Wednesday, January 27, 2016

2015 Assisted Living Salary & Benefits Report Released

Lindsay Schwartz

Hospital & Healthcare Compensation Service (HCS) has just released the 18th annual Assisted Living Salary & Benefits Report. The report is published in cooperation with LeadingAge and supported by the National Center for Assisted Living.

1,286 Assisted Living communities participated in the study and provided compensation data on 64,362 employees nationwide. 1,153 for-profit and 133 not-for-profit communities provided data for the study.

The report covers 20 management and 29 non-management positions. Data are reported according to for‑profit and not-for-profit status, revenue size, unit-size, state, county, and geographic region. Also covered are 18 fringe benefits, turnover rates by department, and projected salary increases for 2016. Data are effective as of October 2015.

HCS highlights one key finding - that the national average hourly rate of Dementia Personal Care Aides (PCAs) in assisted living communities increased 3.55%. This represents a continued increase from the 2014 figure of 2.50%. Turnover rates for PCAs increased from 34.99% in 2014 to 39.35% in 2015. Average vacancy rates fell from 19.81% to 14.45% in 2015.

To read the full report, please go to NCAL members may purchase the report at the reduced rate of $250; members will soon be able to purchase this report in the AHCA/NCAL Bookstore.

CMS Open Door Forum: Understanding the IMPACT Act

Dan Ciolek

Next week CMS will host a Special Open Door Forum: Understanding the IMPACT Act-Measure Alignment and IMPACT Outcomes on Tuesday, February 2, 2016 at 2:00 -3:00 pm Eastern Time.

The purpose of this call is to provide information and solicit feedback pertaining to the Improving Medicare Post-Acute Care Transformation Act of 2014 (commonly referred to as the IMPACT Act). The IMPACT Act mandates the standardization of patient assessment data across post-acute care settings including Skilled Nursing Facilities, Home Health Agencies, Inpatient Rehabilitation Facilities, and Long Term Care Hospitals in order to improve quality of care and quality of life.

This Special Open Door Forum will offer discussion on the history of the IMPACT Act, including discussion of what is the IMPACT Act, how CMS is standardizing quality measures and data items, and what is the Skilled Nursing Facility Quality Reporting Program (commonly referred to as the SNF QRP). This SODF will serve as a platform to update consumers, stakeholders, researchers, and advocates alike on the work around the IMPACT Act.

CMS requests questions from patients, consumers, researchers, and advocates in advance or during the Forum. Please submit questions to: You may follow along during the call from the PowerPoint slides that were posted to:

Special Open Door Participation Instructions:
Participant Dial-In Number: 1-800-837-1935
Conference ID #: 17589814

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website at for downloading.

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at

Congress Gets Snowed Out

Drew Thies

The historic winter storm that hit Washington, D.C. over the weekend caused delays in what is an already abbreviated calendar for lawmakers. The House will not return to session until next week and the Senate begins legislative business today.

The Senate will have its first hearing this morning after digging out from nearly two feet of snow and two days with the federal government closed.

The House, already facing a shortened week due to a Democratic strategy retreat with President Obama in Baltimore to take place Thursday and Friday, decided to cancel votes until next week because of travel issues for Members of Congress returning to Washington.

The GOP already had its caucus planning meeting earlier in the month and promises to unveil a variety of task forces focusing on areas such as health care reform. The GOP will also begin to focus on developing a fiscal 2017 budget plan and the annual spending bills in the coming months.

Tuesday, January 26, 2016

Stand Out From Your Competition: Credential Your RNs!

Dave Kyllo

Whether seeking to participate in an Accountable Care Organization or Managed Care Organization or attract referrals from the local hospital, providers need to demonstrate that their health care expertise and services are better than the competition. The AHCA/NCAL Gero Nurse Prep program is an important step toward demonstrating your company’s geriatric nursing expertise.

The time is right to take this step because AHCA/NCAL Gero Nurse Prep program is on sale through the end of February. Save $100 on each training spot through February 29 by entering promo code QS2016 (all caps) when registering.

This unique program prepares RNs for the American Nurses Credentialing Center board certification test in gerontological nursing. Board certification (RN-BC) is the gold standard for demonstrating clinical excellence in geriatric patient care. Less than one percent of nurses have this prestigious credentialing, so investing in this program can give providers a competitive edge when negotiating with ACOs, MCOs and hospitals.

Gero Nurse Prep is also a smart and effective use of training dollars. Gero Nurse Prep Alums can boast a 96% pass rate on the ANCC gerontological nursing certification exam. RNs can study on their own schedules and earn 30 CEUs by completing the program.

Become the first choice for long term care in your area. Check out the AHCA/NCAL Gero Nurse Prep program and try a free demo today!

CMS Issues Emergency Update to 2016 Medicare Part B Physician Fee Schedule File – Updated Therapy File Posted on AHCA Website

Dan Ciolek

On November 25, 2015 we posted a Long Term Care Leader article regarding the calendar year 2016 Medicare Part B physician fee schedule update including a link to a useful therapy-specific file posted on the AHCA website that provided the 2016 therapy fees for each CPT/HCPCS code in each geographic area.

