Wednesday, February 26, 2014

"Best Nursing Homes" on the Rise Reeves

Today, U.S. News & World Report released its annual rankings on skilled nursing care centers, called “Best Nursing Homes.” The publication derives its rankings from CMS’ Five-Star Ratings System, naming all those which achieved a five-star rating a “best nursing home.”

In 2014, U.S. News found five-star centers were increasing dramatically, with 25% of America’s skilled nursing care centers earning the distinction this year, compared to 19% in 2013.

AHCA’s own Dr. David Gifford helped explain the rising tide in an article previewing the release of Best Nursing Homes 2014:
“For example, says Gifford, large numbers of nursing homes have bolstered their staffing, allowing nurses to spend more time with residents and potentially improving their staffing star rating. He also says nursing homes are providing better clinical care to residents, which can push up the star rating in that category. Facilities are paying more attention to cutting down on the use of antipsychotic drugs that make residents easier to handle, says Gifford, and are becoming more diligent about taking precautions to prevent bedsores.” 
U.S. News found that California has the most five-star centers, followed by Florida, Ohio, Texas and Pennsylvania.

U.S. News also provides a searchable database on all nursing centers in the country, with data and information on care, safety, health inspections, staffing and more.

As part of the series, U.S. News offers additional articles on how to pay for care, spot warning signs of bad care, understand how the federal Affordable Care Act affects senior care, and otherwise manage the emotional and financial challenges of dealing with an aging loved one.

Tuesday, February 25, 2014

Be Prepared!

Know what to expect and be prepared for a Quality Indicator Survey (QIS) with this important resource. You’ll be able to conduct mock surveys using the same materials field surveyors will use when they enter your facility. This is a great way to test your staff on their standard of quality and survey readiness.

The QIS Mock Survey Guide is a publication that comes with a CD-ROM which provides you with a step-by-step outline of what happens during a survey under the revised process. It simplifies the differences between the traditional survey and the QIS and provides educational tools to complete the survey process.

Product #8294

Price: $149.00
This solution-based guide
  • Includes an overview of the QIS and how to transition into the QIS from the traditional survey process
  • Offers instructions on how to perform both Stage I and Stage II of the QIS at your organization
  • Provides a detailed outline of everything you need to do to prepare before the arrival of surveyors
  • Includes case studies that look at five separate instances where facilities were found deficient under F-tags 329, 309, 314, 323, and 505
  • Outlines the best way to develop a survey team, conduct a mock survey, and troubleshoot any potential problems
  • Contains the actual forms and worksheets used by surveyors in the field today 
Order online at or by phone 800-321-0343.

AHCA Ramps Up Advocacy Efforts for March SGR Deadline

Members of Congress returned this week from their Presidents Day recess ahead of what promises to be a busy March for health care policy. AHCA has numerous fundraisers as well as office meetings planned for this week and next, meeting with the key leadership figures who will be driving legislative decisions this month. Time is of the essence as Congress only has four legislative weeks to either replace or patch the sustainable growth rate (SGR), which is set to expire on March 31.

The Senate Finance Committee as well as the House Ways & Means and Energy & Commerce Committees have released a final plan for what an SGR replacement will look like, but have not decided on how to pay for such a change. If budgetary offsets for a permanent fix cannot be found, a temporary “doc fix” is still expected to cost in the tens-of-billions.

In order to keep post-acute care’s voice heard, AHCA will be meeting with Members of Congress and their staff from all three of the critical committees with the message of preserving Medicare reimbursement and easing regulatory burdens for America’s skilled nursing centers.

You can join in too. Visit to contact your Members of Congress and tell them to keep long term care at the forefront of health care discussions this March.

AHCA/NCAL Joins Efforts to Reinstate and Enhance the IRA Charitable Rollover

A number of critical charitable giving incentives, including the IRA charitable rollover, were allowed to expire on January 1, 2014, along with scores of other temporary tax provisions. Efforts are underway in Congress to reinstate these provisions into law, and AHCA/NCAL recently joined the Independent Sector and close to 500 organizations from across the country in sending a letter to all 100 U.S. Senators advocating to protect the charitable giving incentives. The letter also includes support for bipartisan legislation (the Public Good IRA Rollover Act - S.1772) that has been introduced by Senator Chuck Schumer (D-NY). This legislation not only creates certainty by making the IRA charitable rollover permanent; it also makes important improvements by eliminating the cap on distributions and provides donors greater flexibility in their charitable giving. 

