Wednesday, August 27, 2014

NALW Idea: A Chorus of Voices

Katherine Preede

As the school year begins, consider reaching out to your local elementary and high schools for partnerships during National Assisted Living Week®, September 7-13. One of the most magical aspects of music is that it spans across the generations. Invite local elementary schools to come and perform for and then visit with your residents. Also consider also inviting some high school jazz bands to come and perform for your residents.

Residents will love to listen to and sing along with student choirs and students will learn an incredible amount from this generation. Contact your local school district to see if it is possible to have students come in during National Assisted Living Week® to sing and interact with residents and hone their musical skills.

Share your NALW ideas on our Facebook page.

Tuesday, August 26, 2014

New Head of

Yesterday, the Obama Administration announced that Kevin Counihan, the head of Connecticut’s health insurance marketplace, will be the new CEO of  This is the website that 36 states use to sell Affordable Care Act (ACA) insurance.  

The U.S. Department of Health and Human Services Secretary, Sylvia Burwell, tapped Counihan to lead the site.  According to the Kaiser Health News article on the announcement, Access Health CT, under Counihan’s leadership, is one of the more successful state-run exchanges.

If you have any questions relating to the ACA, please submit them to, and be sure to check out AHCA/NCAL’s ACA website

Webinar: Advancing Towards Population Management: Building the Post-Acute Care Management Network

Adrienne Riaz-Khan

This presentation by The Advisory Board Company highlights ten tactics post-acute providers can use to create meaningful, sustainable care management investments that support the overall Triple Aim goals across an episode of care.

Attendees will learn:

· Opportunities for post-acute providers to use care management capabilities to differentiate themselves
· Six methods of delivering efficient, high quality post-acute care
· Tactics to address gaps in routine care following the end of an episode

Tuesday, September 23, 2014
3:30 PM – 4:30 PM Eastern

The link to register is:

GAO Releases Medicare Program Integrity Report

Dianne De La Mare

The US Government Accountability Office (GAO) has released a report, Medicare Program Integrity: Increased Oversight and Guidance Could Improve Effectiveness and Efficiency of Postpayment Claims Reviews, which specifically recommends that the Centers for Medicare & Medicaid Services (CMS) take actions to improve the efficiency and effectiveness of its contractors’ post payment review efforts including providing additional oversight and guidance regarding data, duplicative reviews and contractor correspondence. These are all issues that AHCA staff have discussed with both GAO and CMS in the past. 

The GAO reports that CMS’ current duplication reduction efforts are insufficient, as the Recovery Audit Data Warehouse, used to track recovery auditor (RA) activities, is not designed to provide information on all possible duplication and the data is not reliable. Communication between CMS and RAs also is flawed and the RA communication sent to providers is unclear and does not always outline the CMS requirements. 

Lastly, CMS coordination strategies should be improved. Currently, CMS has strategies in place to coordinate contractors activities; however, these strategies have not incorporated plans to increase consistency among the various contractors.

To obtain a copy of the full report go to

Check Updated LEIE Database

Dianne De La Mare

The US Department of Health, Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in July 2014. 

This new file is meant to replace the updated LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included in this file. The updated files are posted on OIG’s website at, and healthcare providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines. Instructional videos explaining how to use the online database and the downloadable files are available at

Given the penalties and recent government warnings, long term care providers should check the LEIE on a regular basis.

OIG Explains How to Report Fraud on Hotline

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) has released a new video that shows how the agency accepts tips and complaints about potential fraud, waste, abuse, and mismanagement in health care programs. Reported information is reviewed by a professional staff member but due to the high volume of information received, OIG is unable to reply to submissions.

New Medicare Strike Force Web Page

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) has created a new Medicare Strike Force web page. As reported previously, the Medicare Fraud Strike Force teams conduct data analytics and use the combined resources of federal, state and local law enforcement entities to prevent and combat health care fraud, waste and abuse across the county.

