Wednesday, November 30, 2016

ACL Updates FAQs for States’ Long-Term Care Ombudsman Programs

Lilly Hummel

The Administration for Community Living (ACL) published new Frequently Asked Questions that provide additional guidance to implement the final regulations regarding States’ Long-Term Care Ombudsman Program. State Long-Term Care Ombudsman programs (Ombudsman programs) serve as advocates for residents of nursing homes, board and care homes, assisted living and similar adult care facilities. They work to resolve problems of individual residents and to bring about improvements to residents' care and quality of life at the local, state and national levels. There has been significant variation in the interpretation and implementation of the Ombudsman program among States. This has resulted in residents of long-term care facilities receiving inconsistent services from Ombudsman programs in some States compared to other States. The new questions cover ombudsman authority to resolve complaints about the guardian or other representative of a resident, conflicts of interest of supervisors, intake processes to handle inquiries, appropriateness of people conducting ombudsman program activities, ombudsman program staff with professional licensing requirements, and court orders to disclose ombudsman program information.

National Influenza Vaccination Week


The Centers for Disease Control and Prevention (CDC) will be celebrating National Influenza Vaccination Week (NIVW) December 4-10, 2016.  This observed week was established in order to highlight the importance of continuing flu vaccination awareness through the holiday season.

Many people do not know the importance and benefits of a flu vaccination.  There will be a National Influenza Vaccination Week Twitter Chat next week, where we will be joined by The American Hospital Association's new Chief Medical Officer Dr. Jay Bhatt. This will be an excellent opportunity to learn some new facts and ask questions about this years' vaccinations.  Follow  #UnitedAgainstFlu on Twitter.

Please mark your calendars for Wednesday, December 7 at 12 PM Eastern time for this Twitter event.

AHCA/NCAL has teamed up with other national health care organizations and the CDC to amplify the importance of flu vaccinations at the United Against the Flu partnership.  We recommend checking out the CDC website for guidance and checking with your medical providers to find out more.

CMS Issues Updates Part B Therapy Code List for 2017 – NEW PT/OT EVALUATION CODES


The recent Centers for Medicare and Medicaid Services (CMS) MLN Matters article MM9782 updates the Medicare Part B therapy code list for Calendar Year (CY) 2017 by adding eight “always therapy” codes (97161 – 97168) for physical therapy (PT) and occupational therapy (OT) evaluative procedures. In the article, CMS also announces the retirement at the end of December 2016 of the four codes currently used to report these services (97001 – 97004). 

Please make sure your therapy and billing staffs are aware of these updates.

Check Updated LEIE Database

Dianne De La Mare


The US Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in October 2016. This new file is meant to replace the updated LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included in this file. 

 The updated files are posted on OIG’s website at http://www.oig.hhs.gov/exclusions/exclusions_list.asp, and healthcare providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines. Instructional videos explaining how to use the online database and the downloadable files are available at http://oig.hhs.gov/exclusions/download.asp.

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



Present at the 2017 AHCA/NCAL Convention

Teresa Eyet

LAST CALL! If you are interested in submitting a proposal for consideration as part of the 2017 AHCA/NCAL Convention & Expo education programming, the deadline is today. All submissions must be received before midnight on Wednesday, November 30th. 

The 68th Annual Convention & Expo will be held October 15-18, 2017 in Las Vegas, Nevada. Now is your chance to share ideas, success stories and professional insights to help enhance the long term and post-acute care profession.

Submission guidelines and topics of interest can be found at https://www.conferenceabstracts.com/cfp2/login.asp?EventKey=XDCVJPOA


Trump Nominates HHS, CMS Heads

Drew Thies


President-Elect Donald Trump announced his picks to lead the Department of Health and Human Services and the Centers for Medicare and Medicaid Services this week.


Trump picked Representative Tom Price, a six-term congressman from Georgia, to be his Secretary of Health and Human Services, the nation’s top health position.


Rep. Price is a former orthopedic surgeon and currently serves as the Chairman of the House Budget Committee. He also serves on the Ways and Means Committee, which controls Medicare policy.


AHCA/NCAL CEO and President Mark Parkinson said of Rep. Price in a statement, “Chairman Price is known throughout the country not only for his medical expertise, but also his breadth of policy when it comes to the nation’s health care system.”


Trump also selected health care consultant Seema Verma to run the Centers for Medicare and Medicaid Services (CMS). The head of CMS reports directly to the Secretary of Health and Human Services.


Verma is the President, CEO and founder of SVC, Inc., an Indiana-based consulting firm that worked with Vice President-elect Mike Pence when he was governor to expand Medicaid in the state. Verma has also worked with many other Republican governors to create Medicaid programs palatable to conservatives.


NCAL Executive Director, Scott Tittle, who worked with Verma in his previous capacity as President of the Indiana Health Care Association, said in a statement, “She has always demonstrated a very thoughtful and collaborative approach to complex health care policy, and I'm excited to see my friend and fellow Hoosier bring this approach to the national level.”


Both Rep. Price and Verma will have to be confirmed by the Senate in order to officially take their posts. Confirmation hearings will occur once Trump is sworn into office in January.

Mark Your Calendars – AHCA’s 2017 ID/DD Hill Fly-In Event Date Set!

Dana Halvorson

AHCA’s Intellectual and Developmental Disabilities (ID/DD) Residential Services Providers annual Hill Fly-In event will occur on Wednesday, March 22, 2017, at the AHCA/NCAL offices in Washington, DC. This important event is free to attend. Breakfast and a boxed lunch will be provided to registrants. Congressional speakers are being invited, a legislative update will be provided, and Hill visits will follow in the afternoon. We will provide one-pagers and talking points for registrants to take to the Hill.

If you would like to attend or have any questions, please contact AHCA’s Senior Director of Not for Profit & Constituent Services, Dana Halvorson.  We hope to see you at this important event!










Wednesday, November 23, 2016

Federal Overtime Rule Postponed – New Regulations Will Not Take Effect December 1, 2016

Urvi Patel


Yesterday, a U.S. District Court judge in Texas ruled in favor of preliminary injunction for the Department of Labor’s (DOL) overtime rule, delaying its implementation nationwide. The rule is halted and will not go into effect on December 1, 2016.


