Educating Consumers, Building Advocates

Amy Mendoza

2015 saw a great deal of changes for the long term and post-acute care profession. With these changes came a shift in focus for Care Conversations, an initiative led by AHCA’s Public Education and Communication Committee.

Whereas 2014 was focused on a variety of themes related to aging, caregiving, and more, Care Conversations in 2015 honed in on key advocacy issues affecting the skilled nursing care profession. Topics included:

• The Five Star Rating System Infographic, designed to alleviate consumer confusion around the Five Star Rating System;
• An article explaining the differences between inpatient and observation status;
• 6 Steps to a Successful Hospital Transition, which gives families tools  to help prevent hospital readmission;
• A resident and patient safety worksheet, designed for families considering skilled nursing care centers;
• And much more.

These topics were well received online, resulting in record time on the website and above average engagement by consumers on social media.

The Public Education and Communication Committee is made up of AHCA members with strategic knowledge of the long term and post-acute care profession. The committee meets monthly to review progress with Care Conversations and discuss new opportunities to help individuals make informed, confident decisions.

To learn more, visit the Care Conversations website, stay connected on Facebook, and sign up for the free monthly newsletter.

Omnibus, Tax Extenders Bill Becomes Law; Congress Wraps Up for the Year

Drew Thies

President Obama signed a $1.1 trillion funding and tax bill on Friday that will keep the government funded through September 2016 and extends nearly $700 million in tax breaks.

The Senate sent the legislation to the President earlier in the day on a vote of 65-33, after receiving one joint bill from the House, which voted on the funding and tax portions separately.

Party leaders on both sides had to work to gain support for final passage of the bill. Though there ended up being resounding support in the House—it passed 316-113, many worried prior to passage of the bill if both sides would be able to keep their rank-and-file in line and avert a government shutdown.

The bipartisan bill included some issues of contention for both parties. Republicans were dissatisfied with overall spending levels while Democrats opined a provision to lift the oil export ban, but overall, many contentious riders that threatened the legislation during drafting were not included.

The final signing into law by the president marks the last of legislative business to be settled in 2015. Congress will resume session on January 5, 2016.

OMHA Quarterly Listing of Program Issuances

Dianne De La Mare
The Office of Medicare Hearings and Appeals (OMHA) has released its quarterly notice listing the OMHA Case Processing Manual (OCPM) manual instructions published from July-September 2015. This manual standardizes the day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statues, regulations and OMHA directives, and also gives OMHA staff direction for processing appeals.

 Over the covered 3-month period, OMHA has released new chapters describing: 1) individuals that qualify as parties to the Administrative Law Judge (ALJ) hearing and review process so that those filing requests for a hearing actually have the right to file a request (Chapter 4, Parties); 2) the roles/responsibilities of party representatives (Chapter 5, Representatives); and 3) the roles/responsibilities of CMS and its contractors (Chapter 6, CMS and CMS Contractor Roles).

To access the full text of these new chapters and other current instructions, go to http://www.hhs.gov/omha/OMHA_Case_Processing_Manual/index.html

Government Issues New ACA Waiver Guidance

Dianne De La Mare

On December 16, 2015, the US Department of Health and Human Services (HHS) and the Department of the Treasury issued new guidance for states interested in seeking a State Innovation Waiver under section 1332 of the Affordable Care Act (ACA). The guidance provides states with flexibility to pursue innovative waiver proposals while preserving the important protections of the ACA.

The guidance focuses on coverage, affordability, comprehensiveness, deficit neutrality, impact of other program changes and funding available to the states. The guidance also explains how the HHS and Treasury Secretaries will evaluate waiver applications, so that states have the information they need as they consider a waiver application.

By way of background, 1332 State Innovation Waivers allow states to receive federal funding to implement alternative models of health care coverage that provide high quality, affordable coverage to their residents. In order for a State Innovation Waiver to be approved, a state’s alternative model must provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver; provide coverage to a comparable number of residents as would be provided absent a waiver; and refrain from increasing the federal deficit.

To learn more about the guidance go to https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-12-11.html.

Connect Community for Young Professionals: Join Today!

Peggy Connorton
At the 2015 AHCA/NCAL convention, we hosted a young professional panel and round table session for individuals in their careers ten years or less. During the panel discussion, participants shared how each of them started in the field and the stories of their first week on the job. The common thread across these stories was the connection to the residents.

After the session, the Association developed a place for young professionals to gather—a connected community for this purpose. This community will allow you a place to ask questions like how to handle the demands of the job, how to lead people who are 20 years older than you, or how to deal with finding a work life balance.

Each of us has our own story of why we decided to work in long term care. This community can give you a resource to connect with others who share your experiences. In addition, we will be posting items that are of interest. I encourage you to join today!

How to get started:

• If you don’t have an account on the AHCA/NCAL system already, feel free to create one and connect yourself to your organization. You may already have one and not even realize it. Click here to create a new account or reset your password 
• Once you have an account, you can log in to AHCA/NCAL Connect and join our Young Professionals community. 
• Go to http://connect.ahcanca.org and sign in with your personal username and password (top right corner)
• Click Communities 
• Find the Young Professionals Community, click Join and select your notification preferences. We recommend real-time so you don’t miss anything. 
• Once you have joined the community, take a look at your profile and fill out as much as you’d like. We’d love to see your picture. It doesn’t have to be a professional headshot, any photo will work! 
• If you have any issues, click the Contact Us link at the top of the page and one of our staff members will help.

ahcancalED Update

educate@ahca.org

Since its launch just two months ago hundreds of people have registered to become part of the ahcancalED community. As we speak, over 170 people are taking the 2016 Silver Criteria Series course in preparation for submitting their applications for the Silver level of the AHCA/NCAL Quality Award program. This is a great example of how AHCANCAL is supporting our members through education. This learning management system hosts a wide variety of educational tools and resources to assist members in their quality journey. Members cite that it is easy to use, has many valuable tools and products and is constantly being updated with new products.

Another new and distinctive course was created by the Quality Improvement Committee recognizing that many people want to be proficient in managing business systems such as QAPI. So much of an organization’s success in achieving the Quality Initiative is predicated on their ability to manage systems well. Each of the Quality Initiative goals require the discipline, knowledge and skill of following a systems approach. For many of us, it wasn’t something we learned in business or nursing school. Yet, success lies in knowing how to effectively implement and manage a systems approach. Good news! AHCA/NCAL recognized, based on comments from its members, this critical skill gap and with a band of experts created a course to address the need. It includes case studies, videos, podcasts, worksheets, and a wide array of tools and resources to help follow the process. The course is titled Driving Quality by Operationalizing Business Systems: A Call to Action.

