Friday, February 27, 2015

Supreme Court Hears ACA Litigation in Early March

Dianne De La Mare

AHCA/NCAL consultant, Podesta Group, has released a memo outlining its projected impact, the state of contingency plans, potential alternatives and political consequences in the important Affordable Care Act (ACA) litigation, King v Burwell, scheduled to be heard in the US Supreme Court on March 4, 2015.

Wednesday, February 25, 2015

NOTICE Act on Markup Calendar in Ways and Means Committee

The House Ways and Means Committee announced Tuesday that H.R.876, the NOTICE Act, will be sent to committee for marking up on Thursday, February 26th.

The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, sponsored by Congressmen Lloyd Doggett (D-TX-35) and Todd Young (R-IN-9), 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 legislation was reintroduced February 11th of this year after gaining support in the House last year. The committee markup stage of legislative drafting will allow the full Ways and Means committee to debate, amend, or rewrite the Act, if desired.

Often times, patients have no idea what their status is in a hospital or the importance of it, as hospitals are not currently required by federal law to inform beneficiaries of in- or outpatient status.  Outpatient observation stays do not qualify beneficiaries for Medicare coverage of skilled nursing after time in the hospital. Observation status can cause rapid spend-down, accelerating the time frame in which seniors will have to turn to programs such as Medicaid to pay for their care.

AHCA/NCAL supports the NOTICE Act as it is an important step in ensuring that beneficiaries understand what is happening to them.

Tuesday, February 24, 2015

Hill Takes Up ICD-10

Dianne De La Mare

The House Energy & Commerce Committee held a hearing on the US Department of Health and Human Services (HHS) role in the approaching deadline for ICD-10. The majority of the Subcommittee members concede that there is no need for any further delays for the code set implementation start date on October 1, 2015.

Republicans on the Subcommittee are concerned that the “botched roll out of” have forced them to consider whether the Centers for Medicare and Medicaid Services (CMS) can truly be ready by the October deadline to implement the 10th version of the International Classification of Diseases (ICD-10). The Subcommittee has called upon CMS to share a contingency plan in case its systems have trouble implementing the new codes this fall.

To obtain background information and a transcript of the hearing go to

OIG Discusses Effects of Exclusion from Federal Health care Programs

Dianne De La Mare 

The US Department of Health and Human Services, Office of Inspector General (OIG) has issued an Advisory Opinion (AO) in response to a question from an excluded provider about payments for services performed prior to the effective date of his/her exclusion from the federal health care programs. OIG determined that in this instance, the excluded provider was entitled to receive payment from the buyer of his/her medical practice for services furnished prior to exclusion from the federal health care programs.

Pursuant to a criminal plea and a civil False Claims Act (FCA) settlement, an individual provider was excluded from participation in the Federal health care programs for a period of 20 years. The effective date of the exclusion was October 25, 2013. Under the terms of that global settlement, the provider also was required to divest all ownership of his medical practice. The sale of the practice’s assets were finalized in an agreement dated October 31, 2013. Prior to the exclusion date, the individual provider performed services and submitted claims for services but the federal government did not make any payments for these services until after the individual’s exclusion date. In selling his/her medical practice, the excluded individual negotiated with the buyer that it would remit all payments received from the federal government prior to his/her exclusion date for services that the individual provider had furnished.

According to the OIG, under the Social Security Act, Section 1128, no payment can be made by any federal health care program for any items or services furnished directly or indirectly to an excluded individual. However, in this specific case, OIG distinguished the individual provider’s situation because the services were furnished before the effective date of the exclusion. Therefore, OIG concluded that in this specific instance, receiving payment from the buyer for services after the exclusion date did not violate the terms of the provider’s exclusion and would not give rise to additional administrative sanctions.

To obtain the complete OIG AO 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 January 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.

US Bureau of Census testing in 2015

Lyn Bentley

The US Census Bureau is conducting tests in 2015 that they believe could significantly improve the upcoming 2020 Census. Census tests are scheduled for April 1, 2015 in Maricopa County, AZ and Savannah, GA area.

According to the Census Bureau, the tests will explore new ways for the population to respond to the once-a-decade census, as well as more cost effective ways for census takers to follow up with households that fail to respond. Federal law requires individuals to participate in the U.S. Census. Nursing centers, assisted living communities, ICFs/IID, waiver group homes, and ID/DD residential services in these two areas of the country may be part of the testing. To learn more about these tests, go to:

 Also, a national content test will take place from August to November 2015. According to the Bureau of Census, the 2015 National Content Test has three primary objectives:

      1) Evaluate and compare different census content, including race and Hispanic origin, relationship, and within-household coverage.

