Wednesday, February 14, 2018

2017 Report on Direct Support Professionals Released

People with an intellectual and developmental disabilities (ID/DD) rely on Direct Support Professionals (DSPs) for daily support that enables them to live in U.S. communities. 
The report describes the current state of the DSP workforce as a "crisis," noting that the average DSP wage is $10.72, most work two or three jobs, and the average annual DSP turnover rate is 45%. 
The full report can be viewed here

Hotel Deadline Extended: 2018 Independent Owner Leadership Conference

Hotel Deadline Extended!

The deadline to reserve your hotel for the IO Leadership Conference at the special AHCA/NCAL group rate has been extended! You have until 5 pm on Thursday, February 15! So don't wait. Reserve today, and remember—you must first register for the conference before you can book your hotel room. 

The New Orleans Marriott is conveniently located in the heart of the French Quarter.

Review the agenda, check out the speakers, and meet the sponsors at Take advantage of all that the IO Leadership Conference can offer you.  
  • Gain an understanding of your center's market valuation
  • Connect with risk managers to further evaluate your liability insurance options
  • Receive tax/audit advice, reimbursement and cost solutions from an industry expert
  • Learn new and patient focused therapeutic programs assisting SNF and ALF communities today 
You'll enjoy three days of unbeatable education, networking, and sharing.

Education sessions focus on:
  • Honing your leadership skills 
  • Learning ways to be flexible, adaptable, and transformational in a shifting marketplace
  • Creating new financial opportunities
  • Interpreting how various alternative payment models might influence your company and your service offerings
  • Understanding how Affordable Care Organizations impact post-acute care
  • Providing best-practice solutions to improve outcomes 

Earn up to 8.75 CEUs. You'll also learn specific strategies and solutions you can start implementing at your centers right away.

                                          Register online by March 2, 2018

First-time attendees save $100. The IO Conference immediately follows the AHCA/NCAL Quality Summit, also taking place at the New Orleans Marriott. Save an additional $50 when you register for both!

American HealthTech, Berkadia, CapitalOne, DirectSupply, Dynamic Mobile Imaging, Evans Senior Investments, Genesis Rehab Services, Guardian Pharmacy Services, HealthCap, AHCA/NCAL Insurance Solutions, Kronos, MatrixCare, Mueller Prost, Navigator, Reliant Rehabilitation, Select Rehabilitation, Vivizer Healthcare

AHCA/NCAL Announces New Partnership with ACHCA for Administrator Credentialing

Dave Kyllo

AHCA/NCAL is pleased to announce a new partnership with the American College of Health Care Administrators (ACHCA) for its administrator certification programs. 

The goals of the partnership are to increase awareness of advanced certification and professional growth opportunities and to encourage independent professional certification for nursing facility and assisted living administrators/directors. 

There are many benefits to credentialing including:

National Recognition and Endorsement ACHCA’s professional certification program identifies and honors facility administrators and directors who are preforming at an advanced level of skill and knowledge. 
Commitment to the Public Professional certification through ACHCA reflects a commitment to residents, families and staff.  Certified administrators/directors have advanced knowledge and experience to lead their facilities. 
Enhancement of the Profession Professional certification promotes quality in the profession and improves the public image of administrators/directors. 
Personal Satisfaction and Sense of Achievement Unlike licensure, certification is a voluntary program which allows experienced and practicing administrators to validate their knowledge, skill and abilities. 
Employer Recognition Certification is considered a plus by many employers. 

AHCA has established eligibility criteria prior to taking the exam, including two years of licensure (other options exist for assisted living administrators in states without administrator licensure) and continuing education requirements. Both must be established before an individual is authorized to sit for the credentialing exam. While ACHCA membership has many benefits for administrators/directors, ACHCA membership is not a requirement for ACHCA certification.

The application fee for either the nursing facility or assisted living certification exam is $150. AHCA/NCAL members should use AHCA/NCAL members should use code AHCANCAL when they complete their initial ACHCA applications. The single credential fee (the fee paid after an individual passes the exam) is only $300 for AHCA/NCAL members, a $50 discount off the regular non-ACHCA member price when AHCA/NCAL members use promo code AHCANCAL at checkout. 

Credentialing through ACHCA lasts five years. Recertification involves obtaining 150 hours of continuing education in five areas during the five-year certification period and paying a recertification fee.

