Wednesday, April 29, 2015

Updates Relating to the Veterans Access to Extended Care Act (S. 739/H.R. 1369)

Outreach to your Members of Congress

On April 23, the House Veterans’ Affairs Subcommittee on Health held a legislative hearing on a few VA related bills, including the Veterans Access to Extended Care Act. The AHCA press release on the hearing can be found here, and includes how Rep. Jackie Walorski (R-IN-2) specifically spoke at the hearing on the importance of the Veterans Access to Extended Care Act. In addition, at a recent hearing of the Senate Appropriations Committee on Veterans Affairs, VA Secretary Robert McDonald urged the Senate to support the Veterans Access to Extended Care Act. In the press release on the hearing from Senator John Hoeven’s (R-ND) office, Senator Hoeven said, “Secretary McDonald’s support of our legislation gives us real momentum going forward. Our legislation cuts through the red tape and makes it easier for long-term care facilities to receive reimbursement from the VA so they can serve our veterans. His support will help us to keep our nation’s promise to care for the men and women who have served our country.”

AHCA encourages you to reach out to your Members of Congress if you haven’t already requesting them to sign on to this important legislation as a cosponsor. Those Members that have signed onto the legislation thus far can be found here for the Senate side, and here for the House side. If you have any questions, please don’t hesitate to contact AHCA’s Senior Director of Not for Profit & Constituent Services, Dana Halvorson.

2015 Joe Warner Award Nominees Announced

Drew Thies

AHCA/NCAL has announced this year’s Joe Warner Award winners. Robin Hillier, Barry Lazarus, and Bob Van Dyk will all receive the Joe Warner Award for Patient Advocacy at Congressional Briefing on June 15th.

Robin Hillier currently serves as the Co-Chair of the AHCA Independent Owners Committee and is owner of Lake Pointe Rehabilitation and Nursing Center in Conneaut, Ohio.
Barry Lazarus is Chair of the AHCA Finance Committee as well as Vice President & Chief Compliance Officer at HCR ManorCare in Toledo, Ohio.

Bob Van Dyk is a past Chair of both the AHCA Board of Governors and the NCAL Board of Directors as well as President & CEO of Van Dyk Health Care in Ridgewood, New Jersey.

Registration for Congressional Briefing is officially open. Registration is completely free and open to all AHCA/NCAL members and Associate Business Members.

Come join hundreds of long term and post-acute care professionals June 15-16. The two day event is widely attended by AHCA/NCAL members—last year over 400 advocates attended the conference and took to the Hill to speak to members of Congress and their staffs.

Hotel rooms in the Hyatt Regency on Capitol Hill fill quickly, so register now.

A Day for ID/DD Providers at AHCA/NCAL Convention is Sunday, October 4, 2015

Dana Halvorson
A Day for Intellectual and Developmental Disabilities Residential Services Providers will be held on Sunday, October 4, 2015, at the 66th AHCA/NCAL Annual Convention & Expo.

The theme for this year's session is called, "Leading the Charge for Compassionate Care: A Day for Intellectual and Developmental Disabilities Residential Services Providers." This constituency education program for ID/DD providers is packed with motivational and educational speakers. Charles Bloom, Chief Strategic Officer for the Marquis Companies/Consonus Healthcare in Milwaukie, OR, is the keynote speaker, and will explore and examine with attendees the background of intentional culture and how it can create meaning and purpose in our work. Intentional culture allows us to keep the meaning and purpose in our work, without it, nothing else matters. Participants will also have the opportunity to hear from other educational and top-notch speakers, including CMS.

Learn more about ID/DD Day. Register today and earn 7.0 CEUs.

KC and the Sunshine Band Performs at AHCA/NCAL Annual Convention

Jon Patrick Ewing

Get your tickets now for the AHCA/NCAL Convention Gala Dinner & Show. When you register for the AHCA/NCAL Convention & Expo don’t forget to purchase your Gala Dinner & Show tickets. This year’s featured entertainment is KC and the Sunshine Band. This performance is a separate ticketed event, and tickets will go fast!

KC and the Sunshine Band are as widely popular today as they were forty years ago when they first danced onto the music scene. Their iconic hits, including Get Down Tonight, That’s The Way (I Like It), and Shake Your Booty are an integral part of our memories of the 1970s. Harry Wayne Casey - “KC” for short - and his band sold more than a hundred million records, received nine Grammy nominations, three Grammy Awards, and an American Music Award. Today, the band plays over a hundred live shows each year all over the globe, and KC’s songs have truly withstood the test of time. Just ask any of the thousands of fans who spend the entire concert on their feet, shaking their booties!

For registration information, ticket purchases, events schedule, education sessions, speakers, Expo Hall hours and all the details about this year’s event in San Antonio, go to our Convention & Expo website.

Early bird registration continues through July 17.

Tuesday, April 28, 2015

Trade Package Moves with Medicare Sequester Extension

Drew Thies 
The House Ways and Means Committee voted Thursday to advance trade promotion and assistance bills which include an extension and expansion to Medicare payments. The offset is used to pay for a renewal of health insurance coverage for workers affected by the trade deal.

The measure cleared the committee by voice vote. The Senate Finance Committee on Wednesday evening advanced a similar trade bill package, with the same Medicare sequester offset after an amendment from Mark Warner, D-VA., removing the sequester provision, was withdrawn from consideration.

On Tuesday, the American Health Care Association along with other provider groups sent a letter to the House and Senate, criticizing the surprise addition of the offset extension and urged its removal from the bill.

House committee chief, Paul Ryan, R-Wis., indicated the final measure could find a less objectionable offset source. The trade package has not yet been voted on in the full House.

The Congressional Budget Office estimates the sequester extension provides $700 million in funding.

Sequestration spending cuts mandated by a 2011 budget agreement included a two percent cut in Medicare provider payments, which extended through the ten year period of the budget pact. However, the aging of the 10-year budget window offers an opportunity to extend the sequestration savings. Several Medicare bills have been funded by an extension of the sequester past its original 2021 end date. The current end date is 2024.

AHRQ to Host Continuing-education Webinar on Medication Reconciliation Supported by Clinical Pharmacists

Holly Harmon

A May 20 webinar hosted by the Agency for Healthcare Research and Quality (AHRQ)’s Effective Health Care (EHC) Program will explore how medication reconciliation can help prevent medication errors during transitions in care. Some evidence shows that pharmacist-led processes could prevent medication discrepancies and potential adverse drug events after discharge. Registration is open here:

Additional resources on medical reconciliation are available from AHRQ’s EHC Program. To learn more, access the full Making Health Care Safer II research report (Medication Reconciliation Supported by Clinical Pharmacists is Chapter 25) or read an executive summary of the full Making Health Care Safer II report.

