Wednesday, September 30, 2015

Speaker Boehner Announces Resignation Ahead of Government Funding Deadline

Drew Thies

House Speaker John A. Boehner shocked Washington D.C., the Republican caucus, and the political community at large on Friday, making a surprise announcement that he will step aside as speaker in October and resign his seat in the House.

The move by Boehner comes less than a week before a contentious government spending bill must be passed to avoid a government shutdown. Conservative members of the Republican party in both chambers have called for such legislation to be tied to the defunding of Planned Parenthood, a move that Democrats and President Obama were sure to block.

Speaker Boehner received much criticism from some members of his own party, including the conservative House Freedom Caucus, for ostensibly siding with Democrats instead of working to use the stop-gap funding measure to defund the women’s health organization. Some thought that if a so-called “clean” continuing resolution was passed, members of the House Republican party would seek to enact official parliamentary measures to replace the Speaker of the House.

Boehner said that he woke up on Friday morning and decided the day had come to quit. "I woke up, and decided today's the day I'm going to do this," he said. The previous day, Pope Francis addressed a joint session of Congress and attended a private meeting with Boehner in a visit primarily spearheaded and organized by the Speaker’s office.

The move sparked off an immediate race of Republicans attempting to climb the party ranks as the top post in the House becomes open. Current Majority Leader Kevin McCarthy seems to be the odds-on favorite to take the Speaker’s gavel, but the race to then replace McCarthy as Majority Leader is much murkier.

The House will move to vote on a clean continuing resolution to fund the government until mid-December, leaving new Republican leadership just a few short months to get accustomed to handling their rank-and-file before another important policy deadline.

Tuesday, September 29, 2015

Download the Convention App

Jon Patrick Ewing
If you're attending the 66th Annual AHCA/NCAL Annual Convention & Expo, we are pleased to offer a multi-functional Convention App for this year’s event. With the Convention App you can:
  • Draw on presentation slides, highlight text, and take notes
  • Create a personal schedule by starring the sessions you plan to attend
  • Message app users
  • View exhibitor information and floor plan
  • Receive alerts & updates for the meeting
  • Use social media including, Facebook, Twitter and LinkedIn
  • Access supplementary resources and more!
To make the most of your convention experience, please follow these instructions for downloading the Convention App.
The Convention App for the 66th Annual AHCA/NCAL Annual Convention & Expo is available inside the AHCA/NCAL Events app available in App Store and in the Google Play store (links below). Search using : ”AHCA NCAL Events". If you plan on using the app, please install the mobile app and download the presentations before your arrival to the event. You will need internet access while downloading the app. (Please note, for iOS devices you will need iOS 7.0 or higher and for Android devices you will need Android 4.0 or higher.)
Note: If you have already downloaded the AHCA/NCAL Events App earlier this year when attending an AHCA/NCAL conference, you’ll only need to update to get access to event information for the 2015 Convention & Expo.  
Options for downloading the APP include:
Apple iOS Devices - install the free Apple iOS App and download the conference materials to your device.
Android Devices - install the free Google Play App and download the conference materials to your device.
Once you install and start up the app, find the AHCA/NCAL 66th Annual Convention in the events list. To log in, use your username (email used to register for the event) and password (registration confirmation # or badge #) listed in an email from Note: non-attendees will not have received this email or log in information.

U.S. House of Representatives Votes to Repeal a Piece of the ACA Earlier this Week

Dana Halvorson

According to a Sept. 28, 2015, article by Jon Reid from Morning Consult, “The House on Monday passed legislation to nix an upcoming Obamacare mandate requiring employers with 51 to 100 employees to shift the health coverage they offer to plans on the small-group market. Currently, the small-group market consists of businesses with up to 50 employees. But that is slated to change in 2016, when a new mandate will expand the market to include employers with 51 to 100 workers. Right now, these mid-size businesses can offer employer-based health insurance on the large-group market. Under the law, small-group market plans must cover a larger array of health services than large-group market plans and also have more discrimination protections. The idea is to protect small employers from extreme rate increases if one of their employees gets very sick. But many states are not ready for the transition that would require more employers to use the small-group market. As a result, Democrats and Republicans have called for an alteration of the law. The Protecting Affordable Coverage for Employees Act (PACE Act) — spearheaded by Reps. Brett Guthrie (R-Ky.), Tony Cardenas (D-Calif.), Markwayne Mullin (R-Okla.) and Kyrsten Sinema (D-Ariz.) — would let states choose whether to expand the small-group market to include businesses with up to 100 employees.”

The article goes on to note that, “The Senate is under a time crunch to pass the bill before the mandate takes effect in 2016. Senate Majority Leader Mitch McConnell’s office did not immediately respond to a request for comment, but there is support in the Senate. A companion bill by Sen. Tim Scott (R-S.C.) has the cosponsors of 34 Republicans and 11 Democrats.

The administration has remained silent on the measure. The Department of Health and Human Services did not respond to a request for comment on the bill.” You can read the full Morning Consult article here. More information about the Affordable Care Act (ACA) can be found on the AHCA/NCAL ACA website.

HHS Releases Nondiscrimination in Health Programs and Activities Proposed Rule

Dianne De La Mare

HHS, Office of Civil Rights (OCR) has released a proposed rule to implement section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. It also authorizes the HHS Secretary to promulgate regulations. Formal comments are due on Nov. 9, 2015.

