Wednesday, February 22, 2017

Employer Deadlines Are Almost Here for Filing Mandatory IRS Forms

Dave Kyllo

The Internal Revenue Service has set the deadlines for mandatory forms required by the Affordable Care Act (ACA) that must be completed by an applicable large employer – employers with 50 or more full-time employees, including full-time equivalents. For calendar year 2016, Forms 1094-C and 1095-C are required to be filed with the IRS by February 28, 2017 or March 31, 2017 (if filing electronically.) 

 An applicable large employer also must furnish the Form 1095-C to each full-time employee on or before March 2, 2017. This due date reflects a 30-day extension from the general due date (that is, January 31 of the year immediately following the calendar year to which the information relates). This extension was provided by the IRS in Notice 2016-70 on November 18, 2016.   

These reporting requirements apply regardless of whether health coverage was offered to employees. The two IRS forms that are used for ACA reporting are:

Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return: used to report to the IRS summary information for each employer and to transmit Forms 1095-C to the IRS.
Form 1095-C, Employer-Provided Health Insurance Offer and Coverage: used to report required information to your employees and to report information about each employee to the IRS.

The IRS has a Frequently Asked Questions document about these two mandatory forms. For more information about these reporting requirements, go to Reporting of Offers of Health Insurance Coverage by Employers on

While there is much discussion in Washington about repealing and replacing the ACA, employers should continue to comply with the ACA requirements. This means that employers with 50 or more FTEs should plan on submitting the mandatory employer reporting forms to the IRS for the 2016 tax year.

 In addition, if an employer is currently renewing their employee health benefit plan, they should choose a plan that is ACA compliant. AHCA/NCAL Insurance Solutions was created to help members save money on their employee benefit plans. To explore your health plan options available through AHCA/NCAL Insurance Solutions, contact Dave Kyllo at 202-898-6312 or Nick Cianci at (202-898-2841) or email us at

AHCA’s State Veterans Home Members Storm the Hill

Dana Halvorson

On Wednesday, February 15, some of AHCA’s State Veterans Home (SVH) members were in town for the National Association of State Veterans Home’s 2017 Winter Conference, and advocated on Capitol Hill on a number of issues including the observation stays matter, Medicaid, and SVH construction grant program funding. SVHs are facilities that provide nursing home, domiciliary or adult day care. They are owned, operated and managed by state governments. 

More on SVHs can be found on the VA website here. Pictured from left to right are Congressman Greg Walden (R-OR-2nd District) and individuals associated with the Oregon SVHs including Cheryl Maitland and Van Moore (at right).

AHCA/NCAL Begins Nationwide Medicaid Advocacy Effort

AHCA/NCAL members contacted their Members of Congress in the thousands to call on lawmakers to preserve Medicaid for America’s most frail and vulnerable populations.

The campaign is in response to potential efforts in Congress to restructure and reduce the way in which Medicaid is funded on a federal level. Currently, there is no national limit on the amount the federal government can give to the states to supplement Medicaid spending.

Over 16,000 messages were sent to Congress as a result of the ongoing campaign, which urged lawmakers to “protect those who are the most vulnerable and ensure services, like nursing care, remain a fully-funded benefit for these populations.”

AHCA/NCAL encourages any members to get involved, if they have not already, by using their advocacy system to get in touch with their Members of Congress. A briefing of Medicaid’s coverage of older Americans and individuals with disabilities as well as state Medicaid profiles are available online.

Webinar: SNF RUG Utilization Trends – Finding Your Center in the PUF Data

Many policymakers and government agencies have stated a belief that the SNF prospective payment system over-incentivizes therapy service delivery. Provider utilization patterns are often scrutinized to identify potential areas to target medical review efforts, but until recently, provider utilization patterns were not subject to public review. On January 18, 2017, the Centers for Medicare and Medicaid Services (CMS) released a public use file (PUF) that provides facility-specific, state, and national aggregate information about the Medicare SNF prospective payment system (PPS) utilization for calendar year 2014.

These files, part of the CMS transparency initiative, can be easily downloaded by the public, and contain facility-specific information. The file details include the facility name, address, SNF PPS resource utilization group (RUG) patient volume, number & length of Medicare stays, charges & payments, beneficiary characteristics, and percent of therapy assessments within 10 minutes of the minimum qualifying threshold.

This program will explain what the SNF PUF is, why it is important, and what type of information is presented in the PUF. Additionally, the program will include highlights of key observations and trends observed in the PUF data overall. Finally, you will learn how you can access the PUF files, and identify your facility-specific data reported in the PUF, to see where your SNF PPS patient population and utilization trends compare to other SNFs. Presenter will be Dan Ciolek, Associate Vice President, Therapy Advocacy, AHCA.

