Wednesday, September 30, 2015

Speaker Boehner Announces Resignation Ahead of Government Funding Deadline

Drew Thies

House Speaker John A. Boehner shocked Washington D.C., the Republican caucus, and the political community at large on Friday, making a surprise announcement that he will step aside as speaker in October and resign his seat in the House.

The move by Boehner comes less than a week before a contentious government spending bill must be passed to avoid a government shutdown. Conservative members of the Republican party in both chambers have called for such legislation to be tied to the defunding of Planned Parenthood, a move that Democrats and President Obama were sure to block.

Speaker Boehner received much criticism from some members of his own party, including the conservative House Freedom Caucus, for ostensibly siding with Democrats instead of working to use the stop-gap funding measure to defund the women’s health organization. Some thought that if a so-called “clean” continuing resolution was passed, members of the House Republican party would seek to enact official parliamentary measures to replace the Speaker of the House.

Boehner said that he woke up on Friday morning and decided the day had come to quit. "I woke up, and decided today's the day I'm going to do this," he said. The previous day, Pope Francis addressed a joint session of Congress and attended a private meeting with Boehner in a visit primarily spearheaded and organized by the Speaker’s office.

The move sparked off an immediate race of Republicans attempting to climb the party ranks as the top post in the House becomes open. Current Majority Leader Kevin McCarthy seems to be the odds-on favorite to take the Speaker’s gavel, but the race to then replace McCarthy as Majority Leader is much murkier.

The House will move to vote on a clean continuing resolution to fund the government until mid-December, leaving new Republican leadership just a few short months to get accustomed to handling their rank-and-file before another important policy deadline.

Tuesday, September 29, 2015

Download the Convention App

Jon Patrick Ewing
If you're attending the 66th Annual AHCA/NCAL Annual Convention & Expo, we are pleased to offer a multi-functional Convention App for this year’s event. With the Convention App you can:
  • Draw on presentation slides, highlight text, and take notes
  • Create a personal schedule by starring the sessions you plan to attend
  • Message app users
  • View exhibitor information and floor plan
  • Receive alerts & updates for the meeting
  • Use social media including, Facebook, Twitter and LinkedIn
  • Access supplementary resources and more!
To make the most of your convention experience, please follow these instructions for downloading the Convention App.
The Convention App for the 66th Annual AHCA/NCAL Annual Convention & Expo is available inside the AHCA/NCAL Events app available in App Store and in the Google Play store (links below). Search using : ”AHCA NCAL Events". If you plan on using the app, please install the mobile app and download the presentations before your arrival to the event. You will need internet access while downloading the app. (Please note, for iOS devices you will need iOS 7.0 or higher and for Android devices you will need Android 4.0 or higher.)
Note: If you have already downloaded the AHCA/NCAL Events App earlier this year when attending an AHCA/NCAL conference, you’ll only need to update to get access to event information for the 2015 Convention & Expo.  
Options for downloading the APP include:
Apple iOS Devices - install the free Apple iOS App and download the conference materials to your device.
Android Devices - install the free Google Play App and download the conference materials to your device.
Once you install and start up the app, find the AHCA/NCAL 66th Annual Convention in the events list. To log in, use your username (email used to register for the event) and password (registration confirmation # or badge #) listed in an email from Note: non-attendees will not have received this email or log in information.

U.S. House of Representatives Votes to Repeal a Piece of the ACA Earlier this Week