Online Module on Standards for Adult Immunization Practice

Holly Harmon

Medscape and National Adult Immunization Summit have developed online modules to assist in the implementation of the Standards for Adult Immunization Practice. The second module on Recommendation has recently been launched. It is available at: and features video vignettes of different providers making strong recommendations for different adult vaccines.

This module was developed through the National Adult Immunization Summit via a collaboration between the American College of Physicians, the American Academy of Physician Assistants, the Centers for Disease Control & Prevention, and the Immunization Action Coalition.

Monday, April 27, 2015

OIG Releases Compliance Oversight Guidance to Health Care Boards

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) has released new guidance, Practical Guidance for Health Care Governing Boards on Compliance Oversight, in collaboration with the American Health Lawyers Association (AHLA), the Association of Healthcare Internal Auditors (AHIA) and the Health Care Compliance Association (HCCA), to assist governing boards of health care organizations fulfill their compliance plan oversight obligations. Health care board members have a duty to act reasonably to ensure that the company has an information and reporting system and that the system is adequate to provide the Board with appropriate compliance information, according to the guidance.

Health care Board members should consult OIG’s compliance guidance and also the Federal Sentencing Guidelines and Corporate Integrity Agreements as benchmarks for the Board’s compliance efforts. The OIG recognizes the potential burden on smaller entities; but also states that a company’s legal, compliance and internal audit functions should be separate and independent, which may require hiring additional employees.

Other OIG recommendations in the guidance include:
1) enter into executives sessions (without management present) with only employees responsible for compliance;
2) establish a formal plan to stay up to date with changing regulations;
3) include someone on the Board who is a compliance expert; and
4) consider an employee incentive program focused on compliance.

Overall, the guidance makes clear that health care Board members must play an active role in their organization’s compliance.

For more detail, see our General Counsel, Reed Smith Client memorandum at

Next Week Is National Nurses Week 2015

Katherine Merullo

May 6-12, 2015 will celebrate National Nurses Week 2015 with the theme “Ethical Practice. Quality Care”. This week developed by the American Nurses Association honors the many nurses working the multiple fields of the health care profession. This year’s theme recognizes the importance of ethics in nursing and acknowledges the strong commitment, compassion and care nurses display in their profession. This theme also shows the importance of advocating for the rights, health and safety of nurses and their patients.

Another useful tool is their National Nurses Week 2015 Resource Toolkit available for download off their website.

On Thursday, May 7, 2015 at 1: 00 PM EST there will be a free webinar called, “My Patient, My Code, My Practice: Ethical Decision Making & Action.

Be sure to check out their website to learn some useful ways to recognize and promote your nursing staff’s professional skills and abilities during this health care observance.  If you have any questions about the recognition week, contact Adam Sachs at the American Nurses Association via email:

We would love to see how you recognize your teams during this week.  Be sure to share your ideas and photos on Facebook and Twitter.

Wednesday, April 22, 2015

What’s your SNF PPS Rate?

Prepare yours today at

James Muller

Want to know your facility’s SNF PPS rate? Now you can prepare it yourself. AHCA has developed a Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) rate calculator to assist members in examining and estimating the impact of payment changes to SNF PPS rates. Using information on your distribution of Medicare Part A days by RUG category, the calculator allows you to simulate and understand the impact of the proposed SNF PPS payment policy changes for FY 2016 on your facility.

The rate calculator reflects Medicare payment policy changes found in the SNF PPS notice for fiscal year 2016 that was issued on May 15, 2015.

To prepare your rate estimate, download the .XLS calculator at

CMS to Look at Short Inpatient Stays and Two-Midnight Policy

Dana Halvorson

According to an April 20 Inside Health Policy article by Michelle Stein, the Centers for Medicare and Medicaid Services (CMS) has noted that it plans to address a broad set of issues around short inpatient stays and the two-midnights hospital admissions policy in the hospital outpatient pay rule this summer, including recent Medicare Payment Advisory Commission (MedPAC) recommendations. More details on the April 2 MedPAC meeting on hospital short stay policy issues can be found on the MedPAC site and in the AHCA press statement on the Commission’s vote. 

In the April 20 Inside Health Policy article, “the agency [CMS] acknowledges that stakeholders for years have raised concerns about short inpatient hospital stays, long outpatient stays with beneficiaries under observation, and ‘Medicare policies with respect to when payment for short hospital stays is appropriate under Medicare Part A.’ The agency says that even though CMS has taken steps to address these concerns, like shortening the RAC look-back period for patient status reviews and laying out a series of improvements the agency plans to implement once new RAC contracts can be implemented, hospitals and doctors are still upset.”

Tuesday, April 21, 2015

CMS Updates Medicare Part B Claims Processing Guidance Related to SGR Enactment

Dan Ciolek

The Centers of Medicare and Medicaid Services (CMS) provided the following announcement related to the processing of Medicare Part B claims with dates of service on or after April 1, 2015. With the enactment of the Medicare Access and CHIP Reauthorization Act of 2015 yesterday, CMS will resume processing claims according to the law’s provisions. Prior AHCA announcements regarding this topic are located here and here

The SGR provisions include an extension for the Part B therapy caps exceptions process through December 31, 2017. This means that it will no longer be appropriate for providers to issue advance beneficiary notices (ABN’s) to beneficiaries receiving medically necessary services above the $1940 therapy caps, since providers can use the exceptions process for therapy services above the threshold. More information about therapy cap related ABNs can be found on the CMS website.
Attention Health Professionals: Information Regarding the 
Medicare Access and CHIP Reauthorization Act of 2015 

CMS – April 13, 2015 -- On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly.  This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule.   In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended.  CMS will immediately begin work to implement these provisions.
In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later.  While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount.   The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.  
No action is necessary from providers who have already submitted claims for the impacted dates of service.   

Break the Web of Infection with Advancing Excellence Disrupt Infections Workshop

Advancing Excellence in Long-Term Care Collaborative

Disrupt Infections: Creating a Community of Prevention Creating hands-on workshop is coming to Northampton, MA on April 20, and continuing to 30 more cities nationwide. Presented by Joann Rader, RN, MN, a nationally recognized LTC educator, and sponsored by Advancing Excellence and Kimberly-Clark, find out simple, practical ways to build commUNITY immUNITY in the care setting and help break the web of infection.

A continuum of organizational infection prevention will be described, raising awareness of how current practices inhibit newer, evidence-based actions that would disrupt infections. Walk away with the beginning of a new organizational plan for infection prevention with elevated steps to add to your infection care routines. Administrators can earn 2 CEUs at $79 (Program Approval Number: 2042015-2.00-14506-in). Sliding registration fee for others from the same care community.