You may submit comments, identified by RIN Number 0945–AA02,

See the proposed rule

Administration Plans to Appeal House ACA Lawsuit

Dianne De La Mare

The Obama administration has filed a motion in House v. Burwell asking the district court for permission to appeal its decision allowing the House to pursue a lawsuit over the 2010 health care overhaul and the appropriations process. Among other things, the Obama administration is arguing that allowing the House to sue over an alleged violation of the Appropriations Clause is “a momentous step” that threatens to insert the federal courts into disputes that the political branches have historically worked out for themselves.

See Yale Journal, Notice & Comment for more information at

CMS Announces AIC Threshold Amount for Medicare Appeals

Dianne De La Mare

The US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) has released a notice announcing the annual adjustment in the amount of controversy (AIC) threshold amounts for hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for Administrative Law Judge (ALJ) hearings and judicial review filed on or after January 1, 2016. The calendar year 2016 AIC threshold amounts are $150 for ALJ hearings and $1,500 for judicial review.

For more information see the Federal Register at

Convention Events Help Achieve Quality Award Success!

The AHCA/NCAL 66th annual Convention is finally here. Convention is a great opportunity for members to get involved in the AHCA/NCAL National Quality Award Program. Attendees should make sure to stop by one of the many Quality Award events taking place at Convention. We hope to see in you in San Antonio next week!

2015 Recipient Display
Stop by the Parkview Foyer on the Concourse level to view the Quality Award display with the names of the 2015 Bronze, Silver and Gold recipients.

Quality Award Program Booth (Monday, Oct 5th and Tuesday, Oct 6th)Applicants, recipients and interested members are encouraged to visit Quality Award staff at the Quality Award Program booth, #814. This is a great opportunity to ask questions about the program, the application process or your recent feedback report. The expo hall is open on Monday from 11:30am to 3pm and Tuesday from 11am to 2pm.

Ceremony and Celebration (Tuesday Oct 6th)
The 2015 Quality Award Ceremony will take place from 4 to 6pm in the Convention Center Ballroom C. 2015 Bronze, Silver and Gold Recipients will be recognized at the ceremony, followed by a keynote speech from Jake Wood. Immediately following the ceremony will be a celebration at the Grand Hyatt from 6 to 7pm.

Educational Sessions (Monday, Oct 5th – Wednesday, Oct 7th)
Session date, locations and details can be found in the Convention program book or on the Convention website.
Session Title
Best for:
The Bronze Quality Award: How-To, Tools and Resources
Performance Results: Selecting, Comparing and Using Data to Drive Improvement
Silver and Gold
Through the Eyes of an Examiner
Silver and Gold
The Importance of Continuous Improvement and Innovation
Silver and Gold
It’s More than a List of Questions: Using the Quality Award Criteria as Your Roadmap to Excellence!
All interested attendees
Avoiding the Top Pitfalls of the Silver Application
Bronze Quality Award Workshop: Train the Trainer Session
The Silver Quality Award: Becoming Award Worthy
The Gold Quality Award: How-To, Tools & Resources and Recipient Panel

As always, feel free to reach out to Quality Award staff at

**Dates to Know**
  • September 15: Intent to Apply (ITA) process opens
  • November 19: Intent to Apply deadline
  • December 7: Applications accepted online
  • January 28: Bronze, Silver and Gold application deadlines

ICD-10 Is Here!

Dianne De La Mare 

By the time you read this article, the long awaited ICD-10 implementation date will be here! On Thursday, Oct. 1, 2015, the national standardized coding system will go live, whether or not the federal government shuts down on Oct. 1, 2015, according to the Centers for Medicare & Medicaid Services (CMS). On Sept. 25, 2015, CMS released final information on ICD-10 titled “Coding Around the Compliance Date.”

 This document reminds providers “that if the date of service was before Oct. 1, 2015, [they] must submit the claim with the appropriate ICD-9 diagnosis code—even if [they] submit the claim on or after the ICD-10 compliance date.” It refers Medicare Fee-For-Service providers to more information available on the ICD-10-CM/PCS Frequently Asked Questions and reviews MLN Matters guidance (MLN Matters SE 1325, MLN Matters SE 1408 and MLN Matters 1410) that discuss claims that span the Oct. 1, 2015, implementation date. It reminds providers that CMS will not allow for dual processing of ICD-9 and ICD-10 after Oct. 1, 2105 (See CMS FAQ 12430). It also refers providers to CMS ICD-10 website and for the latest news and resources to help with compliance, including the ICD-10 Quick Start Guide. Lastly, it reminds providers that they can sign up for CMS ICD-10 Email Updates.

Further, on Sept. 22, 2015, CMS updated its Clarifying Questions and Answers Related to the July 6, 2015, CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities. As reported previously, AHCA has been pressing CMS to allow SNF/NF “providers” the flexibilities it is allowing “practitioners.” AHCA is disappointed by the Q&A response to the new Question #17 that the flexibility will not be extended to “providers,” and although we appreciate that CMS highlights that the ICD-10 Ombudsman will “quickly identify and initiate resolution” of any “provider” issues that arise, we strongly disagree with the rationale provided. AHCA also has requested other guidance specific to SNF/NF ICD-10 implementation; but to date CMS has not provided us with any response. AHCA will continue to press on this issue.

To see AHCA ICD-10 resources go to

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 August 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.

Two-Midnight Rule and Recent Federal Judge Ruling

Dana Halvorson

According to a Sept. 23, 2015 McKnight’s article, “The U.S. Department of Health and Human Services must rethink a section of the controversial two-midnight rule that would cut 0.2% from inpatient payments to hospitals, a federal judge ruled this week. U.S. District Court Judge Randolph Moss said HHS Secretary Sylvia M. Burwell needs to better justify the rate cut, which has caused concerns among hospital associations.

