Friday, August 1, 2014

WANTED: Your Adorable Pics!

Rachel Reeves
Now through September 30th, NCAL is accepting photo submissions for its 'Faces of Assisted Living.' Honor the individuals residing in assisted living communities by sharing those everyday moments or special occasions.

Submitted photos with completed image release forms may be featured in NCAL’s Faces of Assisted Living online album, on AHCA/NCAL social media channels and in future publications. 

NCAL started Faces of Assisted Living to feature actual residents from assisted living communities across the country. These photos are meant to celebrate what assisted living is about - providing care and services that respect resident choice, dignity, and independence in a home-like setting.

Learn how to submit your photo(s) and check out adorable photos from previous years at

Enhancing Communication through CHATs

CHAT stands for Communicating Health Assessments by Telephone. It is a quality improvement program to enhance telephone communication between the nurse and the physician.
CHATs are point-of-care decision support tools adapted from the 2004 American Medical Director’s Association (AMDA) protocols. They represent 16 common clinical problems found in long term care settings. The common conditions include:
  • Abdominal Pain           
  • Agitation
  • Confusion     
  • Altered Mental Status  
  • Bloor pressure     
  • Low Blood Pressure    
  • Chest pain     
  • Constipation     
  • Diarrhea     
  • Dizziness/Unsteadiness   
  • Dyspnea/Shortness of Breath   
  • Fall      
  • Fever      
  • Hyperglycemia    
  • Hypoglycemia     
  • Musculoskeletal Complaint   
  • Nausea or Vomiting    
  • Urinary Complaints or Positive urinalysis
Each CHAT is designed to identify pertinent information that needs to be assessed and communicated for the specific clinical issue. The tools focus on the questions needing to be answered and the examinations needing to be conducted before calling the physician.
visit the AHCA/NCAL website. Learn how to use CHATs, and access each CHAT by medical condition.

Clinical Practice Guideline for Care Transitions

Holly Harmon

The Transitions of Care in the Long-Term Care Continuum guide from American Medical Directors Association (AMDA) focuses on transitions of care which may occur within care settings, between care settings, across health states and between providers. This Clinical Practice Guideline is a useful resource that contains seven steps for implementation of a care transition program. Also included in this guide are sample policy and procedure for care transition, suggested common or essential elements for medication reconciliation, hospitalist checklist for an ideal discharge of the elderly patient and quality indicators for transitions between nursing facilities and emergency departments.

Transitions of care are common and it is critical to ensure appropriate measures are in place to support quality of care and quality of life for the individuals experiencing the transitions. 

To access the Transitions of Care in the Long-Term Care Continuum Clinical Practice Guideline from AMDA

Thursday, July 31, 2014

CMS SNF Long Term Care Open Door Forum on August 6, 2014

Dan Ciolek

The next CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum scheduled for:

Date: Wednesday, August 6, 2014
Start Time: 2:00 PM Eastern Time (ET)

Please dial-in at least 15 minutes before call start time.

 **This Agenda is Subject to Change**

I. Opening Remarks
Chair – Jeanette Kranacs (Center for Medicare)
Moderator – Jill Darling (Office of Communications)

II. Announcements & Updates
CM SNF Final Rule Announcement
General Announcements
QM Manual Announcement 

III. Open Q&A

**Next ODF: September 17, 2014**

Open Door Participation Instructions: 
This call will be Conference Call Only.

To participate by phone:

Dial: 1-800-837-1935 & Reference Conference ID: 45684146

Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Encore: 1-855-859-2056; Conference ID: 45684146

Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID beginning 2 hours after the call has ended. The recording expires after 2 business days.

For ODF schedule updates and E-Mailing List registration, visit our website at

Tuesday, July 29, 2014

Number of Americans Without Insurance Declined

Dianne De La Mare

A recent New England Journal of Medicine study indicates that the number of Americans without health insurance has declined significantly since the Affordable Care Act (ACA) open-enrollment period began in October 2013. The pattern of coverage changes were consistent with the eligibility criteria in the ACA regarding subsidized coverage and US Department of Health and Human Services (HHS) statistics on state-level enrollment in ACA programs. National estimates of coverage after the open-enrollment period will not be available from federal surveys until late 2014, and reliable state-level estimates will not be available until the fall of 2015.

The report concludes that future research with government-conducted surveys will be valuable to corroborate these findings, monitor future trends and further assess the downstream effects of coverage.

To obtain a copy of the entire study go to

IRS Continues to Prepare For the ACA Employer Mandate In 2015

Dianne De La Mare
The Obama Administration is moving forward to implement the Affordable Care Act (ACA) employer mandate that has been delayed twice and is the centerpiece of the House’s lawsuit against President Obama.

On Thursday, July 24th, the Internal Revenue Service (IRS) posted a draft form that employers will have to fill out to comply with the Affordable Care Act (ACA) requirement that employers provide health insurance to workers. According to the national press, an Administration official has said that  “the White House is sticking to the timeline announced earlier this year.”

To obtain a copy of the IRS form go to

Federal Appellate Courts Issue Conflicting Decisions

Dianne De La Mare

As you’ve read in the press, two federal courts have issued directly conflicting decisions on the same day (July 22nd) on the availability of subsidies for health insurance purchased by individuals on exchanges established by the federal government under the Affordable Care Act (ACA). A three-member panel of the DC Circuit Court of Appeals has held that the subsidy is only available for insurance purchased on a state exchange (versus a federal exchange); invalidating the Internal Revenue Service (IRS) regulation that authorizes the subsidy for insurance purchased on a federal exchange (Halbig v Burwell).