See below for dates and locations throughout the US. Click here to register in a city near you Disrupt Infections workshops.
North East
April 21: Northampton, MA
April 22: Manchester, NH
April 23: Wallingford, CT
April 24: New York, NY
April 25: North Wales, PA

Mid West

May 4: Pittsburgh, PA
May 5: Columbus, OH
May 6: Detroit, MI
May 7: South Bend, IN
May 8: Chicago, IL

North West
May 18: Reno, NV
May 19: Sacramento, CA
May 20: Medford, OR
May 21: Portland, OR
May 22: Seattle, WA

South East
October 5: Atlanta, GA
October 6: Chattanooga, TN
October 7: Nashville, TN
October 8: Louisville, KY
October 9: St. Louis, MO

South Central
October 19: Oklahoma City, OK
October 20: Dallas, TX
October 21: Austin, TX
October 22: San Antonio, TX
October 23: Houston, TX

November 2: Jacksonville, FL
November 3: Orlando, FL
November 4: Tampa, FL
November 5: West Palm Beach, FL
November 6: Miami, FL

Blue Bell Creameries Recall Impacts Long Term Care

Lindsay Schwartz 

The Centers for Disease Control and Prevention (CDC) has recommended that long term care facilities not serve or sell any Blue Bell Brand products due to the massive Blue Bell Creameries recall of all products. Some Blue Bell ice creams may be contaminated with Listeria, which can cause illness and have been distributed to institutions. For more information, Visit CDC’s Advice to Consumers, Institutions, and Retailers.

Registration Open for 2015 Congressional Briefing
AHCA/NCAL is happy to announce that Congressional Briefing registration is officially open. Registration is completely free and open to all AHCA/NCAL members and Associate Business Members.

Come join hundreds of long term and post-acute care professionals June 15-16. The two day event is widely attended by AHCA/NCAL members—last year over 400 advocates attended the conference and took to the Hill to speak to members of Congress and their staffs.

AHCA/NCAL is also excited to announce that Rep. Cathy McMorris Rodgers (R-WA) will be speaking at the briefing. McMorris Rodgers is a rising star in the Republican Party and currently the top-ranking woman in Republican House Leadership with her post as Party Conference Chair.

In addition to McMorris Rodgers, Emmy-winning television news anchor Chris Wallace will be addressing attendees during the keynote speech. Wallace is currently the host of Fox News Sunday and previously hosted Meet the Press, making him the only person who has served as a host of more than one of the major Sunday political talk shows. Wallace has worked on the Today show, Primetime, Nightline, served as chief White House correspondent for NBC, and anchored the Sunday edition of NBC Nightly News.

Hotel rooms in the Hyatt Regency on Capitol Hill fill quickly, so register now. 

U.S. House Legislative Hearing on Veterans Access to Extended Care Act

Dana Halvorson

On March 16, Senator John Hoeven (R-ND), Senator Joe Manchin (D-WV), Representative Tulsi Gabbard (D-HI, 2nd) and Representative Jackie Walorski (R-IN, 2nd) introduced bipartisan legislation, the Veterans Access to Extended Care Act (S. 739/H.R. 1369), to expand veterans’ access to health care services. As you may know, it is long-standing policy that Medicare (Parts A and B) or Medicaid providers are not considered to be federal contractors. If a provider currently has VA patients, they are considered to be a federal contractor and under the Service Contract Act. Federal contracts come with extensive reporting requirements to the Department of Labor on the demographics of contractor employees and applicants, which have deterred providers, particularly smaller ones, from VA participation. The Veterans Access to Extended Care Act would ensure that providers could enter into VA Provider Agreements, without having to follow these complex federal contracting and reporting rules.

Tomorrow, the House Committee on Veterans’ Affairs -- Subcommittee on Health -- will be holding a legislative hearing to review a few veterans related bills, including the Veterans Access to Extended Care Act. More details about this legislative hearing can be found here, and it will be held in 334 Cannon House Office Building at 10am ET. Congressman Dan Benishek M.D. and Chairman of the House Committee on Veterans’ Affairs Subcommittee on Health, requested a statement from AHCA for the hearing record on the Veterans Access to Extended Care Act. The AHCA statement from AHCA/NCAL’s President & CEO, Mark Parkinson, has been submitted to the Subcommittee for the hearing.

If you have any questions on this legislation, please don’t hesitate to contact AHCA’s Senior Director of Not for Profit & Constituent Services, Dana Halvorson.

AHCA Board Chair Testifies in Front of Congressional Committee

Drew Thies
Len Russ, Chairman of the Board for American Health Care Association, testified in front of the Energy and Commerce Health Subcommittee hearing last Thursday.

The hearing, entitled "Medicare Post-Acute Care Delivery and Options to Improve it," focused primarily on advancing new payment options in the post-acute space, with a specific emphasis on bundling proposals.

In his oral testimony, Mr. Russ focused on AHCA's payment reform model and the association’s collaboration with CMS on quality initiatives.

One of the bundling proposals currently in Congress, the “Bundling and Coordinating Post-Acute Care (BACPAC) Act,” was discussed at length during the hearing. Due to a line of questioning, Mr. Russ was able to articulate issues AHCA has raised with the legislation, particularly that it does not place the post-acute sector in the drivers-seat of the system.

In addition to Mr. Russ, other panelists included, Dr. Steven Landers, President Visiting Nurses Health Association; Dr. Samuel Hammerman, Chief Medical Officer, LTACH Hospital Division, Select Medical Corporation; Melisa Morley, Ph.D., RTI International.

Representatives in attendance were Reps. Pitts, Green, Guthrie, McKinley, Long, Bilirakis, Griffith, Lance, Burgess, Murphy, Brooks, Buschon, Ellmers, Engel, Capps, Pallone, Butterfield, Castor, Sarbanes, Matsui, Schrader, and Kennedy.

AHCA/NCAL Announces Convention Keynote Speakers

 Jon-Patrick Ewing

AHCA/NCAL is excited to announce this year’s keynote speakers at the AHCA/NCAL 66th Annual Convention & Expo, October 4-7, in San Antonio, Texas. General Stan McChrystal is this year’s Opening Keynote speaker. McChrystal, a former Green Beret, is known for his candor, innovative leadership, and going the distance. Called "one of America's greatest warriors" by Secretary of Defense Robert Gates, few can speak about leadership, teamwork, and international affairs with as much insight as he can.