However, that file is no longer correct. The updated new file is here.


Recently, the Centers for Medicare and Medicaid Services (CMS) issued an Emergency Update to the CY 2016 Medicare Physician Fee Schedule Database. Specifically, Change Request (CR) 9495 amends the earlier CMS generated payment files that were based on the CY 2016 Medicare Physician Fee Schedule (MPFS) Final Rule. CMS amended these payment files in order to correct technical errors to the MPFS update files, and to include corrections described in the CY 2016 MPFS Final Rule Correction Notice.

Please note that the amended 2016 fees effective January 1, 2016 reflects all changes included in the CY 2016 Medicare Physician Fee Schedule (MPFS) Final Rule (CMS-1631-FC) published in the Federal Register on November 16, 2015 and reflects the Emergency Update to the CY 2016 Medicare Physician Fee Schedule Database released on January 8, 2016 (Transmittal # R3438CP/Change Request 9495 and MLN Matters Article Number MM9495).

Updated Article Text:

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

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

Change Request 9495 amended the MPFS payment files in order to correct technical errors in the MPFS update files and to include corrections described in the CY 2016 MPFS Final Rule Correction Notice. Specifically, the Conversion Factor was adjusted to $35.8043 and several Relative Value Units were modified.

You may note that the 2016 conversion factor of $35.8043 is slightly lower that the 2015 conversion factor of $35.9335. This is due to the application of a required -0.02 percent Budget Neutrality Adjustment and a -0.77 percent Target Recapture Amount adjustment related to the misvalued procedure code policy.

Supporting documentation and downloads for Regulation #CMS-1631-FC may be found here. An overview of the Physician Fee Schedule Payment Policies may be found at and an overview of skilled nursing facility consolidated billing and annual updates can be found at

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

The file contains the following information:

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

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

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

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

The Part B Fee Schedule amounts are calculated as follows:

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

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

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

Conversion Factor = $35.8043

MPPR Factor = 50%

US Supreme Court Will Hear FCA Case

Dianne De La Mare

In December, the US Supreme Court granted review in Universal Health Services v. United States ex rel. Escobar, to determine important issues about the scope of the federal False Claims Act (FCA), a statute that makes it unlawful for any person to knowingly submit a false or fraudulent claim for payment to the federal government. The FCA applies to both federal contractors and recipients of federal grant and cooperative agreement assistance (including long term care providers).

The steep damages associated with a FCA violation (three times the damage sustained by the government, plus civil penalties of $5,500 to $11,000 per claim) have enabled whistleblowers and the federal government in recent years to recover billions of dollars from various entities, in both court victories and FCA settlements. Much of the significant uptick in government enforcement actions is a result of the whistleblowers increasingly aggressive assertion of the "implied certification" theory under the FCA. Under this theory, a claim for reimbursement submitted when a recipient of federal funds is noncompliant with any regulation, or other federal, state, or local law can be "false" under the theory that the government would not have paid for the services had it known of the provider’s noncompliance. Under the implied certification theory, this is true even where the government does not expressly condition payment on compliance of the provision, regulation, or law. The theory raises important questions about the difference between a breach of the contract or agreement and "defrauding" the government.

AHCA/NCAL will monitor this important and on-going litigation, and plans to submit an amicus brief, asking the court to either reject the “implied certification” theory outright, or in the alternative to impose strict limits on the use of the theory.

The National Council on Disability Releases Report on ACA and Disabilities

Dana Halvorson
Last week, the National Council on Disability (NCD) released a report entitled “Implementing the Affordable Care Act: A Roadmap for People with Disabilities.” This is the first in a series of three reports that examines the provisions in the Affordable Care Act (ACA) that affect the lives of people with disabilities. The press release on the report from the NCD can be found here. To download a copy of the report, please click here.

Wednesday, January 20, 2016

US Supreme Court Refuses to Hear TX Arbitration Case

Dianne De La Mare

AHCA/NCAL applauds the US Supreme Court’s refusal to review a Texas Supreme Court case decision that holds that the Federal Arbitration Act (FAA) preempts the arbitration enforcement provisions in the Texas Medical Liability Act (TMLA)(Perez v Fredericksburg Care Co.). This is a significant win for providers who understand that the use of arbitration agreements is a viable and effective option for ensuring that families are provided adequate remedies for alleged wrongdoings.

In Perez v Fredericksburg Co., the survivors of a nursing center resident brought a suit against the facility, alleging that the resident’s death was the direct outcome of poor care. Previously, the resident had signed an arbitration agreement at admission, and the facility asked the court to compel arbitration. The resident’s family argued that the arbitration agreement was void because it did not comply with a provision of the TMLA, which requires arbitration agreements to contain certain language in boldface type. Both the trial court and the appeals court found in favor of the resident’s family, stating that the McCarran-Ferguson Act prohibits state arbitration agreements to be preempted by the federal law.

In 2013, AHCA/NCAL filed an amicus brief with the Supreme Court of Texas, urging the court to review the incorrect lower court rulings. Subsequently, the Texas Supreme Court overturned the lower court decisions, holding that the FAA does preempt the arbitration enforcement provisions in the TMLA, and the McCarran-Ferguson Act only applies to regulations on insurance business and not to restrictions on arbitration claims by patients and providers.

