Wednesday, January 28, 2015

AHCA’s 2015 ID/DD Hill Fly-In Event Right Around the Corner!

Dana Halvorson

AHCA’s Intellectual and Developmental Disabilities (ID/DD) Residential Services Providers annual Hill Fly-In event will occur on Tuesday, March 24, 2015, at the AHCA offices in DC. This important event is free to attend, and the registration form can be found here. Breakfast and a boxed lunch will be provided to registrants. Congressional speakers are being invited, a legislative update will be provided, and Hill visits will follow in the afternoon. Further details about Hill visits are included in the registration form, and AHCA will provide one-pagers and talking points for registrants to take to the Hill.
If you would like to attend, please fill out the registration form and email it back to AHCA’s Senior Director of Not for Profit & Constituent Services, Dana Halvorson. You can also fax or mail it as well. If you have any questions whatsoever, please don’t hesitate to let Dana know. AHCA hopes to see you at this important event!

The deadline to register for the 2015 Independent Owner (IO) Leadership Conference is fast approaching

Christy Sharp

This year's IO Leadership Conference is jam-packed with exciting events and opportunities. The early bird deadline is fast approaching so register today! Don't miss this opportunity! Register by February 9, and take advantage of the early bird savings.

This year's theme is How To Survive Medicaid Managed Care as an Independent Owner. Numerous education sessions will inspire you and show you how to take on your greatest challenges in new and successful ways.

Now run entirely in the popular Town Hall format, you'll hear more from each other, share ideas, and engage in lively, facilitated discussions.

Additional networking and social opportunities include a reception on Wednesday evening, and a networking lunch and spectacular dinner on Thursday, all in the relaxing atmosphere of the Westin Beach Resort & Spa.

Visit to see the complete agenda and register.

Hotel rooms are going fast so reserve yours today!

 The special AHCA/NCAL group rate is $209 per night single or double occupancy plus 11% occupancy tax. This rate will be extended for three days before the conference based on hotel availability. Hotel reservations must be made by February 9, 2015.

Sponsors as of January 23, 2015:
American HealthTech, Direct Supply, eHealth Data Solutions, ESI, GE Capital, Harmony Healthcare, Kronos, matrixcare, Mueller Prost, My InnerView, Pinnacle, Point Click Care, PointRight, Prime Care Technologies, Select Medical Rehabilitation Services, VCPI, Yadkin, and Ziegler

We Want to Hear From You!

Andrea Todd

Do you have a quality-related question for AHCA and NCAL? We want to hear from you! Mark Parkinson, AHCA/NCAL President and CEO; Leonard Russ, AHCA Board Chair; and Patricia Giorgio, NCAL Board Chair, will answer your questions at the Quality Symposium’s opening general session on Tuesday, February 24. Be sure your voice is heard! Send your questions to Andrea Todd at by Wednesday, February 11.

The AHCA/NCAL 7th Annual Quality Symposium, held in Austin, Texas, February 23-25, continues a tradition of supporting and challenging members who are focused on quality improvement. 

For more information and to register, click here.

NALW: Offer Your Theme Idea Today!

Katherine Preede

Each year, National Assisted Living Week® (NALW) is celebrated in assisted living communities across the country – and this year, we are looking to you for ideas! TODAY is the deadline to visit the NALW Facebook page and submit your ideas for the 2015 theme.

Offer your theme ideas, activity thoughts, or even color suggestions, and NCAL will consider each one. The final theme will be announced in February, plenty of time to prepare for NALW, which will be held September 13-19, 2015.

For reference, here have been the NALW themes the past few years:

2014: The Magic of Music
2013: Homemade Happiness
2012: Art for the Ages
2011: Forever Proud
2010: Living Life

NALW themes encompass all that makes assisted living a premier lifestyle. The care, compassion, laughter, joy and friendship that occurs in these communities every day... where residents, volunteers and team members share the laughter and joy experienced in communities every day. If you or your team have great ideas that you think would make a terrific theme, share them with us!

2015 Quality Symposium Deadline Extended to February 12

Jon Patrick Ewing

There still time to join the crowd! Due to continued demand, AHCA/NCAL is excited to announce its registration deadline for the 2015 Quality Symposium: It’s Time to Roar! has been extended to Thursday, February 12, 2015. Be part of the fastest-growing, quality-focused, event for long term and post-acute care professionals, and get your registration in today. With the opportunity to earn up to 15.5 CEUs, this is the perfect event to help boost your professional development, while focusing on organizational performance excellence, and quality resident care.

AHCA/NCAL’s room block at the Hyatt Regency Austin hotel is sold out and nearly sold out at our overflow hotel, the Radisson Hotel & Suites Downtown. Should you still need housing, we recommend these hotels located near the Hyatt Regency Austin:

Embassy Suites Austin - Downtown/Town Lake
300 South Congress Avenue, Austin, TX,78704
TEL: 512-469-9000

Hampton Inn & Suites Austin-Downtown/Convention Center 
200 San Jacinto Blvd., Austin, TX, 78701
TEL: 512-472-1500

Hyatt Place Austin Downtown
211 East 3rd Street, Austin, TX, 78701
TEL: 512 476 4440

Please note these hotel properties do not have a discounted AHCA/NCAL group rate available. Reservations made at these hotels will be based on availability at the prevailing rate determined by the hotel.

