Friday, June 26, 2015

US Supreme Court Rules in Favor of ACA Subsidies

Dianne De La Mare

The U.S. Supreme Court issued its decision in King v. Burwell, finding in favor of the Obama Administration, and voting 6-3 to uphold the Affordable Care Act’s (ACA) subsidies in states that have a federally-run exchange. Specifically, the Court said that the Internal Revenue Service (IRS) was authorized to issue the ACA-related rule that extends tax-credit subsidies to individuals who purchase insurance through either a state- or federally-run exchange.

This means that the ACA is here to stay, at least for now. In other words, it is "business as usual" in all exchanges, whether those exchanges are state- or federally-run. Currently, 34 states rely on federally-run marketplaces. Another 13, plus Washington, D.C., have their own state-run exchanges, and three others have state marketplaces but use to determine subsidy eligibility.

The Court's decision clarifies that subsidies will continue to be available to any individual who purchases insurance through any exchange (state-run or federally-run), and earns between 100-400 percent of the federal poverty level. That means those individuals who previously had tax-credit subsidies in federal-run exchanges will keep those subsidies to the extent that they continue to satisfy the subsidy requirements. Those same individuals also will stay insured.

This also means that AHCA/NCAL members must continue to comply generally with the ACA requirements. As of January 1, 2015, all employers with at least 50 full time employees or a combination of full-time and part-time employees totaling 50 are required to comply with the Employer Shared Responsibility provisions found in the Internal Revenue Code, Section 4980H . If employers do not offer affordable health coverage that provides a minimum level of coverage to full-time employees (and their dependents), the employer may be subject to an Employer Shared Responsibility payment (e.g., a penalty).

To obtain more information go to AHCA’s website at

AHRQ Resource on Health Literacy Interventions and Outcomes

 A new continuing-education resource from the Agency for Healthcare Research and Quality (AHRQ) is now available at no cost for clinicians’ continuing-education credit. The topic brief explores how low health literacy levels are related to poor health outcomes, including higher risks of death and more frequent visits to hospital emergency departments. This resource also highlights interventions that could be implemented in clinical practice to change health outcomes, such as intensive disease-management programs. Access the free topic brief and obtain continuing-education credit at no cost:

New OSHA Enforcement Memo

Lyn Bentley, MSW

OSHA released an enforcement memo today that provides guidance on inspections in hospitals and nursing and residential care facilities. The guidance is intended to replace the National Emphasis Program. Namely, OSHA indicates that all inspections, whether programmed or complaint-based, will cover on the five focus hazards:

· Safe Patient Handling

· Workplace Violence

· Bloodborne Pathogens

· Tuberculosis

· Slips, trips and falls

Thus, based upon reading of the document, even when the complaint is not based on any of these issues, OSHA will look into these five focus areas for all inspections that they perform at your facilities. Other hazards that may be investigated are exposures to MRSA/MDROs and hazardous chemicals when issues come to the attention of the investigator during this inspection. Questions? Contact Lyn Bentley.

Information from AHCA’s OSHA Consultant: Jackson Lewis, P.C.

Adult Immunization & Advisory Committee on Immunization Practices (ACIP) Updates

Holly Harmon

William Schaffner, MD, of the National Foundation for Infectious Disease will discuss the importance of immunization for adults, latest ACIP updates and recommendations for adult vaccination, and best practices for increasing adult vaccination rates.

At the conclusion of the webinar, participants will be able to: 

• Discuss the impact of vaccine-preventable diseases on US adults

• Describe the current ACIP recommendations for adult immunization

• List the core Standards for Adult Immunization Practice for all healthcare professionals

To register:

Wednesday, June 24, 2015

AHCA/NCAL Applauds Senate Finance Committee for Approval of NOTICE Act

Legislation is positive step forward for Medicare beneficiaries

Dana Halvorson 

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) commends the Senate Finance Committee for approving and supporting the Notice of Observation, Treatment and Implication for Care Eligibility (NOTICE) Act (S.1349) during Committee consideration today. The Committee’s approval clears the way for the NOTICE Act to be considered by the full Senate. The NOTICE Act will require hospitals to notify Medicare beneficiaries of their outpatient status within 36 hours. Outpatient status affects a patient’s ability to receive Medicare coverage for post-acute care in a skilled nursing center. Senators Ben Cardin (D-MD) and Michael Enzi (R-WY) introduced the NOTICE Act in the Senate on May 14. On March 16, the House unanimously passed the NOTICE Act (H.R.876), which was sponsored by Congressmen Lloyd Doggett (D-TX-35) and Todd Young (R-IN-9).