Another valuable educational product found in ahcancalED is Nursing Home Leaders Academy of Excellence Webinar Series. The Nursing Home Leader Academy of Excellence was the brainchild of Jocelyn Montgomery, Director of Clinical Affairs at California Association of Health Facilities (CAHF), who recognized the need for leadership training. To make the program a reality, CAHF partnered with the Quality Care Health Foundation and the American Health Care Association. The program, supported by a grant from the California Health Care Foundation is an intensive, interactive experience that prepares nursing home administrators to be competent and inspired leaders in skilled nursing centers. This webinar series was a component of the Academy and is now being shared with all of you. The series includes: Falls as a Quality Improvement Target - Sue Ann Guildermann; Customer Satisfaction as a Quality Improvement Target - Mary Tellis Nayak; Staff Stability & Consistent Assignment Strategies - Barbara Frank & Cathie Brady; Hospital Readmission Reduction; Not Just Nursing's job - David Farrell; Vision Led organizations -Phil Fogg; Antipsychotics as a Quality Improvement Target- David Gifford ; QAPI in Action - Janet Snipes

ahcancalED is sure to have something that will be of interest to you. Curious about the CJR Rule? We’ve got that! Want to know more about Five-Star? We’ve got that, too!

Do You Know Your Discharge to Community Rate and Why it Matters?

Peggy Connorton

CMS recently released information for review and comment about a new measure in development—the percent of people admitted to a Skilled Nursing Facility (SNF) from a hospital that are discharged back to the community. CMS plans to add this measure to Nursing Home Compare and Five Star next year.

Are you aware of where your center stands on this important metric? You can find data on your performance in comparison to your selected peer groups in LTC Trend Tracker for a similar measure AHCA developed last year. Knowing your rates of individuals discharged back home is important when telling your center’s story about successful post-acute care services to managed care organizations, hospitals, ACOs and family members considering using your SNF. Your ability to demonstrate to prospective clients and their families as well as important network partners that your center is effectively helping patients achieve this goal is important to continuing to attract your desired volume of post-acute patients. Get ahead of the game now by reviewing your data, available exclusively to AHCA members on LTC Trend Tracker! For more information about the importance of your Discharge to Community Rate and how to understand the AHCA measure, visit the Quality Initiative website and LTC trend tracker resource center.

The Regulatory World in 2016: Top 4 Crystal Ball Predictions

Lyn Bentley, MSW

Before heading out for the holidays, make a note of our top four regulatory predictions for 2016 and what you and your team can do to prepare.

1) Adoption of the updated Requirements of Participation.

• QAPI will be real. Make sure you understand the Five Elements of QAPI
• If you haven’t already started to develop your QAPI process, begin with the “QAPI Self-Assessment Tool”. 
• Follow up with The 12 Action Steps. 
• Watch for AHCA’s updates when the final rule is issued for all the changes and timelines. 

2) Final adoption of the 2012 edition of the Life Safety Code: One of the biggest changes related to inspection, testing and maintenance of fire safety systems.

• AHCA will provide additional information for members after the final rule is issued.

3) Final adoption of the Emergency Preparedness rule.

• Visit AHCA’s Emergency Preparedness page. Discover tools and resources to help you be prepared.

4) Expect to see focused surveys: MDS and Staffing-focused survey; Dementia Care-focused Survey; and Adverse Events – focused survey.

• Make sure you have a system to: 1) ensure MDS’s are completed and submitted on time; 2) care plans are consistent with the current MDS for each individual; 3) your center has all posted nurse staffing data retained for 18 months.
• Review the dementia care-focused surveyor checklist that CMS recently posted.
• Be prepared for an adverse-events focused survey. Use the CMS Trigger Tool, attached to this CMS memo

Congress Releases Omnibus Legislation for FY 2016

Drew Thies


Speaker Paul Ryan (R-Wis.) unveiled an extensive spending bill late Tuesday night, in a deal that stripped out many Republican rider hopes but will fund the government deep into 2016.

The 2009-page bipartisan compromise provides line-by-line guidance to every agency through September 30, 2016, at which point lawmakers will need to take action to appropriate the remainder of the funds allocated in the current budget.

The House is scheduled to vote on the legislation Friday, in accordance with Speaker Ryan’s rule to give lawmakers three days to read the legislation.

The GOP also set up another vote on Tuesday on a package of “tax extenders,” which will expire at the end of the year. The tax legislation will likely be a party line vote with Republicans supporting and Democrats opposing. The tax package and the spending proposal will be sent to the Senate as one bill, increasing the likelihood the deal will make it to the President’s desk.

The $1.15 trillion package also ends a 40-year ban on exporting crude oil and funds an expired land conservation account but drops more controversial propositions, such as stricter controls on refugees and campaign finance.

Congress sent a short-term continuing resolution funding the government until December 22 to the Senate, as current funding expires tonight at midnight. The last day of scheduled legislative work this year is December 18th. 

Senator Writes Op-Ep Supporting Direct Care Staff

Drew Thies

Sen. Bob Casey (D-Penn.) penned an opinion article emphasizing the importance of the work direct care employees do in healthcare facilities across the nation.

The article, which ran in the Tribune-Democrat of Johnstown, Pennsylvania, expressed the Senator’s thanks for a group of caregivers “who are often overlooked and underappreciated.”

“Direct care workers also provide a vital service to people with disabilities, allowing them to live more independently,” he continued.

The skilled nursing profession across America employ over 1 million direct care workers in over 15 thousand centers nationwide.

Aspire To Be The Best: Attend the AHCA/NCAL Quality Summit

meetings@ahca.org

Do you aspire to be the best? Do you want to achieve higher levels of family and resident satisfaction? Does your center/organization need more tools and resources to reach performance improvement and quality initiative goals? If you answered yes to any of these questions, you need to register now for the Inaugural AHCA/NCAL Quality Summit.


The AHCA/NCAL Quality Summit should be the first event you plan to attend in 2016! Quality is at the heart of everything we do, so plan to join other like-minded long term and post-acute professionals in San Antonio, February 9-11. The registration deadline is January 12 and with the holidays approaching, it will be here sooner than you expect.


Secure your spot at this event and register today. Attendees must be registered for the event before hotel reservations can be made at the AHCA/NCAL discounted rate. Visit the Quality Summit website for registration, sessions, speakers, and other event details. AHCA/NCAL would like to that our event sponsors for their support.