Shawn Achor is the Closing Keynote speaker. Achor is the author of the international bestseller, The Happiness Advantage. Shawn is regarded as one of the world's leading experts on the connection between happiness and success. He teaches for the Advanced Management Program at Wharton Business School and collaborates on research with Yale and Columbia University.

The Keynote speaker for the AHCA /NCAL National Quality Award Ceremony is Jake Wood. Wood is the founder of Team Rubicon and author of Take Command: Lessons in Leadership: How to Be a First Responder in Business. He will share his insights on the ability to have clarity of mind and purpose, to operate at peak performance, to deliver in the clutch, to build teams with high impact, and then inspire those teams to follow you toward stated goals.

Visit the AHCA/NCAL Convention & Expo website for information on registration, education sessions, the Expo Hall, and other networking events. Early bird registration continues through July 17.

OSHA Releases Guidelines for Preventing Workplace Violence

Lyn Bentley, MSW

OSHA recently released an update to its Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. The publication includes industry best practices and provides some insight on how to reduce the risk of violence in various health care and social service settings. In the document, OSHA recommends that health care providers develop an effective workplace violence prevention program that includes: (1) Management commitment and employee participation, (2) Worksite analysis/Tracking and Trending, (3) Hazard prevention and control, (4) Safety and health training, and (5) Recordkeeping and program evaluation.

The new guidance is not necessarily groundbreaking in its approach but it does include helpful charts and guides related to the five key program components that provide additional guidance on how to implement these elements. Of particular note and worthy of checking out is the specific suggestions related to hazard prevention including engineering, administrative, and work practice controls that can be implemented (see pages 13-21). While some of these may be costly or difficult to implement, there are some suggestions that could easily be implemented. 

OSHA also recommends that all incidents of workplace violence be investigated that include determining the root cause, involving employees in the investigation, and identifying near misses too (see pages 23-24). In addition, there are a list of training topics that OSHA recommends should be covered with employees, supervisors, and security officials – some of them you may not be currently covering with your employees. (see pages 25-27).

OSHA also provides a detailed program evaluation/risk assessment checklist that you may find useful (see pages 30-39).

Reissuing updated guidance suggests to me that OSHA may devote more time and resources to investigating claims of workplace violence in the hospital and residential care environments. It may be a good time to look over your program and consider your risk. 

CMS Results From March 2015 ICD-10 Acknowledgement Testing

Dianne De La Mare
In March 2015, the US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), along with health care professional volunteers conducted a successful acknowledgement testing. Acknowledgement testing gives providers and others the opportunity to submit claims with ICD-10 codes to the Medicare Fee-For-Service (FFS) claims systems and receive electronic acknowledgements, confirming that their claims were accepted. Volunteers were not required to register and there was no limit on the number of claims that they could submit.

Providers can conduct acknowledgement testing with CMS at any time, and many providers have already participated. Results of the March testing indicated that 775 submitters participated, submitting almost 9,000 claims, and CMS accepted 91.8 percent of test claims. This is the highest acceptance rate in any of the previous testing. CMS found that the small percentage of claims that were rejected most often resulted from improperly developed test claims that were totally unrelated to ICD-10. Many rejected claims also were related to an invalid National Provider Identifier (NPI) or an NPI that was not on the NPI crosswalk.

CMS will continue to conduct extensive outreach to testers on setup of test claims to avoid these issues for future acknowledgement testing. For more information on CMS March 2015 Acknowledgement Testing to

New PEPPER Data Now Available

Dianne De La Mare

The Fiscal Year (FY) 2014 4th Quarter release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER), with statistics through September 2014, is now available for download through the PEPPER Resources Portal. To obtain your SNF’s PEPPER, the Chief Executive Officer, President or Administrator of your organization should:

1. Review the Secure PEPPER Access Guide

2. Review the instructions and obtain the information required to authenticate access. A new validation code will be required for this release (medical record number or patient control number from a claim for services from September 1, 2014 through September 30, 2014)

3. Visit the PEPPER Resources Portal

4. Complete all the fields

5. Download your PEPPER

The SNF PEPPER will be available to download for approximately two years. The PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. Visit the SNF Training and Resources page at to access updated resources for using PEPPER, including recorded web-based training sessions, a sample SNF PEPPER and the current SNF PEPPER User's Guide.

CMS Implements ACA Collection of Staffing Mandate

 Lyn Bentley

On April 10, 2015, the US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) issued a Survey & Certification Memorandum entitled Implementation of Section 6106 of the Affordable Care Act – Collection of Staffing Data for Long Term Care Facilities.

CMS has created a system for centers to submit staffing and census information and it is called the Payroll-Based Journal (PBJ). The PBJ is intended to meet the criteria outlined in the Affordable Care Act for electronic submission of direct care staffing information. CMS intends to collect staffing and census data on a voluntary basis beginning October 1, 2015. All nursing centers will be required to submit staffing and census data using the PBJ beginning July 1, 2016.

The memorandum includes a link to access additional information about the system and information specifically for vendors or software developers. Additional information that is currently available for providers includes a Policy Manual for the PBJ. AHCA strongly encourages members to review the information on the PBJ website as well as the PBJ Policy Manual and send any questions or concerns directly to We also ask that you copy Lyn Bentley ( on any email that you send to CMS regarding this matter.

Wednesday, April 15, 2015

Senate Passes Permanent SGR Fix

Drew Thies

Late Tuesday night, the Senate sent a bill permanent repealing the sustainable growth rate (SGR) to the President’s desk. The legislation passed overwhelmingly, with 92 Senators voting for passage. President Obama released a statement last night saying he will be “proud to sign it into law.”

This bipartisan effort marks the end of annual funding fights over “doc-fixes” that have dominated health policy for over a decade.

The House passed its version of the bill two weeks ago, but the Senate did not have enough procedural time to take up the legislation before a two-week holiday recess. The legislation moved out of the Senate just hours before physicians would have seen a 21 percent cut in Medicare payments due to expiration of the previous doc-fix.

The bill was passed with 46 Republicans and 44 Democrats plus 2 Independents voting in favor. The 8 Republican Senators opposing the bill were Sens. Ted Cruz, Mike Lee, David Perdue, Marco Rubio, Ben Sasse, Tim Scott, Jeff Sessions and Richard Shelby.

Final passage of the House-approved measure was uncertain as late as Tuesday, when both parties brought up three amendments each. Any amendment to the bill would have fundamentally changed the structure of the agreement and forced the House to approve a final version.

Republicans offered amendments to repeal the individual mandate within the Affordable Care Act, fix physician payments at .5% for the duration of the legislation, and strike the "pay-go" exemption, triggering sequester cuts if the bill is not fully paid for by the end of the year.