Dana Halvorson

According to a Sept. 28, 2015, article by Jon Reid from Morning Consult, “The House on Monday passed legislation to nix an upcoming Obamacare mandate requiring employers with 51 to 100 employees to shift the health coverage they offer to plans on the small-group market. Currently, the small-group market consists of businesses with up to 50 employees. But that is slated to change in 2016, when a new mandate will expand the market to include employers with 51 to 100 workers. Right now, these mid-size businesses can offer employer-based health insurance on the large-group market. Under the law, small-group market plans must cover a larger array of health services than large-group market plans and also have more discrimination protections. The idea is to protect small employers from extreme rate increases if one of their employees gets very sick. But many states are not ready for the transition that would require more employers to use the small-group market. As a result, Democrats and Republicans have called for an alteration of the law. The Protecting Affordable Coverage for Employees Act (PACE Act) — spearheaded by Reps. Brett Guthrie (R-Ky.), Tony Cardenas (D-Calif.), Markwayne Mullin (R-Okla.) and Kyrsten Sinema (D-Ariz.) — would let states choose whether to expand the small-group market to include businesses with up to 100 employees.”

The article goes on to note that, “The Senate is under a time crunch to pass the bill before the mandate takes effect in 2016. Senate Majority Leader Mitch McConnell’s office did not immediately respond to a request for comment, but there is support in the Senate. A companion bill by Sen. Tim Scott (R-S.C.) has the cosponsors of 34 Republicans and 11 Democrats.

The administration has remained silent on the measure. The Department of Health and Human Services did not respond to a request for comment on the bill.” You can read the full Morning Consult article here. More information about the Affordable Care Act (ACA) can be found on the AHCA/NCAL ACA website.

HHS Releases Nondiscrimination in Health Programs and Activities Proposed Rule

Dianne De La Mare

HHS, Office of Civil Rights (OCR) has released a proposed rule to implement section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. It also authorizes the HHS Secretary to promulgate regulations. Formal comments are due on Nov. 9, 2015.

You may submit comments, identified by RIN Number 0945–AA02,

See the proposed rule

Administration Plans to Appeal House ACA Lawsuit

Dianne De La Mare

The Obama administration has filed a motion in House v. Burwell asking the district court for permission to appeal its decision allowing the House to pursue a lawsuit over the 2010 health care overhaul and the appropriations process. Among other things, the Obama administration is arguing that allowing the House to sue over an alleged violation of the Appropriations Clause is “a momentous step” that threatens to insert the federal courts into disputes that the political branches have historically worked out for themselves.

See Yale Journal, Notice & Comment for more information at

CMS Announces AIC Threshold Amount for Medicare Appeals

Dianne De La Mare

The US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) has released a notice announcing the annual adjustment in the amount of controversy (AIC) threshold amounts for hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for Administrative Law Judge (ALJ) hearings and judicial review filed on or after January 1, 2016. The calendar year 2016 AIC threshold amounts are $150 for ALJ hearings and $1,500 for judicial review.

For more information see the Federal Register at

Convention Events Help Achieve Quality Award Success!

The AHCA/NCAL 66th annual Convention is finally here. Convention is a great opportunity for members to get involved in the AHCA/NCAL National Quality Award Program. Attendees should make sure to stop by one of the many Quality Award events taking place at Convention. We hope to see in you in San Antonio next week!

2015 Recipient Display
Stop by the Parkview Foyer on the Concourse level to view the Quality Award display with the names of the 2015 Bronze, Silver and Gold recipients.

Quality Award Program Booth (Monday, Oct 5th and Tuesday, Oct 6th)Applicants, recipients and interested members are encouraged to visit Quality Award staff at the Quality Award Program booth, #814. This is a great opportunity to ask questions about the program, the application process or your recent feedback report. The expo hall is open on Monday from 11:30am to 3pm and Tuesday from 11am to 2pm.

Ceremony and Celebration (Tuesday Oct 6th)
The 2015 Quality Award Ceremony will take place from 4 to 6pm in the Convention Center Ballroom C. 2015 Bronze, Silver and Gold Recipients will be recognized at the ceremony, followed by a keynote speech from Jake Wood. Immediately following the ceremony will be a celebration at the Grand Hyatt from 6 to 7pm.