The court also ruled HHS must reopen the portion of the rule that includes the rate cut for more public comment. Burwell originally said the cut would help offset the estimated $220 million it would cost to shift patients from outpatient to inpatient status under the two-midnight rule. Hospitals cried foul, saying the cut was unnecessary, and that they weren't given an opportunity to comment on the proposed cut.” The two-midnight rule requires patients to be hospitalized for two midnights before they qualify as an inpatient, which can allow beneficiaries to qualify for SNF coverage. The full McKnight’s article on the ruling can be found here

CMS News: Focused Surveys, Nursing Home Compare, and PBJ

Lyn Bentley, MSW
On September 15, AHCA met with CMS along with other stakeholders and received numerous updates.
  • Starting in July 2015, the focus surveys (dementia, MDS and soon the adverse events – focused surveys) are not included in “complaint survey” information on Nursing Home Compare (NHC) and Five Star. They are reflected as “focus surveys” and NHC and Five Star websites will be updated soon to reflect this change.

  • Most frequent deficiency citation in MDS-focused surveys relates to inconsistency between patient MDS and care plan.

  • in 2016, two new measures will be added to Nursing Home Compare – readmission to hospital and discharge to community. Although not completely decided, it appears that CMS will use claims-based data.

  • Other quality measures are under development, consistent with the requirements for such measures across post-acute care providers specified in the IMPACT Act.  

  • In 2016, there will be a rebasing of Quality Measures in an effort by CMS to continue to “raise the bar” of quality for nursing centers.

  •  As of September 15 more than 500 nursing centers had registered for the voluntary submission of payroll and census data through the Payroll-Based Journal (PBJ).

  • The staffing and patient census data electronically submitted by nursing centers through the PBJ will not be used in Five Star until late 2017 or early 2018. CMS Forms 671 & 672 will also need to be submitted during that time. This “dual-reporting” of the data is to ensure the PBJ system is working well for providers and for CMS.

  • Following full implementation of PBJ, CMS expects there will be “an increase in the role of staffing” in calculating the overall Five Star rating due to the relationship with outcomes.

Young Professional Round Table at AHCA/NCAL Convention

Peggy Connorton

The Quality team is hosting a session for young professionals at this year’s AHCA/NCAL convention on Tuesday, October 6 from 8:00 - 9:30 AM. The purpose of this session is to provide a forum for people who have been in the field for less than 10 years and to hear success stories. At the end of the session, we encourage the participants to stay in touch by joining the AHCA/NCAL connected community.  

There will be a panel of senior living administrators and emerging professionals that will discuss how they entered the field of long term care, why they stay in the field and tactics to manage staff and the stresses of the job. They will also share their perspectives on how generational differences impact the profession, and what this next generation of leadership is looking for in terms of association activities and support. After the session there will be an opportunity for participants to collaborate together via the AHCA/NCAL connected community.

Special IRS Provision for Determining Workforce Size for 2015 Tax Year

Dave Kyllo 

Under the Affordable Care Act, certain employers -- called applicable large employers – are subject to the employer shared responsibility provisions. Whether you are an applicable large employer, and are therefore subject to the employer shared responsibility provisions, depends on the size of an employer’s workforce.

Employers must determine each year – based on their average employee count for the 12 months of the prior year – whether they are an applicable large employer for the current year. However, for 2015, an employer may measure over any consecutive six-month period during 2014, rather than measuring all 12 months of 2014. Information about this transition relief is available here.

This is significant because for 2015, employers with fewer than 100 full-time employees, including full-time equivalent employees, in 2014 will not be subject to an employer shared responsibility payment if they meet certain conditions. Question 34 on the employer shared responsibility employer shared responsibility provision questions and answers page on provides more details regarding these conditions.

To determine whether your organization is an applicable large employers, see Determining if an Employer is an Applicable Large Employer.

For more information on the employer shared responsibility provisions in general, see Go here to learn more about AHCA/NCAL’s Insurance Solutions “Member Only” health benefit program. 

We Can’t Wait to See You in San Antonio!

The Expo Hall at the 66th AHCA/NCAL Annual Convention & Expo provides a tremendous opportunity for Members to familiarize themselves with the many exclusive AHCA/NCAL products, services and programs. AHCA/NCAL staff will be on hand at each booth to meet you and tell you more about these exciting programs.

Be sure to stop by the following AHCA/NCAL booths when you visit the Expo Hall next Monday and Tuesday:

AHCA/NCAL Advocacy Center Booth #714

ahcancalED Booth #710

AHCA/NCAL Insurance Solutions Booth #712

AHCA/NCAL National Quality Award Program Booth #814

LTC Trend Tracker Booth #812

Provider Interview Lounge Booth #600

We look forward to seeing you in San Antonio!

Monday, September 28, 2015

LTC Trend Tracker and Your Quality Award Application

Using LTC Trend Tracker for your Quality Award application is an easy way for you to get comparative data on your center.   LTC Trend Tracker provides AHCA members information on clinical, regulatory, five star and financial results, with most of this data being populated from CMS.  When using LTC Trend Tracker for a comparison you are able to choose your peer group from a predefined set that ranges from the zip code to the national level. Alternatively, you can choose a custom peer group such as a neighboring county or city.  