Democrats offered amendments to extend SCHIP provisions from two years to four years, remove abortion-related language in the bill, and permanently repeal the therapy caps as opposed to the two-year exception currently in the bill (which only failed to pass by two votes).

The current payment system will remain in place for five years as providers transition to the new Merit-Based Incentive Payment System (MIPS). Physicians will be paid more if they meet quality criteria, which are currently being developed.

AARP Report Released on Observation Stays Issue

Dana Halvorson

On April 14, 2015, AARP’s Public Policy Institute released a new report showing how observation patients can face unexpected, high out-of-pockets costs under Medicare rules compared with people who have been admitted as inpatients. Nearly 2 out of 3 observation patients who needed skilled nursing center care after hospital discharge did not meet Medicare’s 3-day inpatient requirement for coverage, according to the report. AARP’s report, “Observation Status: Financial Implications for Medicare Beneficiaries,” includes that being placed under observation can have significant financial implications for Medicare beneficiaries. Keith Lind, JD, MS, Sr. Strategic Policy Advisor, AARP Public Policy Institute, and co-author of the report noted that “The Medicare rules should change so patients get the care they need without the unnecessarily high costs.” AARP’s full press release on the report can be found here.  

AHCA/NCAL and AARP are part of the observation stays coalition, which 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 for Medicare coverage of skilled nursing center care. More details on the observation stays and 3-day stay issue can be found on the AHCA/NCAL observation stays website.

Tuesday, April 14, 2015

PRIME Act Reintroduced

Dianne De La Mare

On March 25, 2015, a bipartisan group of US Senators reintroduced the Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act. The Act seeks to increase oversight of billing procedures, recovery audit contractors and transfers of personally identifiable information.

Among its provisions, the Act would enact stronger penalties for Medicare and Medicaid fraud and curb improper or mistaken payments made by Medicare and Medicaid. It would establish stronger fraud and waste prevention strategies within Medicare and Medicaid to help phase out the practice of "pay and chase” and curb the theft of physician identities. It also expands the fraud identification and reporting work of the Senior Medicare Patrol and takes steps to help states identify and prevent Medicaid overpayments and improve the sharing of fraud data across state and federal agencies and programs.

To see a factsheet of the legislation go to To see the legislation go to go to


CMS Manual Changes Allow Auditors to Adjust Claims Up/Down

Dianne De La Mare

CMS has just released Pub 100-08 Medicare Program Integrity, Transmittal 585, that allows Medicare Administration Contractors (MACs), Supplemental Medical Review Contractor (SMRC), Comprehensive Error Rate Testing (CERT) contractor, Zone Program Integrity Contractors (ZPICs) and Recovery Auditors to refrain from denying the entire claim when the medical record supports a higher or lower level code and instead just adjust the code and the payment. In the past, these claims would just be denied but now they will be adjusted according to what the reviewer believes is appropriate.

To obtain the new guidance go to

We’ve Got You Covered!

New AHCA/NCAL Insurance Solutions Website

The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) now offers a variety of comprehensive insurance programs to meet your business needs. Backed by the strength of our membership, AHCA/NCAL Insurance Solutions programs are designed with exclusive member savings and discounts for both the fully-insured or self-insured members.

The program offers health insurance options, group and voluntary benefit packages, an aggressive Stop-Loss insurance program as well as cloud based HR platforms that will help members achieve savings and greater efficiencies on HR services within your company, while also tracking and reporting on key Affordable Care Act (ACA) requirements.

 For more information, please visit the new AHCA/NCAL Insurance Solutions website, email ​or call 860-416-5333.   

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 March 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, 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 Given the penalties and recent government warnings, long term care providers should check the LEIE on a regular basis.

Recognize Your Champion of Quality Care

AHCA/NCAL is now accepting applications for the 2015 Mary K. Ousley Champion of Quality Award! This award recognizes an individual who has made significant national contributions to advancing quality performance in long term and/or post-acute care, including either skilled nursing or assisted living settings. Previous recipients have demonstrated exemplary achievements in long term and post-acute care, including, but not limited to: 
  •  leadership in education and advocacy for quality improvements; 
  • dedication to performance improvement;
  • significant additions to long term and post-acute care research or interventions, and;
  •  initiative in innovation for quality care. 

Recipients of the award are not required to be AHCA/NCAL members, but the nomination must be submitted by an individual with an organization that is an AHCA/NCAL member of good standing. In addition, the nomination must demonstrate how the nominee has made a significant impact on a national scale. The recipient will be honored at the 2015 AHCA/NCAL Annual Convention & Expo’s Closing General Session in San Antonio, Texas, on October 7. Nomination forms can be found on the Champion of Quality Award page, and must be submitted via email to Courtney Bishnoi by June 11, 2015.  
Please contact Courtney Bishnoi for questions, or visit the Champion of Quality award page for more information.

CMS Announces Medicare Part B Claims Processing “Rolling Hold” Pending SGR Vote

Dan Ciolek

On Monday, April 13, the Centers of Medicare and Medicaid Services (CMS) provided the following announcement that on April 15 they will begin processing Medicare Part B claims with dates of service on or after April 1, 2015 to permit resumption of provider cash-flow. However, until Congress enacts SGR legislation, these claims will be processed with a 21.2% rate cut per law. If Congress later passes the SGR bill, CMS will automatically adjust the claims so that providers are fully reimbursed. CMS intends to implement a “rolling hold” on claims on a daily basis to limit the volume of claims that receive a negative adjustment or a therapy cap related denial while Congress completes the SGR work.

 On March 31, AHCA advised members to hold Part B claims with April 2015 dates of service until after Congress completed their SGR legislative work so that you didn’t have deal with the administrative hassle of reduced payments followed by payment adjustments later. AHCA will provide additional updates as the status of the SGR bill becomes more clear.

            Attention Health Professionals: Information Regarding the
2015 Medicare Physician Fee Schedule

CMS – April 13, 2015 -- On April 1, 2015, the Medicare Physician Fee Schedule (MPFS) was updated using the Sustainable Growth Rate (SGR) methodology as required by current law. The SGR methodology required a 21% decrease in all MPFS payments beginning April 1, 2015. The Centers for Medicare & Medicaid Services (CMS) took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the MPFS with dates of service on and after April 1, 2015. Additionally, Medicare is also holding all therapy claims that would no longer qualify for the therapy cap exceptions (those therapy claims with the ‘KX’ modifier), due to the expiration of the therapy cap exceptions process on April 1, 2015. In the absence of additional legislation to avert the negative update, CMS must update payment systems to comply with the law, and implement the negative update.