ACHCA certification can provide State licensure reciprocity with certain states. Licensing rules and requirements vary by state. Check with your state licensing board for your state’s reciprocity requirements. A list of state licensure boards and contact information is maintained on the NAB website at

For more information about ACHCA certification, go to or call 1-800-561-3148.  

Deliver the “Food of Love” with Music from Mood Media

William Shakespeare said “if music be the food of love, play on…”  Members can deliver the magic of music in their communities through the music offered by Mood Media at AHCA/NCAL “Member Only” discounted rates.

Mood Media offers great musical variety for events or casual common area listening via the internet or streaming, and offers customized commercial free music options that allow facilities to tailor musical selections to meet changing resident preferences. Mood customers enjoy freedom from music licensing worries on Mood Media’s huge collection of music selections played on Mood Media's portable devices.

Use Mood Media’s music to:

  • Improve the dining experience and set the mood in dining areas as residents gather for meals;
  • Provide a variety of background music in common areas;
  • Create a positive environment for activities; and 
  • Provide musical entertainment for social gatherings and happy hours.

AHCA/NCAL members receive exclusive discounted rates on Mood services and equipment with three-year agreements. The core music package starts at $29.99 per month or about $1 per day with a three-year agreement.

For more information about Mood Media’s services, call 800-345-5000 or go to (password: moodpartner).

Even Infection Control Training Feels the Love this Valentine’s Day

Dave Kyllo

A whopping 97 percent of health care professionals who have completed the AHCA/NCAL Infection Preventionist Specialized Training (IPCO) course thus far recommend that their colleagues take the course if they are interested in learning more about the infection prevention and control and antibiotic stewardship.That’s because the AHCA/NCAL course delivers!

The online course provides education for healthcare professionals who seek to serve as Infection Preventionists and prepares individuals to meet the antibiotic stewardship requirements that took effect for nursing facilities on November 28, 2017. The training is also beneficial for assisted living centers because the methods for preventing and controlling infections are universal and apply regardless of setting.

The Infection Preventionist Specialized Training (IPCO) course provides education for all healthcare professionals who want to lead infection prevention efforts and prepares individuals to play an active role in the antibiotic stewardship efforts. Antibiotic stewardship is an overarching goal and priority among all health care professionals and is receiving a lot of attention from state and national health care regulators.

AHCA/NCAL’s course is an online, self-study program with 23 hours of training. It includes online lectures, case studies and interactive components taught by subject matter experts who have real life experience working in long term/post-acute care.

The course addresses both clinical and organizational systems, processes and cultural aspects of infection prevention and control that are fundamental to effectively leading and administering successful infection prevention and control programs and antibiotic stewardship programs. Strong and effective infection prevention programs and antibiotic stewardship efforts can set an assisted living center apart from the competition, especially when working with social workers and discharge planners who help seniors with their post-acute decisions.

Upon successful completion of this program, participants will receive certificates including 23 ANCC contact hours. The training course registration fee is $450 for AHCA/NCAL members and $650 for non-members. There are no refunds and no transfers.

Payment and registration must be made online in ahcancalED. The IPCO course can be accessed here or at:

Discounted group purchase rates are available for groups of 25 or more. Those interested in making a group purchase should email AHCA/NCAL at

To access ahcancalED and the IPCO course, members will need to login with their AHCA/NCAL usernames and passwords. For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail with your name and facility contact information. 

CMS Director to Address Quality Summit Attendees – Register Now!

Karen Tritz, Director, Division of Nursing Homes, Survey and Certification Group at CMS will address Quality Summit attendees during the closing general session.

Tritz oversees the new survey process and five-star system. She is also responsible for making changes and modifications to the guidance each state and regional office must follow when enforcing the new regulations. 

She will provide insight into what CMS plans to focus on during the surveys and tips on how to approach the new regulations as well as CMS's plans for the "Patient Over Paper Work" initiative the new administration has launched.

The hotel deadline for the Quality Summit has been extended through this Thursday, February 15.

Don’t wait, make your hotel reservations today and take advantage of discounted group rates, plus you’ll be steps away from the action.

Congress Permanently Repeals Medicare Part B Therapy Caps

Daniel Ciolek

As you are probably aware by now, on Friday, February 9, both houses of Congress passed a budget deal enacted by the President that provides short-term funding to keep the government open through March 23, 2018, and establishes a two-year budget framework. One very important provision in the deal that immediately impacts residents of AHCA/NCAL member facilities is the permanent repeal of the Medicare Part B outpatient therapy caps. This message outlines the major provisions impacting Part B therapy contained in the new law.