To use LTC Trend Tracker for your Quality Award, first choose the metric you want to measure, such as long-stay antipsychotics. To run the corresponding report in this example you will choose the Quality Measure report, select your peer such as city, and run the report.  Once you are in the report, scroll down to the third quarter view and hit the “more” link for the long-stay antipsychotics. By choosing this link, you’ll see a graph and a table. From here, you can export the graph and that will allow you to cut and paste the graph into your application.  Or you can export data to Excel and that will allow you to select certain data points for your comparison purposes and make a graph from Excel.  

LTC Trend Tracker is a source of data for nursing care centers across the country, since most of the data is populated from a SNF’s Medicare Number.  When you are using this data you have a robust source of comparative data for your application.  

If you are a registered user, go to to get started.  If you are not sure if your center is registered for the system, please email to see if you already have access.  

Wednesday, September 23, 2015

First Attempt to Avoid Shutdown Surfaces

Drew Thies

Senate Majority Leader Mitch McConnell released his short-term funding proposal to avoid a potential government shutdown, but whether or not the plan will work is still up in the air.

Votes on the bill will begin at 2 p.m. on Thursday, leaving less than a week to come to an agreement before the government runs out of funding as Wednesday, September 30th comes to a close.

The short amount of calendar days—and even fewer legislative days—are not the only obstacles between McConnell and a continuing resolution to fund the government: conservative members of the House GOP caucus are breaking with leadership over the strategy to defund Planned Parenthood in the wake of recent controversial videos. Additionally, members of McConnell’s own chamber who are running for President, such as Ted Cruz and Marco Rubio, have publicly stated they support the defunding of Planned Parenthood while on the campaign trail.

This disagreement over strategy puts Republican leadership in both chambers in a difficult position. McConnell’s plan appeases the more conservative voices calling for a defunding of Planned Parenthood, though Senate Democrats are expected to do their best to block the bill and President Obama would almost certainly veto such legislation if it reached his desk—a veto that Republicans do not have the numbers to override.

The other option left to Republican leadership is to go to Minority Leader Nancy Pelosi and the Democrats to seek support for a bipartisan approach to a continuing resolution. Democrats have already indicated that they would seek many concessions if Republicans need their help. Additionally, Speaker of the House John Boehner is facing threats from a growing fringe of Republican House lawmakers who view him as increasingly deferential to Democratic leadership and may strengthen their resolve to remove him of his leadership post if Democrats are able to drive funding negotiations.

Though the administration believes that Congress can avoid a shutdown, the Office of Management and Budget has begun to work with other government agencies to prepare for what would be second government shutdown in exactly two years. Secretary of Health and Human Services Sylvia Matthews Burwell has wrote to HHS employees warning them of potential impending furloughs come October.

Bipartisan Senate Bill Would Eliminate the ACA’s “Cadillac Tax”

Dave Kyllo

Last week, Sens. Dean Heller (R-Nev.) and Martin Heinrich (D—N.M) introduced legislation that would repeal the Affordable Care Act’s (ACA) so-called “Cadillac Tax” which takes effect in 2018. The Cadillac Tax impacts any employer who offers a health insurance plan that costs more than $10, 200 annually for an individual or $27,450 annually for families. Employers will have to pay 40 percent tax of the cost above those limits under existing law starting in 2018.

In a press conference announcing the legislation, Sen. Heinrich said the Cadillac Tax is really more akin to a Ford Focus tax and would negatively impact women, seniors and those workers who live in more expensive geographic regions of the country. Rep. Joe Courtney (D—Conn.) is leading repeal efforts in the House. Repeal of the tax has broad support from large and small employers, labor unions and the insurance industry. The challenge for lawmakers will be making up billions in lost revenue if the tax is repealed.

Health care coverage is one of the largest expenses employers face. AHCA/NCAL members are encouraged to check out AHCA/NCAL Insurance Solutions before making a final decision about their 2016 employee plan coverage. This “Members Only” program is designed to give AHCA/NCAL members access to brokers who understand long term care and who truly know the ACA and its myriad requirements.

More importantly, AHCA/NCAL Insurance Solutions is designed to save members money. For more information, stop by Booth #712 at the AHCA/NCAL Annual Convention in San Antonio, or contact Dave Kyllo (202-898-6312) or Nick Cianci (202-898-2841) or email us at AHCA/NCAL Insurance Solutions.

Take the 2015 NCAL Performance Measure Survey Now!

NCAL is committed to measurably improving the quality of care provided in assisted living. To help determine our profession’s progress, NCAL conducts an annual survey on performance measures. The data that NCAL collects supports the assisted living profession’s advocacy efforts on state and national levels. This year, the survey has been shortened to 10 questions and This should take no more than 10 minutes to complete. You can fill the survey out online here. We ask that you please complete the survey by October 31, 2015. To encourage participation, all completed surveys will be entered into a drawing for one of two $100 American Express gift cards for the community.

Tuesday, September 22, 2015

Advancing Excellence New Video Series Stars Senior from "The Sopranos" and 2015 Champion of Quality

Katherine Merullo

The Advancing Excellence in America’s Nursing Homes Campaign, whose mission is to make nursing homes better places to live, work, and visit, has created a new video series with the help of 2015 Champion of Quality recipient
 Alice Bonner, PhD, RN, and Soprano's actor, and senior, Dominic Chianese.
Advancing Excellence staff and volunteers at video premier at Forest Hills, DC

The nine brief videos were produced to educate nursing home staff and administrators as reminders on how to provide quality care and the tools that are available to them.  The topics covered include pressure ulcers, infections, person-centered care and the typical challenges that are encountered when providing quality care.  It's not too often you'll find a video including a medical epidemiologist from the Centers for Disease Control and Prevention (CDC) and a song in Italian about the bacteria C. dificile and how to prevent infections, like in Video 4 of the series.  Also, sometimes it's just doing this simple thing to prevent unnecessary hospitalizations, as seen in Video 9.

