Friday, September 12, 2014

CMS Open Door Forum: September 17

The next CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum scheduled for:
Wednesday, September 17, 2014
  2:00 PM Eastern Time

Conference Leaders: Jeanette Kranacs & Jill Darling
**This Agenda is Subject to Change**

I. Opening Remarks

Chair – Jeanette Kranacs (Center for Medicare)
Moderator – Jill Darling (Office of Communications)

II. Announcements & Updates

Manual Posting Announcement
Transition memo for FY2015 Policies 

III. Open Q&A

**Next ODF: November 13, 2014**

Open Door Participation Instructions:
This call will be Conference Call Only.

To participate by phone: 

Dial: 1-800-837-1935 & Reference Conference ID: 44424574
Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Please dial-in at least 15 minutes before call start time.
Encore: 1-855-859-2056; Conference ID: 44424574

Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID beginning 2 hours after the call has ended. The recording expires after 2 business days.

For ODF schedule updates and E-Mailing List registration, visit our website at

Wednesday, September 10, 2014

Webinar: Protecting Residents from Financial Exploitation

Adrienne Riaz-Khan

Too many vulnerable adults fall prey to con artists, family members, fiduciaries, and professional advisers who steal their nest eggs and threaten their financial security. The Consumer Financial Protection Bureau (CFPB) has released a new manual to equip assisted living and nursing center staff with the know-how to prevent and spot the warning signs of financial exploitation. In this webinar, CFPB will take you through the manual and its key points.

Learning Objectives:
· Prevent financial exploitation and scams by educating staff, residents, and family members about warning signs and precautions
· Recognize, record, and report financial abuse as early as possible using a model protocol and a team approach
· Get help from first responders in the community

Monday, September 29, 2014
2:00 PM – 3:00 PM Eastern Time

Speakers: Naomi Karp, Senior Policy Analyst, Office for Older Americans Consumer Financial Protection Bureau

House Committee on Ways and Means Subcommittee on Health Hearing on the Status of ACA Implementation Today

Dana Halvorson

The U.S. House Committee on Ways and Means Subcommittee on Health Chairman Kevin Brady (R-TX) held a hearing this morning on the Administration’s continued efforts to implement and administer the Affordable Care Act (ACA).

The Committee heard testimony from Andy Slavitt, Deputy Principal Administrator of the Centers for Medicare & Medicaid Services (CMS) at the U.S. Department of Health and Human Services, and John Koskinen, Commissioner of the Internal Revenue Service (IRS).

CMS is the federal agency that oversees the operation of the Exchanges through the Center for Consumer Information and Insurance Oversight (CCIIO), and the IRS oversees the distribution and verification of the subsidies in the ACA. More details can be found in the hearing advisory.

Congress Returns to Washington for Pre-Election Legislation

Drew Thies

Both the House and Senate returned to Capitol Hill this week to wrap up pending legislative issues before the November midterm elections. After traveling their districts and states in the annual August Recess, Members of Congress will be in Washington for what many expect will be a short, relatively uneventful legislative session.

Both Republicans and Democrats are trying to avoid any missteps while in session, the effect of which could be felt strongly when Americans go to the polls on November 4th. The House and Senate will need to at least pass a continuing resolution to fund the government through the elections, however, or they risk a government shutdown akin to what happened in October of last year.

House Republicans released a stopgap spending bill late Tuesday night to keep the government funded through early December. The legislation contains few surprises: extension of the Internet Tax Freedom Act and reauthorization of the Import Export bank are of the greatest note. The White House also received $88 million in emergency funding to cope with the Ebola outbreak which worsened while Congress was in recess.

The attempt to punt major budget issues until after the election comes on the heels of the last round of primary elections taking place last night and the ballots now being set in every state. Republicans are hopeful about their chances to increase their majority in the House as well as take control of the Senate, whereas Majority Leader Harry Reid and Senate Democrats are trying to stave off viable challengers in key swing states, so avoiding turmoil while Members of Congress are in Washington is at the front of everybody’s mind.

Members of Congress will return to their districts the week of September 22nd for the Jewish New Year and will presumably stay on the campaign trail until the election. This is a great time to ask Members of Congress to tour your skilled nursing or assisted living center. Get in touch with Drew Thies ( if you want any more information.

Tuesday, September 9, 2014

Webinar: Strategic Opportunities for Assisted Living Providers

As the needs of the Assisted Living market continue to evolve, providers are facing new and more complex challenges with medication administration, staffing for acuity, ACO partnerships, compliance, and maximizing occupancy. With the right tools, these challenges can be turned into opportunities.

Join PointClickCare and Kronos as we discuss the influential changes in Assisted Living, how those changes will impact the market and how you can leverage them to build opportunities.

Speakers: Matt D’Angelo, Senior Product Line Manager, ALF, PointClickCare –
                Gaylyn Timiney, Senior Clinical Operations Consultant, PointClickCare
Wednesday, September 17, 2014
2:00 PM – 3:00 PM Eastern Time
Register and receive a complimentary Assisted Living Report. This report will show you what other Assisted Living providers are saying in relation to key trends contributing to complexity in the growing assisted living market.

CMS Recovery Auditor Procurement in Limbo

Dan Ciolek and Dianne De La Mare

Recently, the U.S. Court of Federal Claims (COFC) blocked the Centers for Medicare and Medicaid Services (CMS) from proceeding with issuing contract awards to seven Recovery Auditors (RA) pending a court appeal from CGI Federal. CGI is a current RA and is challenging the terms for three of the new RAC contract requisitions, arguing they violate federal procurement law by delaying payments to the RACs. CMS had indicated that the new process of waiting to issue payments to RAs until the second level of appeals is resolved is intended to provide a disincentive for RAs to issue inappropriate denials. Specifically, CMS stated “…these changes will result in a more effective and efficient program, including improved accuracy, less provider burden, and more program transparency.”