Thursday, March 16, 2017 
2:00 PM – 3:00 PM Eastern Time

ACA Interactive Tool: Repeal & Replace Proposals Available

Dana Halvorson

Kaiser Family Foundation has released a new interactive tool that enables users to create side-by-side comparisons of major ACA alternative plans. According to the Kaiser Family Foundation, with the tool, users can compare the plans’ approaches to more than a dozen key areas of health policy, including individual insurance market rules, requirements and provisions for employers, benefit design, Medicaid, and Medicare. 

For now, continue to comply with the ACA requirements because it is still the law. AHCA/NCAL has created a special web page containing the latest news related to the ACA and will send communications to members about important ACA developments as they occur.

Payroll-Based Journal Changes

This week, the Centers for Medicare and Medicaid Services (CMS) released information regarding two important changes to the Payroll-Based Journal (PBJ) system that will make it easier for providers to successfully submit hire, termination and rehire information for employees. Since the implementation of the system, the American Health Care Association (AHCA), providers and other organizations have advocated for fixes that create efficiencies in the collection of staffing data. The two changes (listed below) are a step in the right direction. AHCA is pleased with CMS' actions and looks forward to continuing to find solutions that support providers in submitting their data. 

On March 19, the following updates will go into effect:
  1. Both hire and termination dates will be optional items in the system
  2. The same employee ID will be allowed to be used more than once in a single PBJ submission XML file
For more on the latest changes, click here.  

The Association also continues to seek feedback from providers on the challenges they face with the system.  If you have any questions or concerns, please email the PBJ team at

Tuesday, February 21, 2017

AHCA Vice Chair Michael Wylie Participates in Long Term Care Summit

AHCA Press Office

Vice President, Development at Genesis HealthCare and AHCA Vice Chair Michael Wylie joined nearly 60 national long term care professionals last week at the National Summit on the Future of America’s Nursing Home Industry in Philadelphia. The event – hosted by the Targeting Revolutionary Eder Care Solutions (TRECS) Institute and the Leonard Davis Institute of Health Economics at the University of Pennsylvania – was an opportunity to discuss how to improve care and reduce costs in the profession.

The goals of the Summit included:

  • Identify opportunities to improve care and process, reduce costs, and identify specific strategies to assure that SNFs remain as quality providers of care for the seniors they serve; and
  • Develop regulatory and reimbursement principles for the long term care profession to maintain quality of care for Medicaid enrollees in a shifting payment environment.

TRECS Institute Executive Director John Whitman, MBA, NHA, opened the day with a State of the Industry address. He highlighted issues such as changing payment models, changing patient/resident characteristics, staffing, regulatory oversight, and the Five-Star rating system.

Discussion then shifted to “Finding the No-Brainers” – immediate opportunities for improving care and reducing costs. The group discussed important concepts, such as:

  • Service delivery (e.g. rehospitalizations, telemedicine, and staffing)
  • Regulatory (e.g. reducing survey redundancy, Five-Star, and liability)
  • Payment (e.g. delayed Medicaid payments, three-day stay, and site neutral)
  • Other arrangements (e.g. workforce training, housing, and advanced care systems)

Participants were then asked to design the nursing care center of the future. Several break-out groups focused on different areas, including design, payment, technology, and more. Mr. Wylie led the discussion on nursing home design, focusing on the need for a specialized memory care unit, a large therapy and public area, treatment rooms for specialty services such as dental and ophthalmology, and a robust telemedicine program.

A full report is being developed based on discussion at the Summit and will be shared with the Centers for Medicare and Medicaid Services (CMS). It is intended to identify achievable changes to the current system with the ultimate goal of improving care and reducing costs.

Friday, February 17, 2017

CMS Delays EPM Bundling Rule Timeline

Mike Cheek

Last week, the Centers for Medicare and Medicaid Services (CMS) delayed the effective date for the second mandatory hospital bundling program issued on January 3, 2017. AHCA/NCAL had asked for the delay. In a letter to the Trump Transition Team, the Association included a request that the incoming administration carefully scrutinize the Episode Payment Models (EPM) final rule for possible significant changes or to completely rescind the rule.

The rule implemented three new mandatory EPMs: coronary artery bypass graft (CABG); acute myocardial infarction (AMI); and surgical hip/femur fracture treatment (SHFFT). The two cardiac episodes will be tested in 98 Metropolitan Statistical Areas (MSAs) across the country, while the SHFFT episode will be tested in the 67 MSAs currently participating in the Comprehensive Care for Joint Replacement (CJR) demonstration.

Under the program, hospitals will be held accountable for total Medicare Parts A and B spending, as well as performance on certain quality measures, during 90-day episodes of AMI, CABG and SHFFT episodes, depending on where the hospital is located. Hospitals may share in risk and in savings with other provider types, including skilled nursing centers, but they are not required to do so. The EPMs will begin on July 1, 2017, and will run for almost five years, through 2021.

Last week’s action delays the effective day of the regulation by 60 days, from an effective day of February 18, 2017 to an effective date of March 21, 2017. The implementation date for the EPM program and related changes to the CJR bundling demonstration remains July 1, 2017. In the Federal Register notice, CMS states: “We are postponing the effective date for 60 days to ... allow for further review and consideration of new regulations.”

While this is a step in the right direction, it is important to continue advocating on behalf of the millions of patients and residents we serve. AHCA/NCAL will host a Congressional fly-in on March 21-22 to visit Capitol Hill and ask members of Congress to put pressure on CMS over the issue of excessive Civil Monetary Penalties and survey relief. For more information or to participate, please contact Matt Smyth. AHCA’s Intellectual and Developmental Disabilities Residential Services Providers annual Hill Fly-In event will occur on March 22. Contact Dana Halvorson with any questions or to register. Furthermore, AHCA/NCAL will host its annual Congressional Briefing June 5-6 at the Hyatt Regency Washington.

Thursday, February 16, 2017

Your Top-Line Publication is on the Way!

LTC Trend Tracker Help

You have a lot to keep track of: Five Star ratings, quality measures, staffing, quality awards … the list goes on. It’s challenging enough to keep a center going, nonetheless keep track of every aspect. However, properly keeping track of this information could set your center apart from those that just stay afloat, to those that thrive.

That’s why the American Health Care Association/ National Center for Assisted Living (AHCA/NCAL) created LTC Trend Tracker, a web-based tool that enables long term and post-acute care providers to find all this information in one central place. This service helps long term and post-acute care providers, including assisted living, to access key information that can help their organization succeed. It gives you access to government data collected by the Centers for Medicare and Medicaid Services (CMS) on skilled nursing centers. All this data is at your fingertips, and with it, you can build and save custom reports to understand your performance.

This week, LTC Trend Tracker has a new publication, Your Top-Line, which was sent directly to your email inbox on Tuesday, February 21. This quarterly report for skilled nursing centers will highlight your facility’s progress on Five Star performance, the quality initiative, and help you understand your survey rating and score breakdown. Check out the new user-friendly design and easy snapshot of data. The figures and colorful graphics are designed to help improve patient care with tailored tools that will allow your organization to easily monitor survey information, quality measures, quality initiative progress, quality awards and five star data. 

In order to receive the Top-Line publication, you must be a current user of LTC Trend Tracker. Please register at as a single organization or if you are part of a multi-facility organization, please have your corporate office register you also at In addition to the email you will receive, LTC Trend Tracker keeps all of these publications saved in your account. After logging in, click on Manage Publications and then View and Download Publications. It will then allow you to select the publication you wish to view.

If you’re unsure about LTC Trend Tracker and availability, please email

Wednesday, February 15, 2017

GAO Releases Two Reports on Medicaid Long-Term Services and Supports

Lilly Hummel
Both reports signal continued interest in strengthening Centers for Medicare and Medicaid Services (CMS) and state oversight of home and community-based services, particularly for personal care services.

 In a recent report, GAO reviewed CMS data collection on services provided in home and community-based settings. GAO found that CMS’ data were limited because of data gaps and errors. Although the agency is developing a new Medicaid claims system and established a new office to support its use of Medicaid data for program management and monitoring, CMS still has not improved data collection or plans for how to use the data for oversight purposes. GAO recommended that CMS improve personal care services data by: establishing standard reporting guidance for key data; ensuring linkage between data on the provision of services and reported expenditures; ensuring state compliance with reporting requirements; and developing plans to use data for oversight.

In a second report issued last month, GAO studied oversight of an increasing number Medicaid managed long term services and supports (MLTSS) programs, which can include services provided in assisted living. However, according to GAO, whether these programs are an effective strategy depends, in part, on the design of the payment structures. GAO recommended that CMS: require all states to report on progress toward achieving MLTSS program goals; establish criteria for what situations would warrant exceptions to federal standards for data used to set rates; and provide guidance with minimum standards for validating encounter data.