AHCA/NCAL are overall pleased with the actions by Congress to permanently repeal the therapy caps.  First, this law permanently removes the risk of dramatically reduced revenues when the caps were enforced.  Second, while we are disappointed that Congress again imposed a Part A market basket cut to help pay for the Part B therapy cap repeal provisions, this law permanently removes the recurring risk for future payment cuts to pay for 1-2-year extensions of the cap exceptions process that we have experienced over the past decade.  Finally, and most importantly, this law now assures that our residents can receive necessary and uninterrupted physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services to improve or maintain their function and quality of life.        


The Medicare Part B outpatient therapy caps limited the amount of PT, OT, and SLP services Medicare would cover per year. These caps were first implemented in 1999 and were enforced for limited periods through 2005. Since 2006, an exceptions process was enacted allowing for medically necessary therapy services above the cap amounts. However, the exceptions process provisions expired at the end of 2017.  Before today's new law, beginning January 1, 2018, Medicare would only cover $2,010 of PT/SLP services combined, and $2,010 of OT services per year. There were no exceptions - even if the therapy was urgently needed for a beneficiary to restore function to remain home, return home, or to maintain their quality of life.  We estimate that, without repeal, SNF Part B therapy revenues would have declined more than $811 million per year (37% of total SNF Part B payments).

What's in the New Law That You Need to Know and Share with Billing and Therapy Staff

  • Therapy caps have been repealed - This means there are no longer any artificial annual limits. 
  • The repeal is retroactive to January 1, 2018 - This means that if you had any residents that had claims denied because they went over the $2,010 cap threshold in 2018 so far, you should be able to resubmit the claims for payment. This should also apply to Medicare Advantage denials as these plans must offer comparable coverage (we are awaiting specific CMS guidance for such situations).  
  • You will still need to submit a KX modifier on claims for any beneficiary services furnished over $2,010 annually for PT and SLP services combined, and over $2,010 annually for OT services separately - This modifier is being used as an attestation of medical necessity. Claims over $2,010 annual thresholds will be denied for noncompliance without this coding. 
  • CMS will restore a targeted medical review program for a limited number of claims over a $3,000 annual threshold - Congress authorized a $5 million annual limit for CMS to conduct limited post-pay medical review, and only on claims that meet specific targeting criteria (such as a pattern of high costs within similar patient populations or similar types of providers). The law prohibits recovery audit contractors from performing these reviews. In recent years, CMS has used a Supplemental Medical Review Contractor (SMRC) to conduct these reviews, and we will update you as CMS begins to implement the new law.
  • The calendar year (CY) 2019 Fee Schedule Update for part B therapy HCPCS billing codes will be 0.25% - In the prior 2014 MACRA "Doc Fix" legislation, Congress had locked in a fee schedule increase of 0.5% for CY 2019. This law has reduced that increase by 0.25%, which we estimate to average about a $350 impact on payments per SNF in 2019 (depending on Part B volume).
  • Starting in CY 2022 the reimbursement for Part B therapy services furnished by PT assistants and OT assistants will be reduced by 15% - This law does not change reimbursement for Part A SNF PPS services furnished by PT or OT assistants - it only impacts Part B billing. The overall impact on SNFs would vary depending on the percentage of treatments furnished by therapy assistants. SNFs with no therapy assistants will not be affected. Most medium to large SNFs likely operate with between 25-50% of therapy furnished by therapy assistants, so we estimate the negative revenue impact for most of these SNFs starting CY 2022 would range from 2.9-5.9% of their Part B Medicare payments. 

We are currently conducting additional impact analyses and will provide updates as they become available.   

If you have additional questions, please contact Dan Ciolek at

Wednesday, February 7, 2018

Alzheimer's Association 2018 Dementia Care Practice Recommendations

To ensure that people living with Alzheimer's or related dementia are receiving high quality care that is based on the most up to date, peer reviewed evidence, the Alzheimer Association released its new Practice Recommendations in a special supplement of The Gerontologist 2018 issue. The topic areas are person-centered care, detection and diagnosis, assessment and care planning, medical management, information, education and support, ongoing care, staffing and therapeutic environment and safety and transitions and coordination of care.