Register for IO Conference Early and Save $

The early registration deadline is next month so what are you waiting for? Now is the time to plan your trip to sunny San Diego so you can join your peers at the best networking opportunity you’ll find for today’s IOs.

Earn up to 11.5 CEUs in three full days of unique programming designed just for you. Visit to get all the details.

The agenda includes Preconference Sessions starting at 10:30 a.m. on Wednesday, March 16th and continues with excellent sessions such as:

• Owner to Owner Town Hall

• AHCA/NCAL Leadership Panel

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

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

• The Power of a Sales Leaseback and 1031 Exchange   

• Secrets to Engaging and Accountable Leadership

• Let's Get Serious About Staffing

• Effective Ways to Hire and Keep New Staff

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

See the complete agenda and register today!

The deadline is February 17, 2016.

Sponsors as of January 19, 2016:American HealthTech, Carpenter Bus Sales, DirectSupply, Kronos, Evans Senior Investments, Greystone, Insurance Solutions, MatrixCare, McCullom Consulting/Health Care Advisory Group, Mueller Prost, My InnerView, Schryver Medical, Walker & Dunlop, Yadkin, Ziegler

AHCA Encourages Passage of Rural Health Care Access Bill

Dana Halvorson 

AHCA released a press statement yesterday in full support of the Rural Health Care Connectivity Act of 2015 (S. 1916/ H.R. 4111.)  This legislation would amend the Communications Act to permit skilled nursing facilities (SNFs) to apply for support from the Universal Service Fund’s Rural Health Care Program (RHCP.)  The RHCP provides funding for telecommunications and broadband services used to provide health care in rural areas and communities. S. 1916 specifies that SNFs be included in the definition of health care providers that are eligible to receive RHCP support. By Federal Communications Commission (FCC) interpretation, SNFs are currently not eligible to receive these funds as, we believe, the Telecommunications Act of 1996 intended. S. 1916 passed unanimously by the Senate Commerce Committee on November 18, 2015.

AHCA’s Senior Vice President of Government Relations, Clifton J. Porter II, stated, “Providers depend on the growing use of technology to deliver needed care and services to rural locations. Broadband networks are critical to accommodate the delivery and exchange of data, images, web streaming, and other health information that ensures the day-to-day care needs of residents and patients are met. Skilled nursing facilities will greatly benefit from access to enhanced telecommunications technologies. The American Health Care Association strongly supports this bill and urges swift passage of it by Congress.”

Unique Quality Improvement & Training Opportunity for 3-5 Star Nursing Homes

Bill Sonterre, Stratis Health

The Agency for Healthcare Research and Quality (AHRQ) created the On-Time Pressure Ulcer Prevention program (OTPP) to help nursing homes with electronic health records (EHR) reduce the occurrence of in-house pressure ulcers. AHRQ contracted with NORC at the University of Chicago, and its partner Stratis Health, to provide ongoing practice facilitation with 50 nursing homes recruited across the U.S. to implement and evaluate this evidence based program.


An outcome evaluation with New York nursing homes showed a 59 percent reduction in the incidence of pressure ulcers when at least three reports were integrated into care planning processes.


The On-Time Program integrates clinical reports from an EHR to identify residents at risk for pressure ulcer development. Using these reports, participating facilities will implement team-based strategies with the help of an experienced facilitator to improve risk identification and care planning. These strategies allow staff to intervene in a timely manner with at-risk residents to reduce the incidence of pressure ulcers. Nursing homes that participate in this project will receive individualized technical assistance and education from the facilitator to successfully implement the On-Time program.


Nursing homes that are interested in participating must apply on-line - applications will only be accepted until 50 nursing homes have been selected. On-line applications will be available beginning December, 2015. Click to get more information and apply.

Please join the introductory webinar on January 27, 2016 from 12:30 PM-1 PM EST/11:30 AM-12 PM CST that will describe the On-Time Pressure Ulcer Dissemination Program in more detail. You can register at:

To learn more contact:

Bill Sonterre, Stratis Health, 612-584-7902,

Tuesday, January 19, 2016

CMS Open Door Forum

Dan Ciolek

The CMS Skilled Nursing Facilities/Long Term Care Open Door Forum has been cancelled on Thursday, January 21, 2016. The next SNF/LTC ODF call is scheduled for Thursday, March 3, 2016.

Be on the lookout for the March SNF/LTC ODF agenda sometime the end of February. To sign up for these email alerts, submit your details here. Additional information regarding the Open Door Forum hosted by CMS is found online.

Wednesday, January 13, 2016

Quality Award Journey: Brandon Oaks Assisted Living

Nicole Bruch, Corporate Marketing Coordinator, Virginia Lutheran Homes, Inc.

In 2014, Brandon Oaks Assisted Living received the Bronze Quality Award and thus began the journey to gold. Most recently, in 2015, we were awarded the Silver Quality Award. While the Bronze Award application was difficult in a sense because we had to take an introspective look at our own organization to see what we did well and what needed improvement, Silver was even more difficult. We had to look at our own practices, patterns and results then compare them with facilities like ours.