The rule, previously set to take effect Dec. 1, and the biggest change to U.S. labor law in more than a decade, would double (to $47,476) the salary threshold under which virtually all workers receive time-and-a-half pay whenever they work more than 40 hours in a given week. The Labor Department has estimated that the rule change would affect 200,000 hospital workers and 300,000 non-hospital health care workers. The Trump administration also could move to reverse the measure.

The Court’s ruling halts enforcement of the overtime rule nationally until it has had an opportunity to complete consideration of the underlying case. The US DOL’s rule that would have increased the minimum salary level for exempt employees from $455 per week ($23,660 annually) to $921 per week ($47,892 annually) WILL NOT go into effect on December 1, 2016, as originally scheduled.

AHCA/NCAL will keep you posted with updates.

CMS issues notice of issue with submitted MDS 3.0 assessments



An issue has been identified with MDS 3.0 assessment records submitted to the ASAP (Assessment Submission and Processing) system beginning October 1, 2016, through November 4, 2016. This issue impacts all NO and SO (Nursing Home and Swing Bed OMRA Other) assessment records with a target date on or after October 1, 2016 and may have resulted in an incorrect ASAP system-calculated RUG code for these assessments. No other assessment record types were affected by this issue. This issue involves submitted MDS response values for M0300B1, M0300C1, M0300D1, and M0300F1 for NO and SO assessment records. The submitted response values were not stored in the ASAP system, despite being required for the NO and SO assessment record. Since these items were not stored, they were excluded from validation and RUG calculations that would have occurred during this time period.


All providers who submitted MDS NO and SO assessment records on or after October 1st through November 4th, with a target date of October 1, 2016 or after, must submit a modification record to the ASAP system. No changes are required in this modification record. Providers may not submit the original record a second time as it will be rejected as a duplicate record if it was accepted into the ASAP system in the original submission. Submission of the modification record will allow the ASAP system to correctly recalculate the RUG value and have accurate data stored for reporting purposes.


If you have any questions concerning this information, please contact the QTSO Help Desk at help@qtso.com or 1 (888) 477-7876.

Tuesday, November 22, 2016

CMS Finalizes New RA Program Contracts

Dianne De La Mare


The US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) has awarded 5 new contracts for Medicare's Recovery Auditor (RA) program to Performant Recovery, Cotiviti and HMS Federal Solutions. Performant Recovery and Cotiviti both have 2 contracts, and will operate in two different regions. Past RA contractor, CGI Group, will not return and opted out of the most recent RA procurements. 

The new contracts update how RAs are paid, audit timelines and the current review process. Medicare RAs will now only receive payment after a provider’s challenge has passed the 2nd level of a 5-level appeals process; and RAs must follow new audit timelines. 

Mood Media Enhances the Resident Experience

Dave Kyllo

AHCA/NCAL is excited to announce that Mood Media is the newest company to join our member-only Preferred Provider Program. Mood offers exclusive AHCA/NCAL member pricing on music, messaging, and scent services that will enhance the resident experience in any long term care center. Mood’s music solutions are 100 percent fully licensed for all Mood usage applications and are commercial free!

Mood offers members significant discounts of up to 33 percent on a large suite of solutions with music services starting at less than a dollar a day. More information about Mood’s services and products can be found in the Frequently Asked Questions link as well as this exclusive AHCA/NCAL member- only pricing sheet link on the Mood website (password:moodpartner).

There are three easy ways to reach out to Mood:

· By calling 800-345-5000 (Select Option 4)

· Go to http://partner.moodmedia.com/ahca-ncal/ (password: moodpartner), or

· Email: ncalahca@moodmedia.com


Set the perfect Mood in your long term care community. Check out Mood today!

Last Week to Save on AHCA/NCAL Gero Nurse Prep

Dave Kyllo


RNs are the backbone of clinical care in skilled nursing centers. CMS is making big changes to how nursing center performance is judged and how Medicare is going to reimburse nursing centers for their performance starting on October 1, 2018.


AHCA/NCAL completed research this summer comparing nursing facilities with RNs who have been certified in gerontological nursing by the American Nurses Credentialing Center (ANCC) with nursing facilities nationwide. The analysis found that nursing facilities with at least one ANCC certified nurse are:

Twice as likely to receive an overall 5-Star rating from CMS (48% versus 24% nationally)
Experiencing lower rehospitalization rates (at least two percentage points lower than the national average since 2011)
Using fewer off-label antipsychotics (3-4 percentage points lower each quarter 2012 through 2015).

ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association. Less than one percent of America’s RNs are board certified in gerontological nursing.

To help increase the number of board certified RNs, AHCA/NCAL’s Gero Nurse Prep program is designed to help RNs prepare for and pass the ANCC gerontological certification exam. RNs who complete the AHCA/NCAL Gero Nurse Prep program have a passing rate of 96 percent on the ANCC exam and receive 30 CEUs.

AHCA/NCAL Gero Nurse Prep is on sale for one more week. Each RN registrant can save $100 off his/her Gero Nurse Prep by entering promo code STARS2016 (all caps) at checkout. That means RNs who are interested can become board certified for less than $1,000 ($590 sale price for AHCA/NCAL Gero Nurse Prep and a separate $395 to take the ANCC exam).


Watch this video to learn more about AHCA/NCAL Gero Nurse Prep or click on the course preview to get a quick view of this engaging on-line curriculum designed to help RNs pass the ANCC exam.

Arm your RNs for success under the new CMS regulatory and Medicare reimbursement systems by enrolling them in AHCA/NCAL Gero Nurse Prep today. Remember to enter promo code STARS2016 by November 30 and save $100 off the registration fee.

OIG Releases 2017 Work Plan

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) has released its 2017 Work Plan, which summarizes its new and on-going activities. New areas of study for skilled nursing facilities (SNFs), home health agencies (HHAs) and hospices reflect the OIG’s continued efforts to identify and make recommendations to reduce improper payments, deter fraud and promote economic payment policies.

Congressional Republicans, Senatorial Democrats Choose Leadership

Drew Thies


Republicans in both the House and Senate confirmed their standing leaders after a Presidential election that expanded Republican control in Washington.

Paul Ryan (R-WI) was chosen to continue leadership of House Republicans as Speaker of the House. Similar votes were cast to continue the terms of Majority Leader Kevin McCarthy and Majority Whip Steve Scalise, the number two and three Republicans in the House.

