Administration Improperly Funded ACA Cost-Sharing Subsidies

Dianne De La Mare


US District Judge, Rosemary Collyer, has held that the federal government has improperly spent billions of dollars over the past two years to reimburse insurance companies for providing health coverage at lower costs to low- and moderate-income consumers (US House of Representatives v Burwell). Judge Collyer has not taken any immediate action to stop this spending, however, and is instead allowing her decision to be challenged on appeal (either to a federal court of appeals or directly to the US Supreme Court).

There is no doubt that the Obama Administration will appeal, especially because this controversy goes to the key question of whether the private insurance industry will remain willing to provide lower-cost health coverage through the ACA exchanges, or marketplaces, that have now enrolled millions of new consumers.

Webinar: An Overview of the Functional Assessment Standarized Item (FASI)

Adrienne Riaz-Khan


This webinar will provide a brief overview of the Functional Assessment Standardized Items (FASI), which is part of the CMS Testing Experiencing and Functional Tools (TEFT) project. CMS will be testing this FASI, a revised version of the CARE tool, for use in home and community-based waiver settings which includes assisted living. CMS will be evaluating the reliability and validity of the FASI and asking states to demonstrate their use of the FASI elements. CMS has requested comments on this project by July 1, 2016. 

An Overview of the Functional Assessment Standardized Item (FASI)
Friday, June 3, 2016
2:00 PM – 3:00 PM Eastern Time

 

Presenters:

Lindsay Schwartz, Senior Director, Workforce & Quality Improvement, NCAL
Lilly Hummel, Senior Director of Policy, NCAL

Objectives: After attending this webinar, attendees will be able to:

· Provide an overview of the Functional Assessment Standardized Items
· Explain how states may use the FASI in HCBS settings
· Provide a brief overview of the TEFT project

Registration is now open: http://webinars.ahcancal.org/session.php?id=18071

AHCA/NCAL Webinar to Provide an Overview of the Functional Assessment Standardized Items (FASI)

Lindsay Schwartz

This webinar will provide a brief overview of the Functional Assessment Standardized Items (FASI), which is part of the CMS Testing Experiencing and Functional Tools (TEFT) project. CMS will be testing this FASI, a revised version of the CARE tool, for use in home and community-based waiver settings which includes assisted living. CMS will be evaluating the reliability and validity of the FASI and asking states to demonstrate their use of the FASI elements. CMS has requested comments on this project by July 1, 2016. This webinar will be held on Friday, June 3rd at 2:00pm –3:00pm Eastern. Please pre-register here for the webinar.

AHCA/NCAL 67th Annual Convention & Expo Preliminary Program

Jon-Patrick Ewing

It’s here and it’s hot! This year’s AHCA/NCAL Convention & Expo Preliminary Program is now available online! You can even read it on your mobile devices. Take a look at what Nashville has in store for you October 16-19 in this easy-to-access, easy-to-read flip book.

This year's Convention & Expo offers national keynote speakers, valuable education, professional networking, exciting exhibits staffed with experts ready to help your company excel, and music, of course! In the spirit of the Grand Ole Opry, the Gala Dinner & Show (separate ticketed event) features three artists, each with their own unique style and sound. You’ll enjoy an evening with award-winning county artists Charlie Daniels, Jo Dee Messina, and Phil Vassar.

Once you preview the electronic Preliminary Program, you’ll be inspired to register for the AHCA/NCAL Convention & Expo. Early bird registration and savings continue through July 22.

CMS Rule Tightens Special Enrollment Periods

Dianne De La Mare

The US Department of Health, Centers for Medicare & Medicaid Services (CMS) has released an interim final rule, Patient Protection and Affordable Care Act; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program.  This requires individuals who enroll in Healthcare.gov coverage through a special enrollment period after a permanent move to prove that they were previously covered for at least 1 day in the 60 days before relocating. 

CMS states that making those changes faster through an interim final rule is necessary to avoid adverse selection or gaming, and it also helps to ensure that issuers have confidence in their pricing.

OCR Releases Nondiscrimination Rule

Dianne De La Mare

On May 13, 2016, the US Department of Health and Human Services (HHS), Office for Civil Rights (OCR) published the Nondiscrimination in Health Programs and Activities; Final Rule, implementing §1557 of the Affordable Care Act (ACA), and prohibiting discrimination on the basis of race, color, national origin, sex, age or disability in certain health care programs (including the Medicare and Medicaid programs), effective July 18, 2016.

Section 1557 extends nondiscrimination protections to individuals participating in:
1) any health program receiving HHS funding;
2) any health program administered by HHS; or
3) health insurance marketplaces and all plans offered by issuers that participate in those marketplaces.

Section 1557 builds on long-standing federal civil rights laws including Title VI of the Civil Rights Act (prohibits race, color or national origin discrimination), Title IX of the Education Amendments (prohibits sex discrimination), the Rehabilitation Act, § 504 (prohibits disability discrimination) and the Age Discrimination Act (prohibits age discrimination). The rule specifically focuses on assurance and notice requirements; general prohibitions; discrimination against persons with limited English proficiency; discrimination against persons with disabilities; sex, gender and sexual orientation and enforcement.

Since the passage of the ACA in 2010, §1557 has been in effect and OCR has been enforcing this provision. In light of this final rule, however, AHCA/NCAL encourages its membership to review the recently released HHS press release, summary and fact sheets, to determine any areas for strengthened compliance.

Over 400 AHCA/NCAL Advocates Hit Capitol Hill

Drew Thies

Members meet with Senator John Hoeven (R-ND)

Over 400 American Health Care Association and National Center for Assisted Living advocates came to Washington to hear from political leaders and advocate on behalf of long term and post-acute care providers on Monday and Tuesday.

The 2016 Congressional Briefing event included over 200 visits to Members of Congress and their staff from 47 states to discuss issues such as recent value-based purchasing proposals and the Medicaid provider assessment.