From our experience compiling data for the Bronze Award, we were able to better keep our data current and accurate for the Silver Award, monitor patterns and change our processes to better serve our residents. Our greatest hurdle during the Silver Award process was finding comparative data for other assisted living facilities. There are many sources of data for hospitals and long term care facilities, but very narrow for assisted living. What we could find was limited and therefore restricted our ability to use other points and results in our application. Nonetheless, we were able to complete a successful application and learn more about the strengths, and weaknesses, of our organization.

Although we were the only assisted living facility in Virginia to be awarded the Silver Quality Award in 2015, we hope more assisted living facilities will begin to apply. Not only would it be a benefit to their organization, it would help all other facilities applying by adding more comparative data that would be available. In addition, the Quality Awards are proof of improvement, and a testament to the importance of quality care and enhancement of the lives of assisted living residents.

In the future we will be applying for the Gold Award to further our dedication to our residents and to externally build trust within the greater community. Applying for these quality awards have pushed our management and staff to do more. Do more for the residents, employees and families to fully encompass, and better, all aspects of life in an assisted living facility.


Applications for the 2016 Quality Awards Program closes on Thursday, January 28 at 8pm EST. Find resources for each level.

AHCA’s Clif Porter Gives Reporters Legislative Outlook for 2016

Drew Thies

AHCA’s top government relations expert weighed in with reporters Monday to discuss the outlook for the long term and post-acute care sector in 2016.

Clif Porter, Senior Vice President of Government Relations, detailed what he predicts will be a quieter year legislatively, but a very busy one for the current administration and their regulators. "Election year politics have a tendency to slow the legislative process to a halt while the President may ramp up administrative activity," Porter said.

At the front of the picture was the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, for which the Centers for Medicare & Medicaid Services (CMS) must develop new measures in 2016. The IMPACT Act, signed into law in 2014, lays out a multiyear path for better record keeping and quality tracking amongst post-acute care providers, but leaves CMS the responsibility of crafting exactly how to define certain metrics.

Porter warned that CMS must be deliberate about how they craft measures, saying "if they move too fast, particularly in a year where the agency is already going to be busy, poor tests of quality could be established, undermining the overall goal of the IMPACT Act."

Presidents in the last year of their second term have historically used executive power as a far reaching tool to implement their policy wishes in lieu of going through the legislative process. Porter saw no reason to believe the current administration would not pursue the same path.

In addition to regulatory concerns, Porter also indicated that AHCA will continue to pursue bipartisan policies that can be agreed upon even during the contentious politics of an election year.

Finding a solution to the observation status problem remains a priority for AHCA. Beneficiaries found some relief in 2015 with the passage of the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which mandates that hospitals inform patients of their observation status. Patients are still at risk, however, of being denied Medicare coverage following a hospital stay if they were under observation rather than inpatient status.

Tuesday, January 12, 2016

IRS Extends Deadlines for New Mandatory Forms for Employers with 50 or more FTEs

Dave Kyllo

The Internal Revenue Service has extended the deadlines for new mandatory forms that must be completed by an applicable large employer – employers with 50 or more full-time employees, including full-time equivalents. The new deadline for the first of these new reporting requirements is now March 31, 2016 which is an extension of nearly two months from the previous deadline.

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

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

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

Forms 1095-C must be provided to employees by March 31, 2016. Forms 1094-C and 1095-C are now due to the IRS by May 31, 2016, if filing on paper, or June 30, 2016, if filing electronically. The IRS has developed instructions for completing these forms.

For more information about these reporting requirements, go to Reporting of Offers of Health Insurance Coverage by Employers on

Concerned about your employee health insurance costs? AHCA/NCAL Insurance Solutions may be able to save you money. For more information about health plan options available through AHCA/NCAL Insurance Solutions, contact Dave Kyllo at 202-898-6312 or email

Make The IO Leadership Conference Your 2016 Winter Getaway!

Temperatures in most parts of the country are getting considerably colder, winter is finally here in earnest, and it's a great time to book your San Diego retreat. Register for the IO Leadership Conference, and get reinvigorated in 2016 while you network, learn, and talk about the issues that matter to you.

This year's conference takes place at the beautiful Manchester Grand Hyatt San Diego, March 16-18, 2016. It's a perfect setting for all the networking opportunities you will have. In addition to three full days of outstanding education sessions, you will have plenty of time to talk to your peers, including a reception on Wednesday evening, a networking lunch and dinner on Thursday, and the ever-popular "Owner to Owner" Town Hall with Joanne Smikle facilitating.

The IO Leadership Conference will jumpstart your year and give you what you need to overcome some of the challenges you are facing. Don't just take our word for it. Here's what some of your peers, who come back year after year, have to say:

Being able to meet with other IOs and participating in IO-focused sessions has helped us improve our performance in meeting the needs of our residents.
- Phil Scalo, President & CEO, Bartley Healthcare

Whether you are a repeat attendee or first time attendee, the value of this conference with fellow IOs is priceless!
- Chris Wright, President & CEO, iCare

The town hall meetings with open group dialog specific to the independent owner and our industry have provided valuable resources.
-Cathy Williams, Owner, Winslow Campus of Care

Get all the details, see the complete agenda, and start planning for your March getaway! It will be here before you know it.