Senate Republicans held similar elections, continuing Mitch McConnell's (R-KY) control since the party regained control on the chamber in 2014. John Cornyn (R-TX) will continue serving as majority whip.

Senate Democrats also selected their leadership positions, with Chuck Schumer (D-NY) taking over for the retiring Harry Reid (D-NV) as Minority Leader.

Dick Durbin (D-IL) will serve as Democratic party whip and Schumer’s chief deputy, continuing his previous role. Patty Murray (D-WA) will serve as the third-ranking Democrat, forgoing what some thought would be a challenge to Durbin.

House Democrats are slated to hold leadership elections next week on November 30. Democratic Leader Nancy Pelosi (D-CA) is running to retain her status against Tim Ryan (D-OH), who is challenging her for the top Democratic post.

Wednesday, November 16, 2016

New Materials to Assist with RoP Implementation Posted on ahcancalED/RequirED



AHCA has developed several new resources to assist members with implementing the Requirements of Participation. The newly posted materials include:

·         Action Briefs which provide highlights of regulatory sections along with implementation strategies and tips, timelines, and related resources.

o   New topics posted include Infection Prevention & Control, Pharmacy Services, and Policies & Procedures on Taking Photos or Videos

·         Tools including detailed implementation checklists on a variety of topics.

o   New tools posted include several Admission, Transfer, and Discharge checklists and a detailed Policies & Procedures checklist.

You can access these materials in the Requirements of Participation Library on RequirED located at https://educate.ahcancal.org/required. Be sure to check back often as we are adding new resources every week! Note members must log in to view the materials. For questions about your AHCA/NCAL membership/account or content questions, email educate@ahca.org. For questions on registration, viewing products, and participating in live webinars, Use the support portal or send an email to ahca@commpartners.com.

Maximize Your RN’s Talent to Reduce Rehospitalizations and Antipsychotic Use


David Kyllo
Hospitals are keeping a close watch on their Medicare patients to ensure that they are not readmitted within 30 days of discharge, including those hospitalized Medicare beneficiaries who live in assisted living settings.  

Research conducted by AHCA/NCAL this summer found that the rehospitalization rates in nursing facilities with at least one RN certified in gerontological nursing by the American Nurses Credentialing Center (ANCC) consistently have run at least two percentage points lower than the national average since 2011. AHCA/NCAL believes that assisted living settings will experience similar results by increasing their RNs’ gerontological expertise. 

Hospitals face having Medicare reimbursements withheld if their rehospitalization rates are too high. In October 2018, SNFs also will face financial consequences if their rehospitalization rates are too high. Managing rehospitalization rates has become a key part of a successful assisted living business strategy in caring for the elderly in an increasingly competitive marketplace.

AHCA/NCAL researchers also found that the off-label antipsychotic use in nursing facilities with at least one RN certified in gerontological nursing by the American Nurses Credentialing Center (ANCC) were an average three to four percent lower than the national average in each quarter calendar years 2012 through 2015. Reducing off-label antipsychotic use is one of the goals in the AHCA/NCAL Quality Initiative. 

ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association. Less than one percent of America’s RNs are board certified in gerontological nursing. 

To help increase the number of board certified RNs, AHCA/NCAL’s Gero Nurse Prep program is designed to help RNs prepare for and pass the ANCC gerontological certification exam. RNs who complete the AHCA/NCAL Gero Nurse Prep program have a passing rate of 96 percent on the ANCC exam and receive 30 CEUs.

AHCA/NCAL Gero Nurse Prep is on sale for two more weeks through November 30 for AHCA/NCAL Members. End each RN registrant can save $100 off his/her Gero Nurse Prep by entering promo code STARS2016 (all caps) at checkout. That means RNs who are interested can become board certified for less than $1,000 ($590 sale price for AHCA/NCAL Gero Nurse Prep and a separate $395 to take the ANCC exam). 

Watch this video to learn more about AHCA/NCAL Gero Nurse Prep or click on the course preview to get a quick view of this engaging on-line curriculum designed to help RNs pass the ANCC exam. Remember to enter promo code STARS2016 by November 30 and save $100 off the registration fee.  

Emergency Preparedness CMS Final Rule Summaries Available

Erin Prendergast and Dana Halvorson


The California Association of Health Facilities and the American Health Care Association have put together the latest information on emergency preparedness regulations and procedures. The Skilled Nursing Facility (SNF) and Intermediate Care Facility for Individuals with Intellectual and Developmental Disabilities (ICF/IID) Emergency Preparedness CMS Final Rule summaries of the 2016-17 regulations can be found here

The rule was released on Friday, September 16, 2016, and can be found here. Members impacted by the rule include SNFs, Nursing Facilities and ICF/IIDs. This final rule is not applicable to Assisted Living providers.






Registration is Now Open for the 2017 AHCA/NCAL Quality Summit

meetings@ahca.org

​​​​​​​​​​​​​​​​
As you strive to reach your quality goals, AHCA/NCAL wants to give you a leg up. The Quality Summit is designed to help you on your journey, bringing excellent speakers, key topics, and all your long term and post-acute care colleagues together in one place.

Join us in spectacular Orlando, Florida on March 6-8, 2017, for an engaging and exciting opportunity you won’t find anywhere else.

Enjoy three days of education sessions designed to help you gain fresh perspectives and strategies for the challenges you strive to meet.

Online registration is easy and you can make your housing reservation at the same time. Early registration ends February 3.

Rep. Blumenauer Visits Provider in Oregon

Drew Thies


Rep. Earl Blumenauer visited AHCA/NCAL member Cascade Terrace Nursing Center, a Prestige Care facility, in Portland, Oregon last week.

Blumenauer was able to speak with both facility staff as well as patients and residents at the facility in an effort to understand issues facing long term care providers.

Cascade Terrace is a nursing and rehabilitation center and provider for Medicaid, Medicare and several managed care health plans. The center received the Silver Award from the AHCA/NCAL National Quality Award Program.

Blumenauer is a member of House Committee on Ways and Means, the House committee that has large jurisdiction over Medicare policy. Advocates at the event informed the Congressman about current efforts in the Ways and Means Committee to institute value-based purchasing for post-acute care providers and emphasized the importance of stakeholder input on any future policy.