Keynote speaker Chuck Todd, host of NBC’s Meet the Press, spoke to attendees at length about his background covering politics in Washington and answered questions about the upcoming presidential election.

Advocates also heard from party leaders on both sides of the aisle: Representative Greg Walden (R-OR), Chairman of the National Republican Congressional Committee; Representative Xavier Becerra (D-CA), Chairman of the House Democratic Caucus, and Kevin McCarthy (R-CA), Majority Leader of the House of Representatives.

New CMS Data Show Half of AHCA Members Hit 30 Percent Antipsychotics Reduction Goal Ahead of Schedule

AHCAPressOffice@ahca.org

The American Health Care Association (AHCA) today announced that half of its skilled nursing center members have reached or surpassed a nationwide goal in reducing antipsychotic usage by at least 30 percent, seven months ahead of the December 2016 deadline. As a result of the Association’s metric-based Quality Initiative and its partnership with CMS’ National Partnership to Improve Dementia Care, the overall decline in antipsychotic use in AHCA member centers is 30.4 percent. The achievement represents a faster rate of reduction than non-members, which currently show a 25 percent decrease.

“Reaching this goal seven months ahead of schedule highlights our profession’s commitment to improve the quality of life for individuals living with dementia,” said Mark Parkinson, President and CEO of AHCA. “This latest milestone means that tens of thousands of residents are no longer experiencing the negative effects of these medications. But we won’t stop with this announcement. We will continue to work with CMS and our Quality Initiative to set new, ambitious goals to reduce usage even more.”

Based on CMS data, 23.2 percent of long-stay residents in non-member centers and 23.6 percent in AHCA member centers were receiving an antipsychotic medication in 2011. Currently, 17.4 percent of residents in non-member centers and 16.4 percent of residents in AHCA member centers are on these medications.

“The sharp drop in usage shows how our members are driving change on a national level,” said Dr. David Gifford, AHCA Senior Vice President of Quality and Regulatory Affairs and a board-certified geriatrician. “Providers, residents and their families are clearly learning more about safer alternatives to treating dementia. Together with CMS and the Partnership, I’m confident we will continue to see progress.”

AHCA launched its metric-based Quality Initiative in 2012 and later joined CMS’ National Partnership to Improve Dementia Care in Nursing Homes to raise awareness about safe alternatives to antipsychotic medications for residents and patients with dementia through a systems-based and person-centered approach to care. In 2014, AHCA and CMS set goals to further decrease the use of antipsychotics in skilled nursing centers by a total of 30 percent by December 2016.

In April, CMS added antipsychotic medications to its long-stay quality measure component of Nursing Home Compare to track and encourage improvements in skilled nursing care centers.

The Association expanded its Quality Initiative in May 2015 to include eight measurable targets that align with the CMS Quality Assurance/Performance Improvement (QAPI) program and federal mandates, such as Five-Star and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act. For more information, visit the AHCA Quality Initiative website.

AHCA Submits Statement for Congressional Hearing Record on VA Provider Agreements

Dana Halvorson



The office of the Chairman of the House Committee on Veterans’ Affairs, the Honorable Jeff Miller (R-FL-01), requested a statement from AHCA for the May 24 hearing record relating to the topic of making permanent the Veterans Choice Program. AHCA’s Senior Vice President of Government Relations, Clif Porter, noted in the AHCA statement that nursing care centers are currently not included in the Veterans Choice Program as one of the eligible health care providers, and that AHCA has been advocating for policies which would grant the U.S. Department of Veterans Affairs (VA) the legislative authority to enter into Provider Agreements for extended care services. As you know from previous correspondence, 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.

VA Provider Agreements would help to ensure that our skilled nursing care centers are able to care for veterans in their communities. Our centers already meet very strict compliance guidelines under the Medicare and Medicaid programs. Adding additional regulations on top of this is simply inefficient, redundant and takes staff time away from these veterans at the bedside. 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.

AHCA/NCAL LTC Career Center Launches a 25% Off Sale for New Users

Dave Kyllo

If you have never used the AHCA/NCAL Long Term Care Career Center, now is the time to give it a try because new users receive 25% off their first posting. Simply enter promo code New25off to receive this special discounted price.

Employers who utilize the site also receive superior exposure through rotating job listings on AHCA’s home page – the web site where long term care professionals go for news and information. In addition, employers who post vacancies through the center receive bonus rotating listings on the Long Term Care Career Center home page.

Rates for posting job vacancies are affordable and give prospective employers far greater exposure than local ads and job boards by connecting to a network of more than 330 health care organizations and societies. Employers are also able to post vacancies as they occur and search resumes on the network. And, of course, the LTC Career Center is always free for job seekers.

To reach talented health care professionals, check out the LTC Career Center today and remember to enter promo code New25off to save 25% on your first job posting.

Claim Review Programs Could Improve

Dianne De La Mare

The US General Accounting Office (GAO) has released a report, Claim Review Programs could Be Improved With Additional Prepayment Reviews and Better Data, recommending that the Centers for Medicare & Medicaid Services (CMS): 

1) request legislation allowing the Medicare Recovery Auditors (RAs) to conduct prepayment claim reviews; and 

2) provide written guidance on calculating savings from prepayment reviews. 

The US Department of Health and Human Services (HHS) disagrees with GAO’s first recommendation; but concurs with the second recommendation. The, GAO was asked to examine the different Medicare claim review contractor activities. GAO specifically examined: 1) differences between prepayment and postpayment reviews and how contractors use them; 2) the extent to which the claim review contractors focus their reviews on different types of claims; and 3) CMS’ cost per review and amount of improper payments identified by the claim review contractors per dollar paid by CMS. GAO found that CMS uses different types of contractors to conduct prepayment and postpayment reviews of Medicare fee-for-service (FFS) claims. 

