviewed had been recently admitted and a signed service plan had not yet been signed.
To review a summary of the other tags from January 2015, click here.
To review a summary of the other tags from January 2015, click here.
Thursday, February 19, 2015
CMS Releases Changes to Five Star Quality Rating System
On February 12, CMS announced changes to the Five-Star Quality Rating System that will impact how CMS assigns stars for both the Staffing and Quality Measure components, which may impact a skilled nursing center's Overall rating. CMS also will add two new measures to the Quality Measure component: the short-stay antipsychotic measure and the long-stay antipsychotic measure that CMS has been using on Nursing Home Compare for the past several years.
CMS will release to the public these changes on February 20th and will be holding a press briefing on the changes. Based American Health Care Association’s (AHCA) estimates, 165 out of 516 facilities in Indiana will see a decrease of either 1 or 2 stars, 351 facilities will see no change, and 1 facility will pick up one star. These are estimates and may differ from what CMS posts. See below under Resources to access this information.
Following is a summary of the changes to the Five-Star components:
Overall Five-Star rating
No changes to methodology but changes to Staffing and Quality Measure (QM) components will impact your overall rating
Survey component
No changes
Staffing component
Changed how 3- and 4-Star ratings are determined on Staffing component.
Quality Measure component
Added two new Quality Measures to the current nine QMs:
- Short-Stay use of antipsychotics
- Long-Stay use of antipsychotics
Rescaled the Cut Points
For each star level on the Quality Measure component, the cut points were moved. CMS did not provide the new cut points on the call but will release this information in the new technical user's manual. This will result in many members losing one or two stars on the Quality Measure component. Since the QM component contributes to the Overall rating, a sizable number of centers may also lose a star on their Overall rating.
• Resources
AHCA has been working to put together a number of resources on these changes for its members and state associations. AHCA has a dedicated website for this information at www.ahcancal.org/FiveStar. IHCA has taken this information and placed it in our member’s only website as well. Click here to access that information. For either the AHCA or IHCA websites, you will need a member ID and login. The resources are:
• A PowerPoint explaining the Five Star Changes
• Instructions on How to access Five Star Preview Reports
• Sample Letter to Payers Regarding Five Star Changes
• Templates for Communications to Families and Media, as well as general talking points
• Overview of Five Star revisions for the Nation and Indiana
• An Excel spreadsheet of all Indiana NFs with estimated impacts (these impacts are based upon AHCA’s replication of the CMS user guide – actual results may differ once CMS releases the data on Feb. 20th)
IHCA and AHCA will continue to monitor and analyze the changes to the Five Star system and keep you updated.
CMS will release to the public these changes on February 20th and will be holding a press briefing on the changes. Based American Health Care Association’s (AHCA) estimates, 165 out of 516 facilities in Indiana will see a decrease of either 1 or 2 stars, 351 facilities will see no change, and 1 facility will pick up one star. These are estimates and may differ from what CMS posts. See below under Resources to access this information.
Following is a summary of the changes to the Five-Star components:
Overall Five-Star rating
No changes to methodology but changes to Staffing and Quality Measure (QM) components will impact your overall rating
Survey component
No changes
Staffing component
Changed how 3- and 4-Star ratings are determined on Staffing component.
Quality Measure component
Added two new Quality Measures to the current nine QMs:
- Short-Stay use of antipsychotics
- Long-Stay use of antipsychotics
Rescaled the Cut Points
For each star level on the Quality Measure component, the cut points were moved. CMS did not provide the new cut points on the call but will release this information in the new technical user's manual. This will result in many members losing one or two stars on the Quality Measure component. Since the QM component contributes to the Overall rating, a sizable number of centers may also lose a star on their Overall rating.
• Resources
AHCA has been working to put together a number of resources on these changes for its members and state associations. AHCA has a dedicated website for this information at www.ahcancal.org/FiveStar. IHCA has taken this information and placed it in our member’s only website as well. Click here to access that information. For either the AHCA or IHCA websites, you will need a member ID and login. The resources are:
• A PowerPoint explaining the Five Star Changes
• Instructions on How to access Five Star Preview Reports
• Sample Letter to Payers Regarding Five Star Changes
• Templates for Communications to Families and Media, as well as general talking points
• Overview of Five Star revisions for the Nation and Indiana
• An Excel spreadsheet of all Indiana NFs with estimated impacts (these impacts are based upon AHCA’s replication of the CMS user guide – actual results may differ once CMS releases the data on Feb. 20th)
IHCA and AHCA will continue to monitor and analyze the changes to the Five Star system and keep you updated.