Help Shape the Future of NCAL


The National Center for Assisted Living (NCAL) wants to hear from you – our members. McKinley Advisors, an independent research firm, is administering a study on behalf of NCAL regarding how well it is serving the needs of long term care professionals and how it can ensure ongoing value in the future.

The survey should take approximately 15 minutes to complete and individual responses will be kept confidential. In appreciation for your participation, all who complete the survey will be given the opportunity to enter a drawing to win one of two $100 Visa gift cards. Please complete this short survey today!

If you have any questions or need assistance, please contact Alison Bramer, Research Manager at McKinley Advisors, by emailing abramer@mckinley-advisors.com.

Thank you in advance for your important input!

Phase One Requirements of Participation Incorporated into Current F-Tags

Lyn Bentley, MSW


On Sep. 28th, CMS released revised Requirements for Participation for Medicare and Medicaid-certified nursing facilities. Most regulations groups were re-designated and have new numbers. CMS has incorporated revised regulation text into the SOM Appendix PP. The regulation text is effective November 28, 2016; the Interpretive Guidance has not been updated. Interpretive guidance will be revised at a later date. The current F-Tags have been revised to include the requirements and regulation text as is presented in the final rule. 

This was posted to the CMS website on November 9, 2016. AHCA is updating The Long Term Care Survey with this recently released information.

Tuesday, November 15, 2016

Reimbursement is Changing. Are Your RNs Ready for the 2017 Medicare Focus on Rehospitalization Measures?



CMS begins tracking skilled nursing rehospitalization rates on January 1, 2017 for the new SNF Value-Based Purchasing (VBP) program. Under the VBP program, claims for services furnished on or after Oct. 1, 2018, will be subject to a 2 percent withhold. Providers will have the opportunity to get some or all of this money back depending on how well they do in managing hospital readmissions and meeting or exceeding performance standards.


SNFs will be rated on achievement against all other facilities nationally as well as on their own improvement, comparing their rate during 2017 with their previous performance during 2015.


The key metric for the program is known as the SNF 30-Day All-Cause Readmission Measure (SNFRM). SNFRM estimates a risk-standardized rate of all-cause, unplanned hospital readmissions of Medicare SNF beneficiaries within 30 days of discharge from their prior acute hospitalization.


Research conducted by AHCA/NCAL this summer found that the rehospitalization rates in nursing facilities with at least one RN certified in gerontological nursing by the American Nurses Credentialing Center (ANCC) consistently have run at least two percentage points lower than the national average since 2011. Lower rehospitalization rates will be key to success under the new CMS VBP program. 


In addition, AHCA/NCAL research found that nursing facilities with at least one ANCC board certified nurse were twice as likely to receive an overall 5-Star rating from CMS and far less likely to receive a 1-Star rating.    


ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association. Less than one percent of America’s RNs are board certified in gerontological nursing. 


To help increase the number of board certified RNs, AHCA/NCAL’s Gero Nurse Prep program is designed to help RNs prepare for and pass the ANCC gerontological certification exam. RNs who complete the AHCA/NCAL Gero Nurse Prep program have a passing rate of 96 percent on the ANCC exam and receive 30 CEUs.


AHCA/NCAL Gero Nurse Prep is on sale for two more weeks through November 30 for AHCA/NCAL Members. End each RN registrant can save $100 off his/her Gero Nurse Prep by entering promo code STARS2016 (all caps) at checkout. That means RNs who are interested can become board certified for less than $1,000 ($590 sale price for AHCA/NCAL Gero Nurse Prep and a separate $395 to take the ANCC exam). 


AHCA/NCAL members seeking to reduce their rehospitalization rates are encouraged to examine ANCC certification for their RN leaders. Watch this video to learn more about AHCA/NCAL Gero Nurse Prep or click on the course preview to get a quick view of this engaging on-line curriculum designed to help RNs pass the ANCC exam. 


Get ready for the new VBP program and check out AHCA/NCAL Gero Nurse Prep today.


Remember to enter promo code STARS2016 by November 30 and save $100 off the registration fee.  

Monday, November 14, 2016

2017 National Nursing Home Week Theme Announced

Andrea Todd

Every year skilled nursing care centers across the U.S. anticipate the week-long celebration of National Nursing Home Week.  The 2017 theme will honor the "Spirit of America" during May 14-20, 2017.

Visit one of the many nursing centers in your city or town, and you will see the American spirit in action.  You will hear stories from proud veterans, immigrants and hardworking people from different faiths and backgrounds within the walls of each center every day.  The unique cultures and experiences help capture what is our proud country.

Check out the Facebook page for updates and information on our website once the planning guide and product catalog become available next year.

Webinar: Future of Episodic Bundling: What Independent Owners Need to Know

meetings@ahca.org

Join Fred Bentley, Vice President, Avalere Health on this one hour webinar, "Future of Episodic Bundling: What Independent Owners Need to Know."

This webinar will examine the evolution of bundled payment models. As CMS expands these mandatory arrangements to new conditions and new providers, the webinar will explore the implications of these bundled payment programs and how developing new analytic capabilities, integrated clinical models, and innovative partnerships will be essential for post-acute providers to excel under bundled payments.



Future of Episodic Bundling: What Independent Owners Need to Know
Tuesday, December 6, 2016
3:00 PM – 4:00 PM Eastern Time


The registration is free for members.  Registration Link: https://educate.ahcancal.org/products/future-of-episodic-bundling-what-independent-owners-need-to-know



Webinar: OCR Nondiscrimination Rule: Requirements & Compliance


The HHS Office of Civil Rights published a final rule May 18, 2016, broadening the nondiscrimination requirements applicable to all health programs and activities receiving federal financial assistance from HHS, those administered by HHS, and Health Insurance Marketplaces. The final rule implements section 1557 of the Affordable Care Act (ACA) and adds two important categories of protections:  (1) prohibition of discrimination on the basis of sex; and (2) mandatory meaningful access for individuals with limited English proficiency. Also included in the final rule, OCR outlines specific actions covered entities must take to signal their compliance with these nondiscrimination requirements.