Originally created by the Pension Protection Act of 2006 as a way to encourage older Americans to make gifts to charities, the IRA charitable rollover provision in the tax code allows individuals age 70½ to donate up to $100,000 to a qualifying public charity directly from his or her IRA without incurring tax on the withdrawal. According to the Independent Sector, during the first two years the IRA charitable rollover was available, it prompted more than $140 million in charitable donations, with the median gift just under $4,500. Beneficiaries included social service providers, skilled nursing care centers, religious organizations, cultural institutions – organizations that benefit communities and improve lives every day.

Upcoming Webinar: Using RN Continuing Education as a Weapon Against Rising Costs and Threats to Quality

The "Using RN Continuing Education as a Weapon Against Rising Costs and Threats to Quality" webinar on Tuesday, March 18, from 2-3pm EST will focus on how the current LTC environment can be improved by an intentional, comprehensive continuing education program for RNs that prepares them to achieve Board Certification. The modest investments LTC facility administrators have made in this program have had a positive impact on the LTC RN workforce, their effectiveness on the job, and their RN turnover rate in a LTC environment characterized by rising acuity of LTC patients, tighter reimbursements, and more stringent regulations. Administrators are finding that the benefits of this program to their residents and financial bottom line far outweigh its costs. Register today!

Speakers: Heidi Keeler, Assistant Professor, University of Nebraska Medical Center

Learning Objectives:
  1. Correlate the attainment of RN board certification with standards of clinical excellence.
  2. Explore the relationships between comprehensive education, RN retention, and overall quality of care outcomes 
  3. Provide data supporting the business case of comprehensive RN education and professional development investment

Tuesday, February 18, 2014

Stay Compliant in 2014!

Did you start the New Year off with the most up to date regulatory manuals? In order to provide the best quality of care possible, you will need to know all the latest information to be compliant with current federal regulations.  Don’t be the only facility without the latest editions of these important resources. Order your copy of The Long Term Care Survey or RAI/MDS manual today at our online store!

CMS Reopens Bundled Payment Models

On Thursday, February 13, CMS announced another opportunity for providers to apply to participate in three of their four bundled payment models. CMS is opening Models 2, 3, and 4 to new applicants. Many post-acute providers are already engaged in Model 2 (includes acute and post-acute care bundled together) and Model 3 (post-acute bundle only). Last month CMS announced that 232 provider organizations had entered the risk-bearing phase of the demonstration; some of those are skilled nursing facilities and AHCA members. The Bundled Payments for Care Improvement (BPCI) Demonstration has been working to move applicants into the risk-bearing phase since their first open period for applications in 2011. CMS has delayed implementation of the demonstration, which was originally scheduled to begin last July, several times due to complexities associated with readying providers to take on risk.

Providers have until April 18th to complete and submit all of the intake application forms which can be found here. AHCA members can visit our Bundled Payment Initiatives website with materials that were developed during the first open period. Providers are also invited to contact AHCA’s point of contact on bundling, James Michel, with any questions.

Monday, February 17, 2014

AHCA and Coalition Partners Urge Congress to Assure Continued Beneficiary Access to Part B Therapy Services

Recently, Congress reached a bipartisan bicameral agreement on the policy portion of the sustainable growth rate (SGR). However, this agreement did not include provisions on extender policies, particularly those related to the Medicare Part B therapy caps. Without Congressional action, the current exceptions process permitting beneficiaries a way to obtain necessary therapy services beyond the $1,920 annual caps are set to expire on March 31, 2014. AHCA has been actively engaged in efforts to assure that beneficiary access to Part B therapy services is assured beyond March 31, regardless of whether the policy is part of a short- or long-term legislative solution.

In addition to our direct advocacy efforts on the Hill, AHCA has aligned with a coalition of 16 beneficiary, consumer, provider, and professional associations to advocate in a common voice to assure that the needs of beneficiaries that require vitally necessary Part B therapy services are addressed in the SGR package. On February 14, the coalition delivered letters to the House leadership and its Committees on Ways and Means and Energy and Commerce. Letters were also delivered to the Senate leadership and its Finance committee. All letters are available on the “Therapy Cap” web page (at the bottom, see “Additional Resources”).
AHCA encourages members to advocate for these positions with your Congressperson and Senators, especially if your state has representation on any of the above House and Senate committees. 