Shortly thereafter (within hours), a three-member panel of the Fourth Circuit Court of Appeals reached the opposite conclusion, and held that subsidies are available to all individuals who purchase insurance from the federal government, regardless of whether or not those exchanges were established by the federal government (as in most states) or by an individual state.(King v Burwell).

If it is eventually determined that the IRS regulation is invalid and subsidies are not available on exchanges established by the federal government, then one leg of the government’s “three-legged stool” in the ACA is removed in more than ½ the states (with federal exchanges) in the US (recall the solutions enacted in the ACA are often referred to as the “three legged stool” of health care and consists of 1) guarantee of insurance; 2) mandate of insurance; and 3) subsidies so that those who can’t afford insurance can get help).

AHCA/NCAL will keep you informed as we follow this important litigation through the judicial process. 

Observation Stays Issue Remains at the Forefront on Capitol Hill

Dana Halvorson
The observation stays issue remains at the forefront before Congress breaks for August recess. The U.S. Senate Special Committee on Aging is holding a hearing today entitled, Admitted or Not? The Impact of Medicare Observation Status on Seniors. Committee Chairman Bill Nelson (D-FL) and Ranking Member Susan Collins (R-ME) will be leading the hearing at 2:00 pm ET in Senate Russell 418, focusing on the observation stays issue. Witnesses will include AHCA/NCAL member Bob Armstrong, Vice President, Elder Care Services, St. Mary’s Health System, Lewiston, Maine. For the witness list, check the website for the Senate Special Committee on Aging
Hospital stays classified as observation, no matter how long and no matter the type or number of services provided, are considered outpatient. These hospital stays do not qualify patients for Medicare-covered care in a skilled nursing center.
In addition to the hearing today, earlier this week, Congressmen Lloyd Doggett (D-TX-35) and Todd Young (R-IN-9) introduced the Notice of Observation Treatment and Implication for Care Eligibility Act H.R. 5232, also called the NOTICE Act. The legislation requires hospitals to give formal notice to patients within a period of time after classifying them as an inpatient or as an outpatient under observation. The bill is a positive step forward, and raises attention to a complex and critical issue hurting the nation’s seniors. Specifically, the NOTICE Act works to ensure that hospitals notify patients entitled to Medicare part A coverage of their outpatient status within 36 hours after the time of their classification or, if sooner, upon discharge. Often times, patients have no idea what their status is in a hospital or the importance of it. This can lead to thousands of dollars in out-of-pocket medical expenses should they need skilled nursing center care following their hospital stay. The observation stays issue is a financial burden on seniors and their families. It can cause unnecessary spend-down, accelerating the time frame in which seniors will have to turn to programs such as Medicaid to pay for their care.
Although the NOTICE Act is an important step in ensuring that beneficiaries understand what is happening to them, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and other provider and beneficiary groups continues to advocate for legislation that would address the observation stays issue once and for all. AHCA/NCAL strongly support Reps. Joe Courtney (D-CT) and Tom Latham (R-IA), along with Sen. Sherrod Brown (D-OH) in the legislation they introduced, The Improving Access to Medicare Coverage Act of 2013, which seeks to count all hospital days spent in observation towards the three-day stay requirement. The association also continues to support the Creating Access to Rehabilitation for Every Senior (CARES) Act of 2013, introduced by Rep. Jim Renacci (R-OH), and the Fairness for Beneficiaries Act of 2013, introduced by Rep. Jim McDermott (D-WA).
For more information about observation stays, please visit the AHCA/NCAL website

Recall of Emergency Light Fixture

Lyn Bentley

The Consumer Product Safety Commission (CPSC) advises that Lithonia Lighting has recalled emergency lights due to a fire hazard. These emergency light fixtures may be used in nursing centers and assisted living centers. The link for the recall information provides a photograph of the fixtures as well as describing the potential danger and remedy.

According to the notice, this recall involves the Quantum® series ELM and ELM2 emergency light fixtures and consumers should contact Lithonia Lighting to receive detailed instructions on how to locate the circuit board and series name and to order a free repair kit, which includes a new circuit board.

Monday, July 28, 2014

INTERACT: Evidence-Based Quality Improvement Program

Holly Harmon

INTERACT (Interventions to Reduce Acute Care Transfers) is a quality improvement program that focuses on the management of acute change in resident condition. It includes clinical and educational tools and strategies for use in every day practice in long-term care centers.

INTERACT is designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents. The goal of INTERACT is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital.

Hospital readmissions not only have the potential for negative physical, emotional and psychological impacts on individuals in skilled nursing care, but also cost the Medicare program billions of dollars.

The issue has become a top priority for CMS and managed care programs over the past several years. Rehospitalization rates will be linked to SNF payments in the near future. Don’t delay efforts to actively work on improving practices that prevent rehospitalizations and developing systems to sustain improvement.

To visit the INTERACT website and obtain more information.

To learn more about the AHCA/NCAL Quality Initiative goal to safely reduce hospital readmissions within 30 days during a SNF stay by 15% by March 2015.