This final rule has largely flown under the radar since its publication, begging the question: are you prepared to comply with the new requirements? Join us on Tuesday, December 6, 2016, for a webinar titled “OCR Nondiscrimination Rule: Requirements and Compliance,” to hear from two experts: Carol Loepere (Reed Smith, AHCA General Counsel) and Janine Valdez (Genesis, Compliance Officer), to learn more about the rule and what steps you should be taking now to ensure compliance.


OCR Nondiscrimination Rule: Requirements and Compliance
Tuesday, December 6, 2016
2:00 PM – 3:00 PM Eastern Time


Registration Link: https://educate.ahcancal.org/products/ocr-nondiscrimination-rule-requirements-and-compliance


Learning Objectives:
  • Review the most important requirements in the regulation (e.g., notification and grievance processes)
  • Recognize instances of prohibited discrimination
  • Identify important steps necessary to come into compliance with the new rule
  • Understand where to find helpful resources

Medicare Part B Therapy Cap Values for Calendar Year (CY) 2017

Dan Ciolek


The Centers for Medicare and Medicaid Services (CMS) recently announced a $20 update to the annual per-beneficiary Medicare Part B outpatient therapy caps for CY 2017. For physical therapy (PT) and speech-language pathology (SLP) combined, the 2017 therapy cap will be $1,980. For occupational therapy (OT), the cap for 2017 will be $1,980. The effective date is January 1, 2017. Make sure that your billing staffs are aware of these therapy cap value updates.


Background:

The Balanced Budget Act of 1997 (P.L. 105-33), Section 4541(c) applies annual financial limitations on expenses considered incurred for outpatient therapy services under Medicare Part B per beneficiary, commonly referred to as “therapy caps.” Therapy caps are updated each year based on the Medicare Economic Index. An exception for the therapy caps for reasonable and medically necessary services has been in place since CY 2006. Originally required by Section 5107 of the Deficit Reduction Act of 2005, the exceptions process for the therapy caps has been continuously extended multiple times through subsequent legislation. The current therapy caps exceptions process, and associated targeted medical review for claims over a $3700 annual PT/SLP or OT threshold, as required by Section 202 of the Medicare Access and CHIP Reauthorization Act of 2015, expires on December 31, 2017.

Wednesday, November 9, 2016

CDC Launches 2016 National Study of Long-Term Care Providers

Lindsay Schwartz

CDC’s National Center for Health Statistics has launched the third wave of the National Study of Long-Term Care Providers (NSLTCP), a biennial national study of the major sectors of paid, regulated providers of long-term care services. This data collection effort includes a representative sample of assisted living and similar residential care communities across the country. Your assisted living or residential care community may be one of them. Data collection started in August 2016 and will continue through February 2017. Residential care operators, managers, administrators or directors are asked to provide information about their residential care community through a mail or web questionnaire that will take on average 30 minutes to complete. Since the third week of October, smaller residential care communities who did not respond by web or mail, have been given the option to complete the survey over the telephone. Larger residential care communities who have not responded via mail or web by November 23 will also be given that option. NSLTCP collects information about the characteristics of residential care providers, the services they offer, and their staffing; and the demographics, functional status and health of the residents they serve. This information will help policymakers, health care planners, and providers better understand, plan for, and serve the future long-term care needs of the older population and disabled adults. While results from this survey, including state estimates, will be made publicly available, all data will be kept confidential and will be aggregated, so that the names of the residential care communities, staff, residents and respondents will not be identifiable. Participation is voluntary. The power of this survey depends on participation. If your residential care community is contacted, make your voice heard by participating in the study. NCHS has contracted with RTI International, an independent, nonprofit research organization, to collect 2016 NSLTCP data. If you have questions about completing the questionnaire, or received a questionnaire packet in the mail but no longer have it or cannot find it, please contact the NSLTCP Help Desk today at 1-866-245-8078. For more information please visit the NSLTCP website.

CMS Releases Updated Reports on Medicaid LTSS and HCBS Waiver Enrollment and Expenditures

Lilly Hummel

On November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid Long-Term Services and Supports Beneficiaries 2012 report which provides updated estimates of the number of people who receive Medicaid long-term services and supports (LTSS). Additionally, CMS released annual updates to two reports that describe recent section 1915(c) Home and Community Based Services (HCBS) waiver program data. Medicaid 1915(c) Waiver Data Based on the CMS 372 Report, 2012 - 2013 identifies the number of people who received HCBS waiver program services, and Medicaid expenditures and duration of service for participants during 2012 and 2013. The other report, Medicaid Expenditures for Section 1915(c) Waiver Programs in FY 2014, provides data and trends regarding waiver expenditures. While these reports do not specify the number of people in assisted living receiving Medicaid-covered services, the reports do help illuminate the extent of Medicaid HCBS Waiver coverage by state. A list of all historical reports can be found here.

Honoring Our Nation’s Veterans


Dana Halvorson 


Veterans Day 2016 will be observed this Friday, November 11. In honor of Veterans Day, American Health Care Association/National Center for Assisted Living (AHCA/NCAL) wanted to share a story of one of its members, the Maine Veterans’ Home. Their skilled nursing care center in Scarborough, Maine, had been selected as one of only three centers across the nation to receive the prestigious AHCA/NCAL Gold – Excellence in Quality Award.

A center that receives this award joins an extremely elite group of long term care providers in the nation. Gold award recipients are rare nationwide, and Maine Veterans’ Home in Scarborough’s (MVH-Scarborough) selection was the first gold award recipient in Maine and only the second State Veterans’ Home (SVH) in the nation to have ever achieved this distinction. Serving veterans, their spouses, and gold-star parents is a mission that Maine Veterans’ Homes has always viewed as a privilege and a sacred trust that goes far beyond simply providing excellent medical care. Provider Magazine covers more about the quality care MVH provides to our nation’s veterans. The full story, entitled Reflections on a Quality Journey by Devin Robinson (director, public relations & marketing, Maine Veterans’ Homes, Scarborough) is online.

AHCA/NCAL is proud to represent a number of SVHs, as well as countless civilian facilities nationwide that serve veterans as their residents. More information can be found on the AHCA’s Veterans webpage

Trump Wins Presidency, Republicans Hold on to Congress


Drew Thies

Donald J. Trump was elected the 45th president of the United States on Tuesday in a stunning rebuke of many pollsters and prognosticators, who gave the businessman slim chances to win the presidency.