CMS Revised ICD-10 Educational Materials

Dianne De La Mare

The Centers for Medicare & Medicaid Services (CMS), Medicare Learning Network (MLN) has revised a number of ICD-10 educational products including: 1) FAQs – ICD-10 End-to-End Testing Article – Revised; 2) General Equivalence Mappings FAQs Booklet – Revised; 3) ICD-10 Myths and Facts Fact Sheet - Revised; 4) ICD-10 Classification Enhancements Fact Sheet - Revised; 5) ICD-10 The Next Generation of Coding Fact Sheet – Revised.

Hill Leaders Urge CMS to Finalize the Equal Access Rule

Dianne De La Mare

In a recent letter from Democratic Committee leaders in both the House and the Senate to the US Department of Health and Human Services (HHS) Secretary, Sylvia Burwell, the leadership urges the agency to finalize the Medicaid Program: Methods for Assuring Access to Covered Medicaid Services, or the so-called “equal access” rule.

With millions of Americans around the nation covered by Medicaid and millions more gaining eligibility for Medicaid benefits, oversight and enforcement of the Medicaid Act’s equal access provision is of critical importance. Further, with the recent US Supreme Court holding in Armstrong v Exceptional Child, making it impossible for providers to enforce the Medicaid Act’s payment provision in federal court, the only recourse providers have to enforce the Medicaid equal access provision is through HHS’ administrative process.

AHCA/NCAL strongly agrees with the Hill Democratic leadership that “CMS must provide firm and immediate oversight to ensure that states are setting and maintaining their Medicaid rate structures as Congress intends in section 1902(a)(30)(A) of the Medicaid Act.”

OIG Releases FY 2015 Work Plan Mid-Year Update

Dianne De La Mare

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG) has released its FY 2015 HHS OIG Work Plan Mid-Year Update, summarizes new and on-going reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. It describes the primary objectives and projected completion day for each activity. Specifically, the Work Plan describes nursing home activities looking at Medicare Part A billing, state agency verification corrections and procedures for national background checks for long term care (LTC) employees. Further, OIG lists activities categorized under Medicare Advantage, Medicaid, Medicaid Managed Care and Fraud and Abuse.

To obtain a copy of the complete report go to

Supreme Court's King v. Burwell Upcoming Decision and Toolkit

Dana Halvorson and Dianne De La Mare

According to a June 23, 2015, email announcement from the Alliance for Health Reform, the organization has a new toolkit will “help you prepare for and understand the Supreme Court's King v. Burwell decision, which could come as early as Friday.” The announcement goes on to note that “the case, a major challenge to the Affordable Care Act (ACA), concerns the legality of health insurance tax credits offered through a federally-run health insurance marketplace, as opposed to a marketplace established by an individual state. Currently, the federal government is operat­ing insurance marketplaces in more than 30 states, and, as of February 2015, 7.5 million people receive premium subsidies in states with a federally-run marketplace. A ruling for the King petitioners could mean that individu­als will no longer be able to receive subsidies to purchase health insurance through the federal marketplace, depending on action by Congress or individual states.” 

The Alliance for Health Reform toolkit summarizes key resources that provide legal, policy, and polit­ical analyses on the case and its implications. It also includes a list of experts, along with contact information. To learn more about the ACA and for helpful resources, please visit AHCA/NCAL’s ACA website.

Tuesday, June 23, 2015

New NPUAP White Paper: Do Lift Slings Significantly Change the Efficacy of Therapeutic Support Surfaces?

Holly Harmon

The National Pressure Ulcer Advisory Panel (NPUAP) has released a new white paper entitled Do Lift Slings Significantly Change the Efficacy of Therapeutic Support Surfaces? The intention of this paper is to increase critical thinking when lift slings are used in combination with therapeutic support surfaces. To view this white paper and others authored by the NPUAP please visit