OIG Releases FY 2016 Work Plan

Dianne De La Mare


The US Department of Health and Human Services, Office of Inspector General (OIG) has released its 2016 Work Plan, which describes new and on-going audits, evaluations and investigations. Key areas especially relevant for long term care (LTC) and post-acute care (PAC) providers include the following:

1. Under Medicare Part A and Part B there are explanations of OIG activities under the categories of Nursing Homes, Hospices, Home Health Services and Contractors:

a. National Background Check Program for LTC Employees

b. New Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Requirements

c. Revised Hospice General Inpatient Care

d. Home Health Services

e. Revised Medicare Benefit Integrity Contractors’ Activities in 2012 and 2013

f. Collection of Zone Program Integrity Contractor (ZPIC) and Program Safeguard Contractor (PSC) – Identified Medicare Overpayments

2. Under Medicare Part C and Part D there are explanations of OIG activities under Medicare Advantage (MA) and Prescription Drug Program:

a. MA Organizations’ Compliance with Part C Requirements

b. Part D Billing and Payments

3. Under Medicaid Program there are explanations of OIG activities under the categories of Home Health Services and Other Community-Based Care, Other Medicaid Services and Controls to prevent Improper Medicaid Payments and Medicaid Managed Care:

a. Room-And-Board Costs Associated with Home- and Community-Based Service (HCBS) Waiver Program Payments

b. State Use of Provider Taxes to Generate Federal Funding

c. State Cost Allocations That Deviate From Acceptable Practices

d. Enhanced Federal Medical Assistance Percentage

e. State Use of Incorrect Federal Medical Assistance Percentage (FMAP) for Federal Share Adjustments

f. Revised State and CMS Oversight of Provider Ownership Information

g. Revised Provider Payment Suspensions During Pending Investigations of Credible Fraud Allegations

h. Oversight of State Medicaid Fraud Control Units

i. State Payments to Managed Care Entities

j. Medicaid Managed Care Entities’ Identification of Fraud and Abuse

Check Updated LEIE Database

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in November 2015. This new file is meant to replace the updated LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included in this file. 

The updated files are posted on OIG’s website at http://www.oig.hhs.gov/exclusions/exclusions_list.asp, and health care providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines. Instructional videos explaining how to use the online database and the downloadable files are available at http://oig.hhs.gov/exclusions/download.asp. Given the penalties and recent government warnings, long term care providers should check the LEIE on a regular basis.

CMS Releases new Medicaid Integrity Toolkits

Dianne De La Mare

CMS has released two new tools on the Medicaid Program Integrity Education website: 1) Home- and Community-Based Services (HCBSs) toolkit, which reviews HCBS service areas and common improper payments; provides suggestions for creating and updating person-centered plans; and provides an overview of the self-directed care option; and 2) Basic Data-Mining Toolkit, which provides a primer for health care physicians and professionals; information on data mining analysis, and claims worksheets.

AHLA LTC and the Law Program Open for Registration

Dianne De La Mare

AHCA/NCAL is pleased to announce its sponsorship (and discounted rates for members) to the upcoming American Health Lawyers Association (AHLA), annual Long Term Care and the Law Conference, taking place in Orlando, FL, at the Loews Portofino Bay Hotel, from Monday, February 22 through Wednesday, February 24, 2016. 

The conference promises to be an exciting and informative meeting where some of the nation’s leading attorneys and professionals including Mark Parkinson, AHCA/NCAL CEO and President, and Scott Tittle NCAL, Executive Director. Speakers in the long term and post-acute care field will be presenting on the legal, compliance, and operational issues facing providers. Sessions will focus on cutting edge issues that are front and center within the LTC and post-acute spectrum and include fraud and abuse, regulatory compliance, HIPAA breaches, labor and employment issues, managed care contracting, emergency preparedness, assisted suicide, and transactions. There will be an individual educational track for nursing facility, assisted living and home health attorneys and providers. Specifically for in-house lawyers, we will have both an assisted living and a skilled nursing facility roundtable session, reserved only for corporate counsel. 

The Assisted Living In-House General Counsel Roundtable is sponsored by NCAL, on February 22 starting at 7:45 AM. This session is open only to in-house counsel and attendance is limited with advance registration. 

To view the draft program go to https://www.healthlawyers.org/Events/Programs/2016/Documents/LTC16_draft_grid.pdf. To register go to https://www.healthlawyers.org/Events/Programs/2016/Documents/LTC16_regform.pdf. 

For more information, contact Dianne De La Mare at ddmare@ahca.org.

Average Individual Mandate Penalty Could Jump 47 Percent in 2016

Dave Kyllo

A new analysis from the Kaiser Family Foundation finds that the average penalty for uninsured people who are eligible for an Affordable Care Act (ACA) marketplace plan will rise to $969 per household – 47 percent higher than the $661 estimated average for 2015.

The ACA requires most people to have health coverage or pay a tax penalty. The penalty for 2016 is the greater of two amounts: either a flat dollar amount equal to $695 per adult and $347.50 per child with a $2,085 annual family cap; or 2.5 percent of family income in excess of the 2015 tax filing thresholds ($10,300 for a single person and $20,600 for a family). The individual mandate penalties are capped at amounts equal to the national average premium for a bronze plan – the minimum coverage available under the ACA.

For more information about AHCA/NCAL “Member Only” health plan options available through AHCA/NCAL Insurance Solutions, email ahcainsurancesolutions@ahca.org or contact Dave Kyllo (202-898-6312) or Nick Cianci (202-898-2841).

Full U.S. Senate Considers and Approves the RAISE Family Caregivers Act

Dana Halvorson

Earlier this year, AHCA and nearly 50 national organizations sent a letter of support to the leads sponsors of the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (S. 1719/H.R. 3099). Introduced by Senator Susan Collins (R-ME), Senator Tammy Baldwin (D-WI), Representative Gregg Harper (R-MS-3), and Representative Kathy Castor (D-FL-14), this legislation would implement the federal Commission on Long-Term Care’s bipartisan recommendation that Congress require the development of a national strategy to support family caregivers. The bill would create an advisory body to bring together relevant federal agencies and others from the private and public sectors to advise and make recommendations. The strategy would identify specific actions that government, communities, providers, employers, and others can take to recognize and support family caregivers and be updated annually. On Tuesday, December 8, the full U.S. Senate considered and passed this legislation. It now awaits House consideration.

According to AARP, in 2013, about 40 million family caregivers provided unpaid care valued at about $470 billion to adults who needed help with daily activities, more than total Medicaid spending that year. According to the Caregiving in the US 2015 study from the National Alliance for Caregiving and AARP, about 3.7 million family caregivers provide care to a child under age 18 because of a medical, behavioral, or other condition or disability.

