Wednesday, July 16, 2014

Congress Goes into a Lull Ahead of Elections

Drew Thies

With fewer than six scheduled weeks of legislative work scheduled between now and the general election on November 4th, both the House and Senate are slowing down action on Capitol Hill and devoting their focus to campaigning.

Primary elections and political campaigns have come to dominate headlines and airwaves both in Washington and in the states despite some contentious fights over appropriations legislation. Members of Congress are hoping to wrap up business in the Capitol as quickly as possible and return to their home districts.

The campaigning has already begun to directly affect legislation’s fate in the chambers. A once bipartisan bill to increase hunting and fishing access on federal land died in the Senate last week after accusations that Senate Majority Leader Harry Reid (D-NV) closed off the amendment process to protect the bill’s vulnerable Democratic sponsor, Sen. Kay Hagan (D-NC). Hagan’s race is listed as a “toss-up” and the bill was largely seen as a boon to more conservative voters in North Carolina.

There is little chance that the elections will sway the balance of the House, which the Republicans control by a safe margin, but control of the Senate is still largely a coin flip. With some Democrats still polling competitively in more conservative states, Democratic leadership seems content to allow the budget fights to be postponed until after the election, and Republicans might follow suit.

Legislators on both sides are trying to avoid the spats that can turn voters against them. Tome Cole (R-OK), a senior member of the House, remarked that “[Speaker of the House] John Boehner (R-OH) and his leadership are taking all the sharp objects out of the room so we can’t hurt ourselves” ahead of the November elections.

Both Chambers are scheduled to recess for the entirety of August, a yearly routine that allows them extended time in their home states, as well as most of October, when campaigns will be in full-swing.

Tuesday, July 15, 2014


Jon-Patrick Ewing

The early bird registration for the 65th Annual AHCA/NCAL Convention & Expo ends this Friday, July 18. If you haven't registered for this year's event, don't wait any longer. Register before the deadline ends and get the maximum discounts available.

Join AHCA/NCAL and thousands of long term and post-acute care professionals in the nation's Capital. This year's event will be held at the Gaylord Resort & Convention Center, across the banks of the Potomac River at National Harbor.

Don't miss this amazing opportunity to learn, network, hear from national keynote speakers, and explore one of the largest health care Expos while discovering the rich history of Washington, DC.

It’s Your Turn

Meg LaPorte

After 40 years of publishing, we think it’s about time to give the readers a little more say in what they see in the pages of  Provider magazine. In other words, we want you to write your own stories about your own experiences in long term and post-acute care. Our first-ever crowdsourced issue of the magazine, which we are calling By You, For You, will be published this December, and we want you—the readers—to get the latest in what’s happening on the ground and in the trenches of this field we love. You will hear more from us in the coming weeks and months, so please stay tuned, and think about what you will write for us!

The confluence of new technological innovations, higher-acuity residents, and increasing attention from REITs makes assisted living a popular sector these days, and Contributing Editor Kathleen Lourde has the story. Some providers are making quality indicators a priority as the potential to partner with ACOs becomes more of a reality. Lourde also examines some innovative approaches to helping residents stay in their assisted living settings for as long as possible, while a handful of REITs are making assisted living investments a priority.

This month’s feature story outlines new guidelines issued for the design of person-centered health care facilities. Architect Jane Rohde describes how the guidelines work and the purpose, as well as importance, of their contents.

Caregiving fatigue is real, and its impact on caregivers needs attention, according to this month’s Human Resources column. Author Susan Reese says that work-hour patterns and varied combinations of weekdays and shifts contribute to fatigue for caregivers, which can lead to exhaustion, absenteeism, and, eventually, higher turnover.
Electronic health records are not new, of course, but implementing them in long term and post-acute care settings can be a bit of a chore. In this month’s Technology in Health Care, OnShift President and CEO Aric Agmon describes the three steps to getting EHR implementation right the first time.

The management of chronic obstructive pulmonary disease (COPD) is the topic of this month’s Focus On Caregiving. Authors John Walsh and Byron Thomashow, MD, walk through the diagnosis and treatment of this crippling disease in the long term care setting.

Monday, July 14, 2014

Access 2014 PEPPER Reports Now

Dianne De La Mare

As reported previously, the 2014 release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for skilled nursing facilities (SNFs) has been available for download through the secure access page at since May 5, 2014. As of June 30th, however, only 7,363 (49%) of the 14,961 SNF PEPPERs have been accessed.

By way of background, PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. AHCA encourages all its members to obtain the report and evaluate and compare its contents to the data from 2013.

To obtain more information go to for facility-specific data, user’s guides, recorded web-based training sessions and sample PEPPERs.

Check Updated LEIE Database

Dianne De La Mare

The US Department of Health, Office of Inspector General (OIG) has just 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 June 2014. 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.