Advancing Excellence was founded in 2006 by a coalition of 28 organizations representing groups ranging from nursing home providers to quality improvement experts to government agencies. 
FREE tools and resources to support evidence-based quality improvement programs and improving clinical and organizational outcomes are available. Support the Campaign through membership or email

Federal Health IT Strategic Plan 2015-2020 Released

Dana Halvorson and James Michel

On September 21, 2015, the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC), in collaboration with over 35 federal partners, released their updated Federal Health IT Strategic Plan 2015–2020 (Plan). According to the press release from ONC, “The final Plan represents the collective strategy of federal offices that use or influence the use of health information technology (health IT). The Plan’s work aims to improve the health IT infrastructure, help transform health care delivery, and improve individual and community health. The Plan sets a blueprint for the federal partners to implement strategies that will support the nation’s continued development of a responsive and secure health IT and information use infrastructure.”

The press release goes on to include that “The final Plan reflects the input from more than 400 public comments, collaboration between federal contributors, and recommendations from the Health IT Policy Committee. ONC leadership also heard from individuals, providers, community organizations, and entrepreneurs from across the United States during listening sessions held in 2014. The strategic goals of the Plan are to:

  1. Advance person-centered health and self-management; 
  2. Transform health care delivery and community health; 
  3. Foster research, scientific knowledge and innovation; and 
  4. Enhance the United States health IT infrastructure. 

Over the next five years, the Plan’s federal partners will assess their individual and collective progress on efforts to use health IT to achieve Plan goals, including progress on the HHS Delivery System Reform initiative. Successful Plan implementation will lead to better individual, community and population health, and will foster research, expand scientific knowledge, and spur innovation.”

The Federal Health IT Strategic Plan 2015-2020 can be found here.

Survey Results from the Jimmo Implementation Council

Earlier this summer, AHCA/NCAL was invited to participate in the inaugural Jimmo Implementation Council meeting on Capitol Hill with a select, multi-disciplinary group of professionals and health care leaders to discuss how well the Centers for Medicare and Medicaid Services (CMS) has done in implementing the provisions of the January 2013 Jimmo v. Sebelius settlement agreement.
As a refresher, in the lawsuit, the plaintiffs alleged that Medicare contractors were inappropriately applying an “Improvement Standard” in making claims determinations for Medicare coverage involving skilled nursing facility, home health, and outpatient therapy benefits. In the settlement agreement, CMS agreed that an “Improvement Standard” is not to be applied in determining Medicare coverage for maintenance claims that require skilled care. Such coverage depends not on the beneficiary’s restoration potential, but on whether skilled care is required, along with the underlying necessity of the services themselves. The settlement agreement contained specific activities for CMS to implement, including issuing clarifications to existing program guidance and developing new educational material on this subject.
The day-long Jimmo Implementation Council meeting was convened by the Center for Medicare Advocacy, with the support of the John A. Hartford Foundation, identified several areas where attendees believed the CMS implementation may not have achieved the objectives outlined in the settlement agreement. Following the meeting, a survey of participants was conducted, and highlights of the results released by the meeting hosts this week are posted below:
Responses about Jimmo education to date offered mixed results:
  • 46% of respondents were not aware of the Jimmo Education Campaign provided by CMS in 2013.
  • Only 37% of respondents participated in the education efforts.
  •  However, 80% of respondents were aware of the Jimmo Fact Sheet released by CMS, and
  • 65% were aware that the Medicare Benefit Policy Manuals had been updated. 
  •  Also interestingly, of the small percentage of respondents who use Electronic Health Record Systems, just over half use a system that allows for documentation of care to maintain a patient’s condition. 
Clearly awareness and application of the Jimmo Settlement is currently far from universal. There is more work to be done.
There is widespread agreement among respondents that further well-funded research will be key to efforts to implement the Jimmo settlement. Suggestions included pilot studies of maintenance care patients v. non-maintenance patients with similar code-demographics; and use of home health records, as home health has had the ability to identify maintenance therapy since 2011. In addition, there is widespread concern about the understanding and application of Jimmo by Medicare Administrative Contractors. Many respondents also expressed concerns about the lack of clarity of guidelines for providers trying to document skilled maintenance care.
Future goals focused on by respondents included:
  • Going back to the Jimmo judge for reinforcement of the education component;
  • Working to get a National Coverage Determination that solidifies the Jimmo Settlement;
  • Ensuring proper Education of Medicare Administrative Contractor and other coverage decision-makers;
  • Seeking inclusion of clear provisions regarding Jimmo compliance in the Medicare Advantage Plan Call Letter;
  • Obtaining studies regarding the value of maintenance care for patients and the long-term costs, compared to those who go without;
  • Compiling a guide for beneficiaries and practitioners to understand, insist on and follow the Jimmo settlement;
  • Providing outreach to professional associations;
  • Obtaining guidance regarding acceptable documentation, especially from CMS, that would demonstrate medical necessity for maintenance therapy services;
  • Collecting stories, stories, stories!
AHCA/NCAL continues to identify and respond to member issues related to maintenance nursing and therapy services under Medicare Part A, Part B and Medicare Advantage. We encourage members to inform Dan Ciolek at or Mike Cheek at of any questions or comments you may have related to the survey results presented above, or if you are having any maintenance care coverage issues that are not being resolved through traditional channels.     