Executive Order Signed Regarding Minimum Wage Increase for New Federal Contract Workers

Dana Halvorson

Last week, President Obama signed an Executive Order raising the minimum wage from $7.25 to $10.10 for new federal contract workers by 2015. The $10.10 per hour raise is effective January 1, 2015. According to a legal alert from Ford & Harrison LLP, on January 1, 2016, and annually thereafter, covered employers will be required to pay their employees an increased amount to be determined by the Secretary of Labor that is tied into the Consumer Price Index. The Executive Order applies if the contract or subcontract is a procurement contract for services or construction, is a contract for services covered by the Service Contract Act, and the wages of workers under such contract are governed by the Fair Labor Standards Act, the Service Contract Act, or the Davis-Bacon Act. The Executive Order requires the U.S. Department of Labor to issue implementing regulations on or before October 1, 2014. Employers with federal contracts or subcontracts should review their contracts and subcontracts with their attorneys before January 1, 2015 to determine whether they might be covered by this Executive Order.

It is important to note that this Executive Order does not impact Medicare (Parts A and B) or Medicaid providers, as it is a long-standing policy that they are not “federal contractors.” However, if you have VA patients, you are considered to be a federal contractor, and thus, this executive action may apply to your circumstances. That being said, AHCA continues its support for the VA’s proposed rule on Provider Agreements, which, among other things, increases the opportunity for veterans to obtain non-VA extended care serves from local providers that furnish vital and often life-sustaining medical services. AHCA is currently awaiting the final rule.

Wednesday, February 12, 2014

2013 AHCA/NCAL Annual Report Now Available

Download your copy of the 2013 AHCA/NCAL Annual Report today!

Clean Debt Ceiling Passes House, SGR Remains in Limbo

After weeks of negotiations, House Republicans moved Tuesday evening on a debt ceiling agreement that does not include external policy riders, forgoing a potential short-term patch to the sustainable growth rate (SGR). The Senate is expected to vote on the legislation Wednesday.

The so-called “clean” debt ceiling increase is a departure from previous attempts by the House GOP to create a policy that will address the debt ceiling using only Republican votes while achieving conservative pet projects such as the keystone pipeline or Obamacare changes. Policies such as an SGR patch and an increase of military pensions were mulled as ways to sweeten the deal for House Republicans.

The Senate still needs to act on the legislation today. House Leadership took an approach that will ease the effect of procedural hurdles in the upper chamber, inserting the increase in an already passed Senate bill.

The move bodes well for those who hope to see the SGR permanently repealed and replaced this year. Many worry that another short-term patch, or “doc fix,” would interrupt the momentum that reform efforts are gaining. Last week, a final SGR replacement policy was agreed upon, though financial offsets and Medicare extenders have not yet been finalized.

The agreement on the debt ceiling comes as another act of bipartisanship following other key compromises on last year’s budget and debt ceiling extension. Among some, memories of the 16 day government shutdown and its political fallout still linger. Sources say House Speaker John Boehner (R-OH) was happy the concession got the “monkey off [Republicans’] backs.”

Others still were more candid about some of their rationale for the compromise. Senate Republicans are concerned with “getting the hell out of town,” according to one GOP Senator. The Nor’easter dubbed “Winter Storm Pax” has the potential to dump double digits of snow on D.C. early Thursday. The House started recess for the President’s Day work week and the Senate will be following the conclusion of legislative business today.

AHCA staff will do our best to brave the storm while we prepare for more SGR negotiations over offsets and extenders. Congress will have to act by March 31 to prevent physicians’ from receiving a 24% cut in their Medicare reimbursement rates. 

Tuesday, February 11, 2014

AHCA/NCAL joins Courtney, Brown in call focused on observation stays issue

Claire Krawsczyn

On Tuesday, Feb. 11, AHCA/NCAL President and CEO Mark Parkinson joined a call hosted by Sen. Sherrod Brown (D-OH) and Rep. Joe Courtney (D-CT-2) regarding the legislation they introduced, The Improving Access to Medicare Coverage Act (H.R. 1179/S.569), to address the observation stays issue impacting Medicare beneficiaries and those that care for them. Parkinson represented long term and post-acute care providers on the call.

“At a time when it seems that not much work is being done, it is very encouraging to see the progress that Congressman Courtney and Senator Brown, along with Congressman Latham and Senator Collins, have made to get this bill passed,” said Parkinson on the call.

The 45-minute teleconference included a testimony from Eric Chomsky, whose 83-year old mother was left with a $4,800 bill for 17 nights of rehabilitative care after a six-night stay in a hospital, during which her status was changed on the third day from inpatient to observation – a change that left her and her family on the hook for any skilled nursing care. H.R. 1179/S.569 would require that time spent in observation be counted towards meeting the three-day prior inpatient stay that is necessary to qualify for Medicare coverage of skilled nursing care. Under current legislation, observation days do not count as qualifying days.