Beginning on April 15th, 2015, CMS will release held MPFS claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they are received. CMS will release one day's worth of held claims, processing and paying at the rate that reflects the negative update. At the same time, CMS will hold the receipts for that day, thus, continuing to hold 10 days' worth of claims in total. This is to provide continuing cash flow to providers, albeit at the rate that reflects the negative update. This “rolling hold” will help minimize the number of claims requiring reprocessing should Congress pass legislation changing the negative update.

Providers should remember that claims for services furnished on or before March 31, 2015 are not affected by the payment cut and will be processed and paid under normal time frames. We are working to limit any impact to Medicare providers and beneficiaries as much as possible. The MACs will automatically reprocess the claims paid at the reduced rate if Congressional action is taken to avert the negative update. No action is necessary from providers who have already submitted claims for the impacted dates of service.

Time-Honored, Respected: National Nursing Home Week

Bring on the Fiesta!

Amy Mendoza

It doesn’t take a social worker to figure out the deeper meanings of this year National Nursing Home Week (NNHW) theme of “Bring on the Fiesta!” Its south-of-the-border roots will have everyone cheering “Ole!” and dancing during the NNHW, May 10 to 16 (see tools and tips here).
Every year celebrating in unison with thousands of skilled nursing and post-acute care centers nationwide reminds us that the profession is ultimately a community striving to care for and socialize with our society’s older adults and persons with intellectual and developmental disabilities. Therefore, this year’s theme of NNHW, “Bring on the Fiesta!” reflects the desire for social interaction and just plain having a good time.  Families, residents, patients, and staff pull together to make special events happen and many care centers will take the opportunity to have an event dedicated to staff recognition.
Specially themed products for 2015 can be ordered here. So, keep up the buzz throughout the week of May 10–16. Be sure to post your NNHW fiesta event pictures to share with your LTC colleagues.


Nominate One to Honor All

Dana Halvorson

The ID/DD Hero of the Year honors individuals who have shown commitment, dedication, and compassion in serving persons with intellectual and developmental disabilities and their families. The NFP Program of the Year honors a community that has implemented either innovative approaches to resident satisfaction or a center’s activities that enhance the quality of life for individuals living in the community-at-large.

AHCA/NCAL members may submit nominees for these two categories; nomination packets are here. The deadline to submit nominations is May 21, 2015. Honorees will be guests of and recognized at the 66th Annual Convention in October in San Antonio, TX.

Monday, April 13, 2015

Join Us in Our Nation’s Capital for the 2015 AHCA/NCAL Congressional Briefing

Spring has sprung in Washington, and the incredible beauty that surrounds the Capitol is alive with cherry blossoms. It’s a great time to visit and find out all the latest news. Congressional Briefing offers you that and more with a unique opportunity to meet with your Members of Congress and talk about the health care issues that matter most to you.

You’ll also hear from great guest speakers like award-winning journalist Chris Wallace, enjoy valuable networking time with your peers, and have the chance to earn 6.5 CEUs.

Learn more about scheduling a meeting, see the complete agenda, and register today!

Hotel Information

Reserve your hotel room early. Rooms are going fast.

Please note that you must register for Congressional Briefing before making your hotel reservation.

Official Sponsor: Medline
Supporting Sponsor: LTC Properties

CMS Updates Several SNF Policies that Impact Billing

The Centers for Medicare and Medicaid Services (CMS) recently issued a MLN Matters article titled Updates to the Medicare Internet-Only Manual Chapters for Skilled Nursing Facility (SNF) Providers. This article summarizes updates to sections of the Medicare Benefit Policy Manual and the Medicare Claims Processing Manual in regards to SNF policy and billing. These policy updates are effective June 15, 2015. AHCA members are encouraged to review and forward to your billers.  
Policy areas updated include:
  •        Definition of what qualifies as a readmission to a SNF
  •         Excluded services beyond the scope of a SNF Part A benefit
  •         SNF consolidated billing annual update process
  •         Health insurance prospective payment system (HIPPS) rate code link
  •         Coding SNF PPS bills for ancillary services
  •        Adjustment requests
  •         SNF PPS pricer software
  •        Annual updates to SNF PPS pricer
  •         Leave of absence (LOA)
  •         Transportation of equipment billed by a SNF to a MAC 

ACL Awards $48 Million to SHIPs

Dana Halvorson

According to an April 9, 2015, email update from the Administration for Community Living (ACL), ACL has awarded up to $48 million in one-year grants for the State Health Insurance Assistance Programs (SHIP). Local SHIP offices provide free, in-depth counseling, education, and outreach to assist Medicare beneficiaries with their Medicare related questions.

The email update notes that SHIPs provide assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs assist people in obtaining coverage through the Original Medicare program, Medicare Advantage (Part C) Plans, Medicare Prescription Drug (Part D) Plans, and/or programs designed to help people with limited incomes pay for their health care, such as Medicaid, the Medicare Savings Program, and the Low Income Subsidy. Awards were made to each of the 50 states, DC, Puerto Rico, Guam, and the U.S. Virgin Islands.

More information on the SHIP program is available here on the ACL website, and to find a program in your area -- please click here.

Friday, April 10, 2015

Webinar: So You Think You Might Want to Run for the AHCA or NCAL Board: Everything You Want to Know But Are Afraid to Ask

Adrienne Riaz-Khan

American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) members in good standing may submit an application for the 2015-16 elections for the AHCA Board of Governors and the NCAL Board of Directors. This webinar will explain the application, credentialing and campaign process. It is perfect for those interested in running this year or in future years.

Neil Pruitt, Jr. CEO, PruittHealth 
Christy Sharp, Sr. Director Member Relations, American Health Care Association
Mike Shepard, CEO, The Shepard Group


· Understand what the AHCA/NCAL Board applications require
· Learn about the credentialing and campaign process
· Identify what is required of AHCA/NCAL Board members

Tuesday, April 7, 2015

University of Iowa Webinar: Supervising Social Work Field Students in Nursing Homes

This free webinar will start off with Cathy Tompkins, MSW, PhD (George Mason University) and Bob Connolly, MSW (Geriatrics Consultant) sharing results from their study about social work field placements in aging settings. Lynda Sowbel will discuss her many years of experience in placing undergraduate social work students in nursing home settings for field placements. She has advice for students and for nursing home social workers on how to make the most of this experience. Lynda R. Sowbel, PhD, LCSW-C is an Associate Professor/Director of Field Education in the department of Sociology & Social Work at Hood College in Frederick, Maryland.
Supervising Social Work Field Students in Nursing Homes
Wednesday, April 22, 2015
3:30 PM-4:15 PM Eastern Time

Assisted Living Residents Craft Works of Art

Rachel Reeves

Skip the museums. The 2014 submissions for NCAL’s Art for the Ages project are now available for viewing through NCAL’s online art exhibit for the public. Last winter, NCAL member communities submitted more than 150 images of resident art and craft work for display.