First established in March 2007, Strike Force teams currently operate in 9 cities including: Miami FL, Los Angeles CA, Detroit MI, Houston TX, Brooklyn NY, Southern LA, Chicago IL and Dallas TX. The new web page features the latest Medicare Strike Force enforcement actions and can be viewed at

ICD-10 Update

Dianne De La Mare

In early August, the US Department of Health and Human Services (HHS) released the long-awaited final rule, Administrative Simplification: Change to the compliance Date for the International Classification of Diseases, 10th Revision (ICD-10-CMS and ICD-10-PCS) Medical Data Code Sets, stating that the compliance date for the health care profession’s transition from ICD-9 to ICD-10 is October 1, 2015.
According to CMS, the deadline will allow providers, insurance companies and others in the health care profession time to ramp up their operations to ensure their systems and business processes are ready to go on October 1, 2015. Last May, CMS issued an interim final rule that set the new ICD-10 compliance date for October 1, 2015; however, this new and final HHS rule officially finalizes the compliance date as October 1, 2015.

To ensure that providers are ready, CMS has stepped up its ICD-10 education. However, many of these training tools do not apply specifically to long term care providers. To obtain a copy of the CMS resources go to or CMS’ Medicare Learning Network at, and click on MLN Catalogue at the bottom of the page; then search for ICD-10 in that document. 

AHCA has reached out to CMS but at the current date, the agency has no plans to schedule training specific to long term care providers. AHCA is working with various experts to plan its own training in the future.

OMB Rejects CMS’ New ACO Regulation

James Michel

On Tuesday InsideHealthPolicy reported that the White House Office of Management and Budget (OMB) rejected CMS’ proposed rule on the second round of accountable care organization (ACO) contracts. Many health care analysts and policy makers have been awaiting publication of the new rule as anticipation and uncertainty around the ACO program builds. In 2011 CMS published the first set of rules governing ACOs’ participation in the Medicare Shared Savings Program and CMMI’s Pioneer ACO Demonstration, but that rule only covered ACOs’ first three-year contract period. Meanwhile, many ACOs, including all of the Pioneer ACOs, are approaching the end of their first contract period.

A recent survey by the National Association of ACOs showed that as many as two thirds of the current Medicare ACOs said they would likely drop out of the program if CMS didn’t make some drastic changes to existing rules. It is unclear what this means for ACOs in terms of continuing on in the program. It is also unclear which portions of the proposed regulation OMB asked CMS to redo or when the updated proposed rule should be expected.

AHCA will continue to follow developments in this story closely and provide updates as information becomes available. In the meantime, AHCA members are encouraged to review the ACO Contracting Guide, released to members last year, which contains a wealth of information and analysis of the current Medicare Shared Savings rules and a robust discussion around SNF-ACO contracting.

Monday, August 25, 2014

GAO Reports NFs Compliance with Abuse/Neglect Regulations

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) has released a report, Nursing Facilities’ Compliance with Federal Regulations for Reporting Allegations of Abuse and Neglect, which looks at nursing facility (NF) reporting practices for abuse and neglect. According to the report, of the nursing facilities (NFs) sampled, 85 percent of the facilities reported at least one allegation of abuse or neglect to OIG in 2012. These allegations included abuse, injuries of an unknown source, misappropriation of resident property, neglect or mistreatment. Overall, in 2012, NFs reported 149,313 allegations of abuse or neglect to OIG in 2012.

The report also found that 76 percent of the sampled NFs maintained policies that addressed the federal regulations for reporting both allegations of abuse or neglect and investigation results. Sixty-one percent of NFs had documentation supporting the facilities’ compliance with the federal regulations under the Social Security Act, Section 1150B (e.g., the Elder Justice Act provisions enacted in the Affordable Care Act requiring NFs to report any reasonable suspicion of crime committed against a resident and to annually notify covered individuals of their obligation to report to the appropriate entities any reasonable suspicions of a crime). Lastly, only 53 percent of allegations of abuse and neglect and the subsequent investigation results were reported, as federally required. 

To obtain a copy of the complete report, go to