Wednesday, September 2, 2015

WANTED: Your Adorable Pics!

Rachel Reeves

Now through October 31st, NCAL is accepting photo submissions for Faces of Assisted Living. Honor the individuals residing in assisted living communities by sharing those everyday moments or special occasions.

Every face in assisted living has a story. When you submit a photo, consider telling us a little more about the resident pictured: something they said that stuck with you, what they did when they were younger, or their favorite things.

Submitted photos with completed image release forms may be featured on AHCA/NCAL’s Facebook page, on Twitter and in future publications. Follow the submissions with the hashtag #FacesofAL.

NCAL started Faces of Assisted Living to feature actual residents from assisted living communities across the country. This project celebrates what assisted living is about – providing care and services that respect resident choice, dignity, and independence in a home-like setting.

Learn how to submit your photo(s) and check out photos from previous years at

Members of National Observation Stays Coalition Send Comment Letter to CMS

Dana Halvorson

Twenty-two members of the national observation stays Coalition sent a letter to the Centers for Medicare and Medicaid Services (CMS) earlier this week on the issue of the observation status. The comment letter was in response to a proposed rule on the annual update to Medicare reimbursement of outpatient care at acute care hospitals, and included proposed revisions to the “two-midnight rule.” Specifically, the Coalition encouraged CMS to fix one of the unintended negative consequences for beneficiaries of the in-patient vs. out-patient payment dilemma, by promulgating new rules that would count all time spent by a patient in the hospital, for purposes of satisfying the three-midnight rule for Medicare Part A coverage of post-acute care in a skilled nursing facility (SNF). 

The letter also specifically notes the Coalition’s support of federal legislation that would count all time spent by a patient receiving outpatient observation services in the hospital for purposes of satisfying Medicare’s three-midnight rule for SNF coverage. The identical bipartisan bills are H.R.1571 and S.843, the Improving Access to Medicare Coverage Act of 2015. For more information about the observation stays issue, please visit the AHCA/NCAL website.  

Convention Registration Deadline: One Week to Register in Advance

Jon-Patrick Ewing

Next Wednesday, September 9, is the deadline to register in advance for the AHCA/NCAL 66th Annual Convention & Expo. After this date, on-site rates apply. AHCA/NCAL has an exciting event planned for you this October in San Antonio, Texas. Thousands of your long term and post-acute colleagues have already registered, so high tail it and register today! On-site registration will be available at 6:45 AM, Sunday, October 4 at the Henry B. Gonzalez Convention Center.

Webinar: Current Nutrition Best Practice to Reduce Hospital Re-Admissions

Adrienne Riaz-Khan

Providers must know how to meet the challenges of new CMS Value Based Purchasing related to Quality Measures and Reducing Hospital Re-Admissions. Food, nutrition and dining are integral components in reducing hospital re-admissions and overall care management. This session will present an overview of current “best practice” nutrition for effective care transition management along with suggestions of how to apply “best practice” for use in daily practice. Join Speaker Brenda Richardson, MA, RDN, LD, CD, FAND to learn about these

Tuesday, September 15, 2015 
 2:00 PM – 3:00 PM Eastern Time 

Learning Objectives:

· Know the background and focus of current “best practice” recommendations related to hospital re-admissions.

· Discuss the importance of effective nutritional management related to Value Based Purchasing and Quality Measures.

· Discuss practical application of “best practice” recommendations in daily practice

Registration is now open:

Quality Improvement: ‘Become Good At Cheating And You Never Need To Become Good At Anything Else’

Dana Halvorson

On August 27, 2015, David Himmelstein and Steffie Woolhandler released an article on the HealthAffairs Blog entitled Quality Improvement: ‘Become Good At Cheating And You Never Need To Become Good At Anything Else’. The article includes that, “The Centers for Medicare and Medicaid Services (CMS) has trumpeted the recent drop in hospital readmissions among Medicare patients as a major advance for patient safety. But lost amidst the celebration is the fact that hospitals are increasingly “observing” patients (or treating returning patients in the emergency department) rather than “readmitting” them. But while re-labeling helps hospitals meet CMS’ quality standards (and avoid costly fines), it probably signals little real quality gain and often leaves patients worse off financially.”

You may read the full article here. For more information about the observation stays issue, please visit the AHCA/NCAL website.

IRS Proposes New “Minimum Value” Definition for Health Plans

Dave Kyllo

The Internal Revenue Service has been busy this week proposing a new rule related to the Affordable Care Act. In a supplemental notice of proposed rulemaking, the IRS proposes withdrawing in part a notice of proposed rulemaking published in 2013 and replacing the deleted portion with new proposed guidance for determining whether health coverage under an eligible employer-sponsored plan provides “minimum value.” 

While the proposed regulations apply for plan years beginning after November 3, 2014, the revised minimum value regulations apply for the end of plan years beginning no later than March 1, 2015. The proposed rule states that an eligible employer-sponsored plan provides minimum value only if the plan’s share of the total allowed costs of benefits provide to an employee is at least 60 percent and the plan provides substantial coverage of inpatient hospital and physician services. Comments are due to the IRS on November 2, 2015.   

The ACA is complex and choosing the right employee health insurance coverage can be daunting task for providers. Before making a final decision about their 2016 coverage, AHCA/NCAL members are encouraged to check out AHCA/NCAL Insurance Solutions. This “Members Only” program is designed to give AHCA/NCAL members access to brokers who understand long term care and who truly know the ACA and its myriad requirements. 

More importantly, AHCA/NCAL Insurance Solutions is designed to save members money on one of their largest workforce expenses. For more information, contact Dave Kyllo (202-898-6312) or Nick Cianci (202-898-2841) or email us at AHCA/NCAL Insurance Solutions.