Also participating in the call were representatives from the Society of Hospital Medicine and the Center for Medicare Advocacy, who joins AHCA/NCAL as part of the observation stay coalition advocating for the passage of H.R. 1179/S.569. Two new members joined the coalition this week: the National Hispanic Council on Aging and the National Association of Local Long Term Care Ombudsmen, bringing the coalition membership to 24 organizations. For more information on observation stays, please visit

AHCA Introduces Therapy Web Site

AHCA continues to strengthen its visibility in the “therapy” discussion with the introduction of the latest part of its web presence – the very first AHCA web site dedicated solely to “Therapy Services.” The new web site includes the main policy topics being discussed today, namely: Therapy Cap; Manual Medical Review (MMR); MMR Clearing House; Improvement Standard; and, Ultra-High RUGs. Each issue landing page explains the topic, then offers links to important resources. Most compelling of all, each site offers a section called “AHCA Says,” which explains AHCA’s formal or informal position on the issue. Given this is a living site, visitors should return frequently for news and updates on today’s most pressing issues in the therapy arena.

Resources To Help Meet Your Yearly Quality Initiative Goals

Product #6913

Price: $59.95

With our annual Quality Symposium underway this week, all eyes are focused on quality of care and meeting this year’s quality initiative goals. AHCA Publications offers many valuable resources to help you and your staff meet these goals. The full inventory of quality products can be found on our online store, but make sure to check out the 18th Edition of the Baldrige Award Winning Quality resource.

Baldrige Award Winning Quality - 18th Edition: How to Interpret the Baldrige Criteria for Performance Excellence is the only book on the Baldrige 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. Reflecting the new criteria (2013-2014) that address education and healthcare, this edition outlines a comprehensive plan that is suitable for any company in any industry.

AHCA/NCAL Endorses the Protecting Health Care Providers from Increased Administrative Burdens Act

AHCA/NCAL is formally supporting Rep. Tim Walberg’s legislation, Protecting Health Care Providers from Increased Administrative Burdens Act (H.R. 3633). This legislation clarifies that certain recipients of payments from the Federal Government related to the delivery of health care services to individuals shall not be treated as Federal contractors by the Office of Federal Contract Compliance Programs (OFCCP) based on the work performed or actions taken by such individuals that resulted in the receipt of such payments. AHCA/NCAL believes it is important to advocate against any further expansion of the U.S. Department of Labor’s OFCCP’s jurisdiction. Implementation costs for initial compliance with OFCCP’s requirements could range from as much as $10K upfront; and subsequent compliance could add an additional $5K annually.

OFCCP enforces the affirmative action and equal employment opportunity requirements that are written into the federal government’s agreements with government contractors or subcontractors. Medicare Parts A and B, as well as Medicaid, are considered insurance reimbursement agreements, and are outside the scope of OFCCP jurisdiction. Participants in Medicare Parts C (Medicare Advantage) and D, the Military Health Care System (TRICARE) and the Federal Employees Health Benefits Program (FEHBP); may be considered federal contractors or subcontractors subject to OFCCP enforcement. Participants with the U.S. Department of Veteran’s Affairs (VA) are subject to OFCCP enforcement. It is important to note that for the last several years, AHCA/NCAL staff have worked tirelessly in negotiations with VA to make available nationwide a new VA/Civilian nursing facility contract vehicle, known as an “agreement,” that would excuse NF providers from most of the OFCCP requirements, and replace the current VA contracts. In February 2013, VA finally released a proposed rule detailing the agreement; but to date, the final rule has not been released. AHCA/NCAL staff stay in consistent contact with VA representatives on this issue, and we are hopeful that the final rule will be released soon.

AHCA/NCAL remains concerned about the lack of clarity regarding OFCCP jurisdiction for Medicare Parts C and D, TRICARE and FEHBP. Given the recent developments in Florida Hospital and UPMC Braddock, health care providers with agreements under Medicare Parts C and D, TRICARE and FEHBP have to think about and anticipate how/when OFCCP will begin to take a more aggressive stance in asserting its jurisdiction. AHCA/NCAL has already begun to reach out to other national associations with similar concerns, to work together to stop OFCCP jurisdiction expansion. We are in communication with the American Hospital Association (AHA), who participated in the litigation on this matter, and who have formally supported H.R. 3633. If you have any questions on this issue, please contact AHCA’s Dianne De La Mare and Dana Halvorson.