The deadline is February 17, 2016.

Sponsors as of January 6, 2016:
American HealthTech, DirectSupply, eHealth Data Solutions, Evans Senior Investments, Greystone, Insurance Solutions, Kronos, MatrixCare, McCollum Consulting/Health Care Advisory Group, Mueller Prost, My Inner View, Schryver Medical, Walker & Dunlop, Yadkin, and Ziegler 

CMS Issues Updated Remittance Advice Fact Sheet and FAQ

Dan Ciolek

The Centers for Medicare and Medicaid Services (CMS) Medicare Learning Network (MLN) recently released an updated December 2015 claim Remittance Advice Resources and FAQs Fact Sheet. 

The document includes information related to:

1) Standard Paper Remittance (SPR) vs Electronic Remittance Advice (ERA) 
2) Enrolling in ERA
3) Free Medicare ERA software, and 
4) Commercial ERA software. 

SNF billers should review the updated guidance.

A Conversation with U.S. Senate Special Aging Committee Chairwoman, Susan Collins

Dana Halvorson

On January 8, 2016, Meg Haskell, wrote an article in BDN Maine entitled, A frank conversation on aging, with Maine’s senior senator. In the article, which also included a video interview with Chairwoman Collins, Haskell notes, “First elected in 1996, Collins has easily won re-election to three additional terms, most recently in 2014. Collins has sat on the Special Committee on Aging since 1997, taking over as chairman last January, with co-leadership from Sen. Claire McCaskill, a Democrat from Missouri.” 

Haskell goes on to include that, “There are five priority areas for the committee’s work: improving retirement security, building support for family caregivers, increasing funding for research into Alzheimer’s disease and other age-related disorders, protecting seniors against financial exploitation and fraud, and investigating recent aggressive price increases for prescription drugs.” To read the full article, please click here

Quality Summit Registration Deadline Extended to January 19
There is still time to register for the AHCA/NCAL Inaugural Quality Summit. The registration deadline has been extended through Tuesday, January 19. It’s only the second week of the new year, and if you’re already feeling the need to recharge and find focus, try the Quality Summit. Held February 9-11, in San Antonio, this inaugural event offers keynote speakers, networking, highly-targeted education for SNF & AL providers with an emphasis of quality improvement, organizational excellence and resident care.

Don’t wait any longer, online registration is easy and you must be registered for the event before hotel reservations can be made.

SHOP Marketplace Application

Dana Halvorson

According to a January 11, 2016, email from the Centers for Medicare & Medicaid Services (CMS), if you submit your initial group enrollment Small Business Health Options Program (SHOP) Marketplace application and make your initial payment by January 15 -- your coverage can be in place as early as February 1.

As noted on the website, the SHOP Marketplace is for small employers who want to provide health and dental coverage to their employees. To use the SHOP Marketplace, your business or non-profit organization must have 50 or fewer full-time equivalent employees (FTEs). (Some states may use different employee maximums for 2016.) If you need assistance, you can call the SHOP Call Center at 1-800-706-7893 (TTY:711) Monday through Friday from 9am to 7pm ET or visit For in-person assistance, find a SHOP-registered agent or broker in your area.

Upcoming QIES systems downtime

Holly Harmon

CMS has announced that all QIES systems will be down from Wednesday, March 16 after 8:00 p.m. (EST) through Monday, March 21, 2016 at 11:59 p.m. (EST). This downtime will affect all QIES connectivity and systems. This means the national database including CASPER reports will NOT be available during this time.

In addition, the following submission system will not be available:

· Skilled Nursing Facilities and the MDS and Payroll-Based Journal

This downtime will affect ALL QIES users. Providers should make the necessary contingency plans to accommodate for this downtime and ensure data is submitted in a timely manner.

Webinar: Core Elements of Antibiotic Stewardship in Nursing Homes

Adrienne Riaz-Khan

Improving the use of antibiotics in health care to protect patients and reduce the threat of antibiotic resistance is a national priority. Antibiotic stewardship refers to a set of commitments and actions designed to optimize the treatment of infections while reducing the adverse events associated with antibiotic use. CDC’s Core Elements of Antibiotic Stewardship in Nursing Homes provides practical ways for nursing homes to initiate or expand antibiotic stewardship activities. This recently released 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.
Tuesday, February 2, 2016 
 2:30 PM – 4:00 PM (EDT) 
Registration is now open:

Speakers: Nimalie Stone, MD, Medical Epidemiologist – Centers for Disease Control and Prevention
Leonard Russ, Principal Partner, Owner Administrator - Bayberry/CPR Associates

Submit Your Quality Award Application: Deadline January 28

The Quality Award website has a number of resources designed to help you submit your application before the deadline on January 28 at 8 p.m. EST.  Whether you are preparing to submit a BronzeSilver or Gold application; there is something for you.