CMS TeleTown Hall: Implementation of the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)

Dana Halvorson


On Monday, December 21, 2015, from 2:00-3:30 PM ET, the Centers for Medicare & Medicaid Services (CMS) will hold a conference call on the implementation of the NOTICE Act. CMS noted in their email that they sent out on this call that on “August 6, 2015, Section 1866(a)(1) of the Social Security Act was amended by Congress to require hospitals and critical access hospitals to provide notification to Medicare beneficiaries receiving observation services as outpatients for more than 24 hours at such hospitals and critical access hospitals.” As noted in previous communications, AHCA/NCAL supports the NOTICE Act, and feels that it is an important step forward.

CMS is hosting a TeleTown Hall meeting to solicit input regarding CMS’s implementation of the NOTICE Act requirements. Participants are asked to come prepared to share comments and/or concerns. CMS noted that all viewpoints are welcome and will be taken into consideration as we work through implementation of the NOTICE Act. Please note that CMS will not be responding to questions or comments. To submit your comments via email, please send them to: Notice_Act@cms.hhs.gov (Please note the underscore in the email address: Notice_Act). CMS anticipates a large number of participants, so please dial-in at least 15 minutes prior to the call start time.


Please dial: 1-800-837-1935
Conference ID: 5106309

Resources to Help Quality Award Applicants!

qualityaward@ahca.org


The 2016 AHCA/NCAL National Quality Award Intent to Apply deadline has passed. Most applicants have likely been working on their application for the past few months; but for those who haven’t started, the time to get started is now! The Quality Award Application portal is now open and accepting applications until the deadline on January 28 at 8 p.m. EST.

The Quality Award website has a number of resources designed to help member organizations with the application process. Whether you are writing a Bronze, Silver or Gold application this year; there is something for you!

• Bronze applicants should check out the Bronze Criteria Series. Thisis a series of YouTube videos, 3-7 minutes in length, with each video covering one question of the Bronze criteria. The series is structured so that application teams are able to view each video and write a response to each question, sometimes in less than 30 minutes total! We suggest that centers form an “application team” that views the videos together and then completes the responses to the criteria as a team effort. Applicants who view the Bronze Criteria Series are much more likely to be successful with the award process.

• Based on the popularity of the Bronze Criteria Series, AHCA/NCAL has released a brand new Silver Criteria Series for the 2016 application cycle. The series starts with an introduction of the program and a webinar on the Silver evaluation process. Eight additional webinars follow, covering each section of the Silver Criteria, from the Organizational Profile through Categories 1-7. Each video provides an explanation of the criteria and questions to help applicants through the process. As with Bronze, we suggest that centers form an “application team” that views the videos together and then completes the responses to the criteria as a team effort. 

• Gold applicants should view the AHCA/NCAL Management Series, which is a sequence of videos each covering a category of the Baldrige Criteria. This series was created to help any center develop a comprehensive and robust management system. For Gold, the series also provides insight from Baldrige experts across the Organization Profile as well as across each criteria category. 

As an additional benefit, all of these webinar series will also fulfill your educational requirement for the program!

Last but not least, check out tips and strategies from recent and past recipients, including Opis Highlands Lake Center , Effingham County Care Center , Pacific Coast Manor, Glen Hill Center, Genesis Healthcare, Oakridge Gardens Rehabilitation and Memory Center, and Bayberry Commons.

If you have any questions, feel free to reach out to Quality Award staff at qualityaward@ahca.org.

Have You Made Your Plans to Attend the Inaugural AHCA/NCAL Quality Summit?

Ruta Kadonoff

Two great events that go great together… for the first time in 2016, the Quality Symposium and NCAL Spring Conference are being integrated.  For those members who have in the past made a tough choice between which to attend, those days are over.  This change means one seamless member experience focused on the top priority issues driving your work today and into tomorrow.  If you wonder how you can possibly keep up on all you need to know to keep your organization thriving in an era of rapidly changing expectations and payment models focused on value and quality, look no further for educational content and networking with your peers to help position you for success!  Among the highlights this meeting has in store for you are:

LED Talks

Back for a second year, join us for the Provider Magazine curated series of six, 18-minute talks challenging attendees to Lead, Engage and Discover new topics and ideas designed to be evocative, inspirational, and sometimes unsettling.  Come here what LED speakers including Jessica Patterson, Certified Nursing Assistant; Dayne DuVall of the National Certification Board for Alzheimer Care; Phil DuBois of St. Joseph’s College; Cindy Halkola, Activities Director at the Chelsea at Brookfield and others have to share with you about their experiences and insights.

Keynote Speakers

Hear from three distinguished and thought-provoking speakers sure to be a highlight of your conference experience: Don Berwick, MD, MPP of the Institute for Healthcare Improvement; Meagan Johnson, generational expert, and Patrick Conway, MD of the Centers for Medicare and Medicaid Services.

Poster Sessions

See and hear compelling success stories from your peer organizations, sharing their journeys in applying the Baldrige Performance Excellence Criteria and the Quality Assurance Performance Improvement (QAPI) approaches to make their centers and communities better places.  Learn valuable lessons that you can use and apply to your work back at home.

Education Sessions

Over twenty concurrent sessions designed to offer valuable, practical learning to help you tackle the challenges your organization faces today and tomorrow and support your efforts to provide the best care possible for those you serve.

Intensives

Our intensives round out your conference experience with four sessions featuring powerful and insightful speakers offering a deep-dive into critical topics including:   Enhancing Well-Being for the Person Living with Dementia; Getting Out of the Weeds and Into Action – Your Organization’s Strategy for Success in New Payment Models; Ten Steps to Staff Stability in a Tightening Labor Market; and How to Have the Important Conversations.

And of course, networking, networking and more networking!  One of the things you tell us is always among the best parts of our meetings, we are making sure you have ample opportunity to connect with your long-time colleagues and to meet new people to share with and learn from.  Join us at the AHCA/NCAL Quality Summit – don’t delay,  pre-registration closes on January 12^th.  See you in San Antonio!

Quality Excellence Through A Systematic Approach

Everton Spencer
Administrator of Opis Highlands Lake Center of Florida
2015 Gold– Excellence in Quality Award Recipient

As a member of the Opis Senior Services Group, Opis Highlands Lake Center for Post-acute, Rehab and Nursing Care in Lakeland, Florida, has long been recognized as one of the state’s leading senior care providers.