Educational Sessions (Monday, Oct 5th – Wednesday, Oct 7th)
Session date, locations and details can be found in the Convention program book or on the Convention website.
Session Title
Best for:
The Bronze Quality Award: How-To, Tools and Resources
Performance Results: Selecting, Comparing and Using Data to Drive Improvement
Silver and Gold
Through the Eyes of an Examiner
Silver and Gold
The Importance of Continuous Improvement and Innovation
Silver and Gold
It’s More than a List of Questions: Using the Quality Award Criteria as Your Roadmap to Excellence!
All interested attendees
Avoiding the Top Pitfalls of the Silver Application
Bronze Quality Award Workshop: Train the Trainer Session
The Silver Quality Award: Becoming Award Worthy
The Gold Quality Award: How-To, Tools & Resources and Recipient Panel

As always, feel free to reach out to Quality Award staff at

**Dates to Know**
  • September 15: Intent to Apply (ITA) process opens
  • November 19: Intent to Apply deadline
  • December 7: Applications accepted online
  • January 28: Bronze, Silver and Gold application deadlines

ICD-10 Is Here!

Dianne De La Mare 

By the time you read this article, the long awaited ICD-10 implementation date will be here! On Thursday, Oct. 1, 2015, the national standardized coding system will go live, whether or not the federal government shuts down on Oct. 1, 2015, according to the Centers for Medicare & Medicaid Services (CMS). On Sept. 25, 2015, CMS released final information on ICD-10 titled “Coding Around the Compliance Date.”

 This document reminds providers “that if the date of service was before Oct. 1, 2015, [they] must submit the claim with the appropriate ICD-9 diagnosis code—even if [they] submit the claim on or after the ICD-10 compliance date.” It refers Medicare Fee-For-Service providers to more information available on the ICD-10-CM/PCS Frequently Asked Questions and reviews MLN Matters guidance (MLN Matters SE 1325, MLN Matters SE 1408 and MLN Matters 1410) that discuss claims that span the Oct. 1, 2015, implementation date. It reminds providers that CMS will not allow for dual processing of ICD-9 and ICD-10 after Oct. 1, 2105 (See CMS FAQ 12430). It also refers providers to CMS ICD-10 website and for the latest news and resources to help with compliance, including the ICD-10 Quick Start Guide. Lastly, it reminds providers that they can sign up for CMS ICD-10 Email Updates.

Further, on Sept. 22, 2015, CMS updated its Clarifying Questions and Answers Related to the July 6, 2015, CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities. As reported previously, AHCA has been pressing CMS to allow SNF/NF “providers” the flexibilities it is allowing “practitioners.” AHCA is disappointed by the Q&A response to the new Question #17 that the flexibility will not be extended to “providers,” and although we appreciate that CMS highlights that the ICD-10 Ombudsman will “quickly identify and initiate resolution” of any “provider” issues that arise, we strongly disagree with the rationale provided. AHCA also has requested other guidance specific to SNF/NF ICD-10 implementation; but to date CMS has not provided us with any response. AHCA will continue to press on this issue.

To see AHCA ICD-10 resources go to

Check Updated LEIE Database

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) has 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 August 2015. 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 health care 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.

Two-Midnight Rule and Recent Federal Judge Ruling

Dana Halvorson

According to a Sept. 23, 2015 McKnight’s article, “The U.S. Department of Health and Human Services must rethink a section of the controversial two-midnight rule that would cut 0.2% from inpatient payments to hospitals, a federal judge ruled this week. U.S. District Court Judge Randolph Moss said HHS Secretary Sylvia M. Burwell needs to better justify the rate cut, which has caused concerns among hospital associations.

The court also ruled HHS must reopen the portion of the rule that includes the rate cut for more public comment. Burwell originally said the cut would help offset the estimated $220 million it would cost to shift patients from outpatient to inpatient status under the two-midnight rule. Hospitals cried foul, saying the cut was unnecessary, and that they weren't given an opportunity to comment on the proposed cut.” The two-midnight rule requires patients to be hospitalized for two midnights before they qualify as an inpatient, which can allow beneficiaries to qualify for SNF coverage. The full McKnight’s article on the ruling can be found here