Trump took the stage around 3 AM Wednesday morning after Secretary Hillary Clinton called him to offer her concession.


Republicans rode Trump’s momentum in down-ballot races, mitigating losses in state and local elections. Only one Republican seat in the Senate was lost, Mark Kirk’s in Illinois, during a cycle in which some predicted Democrats would completely retake the chamber. Similarly, in the House, Republicans only stand to lose a fraction of their historic majority.


Republican victories set up the first time the party controls the White House and both Chambers of Congress since President George W. Bush.


AHCA/NCAL President and CEO Mark Parkinson released the following response in response to the 2016 election results:


“On behalf of the millions of providers, patients, residents and families we serve, AHCA/NCAL congratulates President-elect Trump, Speaker Ryan, Leader McConnell and all those who won last night. While Medicare and Medicaid may not have been a primary focus of this election cycle, we know you share our mission to improve lives by delivering solutions for continued quality care. Our profession stands with this Administration, the House and Senate in a pledged commitment to help this nation’s elected leaders address and solve these critically important issues.


“Our nation’s frail, elderly and disabled are counting on us. Working together, I know we are up for the job.”

CMS Issues MDS Focused Survey Summary


In memorandum S&C: 17-06-NH, dated November 4, 2016, CMS provides an overview of the results of the FY 2015 MDS Focused Surveys, outlining the background on MDS Focused Surveys and the types of deficiencies and errors identified in the surveys. CMS also provides technical resources for providers to help improve accuracy and help providers maintain compliance. CMS implemented MDS Focused Surveys nationwide for a sample of nursing centers in 2015 after piloting the survey in 2014, and will continue to conduct the MDS 3.0 Focused Surveys through FY 2016 and FY 2017. The surveys are used to audit the accuracy and reliability of data reported by nursing centers.


The memorandum summarizes FY 2015 results in terms of the scope and severity of deficiencies, noting that the majority of deficiencies were cited at a scope and severity level of “D”; top cited deficiencies across scope and severity levels, such as MDS Accuracy and Posted Nurse Staffing Information; and common coding errors affecting MDS accuracy, such as those related to antipsychotics and pressure ulcers.


During on-site MDS Focused Survey visits, CMS found that approximately 45% of citations were related to MDS or staffing posting inaccuracy and that 55% were care related. Eighty percent of facilities surveyed had at least 1 deficiency with an overall average of 2.6 deficiencies per survey.


CMS recommends several resources to assist nursing centers in achieving and improving compliance, including a review of Chapter 3 of the RAI Manual; training modules for completing the MDS assessment; and contact information for State RAI Coordinators.


For questions or comments on the memorandum, contact MDSFORSandC@cms.hhs.gov.

November is National Family Caregivers Month


Dana Halvorson

This month is National Family Caregivers Month. According to a blog posting by the AARP chief advocacy and engagement officer, Nancy LeaMond, “National Family Caregivers Month is a time to recognize the 40 million Americans who take care of a loved one.” She goes on to note that “together, family caregivers spend 37 billion hours each year providing unpaid assistance to their loved ones — a contribution valued at $470 billion. They help with bathing and dressing, driving to appointments, preparing meals, managing medications, handling finances and so much more.” You can read the full blog posting here.

The theme for National Family Caregivers Month November 2016 is “Take Care to Give Care,” which you can find here.









Mark Parkinson Named A Top Lobbyist



Every day, thousands of law firms, associations, corporations and advocacy groups and more seek to influence policymaking away from the glare of presidential and congressional politics. Every year, The Hill newspaper issues its annual review of the Top Lobbyists.  These are a select few who have shown an ability to get things done. It's those movers and shakers who are among The Hill’s Top Lobbyists.

Mark Parkinson, President and CEO of the American Health Care Association has been named to this list.

With a booming healthcare demand for aging Americans, the nursing homes and assisted living lobby has helped shape a flurry of federal regulations that seek to substantially alter reimbursements.
To learn more about the association check out the AHCA/NCAL website.


Nursing Home Antimicrobial Stewardship Guide from AHRQ

Holly Harmon


The Nursing Home Antimicrobial Stewardship Guide is a field tested, researched-based resource with four Web-based toolkits, that offer step-by-step instructions and turnkey materials to help nursing homes improve antibiotic use and decrease healthcare-associated infections. The guide offers step-by-step instructions and materials to help nursing homes improve antibiotic use and decrease harms caused by inappropriate prescribing. The guide, which is consistent with CDC core elements of antibiotic stewardship, can also help health care providers meet CMS' new Infection Prevention and Control Program requirements. That program requires providers to have a system to prevent, identify, report, investigate and control infections and communicable diseases for all facility residents, staff, volunteers and visitors. AHRQ's stewardship guide is customizable to meet facilities' specific needs.

The toolkits help nursing homes to:
  • Implement, monitor, and sustain an antimicrobial stewardship program.
  • Determine whether it is necessary to treat a potential infection with antibiotics.
  • Choose the right antibiotic to treat an infection, including an antibiogram module.
  • Educate and engage residents and family members.

Motion Picture Licensing Corporation Discount on Umbrella License Available Through Dec. 31



In August, AHCA/NCAL announced a formal agreement with the Motion Picture Licensing Corporation (MPLC) to help long term and post-acute care providers continue to offer movie night while adhering to federal copyright laws.

Motion picture showings within senior living and health care communities have always required a public performance license in accordance with the U.S. Copyright Act. As a result, AHCA/NCAL (and all other leading industry associations including, LeadingAge, National Association of Activity Professional [NAAP], American Senior Housing Association [ASHA], and Argentum) has entered into a new agreement with MPLC.

The 2016 Agreement better educates members on the need for copyright compliance when motion pictures and other audiovisual programs are shown in senior living and health care communities.

The Agreement states that:

· All communities, regardless of their type or license status, must obtain licensure for exhibitions of Videos transmitted over a closed circuit television system or in-house channel.

· All communities, regardless of their type or license status, must obtain licensure for exhibitions of Videos in common areas such as a theater, lounge, or community room.

· Assisted living, nursing and rehabilitation units receive a reduced rate on the license. Minimum fees are waived for campuses that are strictly nursing, assisted living, or rehabilitation.