The Sept. 2 court order prevents CMS from awarding the affected RA procurement contracts until the appeal has been resolved through the Federal Circuit Court of Appeals. However, the current median disposition time of such appeals in this court is over ten months. It remains uncertain whether CMS will challenge the appeal, or whether they will instead decide to revise the contract language to address the CGI complaint and restart the procurement process, which would probably take another year to complete.

CMS has been preparing for such a possibility. Current RA contracts were set to expire in February, at which time all RA review activities, including Part B therapy manual medical review (MMR), were put on a pause until the planned new contracts were to be issued this summer. As the procurement process delays persisted due to various protest activities, CMS announced on August 4, “Due to the continued delay in awarding new Recovery Auditor contracts, the CMS is initiating contract modifications to the current Recovery Auditor contracts to allow the Recovery Auditors to restart some reviews. Most reviews will be done on an automated basis, but a limited number will be complex reviews of topics selected by CMS.” To date, the CMS website has indicated that such contract modifications have been issued to the current RAs in Regions A,B, C, and D.

AHCA continues to monitor this issue and is communicating with CMS regularly. We will inform AHCA members when any additional details become available, particularly related to when and how CMS intends to proceed with the limited RA reviews (including Part B therapy MMR) in the near future. For any additional information, please contact

Early SHOP Access for Five States

Dana Halvorson 

According to Capsules, the Kaiser Health News Blog, the Centers for Medicare and Medicaid Services (CMS) recently announced that businesses in five states (Missouri, Illinois, Ohio, New Jersey and Delaware) will get an early look at the federal health insurance marketplace for small businesses.

Businesses with fewer than 50 full-time workers in these states will be able to access the Small Business Health Options Program (SHOP) in late October, ahead of the November 15 start of open enrollment. SHOP was created in the Affordable Care Act (ACA), and is a new way for small businesses to buy health insurance for their employees. Noted in the Capsules posting, a CMS official said the five states were selected based on the agency’s analysis of state insurance markets and the availability of employee choice, among other factors.

 If you have any questions relating to the ACA, please submit them to and be sure to check out AHCA/NCAL’s ACA website.

HHS Announces Navigator Grant Awards

Dana Halvorson

Earlier this week, the U.S. Department of Health and Human Services (HHS) announced $60 million in funding to help consumers navigate their health care coverage options in the Health Insurance Marketplace.

On Monday, September 8, HHS Secretary Sylvia M. Burwell announced $60 million in Navigator grant awards to 90 organizations in states with federally-facilitated and state partnership Marketplaces. According to the Department’s press release, these awards support preparation and outreach activities in year two of Marketplace enrollment and build on lessons learned from last year.

In addition to Navigators, Marketplaces make other resources available to consumers to help them access Marketplace coverage, such as certified application counselors, non-navigator assistance personnel (also known as in-person assisters), and agents and brokers. Consumers in federally-facilitated and state partnership Marketplaces can visit Find Local Help to find assistance in their area.

For a list of HHS Navigator awardees or more information about Navigators and other Marketplace resources, please visit:

Free Online Learning Tool to Support LGBT Older Adults in Long Term Care

Lyn Bentley

CMS announces the Release of Learning Tool on Building Respect for Lesbian, Gay, Bisexual, Transgender (LGBT) Older Adults. The training tools are free and targeted for use by long term care providers. There are six on-line training modules, each lasting about 10 minutes.
The learning tool is intended for long term care providers and addresses the needs and rights of older LGBT adults in LTC. The tool is presented in six online training modules including video testimonials, quizzes and helpful information. Each module lasts approximately 10 minutes and can be completed over time.

The tool was developed by the Administration for Community Living and Administration on Aging, with support from many groups including but not limited to SAGE's National Resource Center on LGBT Aging, FORGE Transgender Aging Network, National Center for Transgender Equality, the National Gay and Lesbian Task Force, the Human Rights Campaign Foundation, the National Senior Citizens Law Center, Rose Villa, and the Methodist Home of D.C.
 The learning tool can be accessed through the National Resource Center on LGBT. Users will be required to complete a registration form to access the free tools.

DEA final rule reclassifies hydrocodone combination products to Schedule II

Holly Harmon

The Drug Enforcement Administration (DEA) has issued a final rule imposing stricter regulatory controls and sanctions on people who handle or propose to handle hydrocodone combination products, drugs that contain hydrocodone and specified amounts of other substances. Effective October 6, 2014, the rule moves hydrocodone combination products from Schedule III to Schedule II.

The Controlled Substances Act places substances with accepted medical uses into one of four schedules; schedule II is for substances with the highest potential for harm and abuse. According to an analysis by HHS and the DEA, hydrocodone combination products have a high potential for abuse, which may lead to severe psychological or physical dependence. A Food and Drug Administration advisory committee also recommended the schedule change last year.

AHCA submitted comments requesting delayed implementation or allow SNFs to accept orders for hydrocodone from physicians as done in hospitals. The final rule allows a form of delayed implementation of 45 days from the date of publication to the effective date, versus the usual 30 days. Pages 49672-49673 of the final rule address the impact on long term care facilities. Click here to read the final rule.