  • Bronze applicants should check out the Bronze Criteria Series. This is a series of YouTube videos, 3-7 minutes in length, with each video covering one question of the Bronze criteria. The series is structured so that application teams are able to view each video and write a response to each question, sometimes in less than 30 minutes total! We suggest that centers form an “application team” that views the videos together and then completes the responses to the criteria as a team effort. Applicants who view the Bronze Criteria Series are much more likely to be successful with the award process.  
  • Based on the popularity of the Bronze Criteria Series, AHCA/NCAL has released a brand new Silver Criteria Series for the 2016 application cycle. The series starts with an introduction of the program and a webinar on the Silver evaluation process. Eight additional webinars follow, covering each section of the Silver Criteria, from the Organizational Profile through Categories 1-7. Each video provides an explanation of the criteria and questions to help applicants through the process. As with Bronze, we suggest that centers form an “application team” that views the videos together and then completes the responses to the criteria as a team effort. 
  • Gold applicants should view the AHCA/NCAL Management Series, which is a sequence of videos each covering a category of the Baldrige Criteria. This series was created to help any center develop a comprehensive and robust management system. For Gold, the series also provides insight from Baldrige experts across the Organization Profile as well as across each criteria category. 

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

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

If you have any questions, feel free to reach out to Quality Award staff at

Wednesday, January 6, 2016

Congress Returns for Abbreviated 2016

 Drew Thies

The 114th Congress is only halfway over, but a majority of its legislative accomplishments might already be on the books.

The House returned to vote Tuesday with official legislative business in the Senate delayed until next week, but the presidential election later in the year is already beginning to weigh heavily on lawmakers’ minds.

The Republican-led Congress and Democratic White House closed out a surprisingly productive 2015, passing a $1.15 trillion omnibus spending bill and $680 billion extension of tax breaks, all on top of a two-year budget agreement pushed through by then-Speaker John Boehner after he announced his retirement. This gives lawmakers only one legislative hurdle to contend with this year: passing a new a round of appropriations bills by the end of September.

There are a host of lower-tier areas and pet projects that lawmakers are eyeing, but the election will be the lens through which all legislation is viewed. Unlike last year, when Congress repealed and replaced the Medicare Sustainable Growth Rate, established long-term highway funding, and revamped No Child Left Behind, this year has less room for bills that are not “must-pass” pieces of legislation.

Leadership in both chambers has already precluded the chance of landmark legislation being passed before there is a new President in the White House. Speaker Paul Ryan (R-Wis.) said that any attempt at immigration reform will have to wait until 2017, and Senate Majority Leader Mitch McConnell indicated that he’d like to take action on major trade deals only after the 2016 election.

Some lawmakers are hopeful about the prospects of smaller projects. “We have accomplished a lot of mid-sized bills, and we continue to do that,” said Sen. Amy Klobuchar (D-Minn.). “I would expect we would, at least for the first six months.”

With the Presidency at stake and multiple tightly contested Senate races, leadership in both parties will be angling for policy wins that can be spun into political victories.

Republicans may look to pass messaging bills through the House, though their fate is uncertain, if not completely diminished, upon their arrival in the Senate. Senate Democrats have remained united, filibustering nearly every bill targeting Democratic priorities such as the Affordable Care Act and President Obama’s anti-climate change agenda before a veto could even be issued.

“Our No. 1 goal for the next year is to put together a complete alternative to the left’s agenda,” Ryan said in December in one of his first major speeches as speaker. “Even if [Obama] won’t sign them into law, we will put out specific proposals and give the people a real choice.”

Lawmakers do not have much time to push through special projects, either, as both chambers are only in session for about half the year, giving Members of Congress ample time to spend campaigning in their hometowns and states.

AHCA/NCAL Quality Summit Deadline to Register

Registration Deadline is next Tuesday, January 12, 2016. It's the New Year and there is no better way to start it off than by attending the AHCA/NCAL Inaugural Quality Summit. The Quality Summit will be February 9-11 in San Antonio Texas.

The new Quality Summit combines the AHCA/NCAL Quality Symposium and the NCAL Spring Conference to create a powerful, must-attend event. This merger makes it even easier for you to enjoy top-notch speakers, priceless networking opportunities with your peers, and relevant training on key quality improvement topics that will ensure you reach your personal and professional quality goals. The summit offers a broad spectrum of programming designed for quality practitioners at all levels and in all long term care settings. 

This year's LED (Lead, Engage, Discover) Talks have been finalized and feature six,18-minute presentations. Check out the topics and speakers online.

Don't miss our scheduled event keynote speakers: Donald Berwick MD, MPP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement​; Meagan Johnson Generational Expert
and author From Boomers to Linksters: Managing the Friction Between Generations in the Workplace and Patrick H. Conway MD, Deputy Administrator for Innovation & Quality, CMS Chief Medical Officer leading the Center for Clinical Standards and Quality (CCSQ) and the Center for Medicare and Medicaid Innovation (CMMI) at CMS.

FHA Mortgage Program Restarted

Christopher Donnellan

Advocacy efforts by AHCA and health care lender Capital Funding Group (CFG) have helped restart the Federal Housing Administration’s (FHA) Section 241 mortgage modification program for long-term care facilities and apartment buildings after a nearly year-long suspension.