Medicare Administrative Contractors (MACs) conduct prepayment and postpayment reviews. RAs generally conduct postpayment previews. Supplemental Medical Review Contractors (SMRCs) conduct postpayment reviews as part of CMS-directed studies. Overall, there are few significant differences between conducting and responding to prepayment and postpayment reviews, according to the report. Using prepayment reviews to deny improper claims and prevent overpayments is consistent with CMS’ goal to pay claims correctly the first time and can better protect Medicare funds because not all overpayments can be collected. 

In 2013 and 2014, 98 percent of MAC claim reviews were prepayment, and 85 percent of RA claims reviews and 100 percent of SMRC reviews were postpayment. Because CMS is required by law to pay RAs contingency fees from recovered overpayments, the RAs can only conduct prepayment reviews under a demonstration. From 2012-2014, CMS conducted a demonstration where the RAs conducted prepayment reviews and were paid contingency fees based on claim denial amounts. CMS official considered the demonstration a success. 

However, CMS has not requested legislation that would allow for RA prepayment reviews by amending exiting payment requirements and thus maybe missing an opportunity to better protect Medicare funds. The various contractors focused their reviews on different types of claims and had different costs per review. The RAs focused their reviews on inpatient claims, and had an average cost per review of $158. The MACs focused their reviews on physician and durable medical equipment (DME) claims, and had an unidentifiable cost per review. The SMRCs focused on a variety of claims reviews, and had an average cost per review of $256.

ACOs and 3-Day Stay Waiver for Skilled Nursing

Dana Halvorson

Earlier this week, McKnight’s released an article entitled, Few ACOs interested in 3-day stay waiver for skilled nursing, experts say, by Emily Mongan. The article includes that, “Few accountable care organizations are lining up to waive the three-day stay requirement for skilled nursing facilities, causing some healthcare experts to wonder if the waiver is still relevant.” The article goes on to note that, “The three-day stay waiver, which is set to kick in for Shared Savings Program ACOs in January 2017, allows providers to sidestep the three-day hospital stay requirement if a Medicare beneficiary is discharged to a skilled nursing facility with at least a three-star rating. The waiver will be available only to ACOs participating in Track 3 of the SSP program, where providers can reap rewards if they demonstrate improved quality and reduce spending but face the risk of penalties if they don't.” James Michel, senior director of Medicare reimbursement and policy for AHCA, is also quoted in the article. To learn more about the three-day stay rule and the observation stays issue, please visit the AHCA/NCAL website.

DOL Publishes Final Overtime Rule

Urvi Patel

Today, the Department of Labor final rule Defining and Delimiting the Exemptions for Executive, Administrative, Professional, Outside Sales and Computer Employees was published. Below is a brief summary of the rule prepared by ReedSmith.

The final rule includes:

·         Increases the weekly salary threshold for exempt executive, administrative, and professional employees to $47,476 per year (or $913/week), less than last summer’s proposal. This means that salaried employees earning less than this amount, regardless of job duties, must be compensated for overtime work.
 

·         Automatically updates the salary level for the “white collar” exemptions every three years, beginning on January 1, 2020. Each update will index the salary level for exempt employees to the 40th percentile of weekly earnings for full-time salaried workers in the lowest-wage Census region. At present, the DOL expects that the 2020 update will raise the salary threshold to $51,168/year ($984/week). Beginning August 1, 2019, the DOL will post the new salary levels 150 days in advance of their effective date.
 

·         Allows up to 10% of the salary threshold for exempt executives, administrators, and professionals to be satisfied by non-discretionary bonuses, incentive pay, or commissions, provided that such payments are made on at least a quarterly basis.
 

·         Increases the annual compensation level for the “highly-compensated employee” exemption, an amalgam of the “white collar” exemptions, from $100,000 to $134,004 (of that, at least $913/week must be paid on a salary basis). This will be updated every three years, also beginning on January 1, 2020, by indexing such compensation to the 90th percentile of income for full-time salaried workers nationally. The DOL currently expects the salary threshold for this exemption to rise to $147,524/year in 2020.
 

·         Does not modify the duties tests associated with the “white collar” exemptions.

The full text of the final rule can be found here. The new regulations take effect on December 1, 2016.

AHCA/NCAL is working with our legal consultant Jackson Lewis and will be providing more details on the rule in the near future. 

Latest #ProviderChats Discussion Available

Katherine Merullo

Last week, Provider Magazine hosted a Twitter chat on Elder Care and the Women. During the hour long discussion we heard from panelists as they discussed the importance of female caregivers in both the family and professional roles.  Our panelists had such great advice and information to share, the Twitter discussion could have lasted another hour.

If you missed the discussion, read online  to find the useful ideas and resources that were discussed.  No need for a Twitter account to see what was asked, and how the variety of experts on the panel answered the questions.

Provider hosts quarterly Twitter chats.  If you have a topic that needs to be discussed, please feel free to share it with them.  If you're the subject matter expert and wish to be a part of the panel, we'll let you know what that entails. Email us your suggestions.

Rep. Becerra to Speak at Congressional Briefing

Drew Thies

Representative Xavier Becerra will speak to long term and post-acute care advocates at the 2016 AHCA/NCAL Congressional Briefing on May 24. The California Democrat is the fourth-highest ranking member of his party in the House of Representatives and the highest-ranking Latino on Capitol Hill.

Becerra is known as a renowned policy expert and political operator who actively shapes the Democratic Party’s issues and messaging. Many have speculated he may be chosen as this year’s Democratic candidate for Vice President.

Becerra also serves on the powerful Ways & Means committee, which has broad jurisdiction over Medicare and healthcare policy.

The AHCA/NCAL Congressional Briefing will also feature speeches from Rep. Greg Walden (R-OR) and political analyst Chuck Todd to over 400 advocates at the Renaissance Hotel in Washington, D.C.