Medicare-Required SNF PPS Assessments Educational Tool — Released

Holly Harmon
The “Medicare-Required SNF PPS Assessments” Educational Tool was released and is now available in downloadable format. This educational tool is designed to provide education to Skilled Nursing Facilities (SNFs) on Prospective Payment System (PPS) assessment overviews, factors affecting the assessment schedule, and assessment results reporting. It also includes Minimum Data Set (MDS) 3.0 background information and assessment resources.

DOL Announces Increase in Minimum Wage Rate for Federal Contractors in 2016

Dana Halvorson

On February 12, 2014, President Obama signed Executive Order 13658, Establishing a Minimum Wage for Contractors. The Executive Order raises the hourly minimum wage paid by contractors to workers performing on covered Federal contracts to: (i) $10.10 per hour, beginning January 1, 2015; and (ii) beginning January 1, 2016, and annually thereafter, an amount determined by the Secretary of the Department of Labor (DOL) in accordance with the Order. On October 1, 2014, DOL published the final rule implementing the provisions of Executive Order 13658. According to a September 18 legal alert from Ford & Harrison LLP, DOL announced last week that the minimum wage for certain federal contracts will increase to $10.15 per hour beginning January 1, 2016. The DOL notice on this increase can be found here.

Medicare (Parts A and B) or Medicaid providers are not considered to be federal contractors. However, if a provider currently has VA patients and a VA contract, they are considered to be a federal contractor. Since VA contracts are covered by the Service Contract Act, this Executive Order applies to such contracts. AHCA continues to work with our Congressional champions on getting VA provider agreements across the finish line, and taking those with VA contracts out of the scope of being deemed a federal contractor.

CMS Issues Quarterly update to Medicare Part B CCI Edits

Dan Ciolek
The Centers of Medicare and Medicaid Services (CMS) recently issued a Medicare Learning Network (MLN) article MM9326 – Quarterly Update to the Correct Coding Initiative (CCI) Edits, Version 22.0, Effective January 1, 2016.

CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B services (including therapy services). Billers should review the CCI edit code update prior to the January, 1, 2016 implementation. A useful CMS guide How to Use the Medicare National Correct Coding Initiative (NCCI) Tools is also useful for billers not familiar with the Part B CCI edit policy.  

Monday, September 21, 2015

New Learning Management System to Debut

ahcancalED is the Association’s new online Learning Management System (LMS) built to support the many members who do not have elaborate education departments or time to develop the newest in-service training. We think members will find the new ahcancalED a breath of fresh air! It is the new “go-to” spot for education, tools and resources. We heard from many State Affiliates and members who recognized an education gap due to the fast-paced nature of our industry. AHCA/NCAL responded by creating a solution to bridge the education gap. We are excited to announce its launch on Sunday, October 4, 2015 at Convention.

ahcancalED is home grown. Teams of member experts from around the country working with AHCA/NCAL staff are helping to create content. Currently, one of the most timely products is a course that teaches QAPI/Baldrige Business Systems. It is full of practical examples, tools, case studies and stories that show the transparent and transformative power of change using business systems to improve quality. The course shows how one center reduced its bad debt by thousands of dollars using PIP skills.

ahcancalED allows us to deliver, manage, track, record, and report on instructor-led and online learning activities. Our ahcancalED team is committed to making the online learning experience engaging, meaningful, and interactive for users. ahcancalED includes content and tools for teaching and learning that provide meaningful and memorable learning experiences and will allow users to track learning progress.

AHCA/NCAL is a free member benefit. We look forward to hearing from you with suggestions about content that will help improve quality and strengthen the knowledge, skills and attitudes of staff in the long term care community.

Thursday, September 17, 2015

Track Your Quality Progress Using LTC Trend Tracker!

As we start the 4th Quarter, many organizations are preparing for the year-end goal review and setting 2016 goals.  This process may be dependent on your organization type. The LTC Trend TrackerSM tool compiles your organization’s historical data in a matter of minutes. Here is a short roundup on how you can use one of the many clinical or quality reports as part of your goal setting process.

 - One of the best LTC Trend Tracker reports for this session is the resident Quality Measure Report which is derived from your MDS and updated quarterly. With your QA team, review this report and select a measure, such as LS antipsychotics. 

 - Within the LTC Trend Tracker Quality Measure Report you can pull your antipsychotic usage data.  Click on the “more” link within the report then a graph and percentile chart will load with your center’s historical information and peer ranking.  Use this data to begin your QA committee deliberations and plan with confidence that your decisions are based on “fact” and not seat-of- the-pants thinking. Some typical questions you might use as “discussion starters” are:

  • How does your percentile ranking compare to your peers?
  • What are the national and state top performer rankings? How do you compare?
  • Compare this data to your Five Star QM Report for your SS and LS antipsychotic usage.  What are the total points you need to achieve the next star rating? Or what are the minimum points you need to stay within that range?
  • Decide your reduction goal by comparing historical trends.

Now that LTC Trend Tracker has provided you with a road map of where your organization has been, and assisted you in setting your targets for the future, use LTC Trend Tracker to assist you in other areas of your QA/PI effort. This web-based program can provide numerous reports for your center on Quality, Financial and Clinical Performance.

If you are a registered user and have not used LTC Trend Tracker at your QA meeting, log on today and use the data to track progress on each of your targets.  LTC Trend Tracker is a member resource. 

Start Your Quality Award Journey Today!

Last month, AHCA/NCAL announced that four centers received the 2015 Gold Quality Award. These centers joined only 24 centers in the nation to have received this distinction since the program’s inception in 1996.   The Association also announced a record number of Bronze and Silver recipients this year.