In striving for total excellence, the Center utilizes an integrated process of performance management and continuous quality improvement. As demonstrated by its receipt of the AHCA/NCAL National Gold Quality Award. The process results in measurable value for customers and stakeholders, enhanced organizational and operational effectiveness, improved communications, sustainability and personal learning opportunities.

The journey to winning the Gold Award has been both a satisfying and invaluable learning experience. Begun over four years ago, the process has allowed us to objectively measure our performance against competitors in our marketplace and establish realistic benchmarks for continuous quality improvement.

Building on our successes and learning from untapped opportunities revealed by the National Quality Award assessment process, Opis Highlands Lake was able to make steady progress, advancing from an initial Bronze recognition to our current Gold Quality Award level over that time.

No less important in these efforts, our organization-wide caring mission, vision of revolutionizing health care and life-affirming core values serve as the unshakable foundation on which the Center’s record of achievement rests. Shared by all departments and embraced by team members at all levels, they inform and guide our unwavering quality commitment – whether in clinical services, personal interaction, or quality of life. In fact, they are at the heart of everything we do each and every day and, we believe, make us unique among our peers.

Opis Highlands Lake is truly the “gold standard” in quality senior care and services. In fact, in addition to the AHCA/NCAL National Gold Quality Award, we have also earned the prestigious Florida Governor’s Gold Seal of Excellence Award. Opis Highlands Lake is the only one among 678 centers in the State of Florida to be recognized with both honors in 2015.

The success of these efforts are further reflected in Opis Highlands Lake’s ranking among the nation’s top 100 nursing centers in 2014 by U.S. News & World Report; its 5-star rating by the state of Florida; superior CMS evaluation; and perhaps most important, the 99% overall satisfaction level reported by our customers and families alike.

Having achieved these highest quality standards and experienced the benefits first hand, we would encourage other providers to take up the challenge. While the AHCA/NCAL National Quality Award process can be demanding and the commitment significant, the rewards are great for everyone involved. Moreover, the need to reach the program’s quality goals grows more important with each passing year… for individual long-term care facilities, the healthcare industry and, of course, all those we serve.

____________________________________________________________________

Want to achieve and excel at quality performance? Be sure to submit your Quality Award application by 8 pm EST on January 28!

Have questions? Contact the Quality Award staff at qualityaward@ahca.org.

Schwartz Named Chair of CEAL

NCAL’s quality and workforce expert leads assisted living coalition

 

Rachel Reeves
At its most recent meeting, the Board of Directors for the Center for Excellence in Assisted Living (CEAL) selected Lindsay B. Schwartz, Ph.D., to be its next chair. CEAL is a unique collaboration of national provider, consumer and advocacy organizations committed to enhancing the care provided in these long term care communities. Schwartz is the senior director of workforce and quality improvement programs at the National Center for Assisted Living (NCAL).

Schwartz has been at NCAL for three years, intensifying the organization’s quality improvement efforts. Under her direction, NCAL created the Quality Initiative for Assisted Living, a multi-year, national effort for providers to measurably improve in key areas. She has championed the need for consistent, real-time data in assisted living by spearheading the National Patient Safety Organization for Assisted Living and the expansion of LTC Trend Tracker. These two association tools allow members to track a number of quality measures in comparison to other providers across the country.

CEAL’s current projects focus on shaping potential measures for the profession, including sponsoring research being conducted by the University of North Carolina at Chapel Hill and providing input on the development of definitions and standards for home- and community-based settings. The coalition is planning additional research on Medicaid funding methodologies in assisted living.

CEAL members work closely together to promote excellence in assisted living through practice, public policy, technical expertise, and research. Members are AARP, Alzheimer's Association, American Assisted Living Nurses Association, American Seniors Housing Association, Argentum (formerly the Assisted Living Federation of America), LeadingAge, National Center for Assisted Living, The National Cooperative Bank, Paralyzed Veterans of America, and Pioneer Network. For more information on CEAL's mission and members, visit CEAL's website at www.theceal.org.

Register for the AHCA/NCAL Quality Summit Before the Holidays

meetings@ahca.org


Register now for the AHCA/NCAL Inaugural Quality Summit and check one thing off your holiday “to do” list. The deadline to register is January 12, 2016. Get equipped with the information, tools, and resources to achieve your quality, and performance improvement goals for the New Year.

If you haven’t heard, the NCAL Spring Conference and the Quality Symposium have joined together to become the AHCA/NCAL Quality Summit. This merger makes it even easier for you to enjoy top-notch speakers, priceless networking opportunities with your peers, and strong just-in-time training on key quality improvement topics that will ensure you reach your quality goals. Earn up to 12.75 CEUs and return home with fresh ideas and inspiration. ​

The AHCA/NCAL Quality Summit will be held February 9-11, 2016 in San Antonio, Texas.

AHCA/NCAL would like to that our event sponsors. For complete details about the Quality Summit, go online.

Wall Street Journal Article on Observation Stays

Dana Halvorson

On December 1, 2015, Christopher Weaver, Anna Wilde Mathews, and Tom McGinty, wrote an article in the Wall Street Journal entitled “Medicare Rules Reshape Hospital Admissions.” The authors noted in the article, “Patients on observation status can remain in the hospital for days, and typically receive care that is indistinguishable from inpatient stays, experts say. But under Medicare billing rules, the stays are considered outpatient visits, and as such, don’t trigger penalties under the health law. The Journal’s analysis of Medicare billing data shows that increases in observation stays can skew the readmission numbers, letting hospitals avoid penalties even if patients continue to have complications and return for repeat visits. Observation stays generally are cheaper for the government, but in some cases they can lead to big bills that are the patient’s responsibility.” Click here to read the full article logged into WSJ.


AHCA/NCAL is part of the observation stays Coalition, which currently consists of 28 national organizations such as AARP, the National Committee to Preserve Social Security & Medicare, and the Catholic Health Association of the United States. The Coalition supports the bipartisan Improving Access to Medicare Coverage Act (S. 843/H.R. 1571) that would count a patient’s time in observation toward the 3-day hospital inpatient stay requirement. The updated observation stays Coalition one-pager can be found here. For more information about observation stays and the three-day stay requirement, please visit the AHCA/NCAL website. 

Small Business Health Options Program (SHOP) Marketplace Coverage

Dana Halvorson


According to a December 3, 2015, email from the Centers for Medicare & Medicaid Services (CMS), “There's less than 2 weeks left to enroll in SHOP Marketplace coverage without meeting a participation requirement. Take advantage of this limited time window today. Outside of this window, in most states, small businesses generally must meet a minimum participation requirement of 70% in order to enroll in SHOP Marketplace coverage. You must enroll in SHOP Marketplace coverage by December 15th to take advantage of this limited time window.”