Tuesday, September 1, 2015

CMS Names ICD-10 Ombudsman

Dianne De La Mare

In late August, the Centers for Medicare & Medicaid Services (CMS), MLN Connects ICD-10 call featured Andy Slavitt (CMS, Administrator); Sue Bowman (American Health Information Management Association (AHIMA)); and Nelly Leon-Chisen (American Hospital Association (AHA)). Slavitt provided a national implementation update where he named Dr. William Rogers (CMS, Director Physicians Regulatory Issues Team), as the new ICD-10 Ombudsman. Rogers is currently a practicing physician at Georgetown University Hospital; but he will soon also act as Ombudsman for all health care professionals and work out of the ICD-10 coordination center in Baltimore, Maryland. Beginning in late September, Rogers can be reached at, according to CMS representatives.

As we reported previously, AHCA has sent correspondence and has spoken to CMS about our questions/concerns specific to skilled nursing facilities (SNF) ICD-10 coding which have yet to be answered by CMS, and we are encouraging the agency to get back to us as quickly as possible. We will continue to keep you informed as we learn more on this matter.

3 Silver Application Changes You Need to Know

The Silver AHCA/NCAL National Quality Award level is based on the Baldrige Performance Excellence Program and is updated every two years. This year, the criteria has been updated to align with the 2015-2016 Baldrige Health Care Criteria for Performance Excellence. Along with the global criteria change, there are three key changes that Silver applicants need to know:

 - The Silver criteria for 2016 contains more overall items than the 2015 Silver criteria. For instance, category 1.2 has three overall items that applicants must respond to versus two. All applicants must fully read the 2016 Silver application packet before getting started. To accommodate this increase in criteria requirements, the page limit of the application has been increased from 20 to 25 pages.

 - Starting this year, Silver applicants will be required to present results for each of the five results categories: Healthcare and Process Results; Customer-Focused Results; Workforce Focused Results; Leadership, Governance, and/or Survey Results; and Financial and/or Market Results.

 - To achieve the Silver award, applicants will have to meet the Silver Threshold. That is, to be recommended for a Silver award, an applicant must receive a minimum, cumulative of score of 300 points. Additionally, a minimum of 151 of these points must be scored in the process categories (Categories 1-6) and a minimum of 126 of these points must be scored in the results category (Category 7). 

As always, feel free to reach out to Quality Award staff at with any questions.

**Important Dates to Know**
Mid-September: Intent to Apply (ITA) process opens
November 19: Intent to Apply deadline
December 7: Applications accepted online
January 28: Bronze, Silver and Gold application deadlines

5 Tips to Help You Get from Bronze to Silver

Bronze Quality Award recipients are encouraged to continue on their journey by applying for a Silver Quality Award. While the journey from Bronze to Silver can be difficult, it’s well worth the positive outcomes your organization will gain during the process. Here are some tips to help you along the way: 
  • Use your Bronze Quality Award application as a starting point for your Silver application. Before you begin, go back and read through your Bronze application. The first part of your Silver application is the Organizational Profile, which is the basis for the Bronze criteria. However, remember that the Organizational Profile questions are different in the Silver criteria so make sure to respond to those and not simply copy and paste your Bronze application. 
  •  The Silver Quality Award level is based on the Baldrige Performance Excellence Program and is updated every two years. This year, the criteria has been updated to align with the 2015-2016 Baldrige Health Care Criteria for Performance Excellence and shows a shift in thinking that is required to move towards performance excellence. Returning applicants should be sure to respond to the 2016 Silver criteria in full; applicants who respond to old criteria will be disqualified. 
  • The Silver application is 25 pages in length. This is 20 more pages than your Bronze application. However, realize that the Silver criteria has far more requirements than the Bronze. As such, use your space carefully. While there are no requirements for splitting up the application, we do encourage you to use the first five pages for the Organizational Profile and the remaining 20-pages for your responses to the criteria. Cross-reference material between the different parts of the application, so you don’t waste space repeating material. Consider using an acronym list to save space. Just don’t forget to submit a list defining these acronyms for the Examiners at the end of your application; the acronym list does not count against the page limit. 
  • Shhh…don’t tell anyone (yet) but we have a great educational resource for Silver applicants coming out this fall. Stay tuned for more!
As always, feel free to reach out to Quality Award staff at

**Important Dates to Know**

Mid-September: Intent to Apply (ITA) process opens
November 19: Intent to Apply deadline
December 7: Applications accepted online
January 28: Bronze, Silver and Gold application deadlines

Thursday, August 27, 2015

CMS Opens Registration for Voluntary Electronic Submission of Staffing Data

Lyn Bentley, MSW

Electronic submission of staffing data for long-term care facilities - Payroll Based Journal (PBJ).

Registration is OPEN and ALL Long-term Care facilities are encouraged to register for the voluntary data submission period. Please use the resources listed below to register:

Registration Training:

  • Obtain a CMSNet User ID for PBJ Individual, Corporate and Third Party users, if you don’t already have one for other QIES applications (
  • Obtain a PBJ QIES Provider ID for CASPER Reporting and PBJ system access (
  • PBJ Corporate and Third-Parties must use the current form based process to register for a QIES ID. Registration forms are available under the Access Request Information / Forms section on the right side of the page (

For technical questions on how to register, please email

Additionally, CMS has posted an updated PBJ Policy Manual Draft and a list of frequently asked questions (FAQ) and answers about PBJ instructions and policies. Please visit for more information. For policy related questions, please email