Top Country Artists Take the Stage at the Gala Dinner & Show

meetings@ahca.org

When you register for the AHCA/NCAL Annual Convention & Expo, be sure to get your tickets for the Gala Dinner & Show. They don’t call Nashville the Music City for nothin’, and we’re giving you a taste of that thriving music scene at the Gala Dinner & Show. In the spirit of the Grand Ole Opry, this year features three artists, each with their own unique style and sound. Don’t miss these popular artist: Charlie Daniels, Jo Dee Messina and Phil Vassar.

This event will sell out, so order your tickets early!

New PBJ Resource: Checklist

Urvi Patel 

AHCA/NCAL has created a one page checklist which outlines the major steps that companies should take to be compliant with the Payroll Based Journal (PBJ). No matter where you are in the process of compliance, this checklist will give you a sense of the major steps needed.

 Be sure to visit ahcancalED for PBJ resources like on demand webinars, FAQ documents, and more.

AHCA Education: Payroll Based Journal (PBJ)...Mandatory Staffing Data Collection 

Also check out these companies that offer customized service for PBJ: Kronos, American HealthTech, eHealth Data Solutions, Kronos, MatrixCare, Muller Prost, OnShift, Prime Care Technologies, Smartlinx, StaffScheduleCare. Please note AHCA does not recommend one vendor over another.

One Employee, Two Employees, Three Employees, Four…

Dave Kyllo

A new tax tip from the Internal Revenue Service (IRS) reminds employers of the importance of knowing how many full-time employees they have because two provisions of the Affordable Care Act – employer shared responsibility and employer information reporting for offers of minimum essential coverage – apply only to applicable large employers (ALEs). Whether an organization is an ALE for a particular calendar year depends on the size of its workforce in the preceding calendar year.

To be an ALE, an employer must have had an average of at least 50 full-time employees – including full-time-equivalent employees – during the preceding calendar year. Employers average the number of their full-time employees, including full-time equivalents, for the months from the previous year to see whether they are considered an applicable large employer. So, for example, employers will use information about the size of their workforce during 2016 to determine if their organization is an ALE for 2017.

The IRS tax tip offers helpful links and information on how to determine whether an employee is full-time.

Concerned about rising employee health benefit costs? Know that AHCA/NCAL members are saving money on their employee health benefit programs through AHCA/NCAL Insurance Solutions. One not-for-profit member is saving more than $2,100 annually per employee. AHCA/NCAL Insurance Solutions may be able to save you money too. For more information about health plan options available through AHCA/NCAL Insurance Solutions, contact Dave Kyllo at 202-898-6312 or Nick Cianci at (202-898-2841) or email us at ahcainsurancesolutions@ahca.org.   

Nomination Deadline Nears

Dana Halvorson 

2015 NFP Program of the Year Recipient, CARC Inc. Work Services Program

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

Members may submit nominees for these three categories prior to or on May 23, 2016. Honorees will be guests of and recognized at the 67th Annual Convention in October in Nashville, TN.

For additional information please contact Dana Halvorson or read more online.

CMS Announces Medicare Claim Appeals Relief

Dan Ciolek 

The Centers for Medicare and Medicaid Services (CMS) has issued a revised MLN Matters Special Edition article titled “Limiting the Scope of Review on Redeterminations and Reconsiderations of Certain Claims.” Effective for certain Redetermination (Level 1) and Reconsideration (Level 2) appeals received by a Medicare Administrative Contractors (MACs) or Qualified Independent Contractors (QICs) on or after April 18, 2016, MACs and QICs must limit their review to the reason(s) the claim or line item at issue was initially denied. 

In the past, MACs and QICs reviewing Level 1 and Level 2 appeals have had the ability to find new reasons to deny coverage if the original denial reason was overturned. However, these contractors are now prohibited from such activities while conducting redeterminations and reconsiderations of claims denied following 1) a complex prepayment review, 2) a complex post-payment review, or 3) an automated post-payment review by a contractor. It is important to note that this policy does not apply to all claim denials. For example, if an appeal involves a claim or line item denied on an automated pre-payment basis, MACs and QICs may continue to develop new issues and evidence at their discretion and may issue denials for reasons other than those specified in the initial determination.

This policy will not be applied retroactively. See the article for more details.

OSHA Final Rule on Injury and Illness Recordkeeping

Lyn Bentley, MSW

On May 12, 2016, OSHA released a final rule on injury and illness electronic recordkeeping. The final rule is similar to the proposed rule and has two main elements, electronic submission and updates to how employers inform employees to report work-related injuries or illnesses. This final rule becomes effective on January 1, 2017, except for § 1904.35 (relating to employee involvement in the record-keeping system) and § 1904.36 (prohibiting an employer from discriminating against an employee for reporting an illness or injury), which become effective on August 10, 2016.
 
The final rule requires electronic submission of Part 1904 recordkeeping records to OSHA depending on the employer’s size and industry. OSHA will then post the data from employer submissions on a publically accessible Web site. According to the final rule, OSHA does not intend to post any information that could be used to identify individual employees.
 
Employers with more than 250 employees and those employers in identified industries, including assisted living, nursing centers, ICFs/IID, and group homes for individuals with disabilities must submit this information for 2016 to OSHA on July 1, 2017. 
The final rule requires employers to develop employee injury and illness reporting requirements that meet specific criteria. Specifically, employers must inform employees of the following:
 

• Procedures for reporting work-related injuries and illnesses promptly and accurately. According to the final rule, a procedure is not reasonable if it would deter or discourage employees from reporting injuries or illnesses;
• Employees have the right to report work-related injuries and illnesses;
• Employers are prohibited from discharging or in any manner discriminating against employees for reporting work-related injuries or illnesses.
  
  

There are two effective dates in the final rule. The most immediate effective date will be August 10, 2016 for the provisions regarding employee injury reporting policies. Specifically, the requirements to inform employees they have a right to report a work-related injury and the prohibition from discharging or otherwise discriminating against employees for reporting work-related injuries or illnesses. These provisions will be effective 90 days after publication in the Federal Register.

If you have additional questions, please contact Lyn Bentley.