There is a special introductory discount of almost 40% for qualifying member facilities that secure an Umbrella License® before December 31, 2016. If you operate assisted living, nursing or rehabilitation units, AHCA/NCAL strongly encourages you to secure an Umbrella License prior to December 31, 2016 to ensure the lowest possible license fee. Please visit the AHCA/NCAL website for the application brochure.

The Umbrella License provides the most comprehensive programming available from over 1,000 motion picture studios and producers ranging from major Hollywood studios to educational, independent, specialty, foreign language, documentary, and television producers. The license covers thousands of titles currently available in any legal format originally intended for personal, private use only.

Learn more about AHCA/NCAL’s agreement with MPLC and how to apply for an Umbrella License by visiting AHCA/NCAL’s website.

Tuesday, November 8, 2016

Get your Feedback Report and Recertify!


As potential applicants decide whether or not to submit an Intent to Apply by the November 17th deadline, many are spending some time reviewing the revised set of survey eligibility requirements at each application level that applicants will have to meet. Applicants are encouraged to review all the specific survey eligibility requirements in the respective application packets in detail. Below are some answers to the most common questions that we receive on the survey eligibility requirements.

Can I still apply if the center does not meet the survey eligibility requirements?
  • Yes, centers can apply and receive a feedback report even if they do not meet the survey eligibility requirement. They will simply be ineligible to receive the award.


Can the center recertify if it does not meet the survey eligibility requirements?
  • If a center submits an application meeting the minimum requirements and fails survey eligibility they will still be able to recertify. They will simply be ineligible to receive the award.


How do I calculate the cycle 1 and 2 weighted survey score for the Silver Quality Award and the 3 cycle weighted score for the Gold Quality Award?

Quality Award staff has developed a resource for applicants to view their current survey eligibility based on the August 24, 2016 Nursing Home Compare release. This can be utilized by applicants to review their current survey eligibility; however, applicants are cautioned as this is preliminary and their survey eligibility will change based on what is available as of the application deadline (January 26, 2017) and award notification. Remember that even though you are ineligible to be an award recipient if you fail the survey eligibility, it is still worth your time to apply (see 1 & 2 above).

The deadline for the 2017 Quality Award Intent to Apply process is next Thursday, November 17th. While this is not mandatory, it has two important benefits for applicants:
  1. The overall application fee is reduced; and
  2. Applicants will receive regular emails from Quality Award staff with deadline reminders, tips on applying for the award, and links to exclusive educational webinars.

 As always, if you have any questions Quality Award staff can be reached at qualityaward@ahca.org

Journey to Gold: Maine Veterans Home-Scarborough


By Nora Holliday DNS and Maureen Carland Administrator of Maine Veterans Home- Scarborough

When we began our Quality Award journey, we could not imagine the depths of self-examination nor the heights of pride in self-discovery that we would experience as a team.  As a result of following this quality process from bronze to silver to gold, we have built a stronger, more effective leadership team, but more importantly we learned how to reach out and include staff at all levels; residents past, present, and future; families; community partners; and other veteran advocates.  Our unique Governing Committees (composed of staff, residents, family, and community) is an important part of this process. This reaching out has created a palpable difference in the energy level permeating our facility.

Serving veterans, spouses and gold-star parents is a privilege and a trust we take very seriously.  Our vision, to be the veteran’s advocate goes far beyond providing excellent care.  We believe an active, varied social life paired with community involvement leads to higher levels of satisfaction and engagement.  The annual MaineVets 5K is but one example.  What began as a staff and resident activity with 65 participants has grown into a community event with a long list of local sponsors and over 300 participants, including many family groups pushing their loved-ones in wheelchairs. 

Another example of community involvement is the Living History project with the local middle school.  Students studying American History meet with our residents to learn about their military experiences, bringing history to life.  Several multi-generational friendships have grown out of this project. 

These are examples of how the Baldrige journey has set the framework for how we assess, plan, trial, and re-assess.  Out-of-the-box thinking is encouraged, and those twin phrases, “It’s against the regs,” and “We’ve always done it that way,” have been banned from use.  Now we say, “join a governing committee; let’s make it happen.”  Senior Leaders, who are charged with role-modeling for other staff, are much more open to suggestions and participation.   Collaboration has softened the old model of top-down hierarchy and created a much stronger team focus.

The different Baldridge categories became integral to our success. Strategy development, once a foreign language is now something staff understands. The level of engagement and excitement when staff members understand that they have a say in the future direction of the care process, is amazing to behold. Our workforce is an incredible group of dedicated, highly-trained staff.

Through the process of responding to the criteria from Bronze to Gold Award , we revamped our data collection system and data analysis.  It was an exciting challenge to dig for the best comparative data and the best way to use it to enhance quality of care as well as understanding our competitive situation. 

In short, every category, every question in the criteria shaped our journey toward excellence.  It was not an easy process.  It took years to complete.  With every step, we recognized something we were doing well or a process gap that needed improvement. We are a far better organization today because of this journey.
____________________________________________________________________

Is your center planning to apply for a 2017 AHCA/NCAL National Quality Award?  If so, be sure to submit your intent to apply here before the November 17 deadline to save up to $700 on the overall application fee and get weekly tips from Quality Award staff!  

Updated Requirements of Participation...An Exercise in Performance Excellence

By Kimberly M. Gimmarro | Quality Specialist, Botsford Commons – A Beaumont Community | Farmington Hills MI, and member of the AHCA/NCAL National Quality Award Program Board of Examiners |

A key requirement of the 2017 Final Rule is its overarching theme – know your residents, know their needs, provide staff that can meet them. The similarities between the AHCA/NCAL National Quality Award Programs Bronze and Silver Criteria and new Facility Assessment from the revised Requirements of Participation (ROP) are nothing short of striking. Let’s crosswalk it.