Wednesday, February 4, 2015
Indiana Medicaid 5-8 Year Long Term Care Plan
IHCA, HOPE and LeadingAge met with FSSA and OMPP on February 3rd to re-start discussions on the 5-8 year long term care plan that FSSA Secretary John Wernert challenged the industry to help develop. Medicaid Director Joe Moser made it very clear that he is concerned with the imbalance that Indiana has with respect to spending on institutional services versus home and community based services when compared to other states. Though Director Moser has stated to IHCA in the past that a transition to more HCBS does not have to be driven by budgets, Director Moser explained his concern by comparing spending on institutional services versus home HCBS. He presented the following numbers on annual per patient spending:
*Approx. number (AL Waiver only is $14,968, but this does not include other state plan services and needs to before it is a reasonable comparison)
These numbers reflect all that are eligible for NF care and, except for AL Waiver, reflect both waiver and state plan services.
In addition, Director Moser presented data on the percentage spend, and not persons served, on NF and HCBS. The data he presented is below:
Director Moser made it clear that his goal is to change these percentages so that the NF percentage decreases and the HCBS percentage increases. Director Moser also made it clear that he wants the participation of the nursing facility profession to help make this happen, rather than the agency going it alone on a top-down approach. He wishes to develop benchmarks through the planning process, with incentives and penalties, that both the industry and the State will be held to.
The next steps will include the formation of 4 work groups that will feed into the overall planning process. The groups are:
1. Reimbursement – Will examine other state approaches, including managed care (Sec’y Wernert specifically states that managed care needs to be examined and that some in the industry are in favor of managed care)
2. Entry Point – Will examine the ways in which beneficiaries enter the post-acute system and how they are routed to particular services, and then how to change those patterns to ensure right place, right time, least restrictive/costly setting
3. Housing – Will examine challenges to housing for Medicaid beneficiaries
4. Assisted Living – Will examine other state’s approaches to using AL as an alternative to nursing facilities and how Indiana’s structure for waivers and state plan services may need to change to encourage more AL utilization in the Medicaid program
OMPP will put more details together about these workgroups and the overall planning process. IHCA will reach out to members to find members with specific knowledge and time to participate in these work groups.
If you have any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001
Service Type
|
SFY 2014 Spend Per Patient
|
Nursing Facility
|
$48,756
|
AL Waiver
|
$36,000*
|
Home Care
|
$16,950
|
These numbers reflect all that are eligible for NF care and, except for AL Waiver, reflect both waiver and state plan services.
In addition, Director Moser presented data on the percentage spend, and not persons served, on NF and HCBS. The data he presented is below:
SFY 2014
|
SFY 2013
|
SFY 2012
|
SFY 2011
|
SFY 2010
|
|||||
NF Spend
|
HCBS Spend
|
NF Spend
|
HCBS Spend
|
NF Spend
|
HCBS Spend
|
NF Spend
|
HCBS Spend
|
NF Spend
|
HCBS Spend
|
75.4%
|
24.6%
|
78.4%
|
21.6%
|
78.6%
|
21.4%
|
79.1%
|
20.9%
|
79%
|
21%
|
Director Moser made it clear that his goal is to change these percentages so that the NF percentage decreases and the HCBS percentage increases. Director Moser also made it clear that he wants the participation of the nursing facility profession to help make this happen, rather than the agency going it alone on a top-down approach. He wishes to develop benchmarks through the planning process, with incentives and penalties, that both the industry and the State will be held to.
The next steps will include the formation of 4 work groups that will feed into the overall planning process. The groups are:
1. Reimbursement – Will examine other state approaches, including managed care (Sec’y Wernert specifically states that managed care needs to be examined and that some in the industry are in favor of managed care)
2. Entry Point – Will examine the ways in which beneficiaries enter the post-acute system and how they are routed to particular services, and then how to change those patterns to ensure right place, right time, least restrictive/costly setting
3. Housing – Will examine challenges to housing for Medicaid beneficiaries
4. Assisted Living – Will examine other state’s approaches to using AL as an alternative to nursing facilities and how Indiana’s structure for waivers and state plan services may need to change to encourage more AL utilization in the Medicaid program
OMPP will put more details together about these workgroups and the overall planning process. IHCA will reach out to members to find members with specific knowledge and time to participate in these work groups.
If you have any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001
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