Monday, February 10, 2014

Webinar: Current Best Practice Standards for Nutrition in Long Term Care

Feb. 18, 2014 Webinar: 2-3:30pm (EST)

Best practice for nutrition services is expected from healthcare providers. Facilities are accountable for providing nutrition services that meet professional standards of quality that are provided by appropriate qualified persons (e.g., licensed, certified). This webinar will present current best practice standards for nutrition and for nutrition related to wounds and hydration. The standards reflect evidence based research available to date; and current thinking. Administrators, Directors of Nursing, Dietitians and Dietary Mangers and other Facility Interdisciplinary Team Members are strongly encouraged to attend. Regulatory guidance will be addressed along with clinical standard recommendations. Register today!

Nutrition and MDS 3.0 Webinar – Frequently Asked Questions and Answers Document

On January 21, 2014, AHCA/NCAL hosted a webinar focused on the key nutrition areas and accurate interpretation for the Minimum Data Set (MDS) 3.0. In case you missed it, a recording of this informational webinar can be found here. In addition, a frequently asked questions and answers document authored by the webinar speakers, Janine Lehman, RN, RAC-CT, CLNC, and Brenda Richardson, MA, RDN, LD, CD, can be found here. This Q&A document includes answers to questions that were posed by webinar attendees – both those that were answered during the webinar and those for which we ran out of time. If you have any questions relating to the webinar, or the questions and answers document, please contact AHCA’s Senior Director of Regulatory Services, Lyn Bentley, and AHCA’s Senior Director of Not for Profit and Constituent Services, Dana Halvorson.

National News Story on Observation Stays Issue

Last week, Fox News Tonight aired a segment on the observation stays loophole during their 6pm broadcast “Special Report with Bret Baier.” The story focused on a beneficiary who was deemed to be on observation during her hospital stay, leaving the family to pay a $17,000 bill for her skilled nursing care. Representatives Joseph Courtney (D-CT), who introduced the Improving Access to Medicare Coverage Act of 2013 (H.R.1179) with Tom Latham (R-IA), was featured on the piece. In a separate news piece out of Nebraska, the Omaha World-Herald followed local families impacted by the observation stay loophole.

 As noted in previous Capitol Connections, H.R. 1179 would require that time spent in observation be counted towards meeting the three-day prior inpatient stay that is necessary to qualify for Medicare coverage of SNF care. Senator Sherrod Brown (D-OH) introduced a companion bill, S.569, cosponsored by Senator Susan Collins (R-ME). H.R. 1179 currently has 136 bipartisan cosponsors, while S. 569 has 25 bipartisan cosponsors. For more information about the observation stays issue, please visit the AHCA/NCAL website.

Friday, February 7, 2014

SGR Compromise Emerges from Committees

Lawmakers released a final version of legislation that would repeal the current Medicare Physician Payment schedule, the Sustainable Growth Rate (SGR), and replace it with a permanent fix.

The plan introduced Thursday is a compromise between the Senate Finance Committee and House Ways & Means and Energy & Commerce Committees, all of which had their own versions of the final proposal.

Important items of compromise include a .5 percent payment update for physicians in each of the next five years, a comprehensive incentive program known as Merit-Based Incentive Payment System (MIPS), and creation of committees that will review any new alternative payment methods (APMs).

Lawmakers and their staff hope that, if passed, the proposed legislation will eliminate the need for an annual “doc fix,” wherein doctors’ payments had to be updated to avoid a 24 percent cut in Medicare reimbursement rates, while simultaneously moving toward programs that will encourage more efficient patient care.

After weeks of intense negotiations by health staffers, a final plan began to take shape early in the week. Meetings on Wednesday and Thursday with the GOP Doctors’ Caucus quelled enough of the concerns from the group to garner its initial support.

The group of Republican physicians who have been since elected to serve in Congress expressed skepticism with the .5 percent update for five years. Rep. Phil Gingrey (R-GA), co-chair of the group, said the caucus came to the table “kicking and screaming.”

Though the committees managed to forge a proposal that placated relevant parties, many deadlines still exist that put final passage in jeopardy. The current short-term patch, passed as part of the budget deal struck last December, expires March 31.

Further complicating matters, Senate Finance Chairman Max Baucus (D-MT), a key negotiator on the bill, was confirmed Thursday to become the next ambassador to China. Sen. Ron Wyden (D-OR) is expected to take his position as Chairman of the committee and de facto SGR reform sponsor.

The final hurdle for reform will be how the bill is financed. Lawmakers estimate that the proposal will cost around $130 billion over ten years, but the Congressional Budget Office is currently reviewing it and has yet to release an official figure.