Special thanks to Jackson Lewis PC, the consultant to AHCA/NCAL on workforce issues, for allowing us to use portions of their recent blog post in this announcement. 

OFCCP Publishes Revised Functional Affirmative Action Plans

Dana Halvorson

According to a May 16, 2016, legal alert from Ford & Harrison LLP, the Office of Federal Contract Compliance Programs (OFCCP) has published a revised directive regarding the use of Functional Affirmative Action Plans (FAAPs). A FAAP requires specific OFCCP approval and is a departure from the typical ‘establishment-based’ AAP structure for multi-establishment facilities, using an AAP structure that is more in line with the business functions or business units of the contractor.

A functional or business unit refers to a component within an organization that operates autonomously in the ordinary course of the organization's business. To be considered suitable for a FAAP, the functional or business unit must: 1) currently exist and operate autonomously; 2) include at least 50 employees; 3) have its own managing official; 4) have the ability to track and maintain its own personnel activity.

The alert goes on to include that “the OFCCP had issued guidance establishing procedures for approving such requests, most recently in 2012. The 2016 publication revises the FAAP directive to clarify the requirements of the program. Revisions include:

· Contractors are no longer required to provide a copy of a qualifying federal contract. Instead, the agency requires the contractor to provide specific information about contract coverage, including the contract number from a qualifying contract and that contract's dollar amount, contract period, and the name of the prime contractor (if applicable).

· Contractors are now required to provide information related only to subsidiaries that will be included in the FAAP, rather than all subsidiaries as previously required.

· The FAAP Branch will make every effort to gather sufficient information regarding the contractor's corporate structure to process the FAAP agreement request; however, the agency states that it may be necessary to meet with the contractor to make a final determination on the request.

· Contractors with approved FAAP agreements will undergo at least one compliance evaluation during the term of their FAAP agreement.”

This new directive became effective on April 28, 2016. The full legal alert on it from Ford & Harrison LLP 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.

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. 

Comprehensive CMS-Supported Online Dementia Training at Bargain Prices for Members

Dave Kyllo

For the past year, CARES® Complete Catalog™ has been providing organizations and facilities access to all 6 CARES online dementia training courses for one low price. Due to growing customer interest and the recommendations of several AHCA/NCAL members, this option is now available for individuals, too!

For only $149.95—a savings of more than 25% over buying the 6 programs and certifications one at a time—you get the same 32 hours/32 modules of video-based dementia care training featuring real people with dementia and their caregivers in everyday scenarios. AHCA/NCAL members receive an additional 10% off the $149.95 purchase price by entering promo code AHCA10 when ordering. 

CARES® is the only online dementia training program recommended nationally by CMS to meet the Affordable Care Act Section 6121 mandate for nurse aides. And, staff that is well trained in dementia care and managing difficult behaviors is key to safely reducing the off-label use of antipsychotics – one of AHCA/NCAL’s Quality Initiative goals. 

In the new individual purchase option, each of the 6 programs is available for 10 days. Start with the prerequisite course, CARES® Dementia Basics™ (4 modules/4 hours), complete it within 10 days, and take the Alzheimer’s Association essentiALZ® certification exam (at no additional cost!). Then, continue with the CARES® Plus courses in any order and at your convenience (each program is activated individually and is then available for completion within 10 days). It is recommended that CARES® participants take the associated essentiALZ® Plus certification exam immediately after completing each course.

To purchase the CARES Complete Catalog for individuals or facilities, call (952) 928-7722 or visit www.hcinteractive.com/ccc (for facilities) or www.hcinteractive.com/ccci (for individuals).

CMS issues Save the Date for SNF QRP Provider Training

Holly Harmon

The Centers for Medicare & Medicaid Services (CMS) will be hosting a 2-day training event for the Skilled Nursing Facilities (SNF) Quality Reporting Program (QRP) on Tuesday, June 21, and Wednesday, June 22, 2016, at the Omni Atlanta Hotel at CNN Center.

This important training in Atlanta, Georgia, is open to all SNF providers, associations, and organizations. The objective of this train-the-trainer event is to provide SNFs with an overview of the requirements under the IMPACT Act and the QRP including:

• Information about the Quality Measures included in the SNF QRP
• Guidance on coding the Minimum Data Set (MDS)--Resident Assessment Instrument (RAI) to comply with the QRP requirements
• Data collection and submission requirements for the fiscal year 2018 Annual Percentage Update (APU) and subsequent years

Information about how to register and discounted hotel room rates will be coming shortly. Please mark your calendars.

If you have questions or need additional information, please email the PAC Training mailbox at PACTraining@econometrica.com.

OCR Releases New HIPAA Audit Protocol

Dianne De La Mare


The US Department of Health and Human Services, Office of Civil Rights (OCR) has released the new Health Insurance Portability and Accountability (HIPAA) Audit protocol, which reviews the policies and procedures adopted and employed by covered entities and business associates to meet selected standards and implementation specifications of the Privacy, Security, and Breach Notification Rules. 

These analyses are conducted using the new comprehensive audit protocol that has been updated to reflect the Omnibus Final Rule. The audit protocol is organized by Rule and regulatory provision and addresses separately the elements of privacy, security, and breach notification. The audits performed assess entity compliance with selected requirements and may vary based on the type of covered entity or business associate selected for review. 

Providers may submit feedback about the audit protocol to OCR at OSOCRAudit@hhs.gov.

Medicaid Program Integrity Podcast

Dianne De La Mare

The US Department of Health, Centers for Medicare & Medicaid Services (CMS) continues to release podcasts on its Medicaid program integrity site. The latest podcast is titled June 2016 Podcast - Reporting Fraud and Suspected Fraud, and is posted along with the June 2016 Reporting Fraud and Suspected Fraud podcast transcript. 

Since January 2016, CMS has posted numerous podcasts including topics such as: Improper Payments, Home and Community-Based Services, Medicaid Documentation, Off-Label Use of Prescription Drugs; Basic Audit and Data analysis; and Provider Self-Disclosure. 