For comprehensive information about the symposium, visit our website. Thank you for your interest in the AHCA/NCAL 7th Annual Quality Symposium. We hope to see you soon in Austin!

Tuesday, January 27, 2015

CMS - Emergency Update to the Calendar Year (CY) 2015 Medicare Physician Fee Schedule Database

Dan Ciolek

The Centers for Medicare and Medicaid Services (CMS) recently released a Medicare Learning Network (MLN) article for providers to announce an emergency update to payment files issued to contractors based on the CY 2015 MPFS Final Rule. Change Request CR9081 amends those payment files, including an updated conversion factor of $35.7547 for services furnished between January 1, 2015, and March 31, 2015, consistent with the Protecting Access to Medicare Act of 2014 that provides for a zero percent update from CY 2014 rates. Make sure that your billing staffs are aware of these changes.

AHCA had previously alerted members of this issue (here) and (here). Thanks to the efforts of Tony Marshall, the Senior Director of Reimbursement for the Florida Health Care Association, AHCA is able to post the updated 2015 Medicare Part B Fee Schedule that applies to Part B therapy services for the period from January 1 through March 31, 2015 here. If you downloaded this AHCA resource file prior to January 7, 2015, please download the updated file which reflects the CMS correction.

Leavitt Partners Consulting: White Paper Examines Possible Post-King Scenarios

Dianne De La Mare

The US Supreme Court is set to hear the high-profile Affordable Care Act (ACA) litigation (King v Burwell) in March 2015, and the stakes are high. If the US Supreme court rules against the Obama Administration, nearly 5 million citizens currently enrolled through the federal marketplace could lose access to subsidized coverage. Leavitt Partners Consulting has just released a white paper discussing possible fall-out from the US Supreme Court decision here.

Questionable Tactic Leads to Novel NF Lawsuit

Dianne De La Mare

The New Mexico Attorney General has filed a complaint against a NF corporation alleging violations of fraud, unfair practices, breach of contract, and unjust enrichment. This action seems to be motivated by a national strategy being implemented by plaintiffs’ attorneys Cohen Milstein and David Marks who reach out and contract with state Attorney Generals to move these complaints forward.

Specifically, these complaints construct a minimum PPD (staffing measure in “hours per patient day”) for each defendant using a computer-simulated staffing model that calculates PPDs based on Section G of the MDS. The complaint refers to this model as a “widely-accepted industrial engineering simulation” to determine the level of staffing and cites to documents stating that this is “scientifically-established labor times.”  However, the model has not been approved by the Centers for Medicare & Medicaid Services.

To understand the theory better go here.

2014 Year in Review OIG Update

Dianne De La Mare

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG) has posted a podcast that looks back at OIG highlights of its fraud, waste and abuse activities, including activities within the Medicare and Medicaid programs.

Specifically, in Fiscal Year 2014 the OIG reported: 1) nearly $5 billion dollars in expected recoveries; and 2) 971 criminal actions against individuals or entities that engaged in wrongdoing against HHS programs, as well as 533 civil actions. OIG also excluded from participation in federal healthcare programs more than 4,000 individuals and entities. To view the transcript of the podcast go to

Observation Stay Litigation Goes Back to District Court

Dianne De La Mare

The Medicare beneficiaries (plaintiffs) involved in a class action lawsuit challenging a common hospital practice of admitting patients “for observation” rather than “inpatient” have another opportunity to be heard in District Court. The US Court of Appeals for the Second Circuit has held that plaintiffs have a sufficient property interest in their Medicare Part A benefits to warrant some form of due process, such as a written explanation of an observation or inpatient classification or the right to appeal that certification (Barrows v Burwell).

The plaintiffs in this litigation first filed a complaint in the US District Court of Connecticut in November 2011, but the Court ultimately dismissed the litigation. Subsequently, in 2013, the plaintiffs filed an appeal in the U.S. Court of Appeals for the Second Circuit. The two specific issues on appeal to the Second Circuit included the US Department of Health and Human Services (HHS) Secretary’s:

 1) failure to provide written notification to Medicare beneficiaries, or to require that they receive written notification, of their placement on observation status, of the consequences of that placement for their Medicare coverage, and of their right to challenge that placement violates the Medicare statute and the Due Process Clause of the Fifth Amendment; and
2) policy of failing to provide Medicare beneficiaries the right to an administrative review, including expedited review, of their placement on observation status violates the Medicare statute and the Due Process Clause of the Fifth Amendment.

In February 2014, AHCA filed an amicus brief supporting the plaintiffs by stating that they “have a valid cause of action for injunctive relief to avoid the due process violations inherent in the HHS Secretary’s current approach,” and should be heard in court. The Second Circuit held oral arguments in late fall, and on January 22, 2015, reversed the District Court’s decision on the due process claims. The litigation now goes back to the District Court where the legal question is whether, as a factual matter, the classification is actually within the doctors’ discretion (as the HHS Secretary asserts), or, is being directed by Medicare (as the plaintiffs assert).

AHCA will continue to monitor and provide updates on this important litigation. For more information about observations stays, please visit the AHCA/NCAL website.