To learn more and enroll in SHOP Marketplace coverage, you can visit HealthCare.gov. You can also call the SHOP Marketplace call center at 1-800-706-7893 Monday–Friday, 9 a.m.–7 p.m. ET. To use the SHOP Marketplace, your business or non-profit organization must have 50 or fewer full-time equivalent employees (FTEs). (Some states may use different employee maximums for 2016.)

 

 

 

It’s Not Too Late to Avoid ACA Penalties in 2016

Dave Kyllo


Under the Affordable Care Act, certain employers – called applicable large employers (ALE) – are subject to the employer shared responsibility provisions. If you are an ALE, you may choose to offer affordable minimum essential coverage in order to avoid penalties of $2,000 per full-time employee (minus the first 30 full-time employees). Employers also have the option of offering minimum value plans, which if affordable for employees, eliminates the potential for a $3,000 penalty for each employee who would otherwise be eligible for a tax credit on the exchange.  

The attached tax tip from the IRS provides more information about the requirements for large employers.  

It’s not too late to be compliant with the Affordable Care Act in 2016. AHCA/NCAL Insurance Solutions can still help members with acquire a Minimum Essential Coverage or Minimum Value health insurance plan that will create compliance on January 1. For more information about these ACA—compliant plans, please contact AHCA/NCAL Insurance Solutions or call Dave Kyllo at 202-898-6312 or Nick Cianci at 202-898-2841. 

How Independent Owners Can Leverage Technology to Succeed in Value-Based Care

Christy Sharp

Earlier this year the Department of Health and Human Services (HHS) set explicit goals aimed at moving Medicare reimbursement away from the current fee-for-service program and into value-based programs. By 2016, HHS expects that 85 percent of Medicare payments will be made through alternative payment models (APMs), such as bundled payments, or tied to quality through other value-based purchasing programs. In 2018, that number jumps to 90 percent. Health information technology will be key for providers who wish to participate and succeed in this new environment. Independent Owners will need to think differently about their own internal operation and strategy for succeeding in the future state of health care, and they will need to prioritize technology solutions. In this webinar, presented by American HealthTech, we will examine the unique role of independent owners and how they can leverage technology to position themselves to be the high-value preferred partner of choice in their market. We will also discuss the increasingly vital role quality measurement will play, and how providers can make improvements in their data capture and analysis to prove their value to potential partners. We will make the argument that independent owners need to be prioritizing their technology strategy right now if they wish to keep up with the rest of the health care market.  

 How Independent Owners Can Leverage Technology to Succeed in Value-Based Care
Thursday, December 17, 2015
3:30 PM-4:30 PM  Eastern Standard Time 

Attendees will:

· Better understand HHS’ goals to move Medicare toward value-based reimbursement and what they mean for independently owned provider organizations;

· Understand the increasingly important role technology will play in the success or failure of providers in this new health care environment; and

· Walk away with tactics and strategies to improve data capture and analysis that they can implement in their own organizations.

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IO Leadership Conference Has Timely Speakers and Education Sessions Just For You

meetings@ahca.org

This year’s Independent Owner Leadership Conference (March 16-18, 2016) promises to be better than ever with all the networking opportunities you love and educational sessions you need. Discuss all the challenges you and your fellow IOs face, and take home the innovative strategies and valuable leadership tools you seek.

OPENING GENERAL SESSION
Lindsay Pollak—Harnassing the Power of Milennials

The Hartford's Millenial Workplace Expert and New York Times bestselling author will deliver actionable strategies to effectively manage cross-generational challenges and harness the power and potential of millennial employees.

CLOSING GENERAL SESSION
Dr. Natalie Stavas—Running Toward Chaos

Physician and 2013 Bostonian of the Year by The Boston Globe, Dr. Stavas uses medical expertise and personal experiences, from her upbringing on a Nebraska farm to the Boston terrorist attacks, to provide fascinating and constructive insight on the importance of altruism and strategies for conquering fear and finding meaning in a chaotic world.

EDUCATION SESSIONS YOU WON'T FIND ANYWHERE ELSE

The agenda now includes Preconference Sessions starting at 10:30 am on Wednesday, March 16th. Visit io.ahcancal.org to get all the details on sessions like these:


· Owner to Owner Town Hall

· AHCA/NCAL Leadership Panel

· How Independent Owners Can Make Themselves More Attractive to Payment Networks

· Customer Satisfaction: Is It Hurting or Helping Your Business?

· The Power of a Sales Leaseback and 1031 Exchange  

· Secrets to Engaging and Accountable Leadership

· Let's Get Serious About Staffing

· Effective Ways to Hire and Keep New Staff

· Can a Small Independent Owner Make a Big Market Impact? Five Steps That Turn Your QAPI Efforts Into Genius Marketing Strategies  


The deadline is February 17, 2016. See the complete agenda and register today!

 Sponsors as of December 2, 2015:

DirectSupply, Greystone, Kronos, MatrixCare, McCollum Consulting/Health Care Advisory Group, Schryver Medical, Walker & Dunlop, Yadkin

As Shutdown Looms, Republicans Eye Short-Term Spending Bill

Drew Thies


House Republicans are considering a one-week continuing resolution to fund the government past this week in the face of Democratic opposition to the currently proposed omnibus spending legislation.

The stop-gap legislation would fund the government past the December 11th deadline to avert a government shutdown and allow lawmakers more time to come to an agreement on a larger spending package.

Democrats are pushing for a so-called “clean” omnibus spending package, which would fully fund the government through next year, devoid of non-funding related policy riders. Some Republicans would like to see the omnibus advance several other contentious policies, ranging from checks on refugees to campaign finance to e-cigarette regulation.

Democrats have thus far not agreed to any short term funding legislation and see a clean omnibus bill as the best way to avert the December 11th shutdown date.

“We know that we’re going to get it right instead of get it done fast,” said Speaker Paul D. Ryan (R-Wis.). “We’re going to make sure that members of Congress and therefore the public have the time to read what is agreed to. But we’re not going to let an arbitrary Dec. 11 deadline stop us from getting this right. We’re going to get the best agreement we can possibly get, and those negotiations are ongoing.”

Some Republicans even floated the idea of a six-week extension of current funding levels to give lawmakers more time for negotiations, a plan that White House spokesman Josh Earnest said the President would not endorse.

Both chambers last week passed a bipartisan, multi-year extension of highway funding, leaving government funding and tax extenders the last two major legislative hurdles of 2015.