Inspired by the efforts of these 2015 recipients? Well, you are in luck! The 2016 application process is now open! Bronze, Silver and Gold applications are available with the new criteria and program information.  To get started, here are a few tips….

  • Submit your Intent to Apply! There are a number of benefits, including a reduced application fee and access to additional resources. The deadline is November 19th, 2015 at 8 pm EST. For more information, check out our article.
  • Check out the new Bronze Criteria Series. This free series of short videos will walk applicants through each question on the Bronze criteria, including an explanation of the criteria and a sample response. The Bronze Criteria Series can be accessed on the Bronze website.
  • There have been changes to the Silver criteria and scoring requirements. An overview of those changes is available here. Returning Silver applicants must pay careful attention to the new criteria when completing their application. 
  • An exciting new resource is coming for Silver applicants. Check back on the Silver application website in early October to access it. 
  • Silver and Gold assisted living applicants have access to a new resources to help them in collecting comparative data. These resources are available in the Silver and Gold application packet. To learn more about how the Quality Award applies to assisted living centers, check out this article.

If you have questions about the Quality Award, please contact us at

Customer Satisfaction Questionnaire Announced!

David Gifford, MD, MPH and Lindsay B. Schwartz, PhD

AHCA/NCAL has developed a short questionnaire to develop a customer satisfaction quality measure for use as part of its Quality Initiative.  The CoreQ—consisting of three to four questions—has been independently tested as a valid and reliable measure of customer satisfaction across long-term care providers. No other measure like this exists.  

The Association is working with vendors to add the questions to their existing questionnaires or to only administer it.  Later this year, members will be able to enter CoreQ results into LTC Trend Tracker and benchmark themselves against their peers on a common metric. 

Below are the vendors that have agreed to add the questions to their questionnaire.  If you do not see your vendor listed, we encourage you to ask them to add these questions to their questionnaire or to contact David Gifford, ( or Lindsay Schwartz ( if they have questions.

If you don’t currently use a vendor to collect customer satisfaction, don’t worry you can still participate. You can contact one of the vendors listed below or Nicholas Castle, Ph.D., at the University of Pittsburgh who developed the CoreQ for AHCA/NCAL.  Dr. Castle is willing to work with providers to administer just the CoreQ questionnaire to your residents and their family members.

AHCA/NCAL will also be submitting the CoreQ and satisfaction measure to the National Quality Forum (NQF) for endorsement. 

For more information about this questionnaire and satisfaction measure you can visit the AHCA or NCAL Quality Initiative website. 

Vendors that have agreed to add CoreQ:

Neil Gulsvig
Healthcare Academy (ReadyQ)
National Research Corporation (My Innerview)
Rich Kortum
Nick Castle PhD (Univ of Pittsburgh)
Peter Kramer
Service Trac
Michael Johnson
The Jackson Group, Inc.

Young Professional Round Table at AHCA/NCAL Convention

The Quality team is hosting a session for young professionals at this year’s AHCA/NCAL convention on October 6 from 8:00 - 9:30 am.  The purpose of this session is to provide a forum for people who have been in the field for less than 10 years and to hear success stories.   At the end of the session, we encourage the participants to stay in touch by joining the AHCA/NCAL connected community.  

There will be a panel of senior living administrators and emerging professionals that will discuss how they entered the field of long term care, why they stay in the field and tactics to manage staff and the stresses of the job. They will also share their perspectives on how generational differences impact the profession, and what this next generation of leadership is looking for in terms of association activities and support. After the session there will be an opportunity for participants to collaborate together via the AHCA/NCAL connected community.

AHCA/NCAL Annual Convention: Education Sessions Support Quality Initiative Success

AHCA/NCAL’s annual convention is right around the corner – taking place October 4-7 in San Antonio, Texas.  A rich program of educational content awaits, to support your organization’s quality journey and help position you for continued success in our rapidly-changing environment that is ever-more focused on measurable high performance.  

Look for content in four dedicated tracks focused on Quality Initiative goals: Customer Experience, Dementia Care, Post-Acute Care, Quality Awards, and Staff Stability, as well as throughout the program in tracks including Assisted Living, Data Analytics, Quality & Survey, and Leadership.  Each session—taught by faculty carefully selected by members just like you—is designed to ensure that you and members of your team take away practical and actionable strategies you can implement to improve your organization’s results.  Join us for solutions that will help you and your team to improve lives every day!

Wednesday, September 16, 2015

Hello LTC Trend Tracker Users!

The LTC Trend Tracker Team invites all of our users to join the LTC Trend Tracker Team for a User Group Meeting at the National AHCA/NCAL Convention in San Antonio, Texas, Monday, October 5th at 4:30pm CT, Presidio B at the Grand Hyatt.

This meeting will be an open-forum to discuss with our users any suggestions for a better member experience. We want to hear from you!

This forum is open to all LTC Trend Tracker users attending the Annual 2015 AHCA/NCAL National Convention in San Antonio, Texas. Please RSVP by sending a response to this email to Please RSVP by Friday October 2, 2015 if you will be attending.

We look forward to meeting all of you!!

LTC Trend Tracker Staff

NALW Nourishing Mind, Body & Spirit

Rachel Reeves

This year marks the 20th anniversary of National Assisted Living Week (NALW), sponsored by NCAL since 1995. The NALW theme this year is “Nourishing Life: Mind, Body, and Spirit,” which recognizes the countless ways assisted living caregivers nurture the whole resident. Conversely, residents – with the support of loved ones – nourish the lives of team members and volunteers by sharing their unique lives.