To view all of the podcasts go to https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/podcasts.html.

OIG Releases Enhanced Medicare Enrollment Report

Dianne De La Mare


The US Department of Health, Office of Inspector General (OIG) has released a report, Enhanced Enrollment Screening of Medicare Providers: Early Implementation Results, that discusses the Centers for Medicare & Medicaid Services’ (CMS) efforts to enhance the enrollment screening process for Medicare providers with new antifraud tools such as placing providers in risk categories, increasing site visits, requiring fingerprinting, implementing an Automated Provider Screening system and denying enrollment to providers whose owners have resolved overpayments. 

This report examines CMS’ early implementation of these new screening tools, which are intended to prevent illegitimate providers from enrolling in the Medicare program. The data in the report was obtained from CMS’ enrollment and revalidation applications submitted for the 1-year period before the implementation of enhanced screening procedures (e.g., March 25, 2010-March 24, 2011) and the 1-year period after the implementation of enhanced screening procedures (e.g., March 25, 2012-March 24, 2013). 

In the report, OIG also recommends that CMS implement the following processes:

 1) monitor contractors to determine whether they are verifying information on enrollment and revalidation applications as required; 

2) validate that contractors are appropriately considering site visit results when making enrollment decisions; 

3) revise and clarify site visit forms so that they can be more easily used by inspectors to determine whether a facility is operational; 

4) require the National Site Visit Contractor (NSVC) to improve quality-assurance oversight and training of site visit inspectors; and 

5) ensure that CMS's enrollment data system contains the complete and accurate data needed to execute and evaluate CMS's enrollment-screening enhancements.

Rep. Joe Courtney Contacts HHS Secretary Burwell on Observation Stays Issue

Dana Halvorson

Last week, Rep. Joe Courtney (D-CT) sent the U.S. Secretary of Health and Human Services (HHS), the Honorable Sylvia Burwell, a letter on the observation stays issue and two-midnight rule. Rep. Courtney has been in touch in the past with HHS on the observation stays matter. In this particular letter, the Congressman specifically requested support of his bipartisan legislation, Improving Access to Medicare Coverage Act (S. 843/H.R. 1571), that would count a patient’s time in observation toward the three-day hospital inpatient stay requirement.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) is part of the Observation Stays Coalition consisting of several national provider and patient advocacy organizations who advocate on the Improving Access to Medicare Coverage Act. To learn more about this issue and the Coalition, please visit the Observation Stays page on the AHCA/NCAL website.

CMS Issues Guidance to Surveyors on Federal Requirements for Providing Services to Justice Involved Individuals

Lyn Bentley, MSW


On May 3, 2016 CMS posted a Survey & Certification (S&C) memo that provides new surveyor guidance “… clarifying requirements for providing services to justice involved individuals in skilled nursing facilities (SNFs), nursing facilities (NFs), hospitals, psychiatric hospitals, critical access hospitals (CAHs), and intermediate care facilities for individuals with intellectual disabilities (ICFs/IID). Specifically, this guidance seeks to assure high quality care that is consistent with essential patient rights and safety for all individuals.” The memo is effective immediately.

For SNFs/NFs, the memo emphasizes the importance of each facility ensuring the rights of all residents consistent with law and regulation. Importantly, nursing home residents must not only be able to exercise their rights as residents of the facility and as citizens of the United States (e.g., the right to vote in elections), but also have the right to be free of interference, coercion, discrimination, or reprisal from the facility in exercising those rights.

The memo specifies, “The facility may not establish policies or impose conditions on the resident that result in restrictions which violate federal law and regulation outlined in 42 CFR Part 483, Subpart B. Examples of prohibited facility restrictions include, but are not limited to:

• The facility makes a determination as to which visitors a resident may or may not see. The resident has the right to choose his or her own visitors;

• The facility requires or implements a DOC or law enforcement restriction that the individual must reside in a locked unit in the SNF or NF for reasons that are not derived directly and exclusively from the resident’s assessment(s) as conducted by the facility’s medical professionals;

• The facility does not allow a resident to possess a personal telephone and/or denies a resident the right to conduct telephone conversations in private; or,

• The facility has a requirement that a resident must wear an item (e.g., a color-coded bracelet) that indicates to staff that they are justice involved.”

National Emerging Leadership Summit (NELS)

Urvi Shah

AHCA/NCAL is a proud sponsor of the National Emerging Leadership Summit. Targeted toward Healthcare Administrators in Health and Aging Services, the Summit aims to increase, improve and support the profession to attract talent and future leaders. Summit Participants:

•    Identify, develop, and refine solutions for the next generation of leaders building on themes from the previous year's emerging leaders
•    Meet with representatives of key professional organizations and gain an inside perspective on the legislative process
•    Engage in discussions with other leaders in the field of health and aging services administration to advance an agenda of action

Interested administrators should apply for the limited spaces by May 9th, 2016. See more details here.

Summer Signals Start of Congressional Briefing, Facility Tours

Drew Thies

Both the House and Senate are out this week for the first time in what will prove to be a high-travel season for many Members of Congress fighting to retain their seat this election year.

 The district work week—the first of many this summer—allows time for Members of Congress to meet with constituents ahead of the November general election and serves as a great opportunity for skilled nursing and assisted living providers to invite lawmakers to tour a building.

Many of these tours have already kicked off. Rep. Dave Loebsack (D-IA), a member of the influential Energy and Commerce Committee, visited Briarwood Health Care Center in Iowa City earlier this week.

AHCA/NCAL has a complete set of materials free online for owners and administrators to use, detailing everything from how to contact a Member of Congress to how to handle press, if necessary.

May also marks the month of the annual AHCA/NCAL Congressional Briefing, a crucial time for providers to come to D.C., advocate on behalf of the profession, and invite Members of Congress to tour when they are back in their home districts later this year.