Check out some of the resident artists and their inspiration:

Sylvia of Channel Pointe Village, WA
Sylvia picks fresh flowers, puts them on a card, covers them with a paper towel and takes a hammer and pounds on them and the color and impression from the flowers stains/imprints the cards.

Marc of Arbor Terrace, Maine
Marc has been working on number of drawings with markers and collages with the variety of color paper on his time. He describes his inspiration as the abstract art of the early 20th century which he thinks "meaningless things come together and it seems to have some meaning."

Philip of Fallbrook Woods Residential Care, Maine
Philip is a World War II veteran who had a long, successful career as a professional commercial artist in Portland, Maine. Despite living with memory impairment, Phil’s ability to paint beautifully from a still-life remains strong. Phil finds great joy in painting roses, sailboats, American flags and landscapes.

Diane of Kingsway Manor, New York
Diane, 76, has been a resident of Kingsway Manor Assisted Living in Schenectady, New York for two years. She has been an artist her whole life and says she creates art because she enjoys working with the colors. “I like nature, and enjoy painting different birds and flowers,” she said. When asked to share her inspiration for her piece, titled “Hummingbirds in Spring”, she said simply, “I was just painting from the heart.”

Eleanor of Peachtree Village Assisted Living, Arkansas
Ellie creates art every day.  This is another one of her many creations she has done this year.  She just loves to paint and it keeps her young. 

Josephine of Garden View Senior Community, Iowa
Josephine, 92, is displaying just one of her beautiful pencil drawings. This special drawing is of her husband, Rodney. Josephine estimates she has approximately 20 hours into this particular one. Jo (as the community likes to call her) first took an art class at age 76 and has enjoyed it ever since. Incredibly, she has drawn a total of 38 drawings and is currently finishing up the last of her eight children. She has completed a few of her grandchildren and great-grandchildren as well. In addition, she enjoys pastel and oil paintings. Josephine has been living at Garden View for the past nine years. 

See all of the submissions on NCAL’s website or on Flickr.

NCAL’s Art for the Ages displays the many talented artist-residents from across the country. Art for the Ages also celebrates this life-enhancing and enriching activity for seniors.

Sharing artwork can also give inspiration to other assisted living caregivers on how to implement similar projects in their communities. Follow AHCA/NCAL’s board on Pinterest to save these art activity ideas for your own communities.

Protecting the Integrity of Medicare Act Introduced

Dianne De La Mare

In late February, Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA) introduced the Protecting the Integrity of Medicare Act (PIMA) of 2015. According to the sponsors, the legislation would prevent Medicare fraud by making a number of commonsense reforms such as removing Social Security numbers from Medicare cards and eliminating unnecessary paperwork for employers. PIMA incorporates a number of ideas from legislation previously introduced by committee members from both parties.

To obtain a copy of the bill go to

US Supreme Court Refuses to Hear Another ACA Case

Dianne De La Mare

The US Supreme Court has declined to hear another Affordable Care Act (ACA) case, which would have contested the constitutionality of the Independent Payment Advisory Board (IPAB), established under the Affordable Care Act (ACA), among other things. The IPAB is designed to limit spending growth in Medicare, but many believe it also will result in limiting care for seniors.

The Supreme Court’s refusal to take the case was expected, as lower courts had ruled in favor of the federal government, stating that the case was not ripe. However, the Goldwater Institute, the Arizona legal group that brought the case, promises to bring it back when IPAB begins to take action.

Read more about Coons v Lew at

US Supreme Court Holds Providers Cannot Sue Over Medicaid Rates

Dianne De La Mare

In a 5-4 decision, the US Supreme Court released an opinion , holding private health care providers cannot sue the state over low reimbursement rates (Armstrong v Exceptional Child Center Inc.).  In 2009, private health care providers delivering residential care to disabled patients in Idaho, sued the state alleging that it was illegally keeping Medicaid reimbursement rates at 2006 levels despite data showing that the cost of providing services had significantly increased. A Federal District Court judge sided with the providers, holding that the Idaho Medicaid rates weren’t in line with the federal law’s requirements that states “assure that payments are consistent with efficiency, economy and quality of care and are sufficient to enlist enough providers” to ensure adequate access to care. The District Court decision was upheld by the US Court of Appeals for the Ninth Circuit. As a result of that ruling, Idaho was forced to pay an additional $12 million in 2013 reimbursements. Idaho appealed the ruling to the US Supreme Court.  

On appeal to the US Supreme Court, health care providers argued that the courts are an important venue for challenging low reimbursement rates, which often are the only way to enforce federal payment requirements. Furthermore, providers argued when reimbursement rates are too low, there is lower provider participation in the Medicaid program, which can lead to less access to care for Medicaid beneficiaries. The Idaho Medicaid officials countered those arguments asserting that Congress had not authorized lawsuits under the Medicaid Act, codified under Title XIX of the Social Security Act, and that allowing such a course of action would result in endless litigation. The majority of the US Supreme Court Justices agreed with the state of Idaho, and concluded that a private cause of action is not permitted under the U.S. Constitution’s Supremacy Clause. Further, Title XIX does not allow private parties to enforce the provision in the Medicaid Act that requires state plans to “assure that payments are consistent with efficiency, economy, and quality of care” while “safeguard[ing] against unnecessary utilization of . . .care and services.” Rather, only CMS may scrutinize rate adequacy following its process for reviewing state plan amendments (SPA) pertaining to reimbursement. CMS guidance on SPA review is located here in a State Medicaid Directors’ Letter.  

AHCA/NCAL submitted an amicus brief in support of the Idaho providers in Armstrong v Exceptional Child Center Inc., and the Association is greatly disappointed in the US Supreme Court decision. As you know, AHCA has ample data demonstrating nursing facility Medicaid rates do not cover allowable costs. As a result of this decision, providers with insufficient Medicaid rates may only address rate complaints to the Single State Medicaid Agency (SSMA) as under current state practice but now have little hope of judicial relief.

Monday, April 6, 2015

MDS Focused Survey Tip Sheet and Entrance Document

Lyn Bentley 

In early April, CMS will begin training surveyors in order to expand the MDS-Focused Survey.  Here is a tip sheet for providers that was developed by a joint workgroup of the Survey/Regulatory and Clinical Practice Committees. Also, there is an entrance document that a "test center" was given prior to an MDS-focused survey in early March. Many thanks to the committee members who helped create this tip sheet. And special thanks to two members of the Legal Committee who very quickly answered some questions for the workgroup.