Below are the 10 articles that cover the Alzheimer’s Association 2018 Dementia Care Practice Recommendations:

· The Fundamentals of Person-Centered Care for Individuals With Dementia

· Nonphysician Care Providers Can Help to Increase Detection of Cognitive Impairment and Encourage Diagnostic Evaluation for Dementia in Community and Residential Care Settings

· Person-Centered Assessment and Care Planning

· Ongoing Medical Management to Maximize Health and Well-being for Persons Living With Dementia

· Meeting the Informational, Educational, and Psychosocial Support Needs of Persons Living With Dementia and Their Family Caregivers

· Progressive Support for Activities of Daily Living for Persons Living With Dementia

· Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia

· Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care

· From Research to Application: Supportive and Therapeutic Environments for People Living With Dementia

· Evidence-Based Interventions for Transitions in Care for Individuals Living With Dementia

· Improving Care Through Public Policy

These recommendations will be discussed more at AHCA/NCAL 3rd Annual Quality Summit on March 12-14, 2018 in New Orleans, LA.

House Passes Bill to Fund Government, Repeal Therapy Caps

Drew Thies

The House Tuesday evening voted on bill that funds the U.S. government until March 23, extends important Medicare policies, and permanently repeals the Medicare cap on therapy services.

The legislation repeals Medicare Part B outpatient therapy caps retroactively to January 1, 2018. Without repeal of the therapy caps, revenue and quality of care could suffer significantly. AHCA estimates, without repeal, SNFs’ Part B therapy revenues would decline more than $811 million per year (37% of total Part B payments).

SNF Requirements of Participation require maintaining resident function at the highest practicable level.  However, most long-term residents are on Medicaid or otherwise may have limited funds and cannot pay privately for therapy services.  This could stress SNF nursing staffing further to address the functional needs of these residents if therapy is not an option.

The legislation also permanently restores the limited targeted post-pay medical review program established under the Medicare Access and CHIP Reauthorization Act (MACRA). The program lowers medical review pool threshold for annual beneficiary covered charges from $3,700 for PT/SLP services combined or OT services to $3,000 and limits annual funding for these reviews to $5 million annually.  This eliminates RAC reviews, prior-authorization and pre-pay reviews, as well as 100% review programs.

Issues unrelated to Medicare policy cloud the bill’s path to passage, though the health care aspects of the package are likely to remain in any funding bill that passes both the House and Senate. Republicans will need Democratic support to break the 60-vote filibuster in the Senate and the bill passed on nearly a party-line vote in the House.

Democrats in the Senate disagree with how the spending bill extends defense spending for a year, while only funding domestic programs through the March deadline. There are reports that Congressional leadership is working on a larger deal that matches non-defense spending to defense spending, as well as solves other budgetary items, such as the debt ceiling.

In whatever form it takes, Members of Congress will have to come to an agreement soon. The deadline to extend federal government funding is Thursday, February 8.

Demonstrate Your Geriatric Nurse Competency with Gero Nurse Prep

Dave Kyllo

AHCA/NCAL Gero Nurse Prep does much more than just prepare RNs to take the American Nurses Credentialing Center (ANCC) board certification exam in gerontological nursing. 
It increases experienced RNs’ knowledge of gerontological nursing practice.  Gero Nurse Prep students see a whopping 24 percent average increase on their pre- and post-test scores. 

The statistics prove it.  Gero Nurse Prep grads know more about gerontological nursing.    Taking the AHCA/NCAL Gero Nurse Prep course does obligate a RN to sit for the ANCC Board certification exam.  Registered nurses who are interested in increasing their knowledge of gerontological nursing practice can simply complete the AHCA/NCAL Gero Nurse Prep course earn 30 CEUs, and increase their skills and knowledge of geriatric nursing.
AHCA/NCAL Gero Nurse Prep is also designed to thoroughly prepare RNs to take the American Nurses Credentialing Center (ANCC) board certification exam in gerontological nursing.  It does that.  RNs who complete the Gero Nurse Prep program have a passing rate of 96 percent on the ANCC exam on their first try. 

ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association.  Less than one percent of America’s RNs are board certified in gerontological nursing.  That means having an ANCC Board certified RN can easily give providers an edge in the marketplace. 

AHCA/NCAL Gero Nurse Prep is affordable at $690 for 30 CEUs worth of high quality training that gets results.  For RNs interested in pursuing Board certification through ANCC, that cost is an additional and separate cost of $395. 

Watch this video to learn more about AHCA/NCAL Gero Nurse Prep or click on the course preview to get a quick view of this engaging on-line curriculum designed to increase gerontological nursing knowledge and help RNs pass the ANCC exam. 

Build a strong geriatric nursing team. Check out AHCA/NCAL Gero Nurse Prep today.