This election year, advocates can expect to get timely political updates from respected Washington journalists like Chuck Todd and Congressional leaders such as Greg Walden.

Following the Congressional Briefing, Members of Congress will once again be back in the districts for constituent work during the Memorial Day week, May 30th –June 3rd. A complete list of district work weeks when Members of Congress will be in town for potential tours ahead of the election is below (excluding weekends).

June 27-July 4: House

July 4-July 6: Senate

July 18-July 22: Democrats (GOP at convention)

July 25-July 29: Republicans (Democrats at Convention)

August 1-September 5: Both Chambers

October 1-October 7: House

October 10-November 11: Both Chambers

AHCA/NCAL ANNUAL CONVENTION: EARN CEUs WITH OUTSTANDING EDUCATION SESSIONS

meetings@ahca.org

Whether your focus is clinical or administrative, assisted living or SNF, the 2016 education program has just what you need. The comprehensive education agenda at the AHCA/NCAL Convention & Expo, covers all the issues that will help you be successful in your community or organization. The programming has been thoughtfully designed to bring you practical, implementable, real-world solutions for the challenges you face every day.

Earn up to 15.5 CEUs by attending the main convention program. Participation in RSVP events and separate ticketed events can add to your CEU count. And if you purchase the Premium Full Registration Package, you can increase your CEU count even more — you get access to the sessions you may have missed by listening to them in webinar format.

So get inspired in Nashville! You'll be glad you did.


Find out more about all the exciting education programs.

NCAL Day Turns 10 This October

2015 NCAL Awards Recipients

Rachel Reeves

For nearly a decade, NCAL has offered assisted living providers a day of cutting edge education just for them as we kick off AHCA/NCAL’s Convention & Expo. Do not miss your chance to learn the latest on the assisted living profession and network with peers and business partners from around the country. Join us Sunday, October 16 in Nashville at this milestone event – the 10th Annual NCAL Day!

Hear from keynote speakers Dr. Manny Alvarez, Senior Managing Health Editor for Fox News and Jim Carroll, a futurist, trends and innovation expert. Dr. Alvarez will offer valuable health-related information, insider insight into medical research, and inspiring stories of how he triumphed over adverse conditions to achieve the American dream. Carroll will help attendees peer into the crystal ball and offer unique insights on the workforce challenges the long term care profession faces.

The rest of the day offers educational sessions (and a total of 5.5 CEUs) on the following hot topics:

• Emerging Regulatory & Policy Trends
• The Future of Technology
• Quality Measures
• Making Assisted Living More Affordable
• Recruiting and Retaining Workforce

NCAL Day’s luncheon promises a moving ceremony recognizing the best in the assisted living profession. Awards will be bestowed to recipients of:

• NCAL Administrator of the Year
• NCAL Nurse of the Year
• NCAL Noble Caregiver of the Year
• NCAL National Assisted Living Week® Programming Award
• Jan Thayer Pioneer Award

(Nominations remain open for the NCAL Awards Program and the Jan Thayer Pioneer Award. Recognize a deserving colleague now!)

NCAL Day is a separate ticketed event that must be added to your Convention registration. Adding NCAL Day to your full meeting package only costs $195. For those only attending NCAL Day, members can purchase a ticket for $495, non-members for $645.

Learn more about the AHCA/NCAL Convention & Expo this October 16-19 in Nashville at www.ncalconvention.com.

New Resources About Self-Funded Employee Health Insurance Plans

Dave Kyllo

The concept of having a self-funded employee health insurance plan may seem overwhelming but these plans can easily be constructed to limit an employer’s financial exposure. Such plans typically include stop loss coverage to protect against high-dollar claims and frequently are less expensive than fully insured health plans. Several AHCA/NCAL independent owner members have moved to self-funded plans through AHCA/NCAL Insurance Solutions and saved considerable money on their employee health benefit expenses.

Members who interested in better understanding how self-funded insurance plans work and how they may be the smart choice for their operations can check out new resources available on the AHCA/NCAL Insurance Solutions web page. The first resource is a summary explanation from Meritain about self-funded health insurance plans. The second resource is a Meritain white paper that discusses important factors employers should consider in determining whether a self-funded employee health plan makes sense. 

If you’re concerned about your employee health insurance costs or want to learn more about self-funded employee health plans, AHCA/NCAL Insurance Solutions is a resource available to all AHCA/NCAL members. For more information about health plan options available through AHCA/NCAL Insurance Solutions, contact Dave Kyllo at 202-898-6312 or Nick Cianci at 202-898-284 or email ahcainsurancesolutions@ahca.org.   

OIG Issues New Exclusion Guidance

Dianne De La Mare

The OIG has released a revised policy statement concerning exclusions imposed under Section 1128(b)(7) of the Social Security Act, which OIG uses to exclude individuals or entities from participation in the federal health care programs. OIG typically invokes this section when initiating exclusion proceedings within the context of the False Claims Act (FCA). The revised document describes how the agency evaluates risk to the federal health care programs; and how it overhauls the non-binding factors that it uses in determining that some period of exclusion should be imposed against an individual or entity that has defrauded Medicare or any other health care program. The revised statement supersedes and replaces the 1997 policy statement published by the OIG.

The revised statement describes the process that OIG uses to evaluate risk to federal health care programs, and overhauls the factors used by OIG in determining whether and for how long to impose an exclusion under Section 1128(b)(7) including, but not limited to reviewing: a) the nature and circumstances of the conduct; b) the conduct during the government’s investigation; c) significant “ameliorative efforts” (e.g., internal disciplinary actions, new compliance initiatives, etc.); and d) the history of compliance.

The revised statement also creates a specialized litigation team that will concentrate solely on levying civil money penalties (CMPs) and excluding individuals and entities from Medicare and Medicaid as punishment for alleged fraud schemes.