A disagreement over legal documents between the Internal Revenue Service (IRS) and the Government National Mortgage Association (Ginnie Mae) shuttered the program, which helps facilities with existing FHA mortgages to make improvements for their residents. 

“The Section 241 program has been a great source of capital for our facilities,” said AHCA President Mark Parkinson. “The support we have gotten from our members like CFG, and from Congress and even FHA in helping to get Ginnie Mae and IRS to resolve this has been great. With the right push, agencies can be responsive.”

AHCA and CFG worked with Congress to convince the agencies to resolve their differences as quickly as possible to get the program running again. The bipartisan effort was spearheaded by House Ways and Means Committee members Congressmen Richard Neal (D-MA) and Jim Renacci (R-OH).       

Tuesday, January 5, 2016

Assisted Living for Disabled Veterans

Dana Halvorson

According to a Saturday, January 2, 2016, article entitled Feds to pay for some disabled veterans’ assisted living by Peggy McCarthy of the Conn. Health I-Team, “The federal government will pay for disabled veterans now residing in assisted-living facilities, under a bill passed by Congress in December. But the measure doesn’t cover veterans who may move to such places in the future. 

Disabled veterans living at retirement homes, including those at Seacrest Retirement Center in West Haven, HighVue Manor in Hamden, and Mattatuck Health Care in Waterbury, were told in 2013 by the U.S. Department of Veterans Affairs that coverage of their housing was a mistake and would end. The coverage began in 2010. U.S. Rep. Rosa L. DeLauro obtained extensions for the Connecticut veterans who sought her help and she proposed the language in the bill approved that ensured their coverage would continue. 

Residential care facilities affected by the legislation serve veterans who can’t live independently, but don’t need the skilled nursing care of nursing homes. The facilities generally provide services such as, housing, food, housekeeping and supervision of medicines.” You can also find further information on U.S. Rep. Rosa DeLauro’s website

AHCA/NCAL will continue to follow this matter.

NY Times Article on Financial Incentives and Shorter Hospital Stays

Dana Halvorson

On January 4, 2016, an article written by health economist Austin Frakt and entitled, The Hidden Financial Incentives Behind Your Shorter Hospital Stay, was included in the New York Times. Frakt states in his article, “Since 2010, when almost one in five Medicare hospital patients returned within 30 days, hospital readmissions have fallen considerably. Though this fact was highlighted by the Obama administration, some people are seeing evidence that hospitals are gaming the metric. For instance, patients who are placed under “observation status” are not counted in the readmissions metric even though they may receive the same care as patients formally admitted to the hospital. Likewise, patients treated in the emergency room and not admitted to the hospital do not affect the readmissions metric either. As readmissions have fallen, observation status stays and returns to the emergency department after a discharge have risen.” For more information about the observation stays issue, please visit the AHCA/NCAL website.

New Features of SHOP Marketplace for 2016

Dana Halvorson

On Tuesday, January 5, 2016, the Centers for Medicare and Medicaid Services (CMS) sent out an email noting new features in the Small Business Health Options Program (SHOP) Marketplace for 2016. To see what’s new, click here

According to the website, the SHOP Marketplace is for small employers who want to provide health and dental coverage to their employees. To use the SHOP Marketplace, your business or non-profit organization must have 50 or fewer full-time equivalent employees (FTEs). (Some states may use different employee maximums for 2016.) If you need assistance, you can call the SHOP Call Center at 1-800-706-7893 (TTY:711) Monday through Friday from 9am to 7pm ET or visit For in-person assistance, find a SHOP-registered agent or broker in your area. 

CMS Creates Prior Authorization Process for DMEPOS Items

Dan Ciolek

On December 30, 2015 the Centers for Medicare & Medicaid Services (CMS) issued a final rule that establishes a prior authorization process for certain high-cost durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are frequently subject to unnecessary utilization. This includes items with an average purchase fee of $1,000 or greater, or an average rental fee schedule of $100 or greater.

This prior authorization process, which becomes effective February 29, 2016, will help ensure that certain DMEPOS items are provided consistent with Medicare coverage, coding, and payment rules. CMS has had longstanding concerns about the improper payments related to DMEPOS items. The Department of Health and Human Services’ Office of the Inspector General and the U.S. Government Accountability Office have published multiple reports indicating questionable billing practices by suppliers, inappropriate Medicare payments, and questionable utilization of DMEPOS items. CMS believes the final rule will prevent unnecessary utilization while safeguarding beneficiaries’ access to medically necessary care.

AHCA members should pay attention to this policy as it may change when and how clinical and billing staff may need to submit required documentation to physicians, suppliers and Medicare to assure that beneficiaries are able to receive necessary high cost DMEPOS items in a timely manner, and that the documentation supports payment. For example, the Medicare Claims Processing Manual , Chapter 20, Section 100.2.2 indicates that treating therapists can complete Section B of Certificate of Medical Necessity Forms submitted to a supplier by the certifying physician. With the new prior authorization process, treating SNF therapists that currently complete this section for their patients, or provide other clinical documentation to the certifying physician, may be asked to do it sooner in the process.