Lawmakers are set to adjourn for the year on December 18th, resuming legislative business in 2016.

Got at Least 50 FTEs?

 Then You Have New IRS Forms That Must Be Completed Next Month

Dave Kyllo

 

If you are an applicable large employer ,you are subject to the Affordable Care Act information reporting requirements. The deadline for the first of these new reporting requirements is February 1, 2016.

These requirements apply regardless of whether health coverage was offered to employees. You are an applicable large employer for calendar year 2015 if you had 50 or more full-time employees, including full-time equivalent employees, in 2014.

If you were an applicable large employer in 2015, you must file information returns with the IRS and provide statements to each employee who was a full-time employee for at least one month of the year about health coverage you offered or to show that you did not offer health coverage. 

Two IRS forms will be used for this reporting:

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

Forms 1095-C must be provided to employees by February 1, 2016. Forms 1094-C and 1095-C are due to the IRS by February 29, 2016, if filing on paper, or March 31, 2016, if filing electronically. The IRS has developed instructions for completing these forms. 

For more information about these reporting requirements, go to Reporting of Offers of Health Insurance Coverage by Employers on IRS.gov/aca. 

For more information about health plan options available through AHCA/NCAL Insurance Solutions, email ahcainsurancesolutions@ahca.org.  

Reminder: Quality Award Program Recertification Policy

qualityaward@ahca.org

In 2014, the AHCA/NCAL National Quality Award program implemented a recertification policy that impacts all current and previous recipients. Under this policy, Bronze and Silver Quality Award recipients have three years to apply for the next award level (Silver or Gold) before being designated as a “past recipient” of the award. As a past recipient, an organization must reapply at the Bronze level if they decide to participate in the program again.

The complete recertification policy and Frequently Asked Questions are available on the Quality Award website. It is important to note that all recipients who achieved their awards in or before 2014 have until 2017 to apply to the next level award. 

The purpose of the policy is to maintain the integrity of the program, embrace new standards of care, and promote continued growth of member organizations on the quality journey.

If you have any questions, feel free to reach out to Quality Award staff at qualityaward@ahca.org

Now Accepting Quality Award Applications!

qualityaward@ahca.org

It’s that time of year. Time to complete annual reviews, finalize budgets, and prepare and submit your Quality Award application!

The Quality Award Application portal is now open and accepting applications until the deadline on January 28 at 8 p.m. EST. Application packets are available on the Bronze, Silver and Gold Award pages.

The AHCA/NCAL National Quality Award Program sets high standards for quality based on the Baldrige Performance Excellence criteria and encourages member providers to commit, achieve and excel in quality performance. The Quality Award criteria is based off the Baldrige Performance Excellence criteria and offers organizations an integrated approach to improving in key management areas such as leadership, strategy, measurement & analysis, workforce, operations and results. AHCA/NCAL has a number of resources to help you get started or continue on your Quality Award journey. These include:

• The Bronze Criteria Series, a collection of short YouTube videos to guide Bronze applicants through the criteria. 
• The Silver Criteria Series, ten videos to help Silver applicants understand the criteria and apply it to their organization. 
• The Management Viewing Guide with direct links to slides and seminars for Gold applicants. 

If you have any questions, feel free to reach out to Quality Award staff at qualityaward@ahca.org.

Government Spending Battle Continues as Democrats Reject GOP Offer

Drew Thies

House Democrats today rejected a Republican offer to fix the largest outstanding government spending issues left in 2015. The omnibus spending bill proposed by Speaker of the House Paul Ryan (R-Ohio) and his party is reportedly shot down by Democrats primarily because of policy riders attached to the offer.

The deal was "not serious and unacceptable,” according to a spokesman for Rep. Nita Lowey (D- N.Y.), the ranking Democrat on the House Appropriations Committee. “It’s miles from something that would attract Democratic support,”he said.

The deal aims to appropriate the funds designated by the recently agreed-upon budget deal struck between both parties in the wake of the-Speaker John Boehner’s retirement.

Lawmakers are running out of time to come to a decision on how to appropriate funds budgeted for the next fiscal year. The current continuing resolution gives Members of Congress until December 11th to come up with a solution to avoid a government shutdown.

Republicans are also pursuing an alternative budget strategy known as reconciliation, a byzantine budget process which limits debate and the breath of amendments that can be offered, effectively creating a 51-vote threshold to pass the Senate. While many expect the legislation to garner enough Republican support to pass both chambers, changes to the Affordable Care Act and other Democratic priorities have been met with a veto threat from the White House.

Omnibus spending legislation is the most obvious route for both parties to find compromise and avert a shutdown, as Republicans do not have enough votes within their party to overcome a Presidential veto. Majority Leader Kevin McCarthy (R-Calif.) hinted earlier this week that a week-long continuing resolution could be passed in order to give lawmakers more time to reach a deal.

Top Resources for Quality Award Applicants

qualityaward@ahca.org


The 2016 AHCA/NCAL National Quality Award Intent to Apply deadline has just passed. Most applicants have likely been working on their application for the past few months; but for those who haven’t started, the time to get started is now!

If you need a jump start, than you have come to the right place. The Quality Award website has a number of resources designed to help facilities with the application process. Whether you are writing a Bronze, Silver or Gold application this year; there is something for you!

Bronze applicants should check out the Bronze Criteria Series. The Bronze Criteria Series is a series of YouTube videos, 3-7 minutes in length, with each video covering one question of the Bronze criteria. The series is structured so that application teams are able to view each video and write a response to each question, sometimes in less than 30 minutes total! We suggest that centers form an “application team” that views the videos together and then completes the responses to the criteria as a team effort. Applicants who view the Bronze Criteria Series are much more likely to be successful with the award process.

Following the popularity of the Bronze Criteria Series, AHCA/NCAL has released a brand new Silver Criteria Series for the 2016 application cycle. The series starts with an introduction of the program and a webinar on the Silver evaluation process. Eight additional webinars follow, covering each section of the Silver Criteria, from the Organizational Profile through Categories 1-7. Each video provides an explanation of the criteria and questions to help applicants through the process. As with Bronze, we suggest that centers form an “application team” that views the videos together and then completes the responses to the criteria as a team effort.

Gold applicants should view the AHCA/NCAL Management Series. The AHCA/NCAL Management Series is a sequence of videos, or seminars, each covering a category of the Baldrige Criteria. This series was developed to help any facility develop a comprehensive and robust management system. For Gold, the series also provides insight from Baldrige experts across the Organization Profile as well as across each criteria category.