Health staffers released an unofficial list of potential cuts to offset the cost of the legislation, but attached the disclaimer “not necessarily endorsed by SFC [Senate Finance Committee] Staff.”

AHCA is supportive of a permanent fix, but only one that does not use skilled nursing and assisted living as an offset. We continue to monitor negotiations while pay-fors are being developed, ensuring that funding for long term and post-acute care is preserved.

Find Your Place on the Quality Awards Podium!

Get in the spirit of the Olympic games by beginning your own award-winning journey: Apply for a Silver Quality Award by February 27, 2014! All centers who have previously earned a Bronze AHCA/NCAL National Quality Award are encouraged to apply. Information regarding specific criteria and application requirements is available on the Quality Award website.

In addition, applicants can find numerous resources to assist them in the quality journey under Applicant Resources. Sample application packets, the AHCA/NCAL Management series of management seminars designed around the Baldrige Criteria, sample key factors worksheets and more are available online.

State affiliates and member centers are encouraged to remind others of the upcoming deadline by sharing the Silver Quality Award deadline button pictured above. For more information, visit

Tuesday, February 4, 2014

CMS Must Improve MAC Error Rate Reduction Plans

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG), recently released a report, Medicare Claims Administration Contractors’ Error Rate Reduction Plans, which indicates that too many Medicare providers are receiving improper payments, and the Centers for Medicare & Medicaid Services (CMS) must do a better job overseeing its contractors’ error rate reduction plans. The CMS Comprehensive Error Rate Testing (CERT) program estimates the number of improper Medicare payments made by Medicare Administrative Contractors (MACs) each year.

Based on that information from CERTs, MACs improperly paid an estimated $29.6 billion during the FY 2012 reporting period-- resulting in an 8.5 percent error rate. To reduce the error rate, CMS requires MACs to submit error rate reduction plans. In these plans, MACs must describe the corrective actions that they will take to lower the rates. This OIG report found that although most error rate reduction plans included the required elements; CMS’ oversight of error rate reduction plans is limited. CMS staff reviewing the plans could not always determine if the plans addressed the most recent CERT results. Further, CMS approved sampled plans without recommending different or additional corrective actions. OIG recommends and CMS concurs that it should: a) review its process for overseeing MAC error rate reduction; 2) Ensure that MACs submit clear plans for reducing their error rates; 3) Provide additional guidance for contractors and CMS staff who review plans; and 4) Provide error rate reduction incentives that are aligned with the contracts’ error rates and performance periods. To obtain a copy of the complete report go to the HHS website.

PwC Evaluates CMS Contractors Security Compliance

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG), recently released a report, Review of Medicare Contractor Information Security Program Evaluations for FY 2011, which discusses the Medicare Administrative Contractors (MACs), Fiscal Intermediaries and carriers compliance with the security requirements under the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). To better understand compliance with the security requirements, the Centers for Medicare & Medicaid Services (CMS) contracted with PricewaterhouseCoopers (PwC) to evaluate information security programs for its contractors. PwC reported a total of 127 gaps (e.g., differences between the Federal Information Security Management Act of 2002 and CMS’ core security requirements) at 11 Medicare contractors for FY 2011, which was a decrease of 23 percent from FY 2010. OIG determined that PwC’s evaluations of the contractor information security programs were adequate in scope and were sufficient. To obtain a copy of the complete report go to

ICD-10 Readiness

Dianne De La Mare

CMS has recently released a new MLN Connects video on ICD-10 Coding Basics to ensure that providers are ready to transition to ICD-10 on October 1, 2014. On the video, Sue Bowman from the American Health Information Management Association (AHIMA) provides a basic introduction to ICD-10 coding, and focuses on the similarities and differences between ICD-10 and ICD-9; ICD-10 code structure; and coding processes and examples. To receive notification of upcoming MLN Connects videos and calls and the latest Medicare program information on ICD-10, subscribe to the weekly MLN Connects™ Provider eNews. Also, visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. To obtain a great resource written specifically for LTC providers go to AHCA’s website at, and order ICD-10 Essentials for Long-Term Care: Your Guide to Preparation and Implementation.

Next SNF PEPPER Distributed Electronically

Dianne De La Mare

TMF Health Quality Institute is contracted with the Centers for Medicare & Medicaid Services (CMS) to produce and distribute the Program for Evaluating Payment Patterns Electronic Report (PEPPER). To date, PEPPERs have been available electronically to SNFs/swing bed units of short-term acute care hospitals. Other SNFs have received their PEPPER in hard-copy format via mail. 

TMF is currently developing a secure portal on its website to deliver PEPPERs to SNFs that do not have access to QualityNet. TMF anticipates the PEPPERs will be made available for download in May 2014; and they will remain accessible for approximately one year. To receive notification when the PEPPER is available and guidance on accessing the PEPPER, join the email list at (see the gray box on the upper right section of the Home page).

Please note these requirements:
  1. Access to the PEPPER will be restricted to the provider’s Chief Executive Officer, President or Administrator. Note: Corporate offices and/or facility management companies will need to obtain PEPPERs from each individual provider in their organization.
  2. Requestors will be required to enter their 6-digit CMS certification number (also referred to as a provider number or PTAN) (third digit of “5” or “6” for SNFs). This is *not* the same number as the tax identification number or national provider identification number.
  3. For verification purposes, requestors will be required to enter either a medical record number *or* a patient control number for a patient who received services at the provider during a specified time period (TMF will determine this time period closer to report distribution).
Note: Only numerical entries can be accepted. If providers use only letters in both of these fields they must contact TMF to request assistance. Patient names cannot be entered due to patient privacy laws.
This will not impact providers who receive their PEPPER via QualityNet. SNFs/swing bed units of short-term acute care hospitals will continue to receive their PEPPER via QualityNet. These providers will be notified via email once the QualityNet distribution is complete. Visit for more information about PEPPER or to submit questions about PEPPER.

CMS Announces Further Partial Delay of “Two Midnight” Rule

Dana Halvorson

The Centers for Medicare and Medicaid Services (CMS) recently announced another partial delay of the “two midnight” rule until after September 30, 2014, due to growing pressure from physicians and hospitals. The policy, included in CMS’ FY 2014 Inpatient Prospective Payment System final rule, which provided doctors and hospitals guidance on conferring inpatient status for stays that cross at least two midnights and thereby allow for coverage under the Medicare Hospital Inpatient Part A benefit. Medicare's recovery auditors were ready to begin enforcing the rule on October 1, 2013. However, due to concerns from the provider community, the enforcement was delayed until March 31, 2014. Last week, CMS announced that recovery auditors would now have to wait until after September 30, 2014, to start auditing claims under the two-midnight rule. CMS will still allow Medicare’s administrative contractors to review short stays and deny payment if not deemed medical necessary. Further information about this partial delay can be found here.

New Alzheimer’s Resource for 2014

Karah DeMarco

The current rate of diagnosis of Alzheimer’s and other dementia related illnesses is very high and it is expected to rise in the years to come. You’ll need to be sure that you are fully prepared to care for your current Alzheimer’s residents, as well as your future ones. This informative resource gives the reader understanding of what it is like for the person who has been diagnosed with this debilitating disease.

Product #8310; Price: $21.95

Author, Richard Taylor, was diagnosed with Alzheimer's disease at age 61, the former psychologist courageously shares an account of his slow transformation and deterioration and the growing division between his world and the world of others. He does this with poignant clarity, candor, occasional humor, and more than 80 brief essays address difficult issues faced by those with Alzheimer's disease.

Deadline to Register for the IO Leadership Conference Has Been Extended

Danielle Levitan
It’s not too late to register for the 2014 Independent Owner Leadership Conference. To give you more time to register for this exciting conference, we have extended the deadline to Friday, February 14th. Give yourself a Valentine's treat and join us at Caesars Palace Las Vegas. Register now and save! When you register by Friday, you’ll save $75 off the standard member rate.

Independent Owner Leadership Conference: March 12-14, 2014, Caesars Palace Las Vegas

This year’s theme is Thriving in a Changing World. Earn up to 10.5 CEUs with education sessions that focus on managing staff and residents, improving quality in your facilities, emergency preparedness, and much more.

Reserve your hotel room now and take advantage of the special AHCA/NCAL group rate at Caesars Palace Las Vegas. Rooms are filling up fast. Make your reservations now! Call Caesars Palace Las Vegas reservation center at 1-866-227-5944 and refer to Group Reservation Code SCNCL4. You may also reserve online by visiting the personalized Independent Owner Leadership Conference link.

The deadline to get this special discounted rate is February 11, 2014. Learn more and register for the IO Leadership Conference today!

DirectSupply, ESO, Joerns, Kronos, MatrixCare, Muller Prost- ABR Division, My InnerView, OnShift, Optimus EMR, PointRight, VCPI

Four Decades And Counting

Meg LaPorte

This year marks Provider’s 40th anniversary, and in this month’s cover story, Lynn Wagner, contributing editor and former editor in chief herself, reflects on 40 years of quality news, trends, and clinical best practices, which chronicles the emergence over time of a culture of quality in long term and post-acute care.