The final rule does not change coverage policy. However, the prior authorization process will require the information necessary to support Medicare payment to be submitted before the item is furnished to the beneficiary and before the claim is submitted for payment to assure that all relevant coverage, coding, and clinical documentation requirements are met. This helps ensure that beneficiaries are not held responsible for the cost of items that are not eligible for Medicare payment. Access is preserved in this rule by having both specified time frames for review and approval of requests, and an expedited process in cases where delays jeopardize the health of beneficiaries.

Under Section 1834(a)(15) of the Social Security Act, the Secretary has the authority to develop and periodically update a list of DMEPOS items that are frequently billed improperly and to develop a prior authorization process for these items. The final rule implements this authority by creating: 1) a “Master List” of items that meet specific criteria and are potentially subject to prior authorization; 2) a “Required Prior Authorization List,” 3) a subset of items on the Master List; and 4) a prior authorization program for the Required Prior Authorization List items.

Prior authorization will be required for those DMEPOS items on the Required Prior Authorization List. The process requires all relevant documentation to be submitted for review prior to furnishing the item to the beneficiary and submitting the claim for processing. CMS or its contractors will review the prior authorization request and provide a provisional affirmation or non-affirmation decision. A claim submitted with a provisional affirmation decision will be paid so long as all other requirements are met. A claim submitted with a non-affirmation decision or without a decision will be denied. Unlimited resubmissions of prior authorization requests are allowed.

Medicare or its review contractor will make a reasonable effort to render an initial prior authorization determination within 10 business days and will make a reasonable effort to render a resubmission prior authorization determination within 20 business days. These are maximum time frames and will be adjusted downward for items that require less time for making a determination. An expedited review process will be available to address circumstances where applying the standard time frame for making a prior authorization decision could seriously jeopardize the life or health of the beneficiary. The request for an expedited review must provide rationale supporting the request.

CMS will issue specific prior authorization guidance in subregulatory communications including at the CMS Prior Authorization Initiatives DMEPOS web page.

Congress Postpones the ACA’s “Cadillac Tax” Until 2020

Dave Kyllo

At the close of the first session of the 114th Congress, lawmakers approved a massive spending and tax package that included a postponement of the Affordable Care Act’s so-called “Cadillac Tax” until 2020. The tax was scheduled to take 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. The Kaiser Family Foundation estimates that one in four employers offer at least one health plan that would be subject to the tax.

Postponement of the unpopular tax had broad bipartisan support and the tax is strongly opposed by organized labor. Policy insiders are speculating that the postponement signals a strong likelihood for permanent repeal in the next Administration. The Congressional Budget Office estimates that the tax would raise about $87 billion over 10 years to help defer other ACA costs.

Employee health insurance is costly and AHCA/NCAL members are encouraged to take a look at AHCA/NCAL Insurance Solutions before making a final decision about their employee plan coverage. This “Members Only” program is designed to give AHCA/NCAL members access to brokers who understand long term care and who will work to save AHCA/NCAL members money. For more information, contact Dave Kyllo (202-898-6312) or Nick Cianci (202-898-2841) or email us at AHCA/NCAL Insurance Solutions.

Monday, January 4, 2016

Assisted Living Education Abundant at AHCA/NCAL Quality Summit

NCAL knows that your time and resources are precious, and it can be difficult to attend all the events you would like. Many assisted living members have expressed interest in attending both the AHCA/NCAL Quality Symposium and the NCAL Spring Conference. Now you can! We've combined these two great conferences to form the AHCA/NCAL Quality Summit.

February 9-11 in San Antonio, Texas, the Quality Summit includes all the great things you loved about NCAL Spring Conference, and, in true Texas style, it's bigger! Now it's even easier for assisted living professional to enjoy inspiring speakers, invaluable networking opportunities, and illuminating training.

Earn up to 12.75 CEUs, and return home invigorated with fresh ideas for 2016.

Education specifically for assisted living providers is a pivotal part of the Quality Summit, with sessions like:
  • Applying for a Quality Award: How to Overcome Perceived Assisted Living Barriers
  • Understanding and Managing The Cost of Care as Acuity Increases In Assisted Living
  • Dude, Where’s My Data?
  • Here and Now for Assisted Living
  • Exciting News! Introducing the New FGI Guidelines for Residential Care
  • Three-Hour Intensive: Enhancing Well-Being for the Person with Dementia
We also have sessions that apply to both assisted living and skilled nursing, including:
  • Do You Know Why You Have Staff Turnover?
  • Introducing a New Family & Resident Aid on Hospital & Readmissions
  • Quest for Excellence: Best Practices and Lessons Learned by Quality Award Recipients
  • And more!
The Quality Summit promises additional events in collaboration with our skilled nursing partners, including a moderated poster gallery walk and the LED Talks, a series of brief sessions curated by Provider magazine. And each night offers networking receptions to get to know your fellow long term care colleagues, including one hosted by NCAL.

Quality is at the heart of everything we do in assisted living. Combining NCAL Spring Conference and the Quality Symposium was a natural fit.

Don’t wait until the January 12 deadline to register – make a commitment now to start 2016 on the right foot.

Learn more about the inaugural AHCA/NCAL Quality Summit: