Monday, April 27, 2015

OIG Releases Compliance Oversight Guidance to Health Care Boards

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) has released new guidance, Practical Guidance for Health Care Governing Boards on Compliance Oversight, in collaboration with the American Health Lawyers Association (AHLA), the Association of Healthcare Internal Auditors (AHIA) and the Health Care Compliance Association (HCCA), to assist governing boards of health care organizations fulfill their compliance plan oversight obligations. Health care board members have a duty to act reasonably to ensure that the company has an information and reporting system and that the system is adequate to provide the Board with appropriate compliance information, according to the guidance.

Health care Board members should consult OIG’s compliance guidance and also the Federal Sentencing Guidelines and Corporate Integrity Agreements as benchmarks for the Board’s compliance efforts. The OIG recognizes the potential burden on smaller entities; but also states that a company’s legal, compliance and internal audit functions should be separate and independent, which may require hiring additional employees.

Other OIG recommendations in the guidance include:
1) enter into executives sessions (without management present) with only employees responsible for compliance;
2) establish a formal plan to stay up to date with changing regulations;
3) include someone on the Board who is a compliance expert; and
4) consider an employee incentive program focused on compliance.

Overall, the guidance makes clear that health care Board members must play an active role in their organization’s compliance.

For more detail, see our General Counsel, Reed Smith Client memorandum at

Next Week Is National Nurses Week 2015

Katherine Merullo

May 6-12, 2015 will celebrate National Nurses Week 2015 with the theme “Ethical Practice. Quality Care”. This week developed by the American Nurses Association honors the many nurses working the multiple fields of the health care profession. This year’s theme recognizes the importance of ethics in nursing and acknowledges the strong commitment, compassion and care nurses display in their profession. This theme also shows the importance of advocating for the rights, health and safety of nurses and their patients.

Another useful tool is their National Nurses Week 2015 Resource Toolkit available for download off their website.

On Thursday, May 7, 2015 at 1: 00 PM EST there will be a free webinar called, “My Patient, My Code, My Practice: Ethical Decision Making & Action.

Be sure to check out their website to learn some useful ways to recognize and promote your nursing staff’s professional skills and abilities during this health care observance.  If you have any questions about the recognition week, contact Adam Sachs at the American Nurses Association via email:

We would love to see how you recognize your teams during this week.  Be sure to share your ideas and photos on Facebook and Twitter.

Wednesday, April 22, 2015

What’s your SNF PPS Rate?

Prepare yours today at

James Muller

Want to know your facility’s SNF PPS rate? Now you can prepare it yourself. AHCA has developed a Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) rate calculator to assist members in examining and estimating the impact of payment changes to SNF PPS rates. Using information on your distribution of Medicare Part A days by RUG category, the calculator allows you to simulate and understand the impact of the proposed SNF PPS payment policy changes for FY 2016 on your facility.

The rate calculator reflects Medicare payment policy changes found in the SNF PPS notice for fiscal year 2016 that was issued on May 15, 2015.

To prepare your rate estimate, download the .XLS calculator at

CMS to Look at Short Inpatient Stays and Two-Midnight Policy

Dana Halvorson

According to an April 20 Inside Health Policy article by Michelle Stein, the Centers for Medicare and Medicaid Services (CMS) has noted that it plans to address a broad set of issues around short inpatient stays and the two-midnights hospital admissions policy in the hospital outpatient pay rule this summer, including recent Medicare Payment Advisory Commission (MedPAC) recommendations. More details on the April 2 MedPAC meeting on hospital short stay policy issues can be found on the MedPAC site and in the AHCA press statement on the Commission’s vote. 

In the April 20 Inside Health Policy article, “the agency [CMS] acknowledges that stakeholders for years have raised concerns about short inpatient hospital stays, long outpatient stays with beneficiaries under observation, and ‘Medicare policies with respect to when payment for short hospital stays is appropriate under Medicare Part A.’ The agency says that even though CMS has taken steps to address these concerns, like shortening the RAC look-back period for patient status reviews and laying out a series of improvements the agency plans to implement once new RAC contracts can be implemented, hospitals and doctors are still upset.”