As an additional benefit, all of these webinar series will also fulfil your educational requirement for the program!

CMS Two-Midnight Rule and Comment Period

Dana Halvorson 

According to a November 30, 2015, article by Emily Mongan of McKnight’s, the Centers for Medicare & Medicaid Services (CMS) is “seeking input on a section of its two-midnight policy that would cut inpatient payments to hospitals, after a judge ruled the cuts need to be better justified. CMS' request for comment follows a September ruling by a federal judge that required the Department of Health and Human Services [HHS] to reopen a portion of the two-midnight rule that would cut 0.2% from hospital inpatient payments.

HHS Secretary Sylvia M. Burwell stated the cuts would help offset the estimated $220 million it would cost to move patients from outpatient to inpatient status under the two-midnight rule; hospitals objected, saying the cuts were unnecessary.” The comment deadline is 5pm EST on February 2, 2016, and the final notice will be published by CMS by March 18, 2016. More details about commenting can be found here in the Federal Register. 

Assisted Living Conversion Program

Dana Halvorson 

In a November 22, 2015, article in Senior Housing News entitled, “Financing Without Fear: Program Expands Senior Housing Lending Options,” author Amy Baxter stated, “Would you convert senior housing units into assisted living, if doing so would lead to refinancing problems down the line?"  Previously, some providers faced this choice in the past. But all that has changed, due to new rules under a U.S. Department of Housing and Urban Development (HUD) program.

The Assisted Living Conversion Program (ALCP) provides grants to nonprofit owners to convert a portion of their units into an assisted living facility. Previously, properties that received ALCP grants were blocked from using FHA mortgage insurance through HUD’s Sec. 223(f) and Sec. 221(d)(4) programs.  "Lenders can now tap into these HUD programs to refinance or rehabilitate properties that have undergone a conversion through ALCP, so long as less than 75% of its units and residents receive assisted living services. They no longer have to fear that if they utilize ALCP to expand assisted living, future renovations or refinancings on the property will have to be financed through non-HUD channels."

To read the full article, please click here. In addition, more on the ALCP can be found on the HUD website, and in this Lancaster Pollard article by Ryan Miles.

Bill To Help Improve Access, Availability of Rural Health Care Introduced in the House

Dana Halvorson 


On November 18, the U.S. Senate Commerce Committee considered and passed by voice vote S. 1916, the Rural Health Care Connectivity Act of 2015. The Rural Health Care Co​nnectivity Act of 2015 would amend the Communications Act to permit skilled nursing facilities to apply for support from the Universal Service Fund’s Rural Health Care Program (RHCP). The RHCP provides funding for telecommunications and broadband services used to provide health care in rural areas and communities. S. 1916 specifies that skilled nursing facilities be included in the definition of health care providers that are eligible to receive RHCP support. By FCC interpretation, skilled nursing facilities are currently not eligible to receive these funds. The Rural Health Care Connectivity Act of 2015 would help AHCA members provide enhanced care and services for patients and residents in rural areas throughout the country.​ An AHCA press release on this legislation from earlier this year can be found here.

On November 19, Rep. Leonard Lance (R-NJ-7), Rep. Kevin Cramer (R-ND-At Large) and Rep. David Loebsack (D-IA-2) introduced companion legislation, the Rural Health Care Connectivity Act of 2015 (H.R. 4111), in the U.S. House of Representatives. The legislation has been referred to the House Committee on Energy and Commerce. AHCA will keep its members apprised of any updates relating to this important Senate and House legislation.    

CMS Updates 2016 Medicare Part B Physician Fee Schedule File – Therapy File Posted on AHCA Website

Dan Ciolek

On November 16, 2015, the Centers for Medicare and Medicaid Services (CMS) published the CY 2016 Medicare Physician Fee Schedule (PFS) Final Rule (CMS-1631-FC) in the Federal Register. This is the first PFS final rule since the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which repealed the Sustainable Growth Rate formula. The MACRA allowed the zero percent update that would have ended on March 31, 2015, to continue through June 30, 2015, allowed for a one-half percent (0.5%) update from July 1, 2015, to December 31, 2015, and allows for a one-half percent (0.5%) update for CY 2016. The MACRA also extends the physician work geographic practice cost index (GPCI) floor of 1.0, and the therapy cap exceptions process, through December 2017.

You may note that the 2016 conversion factor of $35.83 is slightly lower that the 2015 conversion factor of $35.93. This is due to the application of a required -0.02 percent Budget Neutrality Adjustment and a -0.77 percent Target Recapture Amount adjustment related to the misvalued procedure code policy.

The final rule continues the multiple procedure payment reduction (MPPR) policy for “always therapy” services. The MPPR policy required, effective April 1, 2013, a 50 percent reduction to be applied to the practice expense component of payment for the second and subsequent “always therapy” service(s) that are furnished to a single patient by a single provider on one date of service (including services furnished in different sessions or in different therapy disciplines). The MPPR worksheet lists those “always therapy” services subject to the MPPR policy and the reduced fee payment amounts.

Supporting documentation and downloads for Regulation #CMS-1631-FC may be found here. An overview of the Physician Fee Schedule Payment Policies may be found at http://www.cms.hhs.gov/PhysicianFeeSched/ and an overview of skilled nursing facility consolidated billing and annual updates can be found at http://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/.

Thanks again to the efforts of Tony Marshall, President and CEO of the Georgia Health Care Association; AHCA is able to offer members the 2016 therapy fees for each CPT/HCPCS Code in each geographic area are provided in this Excel file. The file contains the following information:


1. The 2016 Medicare Part B Fee Schedule (Part B Fees) for Outpatient Rehabilitation for each Carrier and Locality

2. The 2016 Medicare Part B MPPR Fee Schedule for "Always Therapy Services (50% MPPR Factor) for each Carrier and Locality

3. The 2016 Relative Value Units (RVUs) for each Outpatient Rehabilitation Therapy Code

4. The 2016 Geographic Practice Cost Indices (GPCI) by Medicare Carrier and Locality


The Part B Fee Schedule amounts are calculated as follows:

((A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor (Part B Fees), and

((A1 x B1) + ((A2 x B2) x (1-MPPR Factor) + (A3 x B3)) x Conversion Factor (MPPR Part B Fees), where:

A1 = Physician Work RVU
A2 = Non-Facility Practice Expense RVU
A3 = Malpractice RVU
B1 = Work GPCI
B2 = Practice Expense GPCI
B3 = Malpractice GPCI

Conversion Factor = $35.8279

MPPR Factor = 50%