GAO Releases Fraud, Waste and Abuse Report

Dianne De La Mare

The US General Accounting Office (GAO), has released a report, Medicare Fraud: Further Actions Needed to Address Fraud, Waste and Abuse, concluding that although the Centers for Medicare & Medicaid Services (CMS) has made progress in implementing key strategies to protect the Medicare program from fraud and abuse, there are important actions that CMS must still implement. Areas where CMS needs to continue its work include provider and supplier enrollment, prepayment and post payment claims review, and identify and address vulnerabilities.

Although CMS has implemented actions to strengthen provider and supplier enrollment that addresses past weaknesses identified by GAO; it could further strengthen enrollment screening by issuing a rule to require additional provider and supplier disclosures of information. GAO also has encouraged CMS to increase its use of prepayment edits to help prevent improper Medicare payments up front. To date, CMS has yet to implement past GAO recommendations encouraging CMS for better oversight of the information systems that analysts use to identify claims for post-payment review and the contractors responsible for these reviews.

Lastly, CMS’ mechanisms and processes continue to show vulnerabilities that could lead to improper payments. For example, GAO has made multiple recommendations to CMS to remove Social Security numbers from beneficiaries’ Medicare cards to help prevent identify theft, but CMS has yet to proceed with the changes.

To obtain a complete copy of the GAO report go to

DOJ/HHS Announce Framework for Elder Abuse Prevention

Dianne De La Mare

The US Department of Justice (DOJ) and the Department of Health and Human Services (HHS) have just released the Elder Justice Roadmap (Roadmap), which describes the government’s top five priorities (i.e., awareness, brain health, caregiving, economics and resources), for understanding and reducing elder abuse in this country. The Roadmap was developed by obtaining information and expertise from hundreds of public and private stakeholders from across the country during summits. The goal of those summits was to identify the most critical priorities and concrete opportunities for greater public and private investment and engagement in elder abuse issues.

As part of this effort, DOJ has developed an interactive, online curriculum to teach legal aid and other civil attorneys how to identify and respond to elder abuse. The first three modules of the training cover:
  • what lawyers should know about elder abuse;
  • practical and ethical strategies to use when facing challenges in this area;
  • a primer on domestic violence and sexual assault.
The training will eventually expand to include six one-hour modules covering issues relevant to attorneys who may encounter elder abuse victims in the course of their practice.

HHS also is supporting this effort by developing a voluntary national adult protective services (APS) data system, which will better inform the development of improved, more targeted policy and programmatic interventions. To obtain the Roadmap and accompanying materials go to

Establishing a Minimum Wage for Contractors and the VA

Dana Halvorson and Dianne De La Mare

As noted previously, on February 12, 2014, President Obama signed Executive Order 13658, Establishing a Minimum Wage for Contractors. The Executive Order raises the hourly minimum wage paid by contractors to workers performing on covered Federal contracts to: (i) $10.10 per hour, beginning January 1, 2015; and (ii) beginning January 1, 2016, and annually thereafter, an amount determined by the Secretary of the Department of Labor (DoL) in accordance with the Order. On June 17, 2014, DoL released the proposed rule that establishes standards and procedures for implementing and enforcing the minimum wage protections of Executive Order 13658. The proposed rule incorporates existing definitions, procedures, remedies, and enforcement processes under the Fair Labor Standards Act, the Service Contract Act, and the Davis-Bacon Act.

AHCA has submitted comments to the DoL relating to the VA provider agreements and wage increase. Specifically, AHCA is seeking clarification that the Veterans Administration (VA) provider agreements are exempted from the requirements of the DoL proposed rule. AHCA is also asking that if the VA provider agreement 2013 proposed rule, Use of Medicare Procedures to Enter Into Provider Agreements for Extended Care Services, is not finalized and released before the end of this year, that DoL consider exempting nursing facilities (NFs) from the Department’s proposed rule until such time that the VA proposed rule is finalized. This would thereby exempt NFs with VA contracts from the DoL requirements on establishing a minimum wage for contractors.

If you have any questions relating to this matter, please contact AHCA’s Dana Halvorson or Dianne De La Mare.

Friday, July 11, 2014

"The Medicare Overpayment Collection Process Fact Sheet" Updated by CMS

Dan Ciolek

The “Medicare Overpayment Collection Process” Fact Sheet (ICN 006379) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the collection of Medicare provider and supplier overpayments. It includes the definition of an overpayment, an overview of the overpayment collection process, timeframes for the debt collection process for provider overpayments, and additional resources.

Thursday, July 10, 2014

Medicare Signature Requirements Article Released by CMS

Dan Ciolek
MLN Matters® Special Edition Article #SE1419, “Medicare Signature Requirements - Educational Resources for Health Care Professionals” has been released and is now available in downloadable format. This article is designed to provide education on the availability of resources related to signature requirements for Medicare-covered services. It includes a variety of educational products along with a brief description, and additional information.