Senate Last Step for Permanent SGR Repeal

Drew Thies

The Senate is poised to vote on a permanent repeal of the Sustainable Growth Rate (SGR) after the House voted 392-37 to send it to the upper chamber. The bill, H.R. 2, implements a new payment system for doctors that supporters hope will end the annual battle to fund short-term “doc fixes.”

 Due to procedural hurdles and time constraints, the Senate was unable to vote on the measure after the House passed the bill Thursday morning. An all-day budgetary amendment process followed by a two-week holiday recess moved the SGR vote to the week of April 13th.

 Delaying the vote puts the Senate on a tight schedule, as CMS is currently holding Medicare claims that would result in a substantial cut to doctors’ reimbursement. The agency is allowed to hold the claims for 2 weeks after the March 31st expiration of the last SGR patch, leading to an April 14th cutoff.

Senate Leadership expressed faith the bill would be passed with a wide margin of support before recessing last week. Senate Majority Leader Mitch McConnell (R-KY) said “there’s every reason to believe it’s going to pass the Senate by a very large majority.” Minority Leader Harry Reid said Democrats are “hoping to get this done,” quipping about the delay early Friday morning, “I understand it’s late, whatever day it is.”

AHCA will continue to monitor the bill during recess and provide any updates.

2015 AHCA/NCAL Congressional Briefing Offers Unique Opportunity to Members

It’s time for you to bring your voice to the Hill and be heard. Congressional Briefing provides you with an important chance to talk face-to-face with your Members of Congress about the issues that matter to you. Registration is now open so don’t wait.

The conference registration fee is complimentary to AHCA/NCAL Members and AHCA/NCAL Associate Business Members only. All registrations include continental breakfast, networking lunch, and cocktail reception.

 The registration deadline is May 19, 2015.

Don't miss this opportunity to meet with your Members of Congress, hear the latest about all that is happening on the Hill, and network with your peers. You can also earn 6.5 CEUs. Learn more about scheduling a meeting, see the complete agenda, and register today!

Hotel Information

Washington, D.C. is a very popular destination in the spring, so plan ahead and reserve your hotel room early. Please note that you must register for Congressional Briefing before making your hotel reservation.

Official Sponsor: Medline
Supporting Sponsor: LTC Properties

AHCA/NCAL 2015 Convention & Expo: Registration Now Open!

Jon-Patrick Ewing

They say things in Texas are bigger and better. The ACHA/NCAL 66th Annual Convention & Expo is shaping up to be just that, all from historic and beautiful San Antonio. Experience the food, the landmarks, and the fun of this Texas-sized destination, while you network, learn, and enjoy yourself at this must-attend event.

Early Bird Registration ends July 17, so make your reservations today! Visit our official Convention & Expo website for event times, speakers and all the important information.

New Resource Available from the Suicide Prevention Resource Center:

The Suicide Prevention Resource Center (SPRC) has a new information sheet: The Role of Senior Living Community Professionals in Preventing Suicide. This sheet provides basic information to help professionals in senior living communities recognize and respond to people who may be suicidal or at high risk. It also contains a list of relevant resource materials and organizations. This resource was developed with input from senior living community professionals at the national and local levels. 

If you have any questions about these sheets, please contact Laurie Rosenblum at the Suicide Prevention Resource Center

AHCA/NCAL Insurance Solutions

AHCA/NCAL wanted to be sure that you are aware of AHCA/NCAL Insurance Solutions, LLC, our insurance agency that is dedicated to providing our members with Affordable Care Act (ACA) compliant insurance solutions, for both fully insured and self-insured groups of any size. Insurance Solutions is a full service insurance agency exclusive to our members.

AHCA/NCAL Insurance Solutions provides members with a full array of competitive insurance products. Contact us today to see what the AHCA/NCAL Insurance Solutions, LLC can do to meet your company’s insurance needs. For more information, contact or call 860-416-5333.

IRS Releases Final Forms and Instructions for ACA Reporting

Dana Halvorson and Dianne De La Mare

According to a recent client alert from Proskauer, in February of 2015, the Internal Revenue Services (IRS) released final forms and instructions related to information reporting under the Affordable Care Act (ACA). These forms include Form 1095-B, Health Coverage, Form 1094-B, Transmittal of Health Coverage Information Returns, Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, and Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage. 

The Proskauer client alert notes that the issuance of the final forms is a critical step in implementing the ACA's reporting requirements, and that although these forms are not required to be provided to employees and filed with the IRS until early 2016 -- the reporting requirements are complex and require reporting detailed coverage and employment information for the 2015 calendar year. The client alert gives employers steps they should consider taking in preparation for these deadlines. The full Proskauer client alert can be found here. To learn more about the ACA and for helpful resources, please visit AHCA’s ACA website.

Wednesday, April 1, 2015

CMS Survey & Certification Memo & Focused Dementia Care Survey Pilot

Lyn Bentley, MSW

Today we received a new CMS Survey & Certification Memo and the final report on the Focused Dementia Care Survey Pilot, which was conducted in the summer of 2014. 

Key Points from Report
1) The states where the pilot surveys were conducted: Illinois, Minnesota, New York, California, and Louisiana.

2) There were five nursing centers in five states that were surveyed for this pilot: one that was considered by the state a “best-practice” center and four others. The “best practice” centers received no deficiency citations, even if surveyors identified potential deficiencies.

3) Of the 20 centers that were surveyed, 16 were cited at either F309 (Care of a Resident with Dementia) or F329 (Unnecessary Use of Medications).

4) 11 of the 20 centers were cited at both tags (F309 and F329).

5) Of the 68 total deficiency citations, 4 were at a G or harm level (three in CA and one in IL).

6) Next Steps:

a. The dementia care focused survey process will be revised and this streamlined version will be used in both traditional and QIS States.

b. The streamlined version will also be used during complaint surveys

CMS Expansion Project
1) States have been invited to conduct dementia focused surveys in FY 2015 on a voluntary basis using the revised survey tools.

2) The expansion project will involve a more intensive, targeted effort to improve surveyor effectiveness inciting poor dementia care and the overutilization of antipsychotic medications

 3) CMS will provide criteria for determining specific facilities to be surveyed in those volunteer states.

 4) CMS has initiated a comprehensive survey effort in TX. A CMs subject matter expert will accompany each survey team on its initial survey.

 5) All deficient practices noted during the surveys will result in relevant citations.

AHCA has requested the surveyor worksheets from CMS in order to develop helpful training tools/tip sheets to share with states to prepare members who may receive these focused surveys.