Continuing our long tradition of quality coverage, the 2014 20 To Watch lingers for another month with the second installment of profiles. In this month’s batch of rising starts, I dive a little deeper into the careers of six honorees, all of whom personify quality of care, quality of life, and dedication to the profession.

Bringing remote and exotic travel destinations to long term care residents can enliven their spirits and spark memories of their own voyages, as this month’s Focus on Caregiving reveals. No less than 120 Extendicare centers across the country have implemented just such a program for their residents. Known as Destinations Travelogue, the program brings foreign places to residents via multi-media.

What’s really safe to eat and what’s not when it comes to organic versus nonorganic foods? In this month’s Management column, Amara Rose offers a look at how these foods can impact seniors’ nutrition and what GMO, GE, and GM really mean. Rose also offers some tips on how to enhance flavors when salt is contraindicated.

Helping residents and their families apply for Medicaid can be a cumbersome process; add to it the further step that some providers must take in applying for guardianship of a resident. In this month’s Legal Advisor, two attorneys who specialize in the field offer up their knowledge of the issue.

Vivian Tellis-Nayak, PhD, ends his four-month-long stint as our first blogger in print. As a longtime Parkinson’s disease sufferer, Tellis-Nayak’s candid and poignant narratives of his struggles and small triumphs brings us closer to walking in his shoes and learning what others with this cruel disease face.

Further Information Regarding Minimum Wage Increase for New Federal Contract Workers

Dana Halvorson

As noted in Capitol Connections last week, the White House released some details of an executive action that would raise the minimum wage from $7.25 to $10.10 for new federal contract workers by 2015. It is estimated that this executive action could impact roughly 250,000 people, a relatively small number of the workforce. It is important to note that this executive action does not impact Medicare or Medicaid providers, as it is a long-standing policy that they are not “federal contractors.” However, if you have VA patients, you are considered to be a federal contractor, and thus, this executive action may apply to your circumstances. That being said, AHCA continues its support for the VA’s proposed rule on Provider Agreements, which, among other things, increases the opportunity for veterans to obtain non-VA extended care serves from local providers that furnish vital and often life-sustaining medical services. AHCA is currently awaiting the final rule. The White House fact sheet on the announcement has further details regarding the minimum wage increase.

OIG Releases 2014 Work Plan

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) has just released its Work Plan for FY 2014, which summarizes new and ongoing OIG reviews and activities for 2014. Usually released each year in October; but delayed this year, the Work Plan helps LTC providers to focus on the issues most critical to the federal government. Under the heading Nursing Facilities, OIG’s Work Plan focuses on Medicare Part A billing by skilled nursing facilities (SNFs); Questionable billing practices for Part B services during nursing home stays; State agency verification of deficiency corrections; Program for national background checks for long term care employees; and Hospitalizations of nursing home residents for manageable and preventable conditions. Under the heading Hospices, the Work Plan focuses on Hospice in assisted living facilities. Under the heading Part A and Part B Contractors, the Work Plan focuses on Medicare administrative contractors—use and evaluation of local edits; Medicare benefit integrity contractors’ activities; and ZPICs and PSCs—identification and collection status of Medicare overpayments.

Under the heading Other Part A and Part B Program Management Issues, the Work Plan focuses on Payments for incarcerated beneficiaries; Enhanced enrollment screening process for Medicare providers; Idle Medicare provider records; and Payments to providers subject to debt collection. Under the heading Medicare Advantage, the Work Plan focuses on Encounter data—CMS oversight of data integrity; and Risk adjustment data—sufficiency of documentation supporting diagnosis. Under the heading State Management of Medicaid, the Work Plan focuses on State mechanisms to fund their Medicaid Programs; State claims for federal reimbursement; State adjustments of federal reimbursement; State program integrity activities and compliance with federal requirements; and OIG oversight of state Medicaid Fraud Control Units. Under the heading Medicaid Managed Care, the Work Plan focuses on State payments to managed care entities; data collection and reporting; program integrity in managed care; and beneficiary protections in managed care. Under the heading Legal Activities, the Work Plan focuses on Exclusions from program participation, Civil monetary penalties; False Claims Act cases and corporate integrity agreements; Providers’ compliance with corporate integrity agreement; Advisory opinions and other industry guidance; and Provider compliance training and provider self-disclosure. To obtain a complete copy of OIGs work plan go to the HHS website.