Tuesday, April 21, 2015

CMS Updates Medicare Part B Claims Processing Guidance Related to SGR Enactment

Dan Ciolek

The Centers of Medicare and Medicaid Services (CMS) provided the following announcement related to the processing of Medicare Part B claims with dates of service on or after April 1, 2015. With the enactment of the Medicare Access and CHIP Reauthorization Act of 2015 yesterday, CMS will resume processing claims according to the law’s provisions. Prior AHCA announcements regarding this topic are located here and here

The SGR provisions include an extension for the Part B therapy caps exceptions process through December 31, 2017. This means that it will no longer be appropriate for providers to issue advance beneficiary notices (ABN’s) to beneficiaries receiving medically necessary services above the $1940 therapy caps, since providers can use the exceptions process for therapy services above the threshold. More information about therapy cap related ABNs can be found on the CMS website.
Attention Health Professionals: Information Regarding the 
Medicare Access and CHIP Reauthorization Act of 2015 

CMS – April 13, 2015 -- On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly.  This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule.   In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended.  CMS will immediately begin work to implement these provisions.
In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later.  While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount.   The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.  
No action is necessary from providers who have already submitted claims for the impacted dates of service.   

Break the Web of Infection with Advancing Excellence Disrupt Infections Workshop

Advancing Excellence in Long-Term Care Collaborative

Disrupt Infections: Creating a Community of Prevention Creating hands-on workshop is coming to Northampton, MA on April 20, and continuing to 30 more cities nationwide. Presented by Joann Rader, RN, MN, a nationally recognized LTC educator, and sponsored by Advancing Excellence and Kimberly-Clark, find out simple, practical ways to build commUNITY immUNITY in the care setting and help break the web of infection.

A continuum of organizational infection prevention will be described, raising awareness of how current practices inhibit newer, evidence-based actions that would disrupt infections. Walk away with the beginning of a new organizational plan for infection prevention with elevated steps to add to your infection care routines. Administrators can earn 2 CEUs at $79 (Program Approval Number: 2042015-2.00-14506-in). Sliding registration fee for others from the same care community.

See below for dates and locations throughout the US. Click here to register in a city near you Disrupt Infections workshops.
North East
April 21: Northampton, MA
April 22: Manchester, NH
April 23: Wallingford, CT
April 24: New York, NY
April 25: North Wales, PA

Mid West

May 4: Pittsburgh, PA
May 5: Columbus, OH
May 6: Detroit, MI
May 7: South Bend, IN
May 8: Chicago, IL

North West
May 18: Reno, NV
May 19: Sacramento, CA
May 20: Medford, OR
May 21: Portland, OR
May 22: Seattle, WA

South East
October 5: Atlanta, GA
October 6: Chattanooga, TN
October 7: Nashville, TN
October 8: Louisville, KY
October 9: St. Louis, MO

South Central
October 19: Oklahoma City, OK
October 20: Dallas, TX
October 21: Austin, TX
October 22: San Antonio, TX
October 23: Houston, TX

November 2: Jacksonville, FL
November 3: Orlando, FL
November 4: Tampa, FL
November 5: West Palm Beach, FL
November 6: Miami, FL

Blue Bell Creameries Recall Impacts Long Term Care

Lindsay Schwartz 

The Centers for Disease Control and Prevention (CDC) has recommended that long term care facilities not serve or sell any Blue Bell Brand products due to the massive Blue Bell Creameries recall of all products. Some Blue Bell ice creams may be contaminated with Listeria, which can cause illness and have been distributed to institutions. For more information, Visit CDC’s Advice to Consumers, Institutions, and Retailers.

Registration Open for 2015 Congressional Briefing
AHCA/NCAL is happy to announce that Congressional Briefing registration is officially open. Registration is completely free and open to all AHCA/NCAL members and Associate Business Members.

Come join hundreds of long term and post-acute care professionals June 15-16. The two day event is widely attended by AHCA/NCAL members—last year over 400 advocates attended the conference and took to the Hill to speak to members of Congress and their staffs.