Employer Deadlines are Approaching for Filing 1094-B&C and 1095 –B&C Forms with the IRS

Dave Kyllo

All applicable large employers – employers with 50 or more full-time employees, including full-time equivalents – must provide the Internal Revenue Service must file their paper 1095-C forms by May 31 or E-file with the IRS by June 30 according to a recent IRS announcement reminding employers of the upcoming deadlines. 

Employers filing 250 or more Forms1095-B or 1095-C forms must file electronically which requires an application process separate from other electronic filing systems. Self-insured employers that are not applicable large employers have identical deadlines for filing their 1094-B and 1095-B forms with the IRS. 

For more information about the Affordable Care Act and IRS requirements, go to IRS.gov/aca. 

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 ahcainsurancesolutions@ahca.org.

New SNF PEPPER Now Available

Dianne De La Mare

The Centers for Medicare & Medicaid Services (CMS) Contractor, TMF Health Quality Institute, has just released the 4th Quarter FY 2015 skilled nursing facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2015 is now available. Free-standing SNFs can download PEPPER through the PEPPER Resources Portal.

Specifically, the appropriate staff person should:
a) review the Secure PEPPER Access Guide;
b) review the instructions and obtain the information required to authenticate access (Note: a new validation code is currently required. A patient control number or medical record number from a claim for a traditional Medicare fee-for-service (FFS) beneficiary with a “from” or “through” date in September 1-130 is required);
c) visit the PEPPER Resources Portal;
d) complete all the fields; and e) download the PEPPER. By way of background, PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments.

Providers are encouraged to use the data to support internal auditing and monitoring activities.

Rural Health Care Access Legislation Approved out of Full House Committee

Dana Halvorson

Last week, the full House Energy and Commerce Committee approved Rural Health Care Connectivity Act of 2015 (S. 1916/ H.R. 4111).   AHCA is in full support of this legislation that would amend the Communications Act to permit eligible not for profit and public 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/H.R. 4111 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.

Last month, Dan Holdhusen, Director of Government Relations at the Evangelical Lutheran Good Samaritan Society and AHCA member, testified in front of the Energy and Commerce Subcommittee on Communications and Technology during a hearing in support of the Rural Health Care Connectivity Act of 2015. Dan encouraged swift passage of this important legislation. On April 19, the Subcommittee cleared and passed H.R. 4111.

Next steps include full Senate and House consideration. AHCA will keep its membership apprised on further updates relating to this legislation.

IRS Health Care Law Webinars Available for Employers and Health Coverage Providers

Dana Halvorson


According to a May 3 email update from the Internal Revenue Service (IRS), “Employers and health coverage providers have access to newly updated webinars from the IRS. These recorded webinars explain the employer provisions, information reporting, and related tax requirements that are part of the Affordable Care Act. If you are a business owner, tax manager, employee benefits manager, or health coverage provider, you can access and review these videos on the IRS Video Portal at your convenience.”

More information about the health care law in general can be found on the AHCA/NCAL website.

Kaiser Family Foundation Releases Infographic on Employer-Sponsored Health Insurance

Dana Halvorson 

On May 3, the Kaiser Family Foundation (KFF), in partnership with the Journal of the American Medical Association (JAMA), released a Visualizing Health Policy infographic that looks at eligibility and coverage trends in employer-sponsored health insurance. According to an email alert from KFF on the infographic, “Between 2000 and 2015, the share of workers covered by health benefits offered by their employers dropped from 63 percent to 56 percent, with some firms not offering coverage and some employees not enrolling when coverage is offered. The biggest decrease occurred among employees working for small firms (3-199 workers). Among people younger than 65, those with lower incomes continued to be less likely to have coverage from an employer-sponsored health plan, as has been the trend since 1999.

In 2015, larger firms were more likely than smaller ones to offer health benefits, as were organizations with more higher-wage employees, fewer lower-wage employees, and fewer workers younger than 26. Most large employers offered coverage to spouses and other dependents, while fewer than half of these firms offered coverage to same-sex or opposite-sex domestic partners. Few firms took action in 2015 in response to the Affordable Care Act’s employer mandate, including changing some jobs from part-time to full-time so employees would be eligible for coverage.”

More information about the health care law in general can be found on the AHCA/NCAL website.

Oral Health America Releases State-by-State Report

Dana Halvorson


Oral Health America (OHA) recently released its biennial report entitled, A State of Decay: Are Older Americans Coming of Age without Oral Healthcare? According to the Toothwisdom.org website, “A State of Decay Vol. III by OHA is a state-by-state report of the oral health of the country's 65+ population and the success or failure of states to address those needs. The 2016 State of Decay is the 3rd in a series of reports from OHA surveying the state of oral health for older Americans. It is one of five strategies for OHA’s Wisdom Tooth Project®, a program designed to meet the oral health challenges of a burgeoning population of community dwelling older adults, their family caregivers and the health professionals who work to help them age healthily and independently.” The full report can be found here. 

It’s a Small World

Tom Burke

As long term and post-acute care professionals are about to celebrate “National Nursing Home Week,” May 8 to 14, 2016, and May is Older Americans Month, this is an excellent time for everyone to reflect on their role and how best to contribute to improving the lives of residents, patients and clients, as well as improving both the skills of the professional and the public perception of the profession.


The American Health Care Association (AHCA), which established the special week in 1967, has chosen this year’s theme to be “It’s a Small World, with a Big Heart” to commemorate a historical time for older adults:

• Today’s residents will remember the New York World’s Fair of the 1960s and two songs popular in that era: Disney’s “It’s a Small World After All” and the New Seekers’ “I’d Like to Teach the World to Sing,” a sentiment shared by all.
• “With a Big Heart” symbolizes staff and families embracing the resident or patient with individualized care, social interaction, and a compassionate heart.

Join with others in the profession to recognize National Nursing Home Week. It’ll be fun! Let the community see that skilled nursing care centers are, indeed, operating in the fast lane of health care, yet at the pace of older adults and other vulnerable individuals.


Be a friend too! “Like” the Nursing Home Week Facebook page and be sure to visit the home page here.