Monday, December 30, 2013

The Hill runs Parkinson, Coalition Piece on Observation Stays

By: Claire Krawsczyn

Last week, a DC-based online publication, The Hill, which is widely read by members of Congress and their staffs, featured a piece penned by the observation stays coalition. The 1,100-word article, “Don’t deny seniors nursing care,” focuses on how observation stays impact Medicare beneficiaries and the proposed legislation that seeks to address the issue. As noted in the opinion-editorial, the coalition writes:

“The issue is gaining ground in Washington, and we are here to ensure that it does not fade away – that Congress continues to listen to Medicare patients and their advocates. We must continue this momentum. More can be done – and more must be done. Patient advocates and provider groups alike are calling on policymakers to fix this problem once and for all, and enact into law the Improving Access to Medicare Coverage Act. Now is the time. Our aging population simply cannot afford to wait any longer for this issue to be addressed.”

The coalition members who participated in penning the article are: AARP; AMDA; Alliance for Retired Americans; American Case Management Association; American Health Care Association; American Medical Association; Center for Medicare Advocacy, Inc.; The Jewish Federation of North America; LeadingAge; Medicare Rights Center; National Academy of Elder Law Attorneys; National Association of Professional Geriatric Care Managers; National Association of State Long-Term Care Ombudsman Programs; National Center for Assisted Living; National Committee to Preserve Social Security and Medicare; National Consumer Voice for Quality Long-Term Care; National Senior Citizens Law Center; Society of Hospital Medicine.

2014 AHCA/NCAL Independent Owner Leadership Conference

By: Danielle Levitan

Don’t let 2013 come to an end without registering for the 2014 Independent Owner Leadership Conference. The theme of the conference is Thriving in a Changing World. You’ll discover the best practices in change management, learn new ways to meet the challenges of managing staff and patients, explore different approaches for dealing with new laws and regulations, and get inspired to raise the quality of care you provide.

Register now and take advantage of this opportunity to join your senior level colleagues March 12-14 at Caesars Palace Las Vegas.
  • Earn up to 10.5 CEUs
  • Discuss the latest issues that matter to you
  • Learn innovative strategies and ideas 
  • Hear from terrific speakers
  • Attend numerous networking events
The early registration deadline is February 11, 2014.

Early registration saves $75 off the standard member rate. Register and attend the NCAL Spring Conference that also takes place at Caesars Palace from March 10-12, and save even more.

Learn more, register online, or download a registration form today.

Sponsors as of December 30, 2013: Evans Senior Investments, Kronos, MatrixCare, My Inner View by National Research Corporation, OnShift, Optimus EMR, PointRight, VCPI

Wednesday, December 18, 2013

Don’t Forget To Post OSHA Injuries And Illness Summary Forms By Feb. 1st

By Lisa Gluckstern

February 1 is the deadline for employers to post the Summary of Occupational Safety & Health Administration Occupational Work-Related Injuries and Illnesses Summary Form 300A, which must remain posted until April 30, 2014. The injuries and illnesses being reported are for calendar year 2013.

Work-related injuries and illnesses that must be reported are those that occur in a work environment and results in one of the following conditions: a loss of consciousness, sick days, medical treatment beyond first aid, restricted work activities, a job transfer, and death. Other conditions that must be recorded are needle stick injuries or cuts from sharp objects as well as sprain and strain injuries to muscles joints and connective tissue according to the OSHA Form 300. For a complete list of injuries and illness that need to be recorded, click here.  There are forms that can be completed by printing a blank form or forms can be filled out online.

An employer must keep the OSHA’s log and summary for five years after the reported year. For example, 2012 must be retained through 2017.

Direct Enrollment in the Federally Facilitated SHOP Marketplace

As noted in previous communications, the Small Business Health Options Program (SHOP) was created in the Affordable Care Act (ACA), and is a new way for small businesses to buy health insurance for their employees.  You can offer employee coverage through the SHOP Marketplace at any time during the year.  Included in this article is important information about direct enrollment.  If your small business is located in a state that is using the Federally Facilitated SHOP Marketplace, you can use’s new “direct enrollment” process to get coverage for your employees.  Here is how it works:

  1. Contact an agent, broker, or insurance company that offers plans through the SHOP Marketplace.
  2. Be sure you and your employees enroll in a SHOP Qualified Health Plan.
  3. Claim your tax credit.
According to the site, the insurance company can tell you exactly how much coverage will cost and can enroll your employees directly into the plan. If you prefer, you can opt to wait to enroll employees until after you receive an official notice of eligibility from the Federally Facilitated SHOP. You’ll need this notice before you file your tax returns, if you want to claim the enhanced Small Business Tax Credit.  If your business is located in a state that is running its own SHOP Marketplace, you’ll need to follow that state’s application and enrollment process.

All the federally facilitated exchanges are available for employers with less than 100 employees.  The State exchanges are available to those employers with less than 50 employees, and there are 16 state exchanges and 35 federally facilitated exchanges.  Employers that are eligible for SHOP can call the Health Insurance Marketplace Small Employer Call Center at 1-800-706-7893 to get general SHOP and small business questions answered by a customer service representative Monday through Friday, 9am to 7pm EST. 

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

Senate Set to Pass Budget, Wrap-Up Health Care Issues for 2013

By Drew Thies

The Senate voted Tuesday to cut off debate on the bipartisan budget deal, making final passage highly likely. A vote to send it to the President’s desk is expected by the end of the week.

The chamber agreed 67-33 to bypass the final procedural hurdle for the legislation, the result of the budget panel led by Rep. Paul Ryan (R-WI) and Sen. Patty Murray (D-WA).

The deal increases discretionary spending to $1.012 trillion for the current fiscal year and $1.014 trillion for FY 2015. It raises revenue through fee increases, avoiding hot-button issues such as tax hikes and entitlement reform, and replaces the upcoming round of across-the-board sequester cuts with a more targeted approach.

The debt ceiling, which will likely have to be raised this spring, is unaddressed in the deal.
A three-month physician payment patch, or doc-fix, is included. The stopgap measure will update doctors’ Medicare reimbursement through March, at which point new legislation will have to be passed.

Twelve Senate Republicans broke with Senate Majority Leader Mitch McConnell (R-KY) to vote with Democrats to cut off debate. Roy Blunt (R-MO) was the only member of Republican Senate Leadership to break ranks. Many Republicans with known primary challengers sided with party leadership.

Final passage of the budget deal will mean that major legislative health care decisions are effectively finalized for 2013, all without a major cut to skilled nursing or assisted living.

The AHCA Government Affairs team extends our utmost appreciation to all our advocates, without whom the successes of this year simply would not have happened.

Thank you to all who flew into DC, contributed to AHCA/NCAL PAC, responded to our Advocacy Alerts, hosted facility tours and in-district fundraisers, and simply stayed in touch with your Members of Congress. Every action, small or large, helps to keep our voice strong. This year, we proved that the voice of long term care is one that is not only heard, but followed on Capitol Hill.

Tuesday, December 17, 2013

Quality Time in the Big Easy!

AHCA/NCAL’s first major educational opportunity of 2014 and the quality event of the year - the 6th Annual Quality Symposium – is fast approaching! Join us in New Orleans this coming February 10-12 for engaging speakers, lively discussions and an inspiring atmosphere to learn why “quality is our business solution.”

What would you hope a conference dedicated to quality be?

  • Keynote speaker Dr. Shari Ling from CMS, Deputy Chief Medical Officer serving in the Center for Clinical Standards and Quality, will focus on achievement of meaningful health outcomes through delivery of high quality person-centered care across all care settings.
  • A diverse array of educational sessions allows you to earn up to 14.25 NAB-approved administrator CEUs and 7.12 Nursing CEUs.
  • Choose between 5 intensive sessions on the first day. Each provide a “deep dive” into key areas, including QAPI, changing payment models focused on quality outcomes, and rising acuity in assisted living.
  • NEW – education just for you! 3 sessions designed just for long term and post-acute care clinicians and 3 sessions focused on the assisted living setting.
  • Strategery. Practical content on issues of strategic importance, including ways to successfully lead practice changes to meet your quality goals and how to effectively use data to manage and improve your organization’s performance.
  • Celebrate your and your peers’ successes at our Quality Initiative Recognition Program luncheon on Tuesday, February 11th!
  • Visit the AHCA Poster Gallery to hear from your peers about their efforts and achievements - draw inspiration as well as practical tips and takeaways from their journeys.
  • Keynote speaker Christopher Ridenhour will share insights on why positive, purposeful and empathetic relationships define the workplace culture and how each person can become a “champion” of possibility.
  • The best opportunity you will find to network with professionals from across the country focused on continuously taking their organizations to the next level of performance.
  • Participate in our first “Gallery Walk” - leave the classroom and accompany a faculty moderator to pre-selected storyboards to discuss the improvement journey depicted on each with their presenters.
  • New Orleans. Need we say more?


Is Your Organization on Track to Meet Our Antipsychotics Goal?

As 2013 winds down, it’s time once again to take stock of progress on our Quality Initiative goals. The end of the year is always a great time to reflect on where we’ve been and to plan our next steps.  AHCA recently released results for the most recent reporting period for which national data are available, Q2 of 2013. Where does your center stand today?  If you are among those organizations that have successfully met the goal of a 15% reduction in off-label use of antipsychotic medications – we applaud you! Be sure to pause to acknowledge your team for their hard work and celebrate that success.  If you are still working on getting there, don’t give up – change takes time.  In either case, there is more work to do!  It’s important to assess where you are, to set your next milestone and determine what else you need to do to get there.

A great place to start is the AHCA Quality Initiative website, which offers members guidance and helpful resources to assist you on your journey.  On our antipsychotics page, be sure to check out the brand new addition to our member tool box, A Guide to Reducing Antipsychotic Drugs While Enhancing Care for Persons with Dementia: A Competency-Based Approach (available exclusively to members).  This guide frames the actions needed to create change from a competency-based perspective.  To improve care for persons with dementia and reduce antipsychotic use, AHCA has identified the competencies that staff would exhibit in their daily work.  The framework can help you self-assess to identify and target areas that may need additional attention.  It can also support your QAPI process, providing a structure for your Quality Committee to use in reviewing and considering opportunities for Performance Improvement Projects (PIPs).  And last but not least, the guide directs you to topic-specific educational resources, exercises, and practical tools that can help address gaps and challenges you identify.

Another important resource to remember is the consumer fact sheet, FAST FACTS: What You Need to Know About Antipsychotic Drugs for Persons Living with Dementia (available in English and Spanish).  With the holidays approaching, you will likely have more interaction with family and friends whose loved ones are living in your center.  Their visits provide a great opportunity to initiate meaningful conversations about your efforts to provide person-centered care for persons with dementia and to help educate families about the concerns surrounding antipsychotic medication use in this population.  The fact sheet can be a great starting point for this conversation.

Last, but far from least, AHCA/NCAL has a new tool to help you enhance your staff’s ability to provide person-centered caring for individuals with dementia. We are pleased to offer the CARES® Online Dementia Care Training, a program offering basic and advanced levels of training for direct care staff, and the Alzheimer’s Association® essentiALZ® certification program. The training program is an interactive online format that engages staff and provides them with added knowledge about the fundamentals of Alzheimer’s disease and related dementias. It also offers them practical strategies for improving care and meeting the needs of persons with dementia.  The essentiALZ certification program recognizes staff and documents their added knowledge and skills in this area.  For more information and a special, member-only 10% discount, see our resource sheet on our antipsychotics webpage.

We commend you for the hard work you are doing and encourage all of you to keep it up! By seeking to understand and respond to behavior as communication, your efforts are enhancing care and improving lives for residents living with dementia.

Resources Highlighted:

New Report Reflects Trends in Long Term, Post-Acute Care Centers

By Dave Kyllo

The National Center for Health Statistics (NCHS) recently released its new report profiling the nursing home (SNF/NF), residential care communities (assisted living), hospice, home health agency and adult day services center industries.  This “first of its kind” report will be published every two years going forward with updated data.

The report contains a number of data points including usage.  On any given day, there are 26 individuals per 1,000 people aged 65 and older residing in nursing centers and 15 individuals per 1,000 age 65 and older living in residential care settings.  Using the same metric, home health agencies had the highest utilization with 94 individuals per 1,000 and adult day services had the least with four individuals.  The figure for hospice is 28 individuals per 1,000 age 65 and older.

Alzheimer’s disease and other dementias are most prevalent in nursing centers representing 48.5 percent of the population, followed by hospice with 44.3% of all residents.  Residential care communities were third with 39.6 % of residents.

Across all settings (hospice data was not available), bathing is the most common activity of daily living that people need assistance with followed by dressing, then toileting and then eating.  Figures for transferring were not included.

The report, titled “Long-Term Care Services in the United States: 2013 Overview,” contains numerous other statistics and can be found here. Surveys were conducted of the residential care and adult day services industries.  Administrative data was used to compile statistics for the other three industries.  All data is from 2012.  NCHS will begin collecting data for its next report in 2014. 

Holiday Sale: Increase Quality Care By Building Relationships

By Karah DeMarco

Product #8300
Price: $15.95

The holiday season is upon us, and what better time of year to reflect on our own personal and professional relationships. This AHCA/NCAL publication offers great tips and advice on how to build stronger relationships and ultimately raise the quality of care you provide.

The 100/0 Principle: The Secret to Great Relationships author, Al Ritter, is a management consultant who works with CEOs, other leaders, and teams who are committed to achieving breakthrough results. Also, as a professional speaker, Al has delivered over 500 speeches, workshops, and seminars.

Order before January 2 and SAVE 10% on your entire order by entering the coupon code, SAVE10 when shopping online. Provide the same code to a customer service member when ordering over the phone to receive your discount. 

Orders may be placed at or by phone at 800-321-0343.

Senate Special Committee on Aging Hearing on Long Term Care

By Dana Halvorson

This Wednesday, December 18, the U.S. Senate Special Committee on Aging, led by Chairman Bill Nelson (D-FL) and Ranking Member Susan Collins (R-ME), will hold a hearing at 2:15pm EST in Senate Dirksen Room 562 entitled, “The Future of Long-Term Care Policy: Continuing the Conversation.”  Witnesses include:
  • Bruce Chernof, MD, President and Chief Executive Officer, The SCAN Foundation
  • Mark J. Warshawsky, Visiting Adjunct Scholar, American Enterprise Institute
  • Judy Feder, PhD, Professor, Georgetown University McCourt School of Public Policy and Fellow, Urban Institute
  • Anne Tumlinson, MMHS, Senior Vice President, Avalere Health
Last month, Chairman Nelson noted that “this year, the committee has examined the importance of advance care planning as well as why a majority of Americans have done little to no planning for future long-term care needs.  Next month [December], we will continue this series of hearings by looking at expert recommendations for reforming our long-term care system.” 

According to a recent email from the Senate Special Committee on Aging, the Senators will hear from a panel of experts, including three members of the U.S. Commission on Long-Term Care, on a number of ideas aimed at helping families and the government prepare for the increasing demand for long-term care services.  Among other things, they include expanding Medicare and making private long-term care coverage more affordable for those who need it.  AHCA/NCAL will be closely following this hearing.

Key Dates for the SHOP Marketplace

By Dana Halvorson

As noted in previous communications, the Small Business Health Options Program (SHOP) was created in the Affordable Care Act (ACA), and is a new way for small businesses to buy health insurance for their employees.  You can offer employee coverage through the SHOP Marketplace at any time during the year.  Included in this article are a few key enrollment dates to remember from  If your employee enrollments are submitted between the 1st and 15th day of the month, your group coverage begins the first day of the next month.  For example, if your employee enrollments are submitted on February 10, 2014, your group coverage begins March 1, 2014.  For enrollments submitted after the 15th of the month, coverage begins the second following month.  So, if employee enrollments are submitted on February 18, your group coverage will begin on April 1.  If you want your employees’ coverage to begin on January 1, 2014, the current deadline is December 23. 

All the federally facilitated exchanges are available for employers with less than 100 employees.  The State exchanges are available to those employers with less than 50 employees, and there are 16 state exchanges and 35 federally facilitated exchanges.  Employers that are eligible for SHOP can call the Health Insurance Marketplace Small Employer Call Center at 1-800-706-7893 to get general SHOP and small business questions answered by a customer service representative Monday through Friday, 9am to 7pm EST.  If you have any questions relating to the ACA, please submit them to, and be sure to check out AHCA/NCAL’s ACA website.

Strategy for Diversifying Seniors Housing Assets

By Dana Halvorson

On February 5, 2014, at 2:00PM EST (60 minutes), AHCA will be hosting a webinar entitled, Strategy for Diversifying Seniors Housing Assets.  This webinar is designed to provide owners and operators of seniors housing assets a sound perspective on why they should diversify across asset types and how to strategically add to their portfolio.  The potential seniors housing resident population is growing at a rapid pace and the demands for product type continue to evolve.  As such, diversifying your seniors housing portfolio can help eliminate risk in these shifting market demands and help to increase financial performance.  This webinar will cover trends in the market demand and which diversification strategies help maximize profitability.  Key learning objectives include:
  • Understanding the market demand trends and the effects it has on seniors housing product types
  • The reasons for diversifying a seniors housing portfolio
  • To uncover the diversification strategies that provide the most benefit to seniors housing owners and operators
Speakers will include Jason Stroiman, President of Evans Senior Investments, and Jeremy Stroiman, CEO of Evans Senior Investments.  If you have any questions about this webinar, please contact AHCA’s Director of Not for Profit & Constituent Services, Dana Halvorson

Twitter Chat: Seniors and Disaster Preparedness

By Amy Mendoza

Use the Hashtag: #Seniorprepare in your tweets!

What: Twitter Chat: Preparing for an Emergency – 10 Things to Consider with Loved Ones in a Care Center

When: Thursday, December 19, 2013 2:00pm EDT

Who: AHCA and The National Healthcare Coalition

Where: Join us online via your Twitter account. Use the hashtag #seniorprepare in your tweets! You may also submit questions or comments prior, during and after the chat!

Why: Designed for families, friends, and/or staff in skilled care centers, this chat will provide knowledge and important things to consider before and during a disaster.

For questions, contact Amy Mendoza at

Former AHCA Chair Shares Best Practices

By Claire Krawsczyn

Former AHCA Chair Bob Van Dyk shared important advice about starting care conversations with loved ones. In an article posted on Expert Beacon, Van Dyk, President and CEO of Van Dyk Health Care, outlined important things families should and should not do when discussing long term and post-acute care with aging family members.
The article hits highlights on how to begin difficult conversations, how to plan and prepare for care and ways to ease the transition for family members. The content of the article stems largely from AHCA’s ongoing Public Education and Communications Campaign (PECC), which was started in 2011 in an effort to educate the public about long term and post-acute care. As a result of the campaign, AHCA helped to establish, a website devoted to educating consumers about the types of care available. The website also features a facility locator to allow families to easily search for long term care facilities in their communities. For questions about CareConversations or the PECC, please contact Claire Krawsczyn.

2014 Quality Award Applications Now Available!

By Claire Krawsczyn

The AHCA/NCAL National Quality Award Program is now accepting applications for the 2014 award cycle. Centers who are interested in participating can download an application packet online

To support centers as they complete their applications, AHCA/NCAL has a variety of helpful resources. Applicants can watch the 2014 Bronze Criteria Series and AHCA/NCAL Management Series videos. Applicants can also view a sample application for each level of the program, a sample key factors worksheets, and the 2014 application cycle calendar. Also, all applicants are reminded of the new National Quality Award Recertification Policy, effective for the 2014 award cycle.

Mark your calendars today! Bronze and Gold applications are due January 30 and Silver applications are due February 27.  For questions and more information, visit

Monday, December 16, 2013

OIG Releases Strategic Plan for 2014-2018

By Dianne De La Mare

The US Department of Health, Office of Inspector General (OIG) has released the OIG Strategic Plan 2014-2018 (Plan), which focuses on the agency’s goals of fighting fraud, waste and abuse; promoting quality, safety and value, securing the future; and advancing excellence and innovation.  Under the category of fighting fraud, waste and abuse; OIG will use data analysis and risk assessments of emerging issues to identify suspected fraud, waste and abuse and to deploy oversight and enforcement resources.  Its priorities under this category are to hold wrongdoers accountable and maximize recovery of public funds, as well as to prevent and deter fraud, waste and abuse up front.  Under the category of promoting quality, safety and value; OIG will continue to evaluate and recommend improvements to the systems intended to promote quality of care, exemplified by its series of reviews of adverse events.  Further, it will investigate and refer for prosecution cases involving abuse or grossly deficient care of Medicare and Medicaid patients.  Its priority under this category is to promote public safety.  Under the category of securing the future; OIG will foster sound financial stewardship and the reduction of improper payments.  OIG will continue to review HHS’ annual financial statement audits and error rate reports.  It will conduct targeted reviews to identify improper payments to be recovered and recommend management improvements to systemic weaknesses that contribute to improper payments.  Its priorities under this category are to support a high-performing health care system and promote the secure and effective use of data and technology.  Under the category of advancing excellence and innovation; OIG will strive to advance excellence and innovation in its own organization and operations.  Its priorities under this category is to recruit, retain and empower a diverse workforce; leverage leading edge tools and technology and promote leadership, vision and expertise.  To obtain a copy of the complete report, click here.

2014 Quality Awards Application Period Now Open!

By Courtney Bishnoi

2014 Quality Award applications are now being accepted online. Please visit the application submission website to review our Quality Award application upload policy, and submit your application.

Please note that the Bronze and Gold application deadline is January 30, 2014 at 8:00pm EST, and the Silver Application Deadline is February 27, 2014 at 8:00pm EST. Remember, late applications are not accepted for any reason, so please make sure you have proof of the following confirmations:

  • Confirmation #1: The first confirmation is a web page that populates after a successful submission and reads "Application Confirmation." As the message indicates, you should print this screen for your records.
  • Confirmation #2: Once you submit your application, the system will immediately generate a confirmation email for a mailbox called If you do not receive this confirmation email within 1 hour (and you cannot locate it in your SPAM filter); please email However if this occurs after the 8:00pm EST deadline, your application may not be accepted.
If you have any questions on the application submission website, please contact

Georgia Holiday Program Encourages Public to Visit Skilled Nursing Centers

The Georgia Health Care Association's (GHCA) successful "Share a Moment of Love this Holiday" campaign encourages the public to visit residents of skilled nursing centers during the holidays. The program, now in its second year, has already helped to bring holiday cheer to nursing care centers across Georgia.

In his interview with The Atlanta Journal-Constitution, Deke Cateau, administrator of A.G. Rhodes Health & Rehab in Atlanta reflected on why it is particularly important to spread holiday cheer to residents.
"[The holidays are] a time when a lot of residents reflect," said Cateau. "They think about the loved ones they have lost over the years. People assume that all of our patients have families that live here locally. We have many residents whose families may live out of town. We have some who do not have family support at all, which emphasizes the needs for campaigns like this."

Thursday, December 12, 2013

AHCA/NCAL Statement on Congressional Budget Deal

Late yesterday afternoon AHCA/NCAL issued the following statement from President and CEO Mark Parkinson regarding the congressional budget deal:

AHCA is supportive of the bipartisan budget deal.  In addition to providing the country certainty, it also includes an agreement to extend the therapy exceptions process to ensure that seniors receive the therapy they need.  Congress ends the year on a positive, constructive note.  We look forward to working with both chambers in 2014 to continue to provide solutions to the challenges facing America’s seniors.”

NCAL Spring Conference Promises Top-Notch Education

By Katherine Preede

Are you looking for a conference with excellent keynote speakers, the latest in assisted living programing and the chance to network with providers from around the country? If so, then register today for the 2014 NCAL Spring Conference, taking place at Caesars Palace in Las Vegas Nevada!

The 2014 theme, theme, “The Future is Now,” brings to light the person-centered care assisted living is known for and provides attendees with the very best in-depth learning experience. Featuring keynote speakers Chef Jeff Henderson and marketing guru John Moore, this must attend will be held March 10-12, 2014.

This premier assisted living conference consists of two tracks, one for Owners/Operators and one for Executive Directors/ Community Leaders that will help you learn how to analyze your environment and implement the processes that will exceed expectations, and improve your reputation. Earn up to 10.25 CEUs through premier educational sessions including:

  • Interactive and hands-on sessions regarding ACOs, resident acuity Assisted Living Aligning with ACOs, and the role of REITs.
  • Valuable resources for developing your social media presence, handling resident bullies, preparing for emergency events and addressing workplace violence.
  • Opening Keynote Speaker Chef Jeff Henderson, an award-winning chef, motivational speaker, New York Times best-selling author, and Food Network television personality.
  • Closing keynote speaker John Moore, a branding expert and marketing mastermind from Starbucks and Whole Foods.
The AHCA/NCAL Independent Owner Leadership Conference takes place immediately after this event March 12-14, 2014.  Register for both and save!

Wednesday, December 11, 2013

We are the Solution Reaches Millions

By AHCA Press Office

This week, AHCA/NCAL began airing its new 30-second commercial on national TV programs. As part of the We Are theSolution campaign, the commercial aims to share the Association’s message of providing solutions that save the government money, advance our profession and enhance the lives of residents.
Viewers of programs such as Face the Nation, Meet the Press, Fox News Sunday and CNN’s State of the Union, among others, had the opportunity to see the commercial. The TV spot is part of a larger ongoing campaign that includes print, online and radio advertisements.

To view the commercial and the print ads, and to stream the radio spot, visit the AHCA/NCALSolutions website.

Budget Panel Announces Deal

By Drew Thies

Rep. Paul Ryan (R-WI) and Sen. Patty Murray (D-WA) announced a two-year budget agreement Tuesday night that averts another government shutdown in January and replaces sequester spending cuts.
The bipartisan package, developed as a result of the bipartisan, bicameral budget panel created in the wake of the government shutdown in October, includes $63 billion of sequester relief offset by $85 billion in savings.

In their announcement, Rep. Ryan and Sen. Murray acknowledged that core principles of both parties were not on the table, resulting in an agreement which did not overhaul the tax code or entitlement programs.
The agreement has the support of the White House. In a statement released shortly after the announcement, President Obama said, “it’s a good sign that Democrats and Republicans in Congress were able to come together and break the cycle of short-sighted, crisis-driven decision-making.”

Party leaders on both sides of the aisle and in both chambers also offered their support. House Majority Leader Eric Cantor (R-VA) and Senate Majority Whip Dick Durbin (D-IL) backed the deal. Ryan and Murray expect the budget to pass both the House and Senate.
Many supporters of the plan want to hasten its passage and hope to hold votes in both chambers by the end of the week, at which point both Chambers adjourn for the holidays. Backers fear that if the legislation does not become law before 2014, it will give a chance for opponents to push potential supporters away from the bill.

New! Poster Session Gallery Walk

By Jon-Patrick Ewing
Join us for this unique and new Quality Symposium experience! During this session, participants will leave the classroom and accompany a faculty moderator to pre-selected storyboards. There, they will discuss the improvement journey depicted on them. Storyboard presenters will be on hand to answer questions. The storyboards that will be part of this special Gallery Walk will depict work on topics from the AHCA goals: Customer Experience, Staff Stability, Reducing Rehospitalizations and Reducing the use of Antipsychotic Drugs. Why not get out of your seat and join the Gallery Walk, Monday, February 10, 11 am-12 pm?

The AHCA/NCAL Quality Symposium is scheduled for February 10-12, 2014 in New Orleans. Don’t delay, registration is now open. The deadline is January 10, 2014.

Tuesday, December 10, 2013

December Issue of Provider Now Available!

By Meg LaPorte

Stroke rehabilitation has made some significant strides in recent years. It used to be that whatever progress patients made in the first six months after stroke was all that could be expected. But scientists and practitioners have since found that survivors are able to develop new neuropathways that lead to progress long after six months post-stroke, as Contributing Editor Joanne Kaldy finds in Provider’s December cover story. What’s more, it turns out that despite all the high-tech hype that goes with stroke rehab, high-touch and getting to know the person are the best ways for getting patients back to where they once belonged.

Caring for elders inside the Arctic Circle can be challenging, but at Utuqqanaat Inaat in Kotzebue, Alaska, the northernmost nursing home in the country, caregivers provide person-centered care to their 18 residents with great success. In this month’s Focus on Caregiving column, we learn a little about the Inupiat customs and diet and a lot about making the most of the eternal sunshine of summer.

In December’s Management column, the dining director at Manchester Manor Health Care Center in Manchester, N.H., describes his home’s shift to direct dining. In addition to a methodical roll out, the center realized significant savings.

In this month’s feature article, researchers working for the U.S. Agency for Healthcare Research and Quality suggest that assisted living providers post consumer-friendly information about the services they offer.

Finally, in the second installment of ProviderNation In Print, Vivian Tellis-Nayak continues his poignant and revealing narrative about his struggle with Parkinson’s disease and the toll it has taken on his marriage and family life.

Observation Stays Issue Update

By Dana Halvorson

AHCA/NCAL continues its support and advocacy for legislation, The Improving Access to Medicare Coverage Act of 2013 (S. 569/H.R. 1179), introduced by Reps. Joe Courtney (D-CT) and Tom Latham (R-IA), along with Sen. Sherrod Brown (D-OH), which seeks to count all hospital days spent in observation towards the three-day stay requirement.  The number of cosponsors since the bills were introduced earlier this year have increased significantly.  Currently, S. 569 has 24 bipartisan cosponsors, while H.R. 1179 has 125 bipartisan cosponsors.  AHCA/NCAL also continues its work as part of the Observation Stays Coalition, which now consists of 19 organizations advocating for this important legislation.  Most recently, The Jewish Federations of North America (JFNA) joined the efforts.  In addition to AHCA/NCAL and JFNA, Coalition members include:  AARP, AMDA, American Case Management Association, American Medical Association, Alliance for Retired Americans, Center for Medicare Advocacy, Inc., Leadership Council of Aging Organizations, LeadingAge, Medicare Rights Center, National Academy of Elder Law Attorneys, National Association of Professional Geriatric Care Managers, National Association of State Long-Term Care Ombudsman Programs, National Committee to Preserve Social Security and Medicare, National Consumer Voice for Quality Long-Term Care, National Senior Citizens Law Center, and Society of Hospital Medicine.  The updated Coalition fact sheet can be found here.  For more information about observation stays, visit the AHCA/NCAL website.

OIG Claims OCR Failed to Meet All Enforcement Requirements of HIPAA Security

By Dianne De La Mare

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG), has released a report, The Office For Civil Rights Did Not Meet All Federal Requirements In Its Oversight and Enforcement Of The Health Insurance Portability And Accountability Act Security Rule, indicating that the HHS, Office of Civil Rights (OCR), did not meet all the federal requirements in its oversight and enforcement of the current federal security rule.  Although OCR met with some of the federal requirements; it did not meet with the “critical” requirements for the enforcement of the security rule which includes assessing the security risks and establishing priorities or implemented controls under the Health Information Technology for Economic and Clinical Health (HITECH) requirement (e.g., periodic audits of covered entities to ensure compliance with the security rule).  OCR investigation files did not contain the required documentation supporting key decisions, according to the OIG report.  The OCR staff did not consistently follow OCR investigation procedures by sufficiently reviewing investigation case documentation.  Further, OCR had not implemented sufficient controls, including supervisory review and documentation retention, to ensure investigators followed investigation policies and procedures for properly initiating, processing and closing security rule investigations.  The OIG report also found that OCR had not fully complied with federal cybersecurity requirements included in the National Institute of Standards and Technology (NIST) Risk Management Framework for its information systems used to process and store investigation data. The OIG recommends that OCR 1) assess the risks, establish priorities and implement controls for its HITECH auditing requirements; 2) provide for periodic audits in accordance with HITECH to ensure security rule compliance at covered entities; 3) implement sufficient controls, including supervisory review and documentation retention, to ensure policies and procedures for security rule investigations are followed; and 4) implement the NIST Risk Management Framework for systems used to oversee and enforce the Security Rule.  To obtain a copy of the entire report, click here.

GAO Medicare Program Integrity Report Shows Improvements Needed

By Dianne De La Mare

The US General Accounting Office (GAO) has released a report, Medicare Program Integrity:  Contractors Reported Generating Savings; BUT CMS Could Improve Its Oversight, indicating that Centers for Medicare & Medicaid Services (CMS) Medicare contractors have generated savings; but the agency should improve its oversight.  According to the report, in 2012, the cost-saving activities of Zone Program Integrity Contractors (ZPICs) were associated with a reported $251.9 million in associated savings to Medicare. In 2012, CMS gave close to $108 million to six operating ZPICs, most of which ($77 million) went toward reimbursing contractors for their fee-for-service work.  Despite CMS’ sizeable investment and the savings generated by the ZPICs; the GAO report stated that CMS lacks the information necessary for determining whether additional savings could be generated.  Additionally, CMS’ approach to addressing Medicare fraud is reactive instead or proactive. Of the 5,000 investigations of potential Medicare fraud that were carried out in 2012, close to 90 percent were in response to complaints, according to the report.  CMS also failed to link ZPIC performance to its program integrity measures.  GAO ask CMS to consider the following recommendations:  1) Collect and evaluate information on the timeliness of ZPICs’ investigative and administrative actions, such as how soon investigations are initiated after ZPICs identify potential fraud and how swiftly ZPICs initiate administrative actions after identifying potentially fraudulent providers; and 2) Develop ZPIC performance measures that explicitly link their work to the agency’s Medicare fee-for-service program integrity performance measures and targets for its Government Performance and Results Act (GPRA) goal of fighting fraud and working to eliminate improper payments.  To read the complete report, click here.

CMS Should Ensure States Report Medicaid Overpayments

By Dianne De La Mare

The US General Accounting Office (GAO) has released a report, Medicaid:  CMS Should Ensure that States clearly Report Overpayments, that indicates despite the $9.8 million in Medicaid overpayments recovered by the states, they did not clearly report the overpayments or the return of the federal share to the US Department of Health, Centers for Medicare & Medicaid Services (CMS).  Federal audits initially identified about $20.4 million in potential Medicaid overpayments across the 19 states with identified overpayments (from June 2007-Feburary 2012).  According to the report, there were $7.1 million in reductions, primarily due to successful provider appeals and settlements.  Of the $13.3 million in net overpayments remaining, states recovered $9.8 million, and were in the process of recovering the remaining $3.5 million.  States should have reported the return of the federal share for $13.3 million on the line designated for overpayments identified by the national audit program contractors on the form that states fill out quarterly to obtain federal reimbursement for Medicaid services (Form CMS-64).  However, states made multiple reporting errors on Form CMS-64.  Further, CMS generally reviewed the states’ reporting of overpayments; but was not always aware of incomplete reporting.  All 7 CMS regional offices who GAO spoke to about this report, indicated that reviewing states’ reporting of the return of the federal share of overpayments was a routine part of their quarterly review of the Form CMS-64 and helped to ensure the timely return of the federal share of overpayments.  In some cases, however, the regional offices were not always aware that states’ reporting was incomplete.  Currently, reviewing the data on the Form CMS-64 will not yield a clear picture of the return of the federal share of overpayments.  GAO recommends that CMS increase its efforts to ensure that states are clearly reporting overpayments identified by federal audits in the designated location of the Form CMS-64.  To obtain a complete copy of the report, click here.

Congressional Hearing Focused on the Small Business Health Options Program (SHOP)

By Dana Halvorson

On Wednesday, December 11, 2013, at 1:00pm EST, the US House of Representatives Committee on Small Business will hold a hearing titled, The Small Business Health Options Program: Is It Working for Small Businesses?  The hearing will be held in Room 2360 of the Rayburn House Office Building, and will be webstreamed live.  According to the website of the House Committee on Small Business Chairman Sam Graves (R-MO-6th), the purpose of the hearing will be to examine the status of the establishment of both federally-run and state-based SHOP exchanges.  As noted in previous communications, SHOP was created in the Affordable Care Act (ACA), and is a new way for small businesses to buy health insurance for their employees.  All the federally facilitated exchanges are available for employers with less than 100 employees.  The State exchanges are available to those employers with less than 50 employees, and there are 16 state exchanges and 35 federally facilitated exchanges.  Employers that are eligible for SHOP can call the Health Insurance Marketplace Small Employer Call Center at 1-800-706-7893 to get general SHOP and small business questions answered by a customer service representative Monday through Friday, 9am to 7pm EST.  If you have any questions relating to the ACA, please submit them to, and be sure to check out AHCA/NCAL’s ACA website.

Monday, December 9, 2013

Final CMS Rule on Medicaid Waiver Programs Expected in Late 2013 or Early 2014

By Dave Kyllo

Last week, Mark Parkinson, several NCAL/AHCA staff members and representatives from the National Association of States United for Aging and Disabilities (NASUAD), the Alzheimer’s Association (ALZ) and the National Association of Medicaid Directors (NAMD) met with representatives of the Office of Management and Budget (OMB) and the Administration to discuss the final CMS rule defining home and community-based settings under Medicaid waiver programs.  The final rule is currently at OMB for review before being published. 
NCAL/AHCA stressed the importance of keeping assisted living as an option for Medicaid waiver beneficiaries and said that several provisions in the last proposed version of the rule were troublesome and would displace a large number of Medicaid recipients.  The latest government statistics show that 19 percent of assisted living residents rely on Medicaid to pay for their services and 43 percent of assisted living communities nationwide have at least one Medicaid resident.  The other participating organizations, NAMD, AA, and NASUAD, also expressed notable concerns about the rule. 
Of particular concern are provisions related to proximity of an assisted living community to an institution such as a nursing facility, restrictions on locked units for residents with dementia and requirements that individuals be given the option of whether to share a room or demand an individual room. 
It is anticipated that the final rule will be published in late 2013 or early 2014. 

Save the Date: Seniors and Disaster Preparedness

By Amy Mendoza

What: Twitter Chat: Preparing for an Emergency – 10 Things to Consider with Loved Ones in a Care Center

When: Thursday, December 19, 2013 2:00pm EDT

Who: AHCA and
The National Healthcare Coalition

Where: Join us online via your Twitter account. Hashtag to follow soon.

Why: Designed for families, friends, and/or staff in skilled care centers, this chat will provide knowledge and important things to consider before and during a disaster.

For questions, contact Amy Mendoza at

Twitter Chat: Seniors and Alzheimer’s... Join us this Friday!

By Amy Mendoza

What: Twitter Chat: 10 Things to Know About Seniors and Alzheimer’s

When: Friday, December 13, 2013   12:00pm EDT

Who: AHCA and The Alzheimer’s Association

Where: Your computer! Log into Twitter and use #SeniorAlz in your tweets to follow the chat.

Why: Come learn about resources and tips regarding seniors and Alzheimer’s disease. This chat is perfect for anyone with a senior friend or loved one with Alzheimer’s disease or for those who would like to learn more.

For question, contact Amy Mendoza at

Make Sure You’re Ready For A Site Visit in 2014

By Karah DeMarco

Product: 6913

Price: $59.95

The definitive resource for helping companies achieve world-class results, Baldrige Award Winning Quality - 18th Edition: How to Interpret the Balridge Criteria for Performance Excellence is the only book on the Balridge criteria to detail, in simple and straightforward language, every category, examination item, and area to address. From understanding the scoring system to preparing for a site visit, it guides you through all stages in the process. It offers detailed explanations of each of the 17 "Examination Items" and the 36 "Areas to Address" that compose the seven major categories, the book reveals exactly what examiners look for in each area and suggests what you need to include. This publication reflects the new criteria (2013-2014) that address education and healthcare.

Holiday Sale: Order before January 2 and SAVE 10% on your entire order by entering the coupon code, SAVE10 when shopping online. Provide the same code to a customer service member when ordering over the phone to receive your discount. 

Order your copy today at or call 800-321-0343.

Mark Your Calendars-- Webinar Next Thursday!

By Adrienne Riaz-Khan

Date & Time: Thursday, December 19, 2013 – 2:00pm – 3:00pm(EST)

Webinar title: Insights Into the Healthcare Ecosystem: The National Research Report for Post-Acute Providers

Speakers:  Jason Stevens, Vice President, Business Development – My InnerView by National Research Corporation

Session Description: Professional and policy movement continues to accelerate toward the need for healthcare providers to collaborate across the continuum. The virtual walls separating various types of providers are collapsing.

Join My InnerView by National Research Corporation to explore the first-ever report to integrate ideas and data from five post-acute care segments: skilled nursing, assisted living, independent living, home health, and hospice.

Attendees will walk away with exclusive findings on some of the most hard-hitting topics for senior care and other post-acute providers, including person-centered care, the critical importance of staffing, and the larger changes of care delivery within the healthcare ecosystem or continuum.

Learning Objectives:

  1. Gain a deeper understanding of the needs of residents and patients and how post-acute providers are meeting those needs.
  2. Get a fresh perspective on the post-acute workforce to uncover the driving force behind staff satisfaction.
  3. Explore the changing role of the post-acute provider and how to overcome common challenges across the care continuum.