       2) Test different contact strategies for encouraging households to respond and, specifically, to respond using the less costly and more efficient Internet response option.

       3) Test different options for offering non-English materials, to provide language support for respondents with limited English proficiency.

 As referenced for the above April 1, 2015 tests, the National Content Test may also impact nursing centers, assisted living communities, ICFs/IID, waiver group homes, and ID/DD residential services.

Survey on Insulin Pen Use in LTC

Holly Harmon

Earlier this month, AHCA shared information about Purdue University College of Pharmacy’s Center for Medication Safety Advancement performing a research survey to assess the current insulin pen utilization in the long-term care setting. The goal of the survey is to assess the prevalence of insulin pen utilization in the long-term care setting and identify best practices to mitigate risks associated with pen utilization.

The survey can be found here: Please complete before Friday, February 27th.

All responses are anonymous and it should only take 5-7 minutes to complete. For any questions, please contact Katelyn E. Brown, PharmD Medication Safety Fellow at

Webinar: What Employers Need to Know Regarding ACA Reporting & Tax Requirements

Adrienne Riaz-Khan

The Affordable Care Act (ACA) contains a number of provisions affecting taxes, fees, and additional reporting requirements. Most of these provisions apply to all types of entities including long term and post-acute care providers. As an employer, it has been increasingly difficult to monitor and comply with all ACA provisions. Rick Krueger of CliftonLarsonAllen will provide an overview of key provisions affecting employers and explain key action items required to comply with the law during this webinar.

What Employers Need to Know Regarding ACA Reporting and Tax Requirements
Wednesday, March 25, 2015
2:00 PM-3:00 PM Eastern Time

Rick Krueger, CPA
Health Care, CliftonLarsonAllen LLP

Learning Objectives
· Review and gain an understanding of key changes to tax law affecting employers and employees.

· Discuss key changes in arrangements to reimburse employees for health insurance.

· Review employer reporting requirements and deadlines.

· Discuss other changes affecting fees and premiums under the ACA.

Length of Stay Data Now Available on LTC Trend Tracker

AHCA members can now utilize the new Length of Stay (LOS) metric offered in LTC Trend Tracker, an online analytics tool that enables long term and post-acute care providers to access key information that can help their organization succeed. 

The new feature calculates the median LOS for all new admissions from a hospital, as well as the percentage of new admissions who have stays of seven, 14, 20 and 45 days or fewer. The LOS metric is:

· Based on MDS 3.0 data

· Calculated for new admissions regardless of payor status to a nursing center from a hospital

· Calculated based on the number of days between their admission and discharge from the Center

 This new feature is part of AHCA’s ongoing efforts to make LTC Trend Tracker a central place to access key data, including all the data CMS collects on skilled nursing centers. In addition, members can find exclusive, in-house measures to help gain insight on hospital readmissions and discharges to the community. They can also upload their RUG data and will soon be able to learn about CMS’s recent changes to the Five Star rating system.  

Visit for more information and to learn about the new LOS metric.

Please contact the LTC Trend Tracker team with any questions.

ENERGY STAR’s 2015 Battle of the Buildings Competition is Now Open

Lyn Bentley

ENERGY STAR’s 2015 Battle of the Buildings competition is now open for registration. In past years, competitors who reduced their energy consumption saved an average of $25,000 and reduced energy consumption by 8%.

This is EPA’s fifth year and in 2014, more than 100 teams threw their hats in the ring. Teams were made up of at least 5 buildings and included different types of buildings. Teams can come from a region, by city, state, or other configuration.

EPA will recognize teams and buildings with the biggest reductions, and will once again offer recognition to any competitor reducing energy or water use by 20% or more. ENERGY STAR is making a massive recruitment effort now in the senior care sector and is offering the following items.  Check out the sample Web banner, buttons, newsletter articles, tweets, and web text.  Would you consider using it?

This past fall, ENERGY STAR expanded space types eligible for a score and recognition to include multifamily. This will enable members that have predominantly senior independent living to benchmark, receive a score, and potentially be eligible for recognition.

More information can be found at