AHCA/NCAL is also excited to announce that Rep. Cathy McMorris Rodgers (R-WA) will be speaking at the briefing. McMorris Rodgers is a rising star in the Republican Party and currently the top-ranking woman in Republican House Leadership with her post as Party Conference Chair.

In addition to McMorris Rodgers, Emmy-winning television news anchor Chris Wallace will be addressing attendees during the keynote speech. Wallace is currently the host of Fox News Sunday and previously hosted Meet the Press, making him the only person who has served as a host of more than one of the major Sunday political talk shows. Wallace has worked on the Today show, Primetime, Nightline, served as chief White House correspondent for NBC, and anchored the Sunday edition of NBC Nightly News.

Hotel rooms in the Hyatt Regency on Capitol Hill fill quickly, so register now. 

U.S. House Legislative Hearing on Veterans Access to Extended Care Act

Dana Halvorson

On March 16, Senator John Hoeven (R-ND), Senator Joe Manchin (D-WV), Representative Tulsi Gabbard (D-HI, 2nd) and Representative Jackie Walorski (R-IN, 2nd) introduced bipartisan legislation, the Veterans Access to Extended Care Act (S. 739/H.R. 1369), to expand veterans’ access to health care services. As you may know, it is long-standing policy that Medicare (Parts A and B) or Medicaid providers are not considered to be federal contractors. If a provider currently has VA patients, they are considered to be a federal contractor and under the Service Contract Act. Federal contracts come with extensive reporting requirements to the Department of Labor on the demographics of contractor employees and applicants, which have deterred providers, particularly smaller ones, from VA participation. The Veterans Access to Extended Care Act would ensure that providers could enter into VA Provider Agreements, without having to follow these complex federal contracting and reporting rules.

Tomorrow, the House Committee on Veterans’ Affairs -- Subcommittee on Health -- will be holding a legislative hearing to review a few veterans related bills, including the Veterans Access to Extended Care Act. More details about this legislative hearing can be found here, and it will be held in 334 Cannon House Office Building at 10am ET. Congressman Dan Benishek M.D. and Chairman of the House Committee on Veterans’ Affairs Subcommittee on Health, requested a statement from AHCA for the hearing record on the Veterans Access to Extended Care Act. The AHCA statement from AHCA/NCAL’s President & CEO, Mark Parkinson, has been submitted to the Subcommittee for the hearing.

If you have any questions on this legislation, please don’t hesitate to contact AHCA’s Senior Director of Not for Profit & Constituent Services, Dana Halvorson.

AHCA Board Chair Testifies in Front of Congressional Committee

Drew Thies
Len Russ, Chairman of the Board for American Health Care Association, testified in front of the Energy and Commerce Health Subcommittee hearing last Thursday.

The hearing, entitled "Medicare Post-Acute Care Delivery and Options to Improve it," focused primarily on advancing new payment options in the post-acute space, with a specific emphasis on bundling proposals.

In his oral testimony, Mr. Russ focused on AHCA's payment reform model and the association’s collaboration with CMS on quality initiatives.

One of the bundling proposals currently in Congress, the “Bundling and Coordinating Post-Acute Care (BACPAC) Act,” was discussed at length during the hearing. Due to a line of questioning, Mr. Russ was able to articulate issues AHCA has raised with the legislation, particularly that it does not place the post-acute sector in the drivers-seat of the system.

In addition to Mr. Russ, other panelists included, Dr. Steven Landers, President Visiting Nurses Health Association; Dr. Samuel Hammerman, Chief Medical Officer, LTACH Hospital Division, Select Medical Corporation; Melisa Morley, Ph.D., RTI International.

Representatives in attendance were Reps. Pitts, Green, Guthrie, McKinley, Long, Bilirakis, Griffith, Lance, Burgess, Murphy, Brooks, Buschon, Ellmers, Engel, Capps, Pallone, Butterfield, Castor, Sarbanes, Matsui, Schrader, and Kennedy.