The week began on Sunday, Sept. 13 and continues through Saturday, Sept. 19.  Thousands of America’s assisted living communities and their staff, residents, families, volunteers, and local members of their community will celebrate National Assisted Living Week® (NALW). The national observance – which begins each year on Grandparent’s Day – honors the individuals served as well as the individuals who serve in assisted living and residential care communities across the nation with special activities and events.

Assisted living caregivers and members of the public are encouraged to share their celebrations throughout the week on social media with the hashtag, #NALW.

Don't forget to keep track of all the fun activities for the National Assisted Living Week Programming Award.  Nominees are evaluated on their successful incorporation of the previous year's National Assisted Living Week theme into their activity plans and implementation resulting in outstanding special activities and community events for their residents, families, staff, and volunteers to enjoy.

AHCA/NCAL Future Leaders Hit the Hill

Drew Thies 
AHCA/NCAL’s newest class of Future Leaders is in Washington and ready to take to the Hill this week right in the middle of a busy September for Congress.

The group, which consists of individuals identified by state affiliate organizations as rising leaders in the long term care profession, will undergo advocacy training before lobbying their Members of Congress on post-acute care issues.

24 Future Leaders from as many states and the District of Columbia arrive in the capital Wednesday for a political event and then are scheduled to meet their Representatives and Senators on the Hill Thursday afternoon.

The visits come at a key time, as stakes are high in Congress ahead of must-pass government funding legislation. Both chambers must approve either an omnibus spending bill—which is highly unlikely given time constraints—or a short-term, stop gap continuing resolution to fund the government before the end of September.

 AHCA/NCAL advocates, including the Future Leaders, are remaining vigilant, as any legislation that requires spending to fund the government could cut funds from Medicare or Medicaid. So far, leadership on both sides of the aisle is adamant about funding the government and avoiding a shutdown, but the two sides are still at loggerheads on how to come up with the contentious offsets.

Tuesday, September 15, 2015

NPUAP Webinar on Pressure Ulcer Prevention in Vulnerable Elders

Holly Harmon

Mr. Antokal and Dr. Garcia’s webinar, titled Pressure Ulcer Prevention in Vulnerable Elders will describe the unique aspects of aging skin in a geriatric population, understand the clinical factors that make pressure ulcers more prevalent in the elderly population and identify regulatory guidelines as they pertain to pressure ulcers in different care settings.

This webinar is only open to the first 1,000 registrants so register today! 1 hour of multidisciplinary CEU is also available!

Thursday, October 1, 2015 
1:00PM–2:00PM Eastern Time (includes a Q&A period)

1. The learner will describe the unique aspects of aging skin in a geriatric
2. The learner will understand the clinical factors that make pressure
ulcers more prevalent in the elderly population
3. The learner will identify regulatory guidelines as they pertain to
pressure ulcers in different care settings

􀀀Steven Antokal, BSN,CWCN,CCCN, DAPWCA is the Director of Enterostomal
Therapy for HCR Manor Care. He has served on the NPUAP Provider Organization Council (POC) since 2001. He currently serves as a member of the the NPUAP Education Mission Committee.
􀀀Aimee Garcia, MD,CWS is an Associate Professor in the Department of Medicine, Geriatrics Section at Baylor College of Medicine and the Program Director for the Clinical Wound Care Fellowship Program at Baylor College of Medicine. She is the Medical Director for the Wound Clinic and Consult Service at the Michael E. DeBakey VA Medical Center. Dr. Garcia is Past President of the
National Pressure Ulcer Advisory Panel, and Co-Chair of the Public Policy Committee. She is also Past Chair of the American College of Certified Wound Care Specialists. Dr. Garcia is also currently serving on the Board of Directors of St. Dominic Village Nursing Facility.

For more information on the webinar and how to register please visit

NATIONAL PRESSURE ULCER ADVISORY PANEL (NPUAP) serves as the authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment through public policy, education and research. 􀀀

If you are unable to attend the live webinar or are interested in viewing previous webinars that were presented this year please visit the following website to access the recordings and handouts:

CDC Core Elements of Antibiotic Stewardship in Nursing Homes

Kate Wiedeman, CDC's Division of Healthcare Quality Promotion

Today, CDC releases the Core Elements of Antibiotic Stewardship in Nursing Homes. This resource is designed to help nursing homes improve antibiotic prescribing practices and reduce inappropriate use to protect residents from the consequences of antibiotic-resistant infections, such as C. difficile. 

CDC’s Core Elements of Antibiotic Stewardship in Nursing Homes will provide practical ways for nursing homes to initiate or expand antibiotic stewardship activities.

CDC advises all nursing homes take steps to improve antibiotic prescribing practices and reduce their inappropriate use in order to protect residents from the consequences of antibiotic-resistant infections, such as C. difficile. CDC just released a new resource, The Core Elements of Antibiotic Stewardship, to guide these improvements. This resource provides examples of how antibiotic use can be monitored and improved by nursing home leadership and staff. A companion checklist is also available to help nursing homes assess policies and practices already in place and review progress in expanding stewardship activities on a regular basis.

Visit the Core Elements webpage to access the Core Elements document and supplemental resources, such as the companion checklist.

Join the conversation around antibiotic stewardship in nursing homes on social media and online:

Following the below Twitter handles:
Dr. Frieden - @DrFriedenCDC
CDC National Center for Emerging and Zoonotic Infectious Diseases - @CDC_NCEZID
CDC - @CDCgov
Follow CDC on Facebook and to read long-term care antibiotic stewardship posts in CDC’s Safe Healthcare Blog