“We require facilities to conduct, document, and annually review a facility-wide assessment to determine what resources are necessary to care for its residents competently…”
•    Bronze/Organization Profile: P.1b(2) What are your KEY markets, PATIENT and other CUSTOMER groups, and STAKEHOLDER groups as appropriate? What are their KEY requirements and expectations of your HEALTH CARE SERVICES, PATIENT and other CUSTOMER support services, and operations?
•    Silver: 1.1 Senior Leadership: HOW do your SENIOR LEADERS lead the organization? 1.1a HOW do SENIOR LEADERS’ personal actions build an organization that is successful now and in the future? 1.1b HOW do SENIOR LEADERS communicate with and engage the entire WORKFORCE and KEY CUSTOMERS? 1.1c HOW do SENIOR LEADERS create a focus on action to achieve the organization’s MISSION? 3.1 Voice of the Customer: HOW do you obtain information from your CUSTOMERS? 3.1a HOW do you listen to, interact with, and observe CUSTOMERS to obtain actionable information? 3.1b HOW do you determine CUSTOMER satisfaction, dissatisfaction, and engagement? 3.1c HOW do you obtain information on CUSTOMERS’ satisfaction with your organization relative to other organizations including direct competitors, if available? 3.2 Customer Engagement:
HOW do you engage CUSTOMERS by serving their needs and building relationships?
3.2a HOW do you determine your HEALTH CARE SERVICE offerings? 3.2b HOW do you build and manage CUSTOMER relationships? 3.2c HOW do you manage CUSTOMER complaints?

during both day-to-day operations and emergencies….”
•    Silver: 6.2 Operational Effectiveness: HOW do you ensure EFFECTIVE management of your operations? 6.2a HOW do you control the overall costs of your operations? 6.2b HOW do you provide a safe workplace and operating environment? 6.2c HOW do you ensure that your organization is prepared for potential disasters or emergencies?

“Facilities are required to address in the facility assessment the facility’s resident population (that is, number of residents, overall types of care and staff competencies required by the residents, and cultural aspects),…”
•    Bronze/Organization Profile: P.1a(1) What are your main HEALTH CARE SERVICE offerings? What is the relative importance of each to your success? P.1a(2) What are your stated MISSION, VISION and VALUES? What are your organization’s CORE COMPETENCIES, and what is their relationship to your MISSION? P.1b(2) What are your
KEY markets, PATIENT and other CUSTOMER groups, and STAKEHOLDER groups as appropriate? What are their KEY requirements and expectations of your HEALTH CARE SERVICES, PATIENT and other CUSTOMER support services, and operations?
    Silver: 5.1 Workforce Environment: HOW do you build an EFFECTIVE and supportive WORKFORCE environment? 5.1a HOW do you manage your WORKFORCE CAPABILITY and CAPACITY needs?

resources (for example, equipment, and overall personnel),…”
•    Bronze/Organization Profile: P.1a(4) Assets: What are your major facilities, technologies, and equipment?
•    Silver: 4.2 Knowledge Management, Information, and Information Technology: HOW do you manage your organizational KNOWLEDGE ASSETS, information, and information technology infrastructure? 4.2c How do you ensure hardware and software reliability?
5.1b HOW do you recruit, manage, and retain your WORKFORCE? 5.1c HOW do you
provide supportive benefits and ensure workplace health and security for your WORKFORCE? 5.2a HOW do you foster an organizational culture that is characterized by open communication, HIGH PERFORMANCE, and an engaged WORKFORCE? 5.2b HOW do you assess WORKFORCE ENGAGEMENT? 5.2c HOW does your performance management system support HIGH PERFORMANCE and WORKFORCE ENGAGEMENT?
5.2d HOW does your LEARNING and development system support the organization’s needs and the personal development of your WORKFORCE members, managers, and leaders?

and a facility-based and community-based risk assessment.
    Bronze: P.2a(1) What are your KEY STRATEGIC CHALLENGES and ADVANTAGES in the areas of health care services, operations, societal responsibilities, and WORKFORCE?
    Silver: 2.1 Strategy Development: How do you develop your strategy? 2.1a HOW do you develop your strategic plan to achieve ongoing success and organizational
improvement? 2.1b What are your organization’s KEY STRATEGIC OBJECTIVES, their related GOALS, and the timetable for achieving them? 2.1c HOW do your STRATEGIC OBJECTIVES address your STRATEGIC ADVANTAGES and CHALLENGES? 2.2 Strategy Implementation: HOW do you implement your strategy? 2.2a HOW do you translate your STRATEGIC OBJECTIVES into ACTION PLANS? 2.2b What are your KEY ACTION PLANS and MEASURES you use to track progress on these action plans? 2.2c HOW do you DEPLOY your ACTION PLANS?

“We are requiring all LTC facilities to develop, implement, and maintain an effective comprehensive, data-driven QAPI program that focuses on systems of care, outcomes of care and quality of life.
    Bronze/Organizational Profile: P.2c(1) What are the KEY elements of your PERFORMANCE improvement system, including your PROCESSES for evaluation and improvement of KEY organizational projects and PROCESSES? P.2a(3) What KEY sources
of COMPARATIVE DATA are available from within the health care industry? What limitations, if any, affect your ability to obtain or use these data?
    Silver: 4.1 Measurement, Analysis and Improvement of Organizational Performance: HOW do you measure, analyze, and then improve organizational PERFORMANCE? 4.1a HOW do you use DATA (and information) to track daily operations and analyze overall organizational PERFORMANCE? 4.1b HOW do you use COMPARATIVE DATA and information? 4.1c HOW do you review and improve your organization’s PERFORMANCE?
4.1d What are your KEY PERFORMANCE MEASURES? 4.2a HOW do you ensure the
quality and security of organizational DATA and information? 4.2b HOW do you ensure the availability of organizational DATA and information? 5.2d HOW does your LEARNING and development system support the organization’s needs and the personal development of your WORKFORCE members, managers, and leaders? 6.1d HOW do you improve your KEY HEALTHCARE services and KEY WORK PROCESSES?

There you have it!  It’s all wrapped up in the Bronze and Silver National Quality Award Criteria.  May I suggest you get a jump on your facility assessment by participating in the National Quality Award Program? In addition to that, studies have shown that recipients of the National Quality Award Program perform better than their peers in a wide array of outcomes[1][2].

The Intent to Apply process is now open for the 2017 AHCA/NCAL National Quality Award Program. The deadline to submit an ITA payment is November 17th at 8pm EST. The ITA is not mandatory to apply, but members who submit benefit by saving money on their overall application fee and receive weekly tips on submitting a successful application.

The deadline to apply for a 2017 Quality Award is January 26, 2017. The criteria and resources are available on the Quality Award website and now is the time to start writing those applications!

For more information and educational resources about the Requirements of Participation, just visit ahcancalED!