Friday, December 28, 2018

Start the New Year Off Right: Strive to Avoid the #1 Cited F Tag on Your 2019 Survey

 Dave Kyllo

The most frequently cited F-Tag in standard nursing facility health inspection surveys under the new survey process is F880 – Infection Prevention & Control.  Since November 2017 when the new survey process began, more than one-third of surveys conducted across the nation have included a F880 Infection Prevention & Control citation. 

AHCA’s Infection Preventionist Specialized Training (IPCO) program is specifically designed to prepare individuals to effectively implement and manage an Infection Prevention & Control program in skilled nursing centers. It addresses both clinical and organizational systems, processes and cultural aspects of infection prevention and control which are fundamental to effectively leading and administering a center’s Infection Prevention & Control program. 

AHCA’s course is an online, self-study program with 23 hours of training that meets the educational requirements outlined by CMS. It includes online lectures, case studies and interactive components taught by subject matter experts who have real life experience working in long term/post-acute care.  The AHCA program gets rave reviews with 96 percent of health care professionals who have completed the course recommending IPCO to their colleagues. 

The course addresses both clinical and organizational systems, processes and cultural aspects of infection prevention and control that are fundamental to effectively leading and administering successful infection prevention and control programs and antibiotic stewardship programs.   Upon successful completion of this program, participants will receive certificates including 23 ANCC contact hours. 

The training course registration fee is $450 for AHCA/NCAL members and $650 for non-members.  There are no refunds and no transfers.  Payment and registration must be made online in ahcancalED.  The IPCO course can be accessed here or at: https://educate.ahcancal.org/p/ipco.  
Discounted group purchase rates are available for groups of 25 or more.  Those interested in making a group purchase should email AHCA at educate@ahca.org.  

While CMS has announced plans to offer a free infection prevention training course some time in Spring 2019, AHCA/NCAL recommends investing in staff training now rather than waiting to train staff on the requirements that already are in effect.  Despite the CMS training announcement, facilities will continue to be surveyed on all the new infection prevention and control requirements and the antibiotic stewardship requirements – the same requirements leading to the most commonly cited F-Tag since November 2017 under Phase I and Phase II of the CMS Requirements of Participation and the implementation of the new survey process.

To access ahcancalED and the IPCO course, members will need to login with their AHCA/NCAL usernames and passwords.  For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail update@ahca.org with your name and facility contact information. 

Prepare your center and staff now for a successful survey this year and avoid the F880 tag. Register for IPCO!

Exclusive Affordable Health Benefit Options for AHCA/NCAL Members

Dave Kyllo

Despite a December court decision finding the Affordable Care Act unconstitutional, the law remains in effect according to Administration officials.  AHCA/NCAL Insurance Solutions offers traditional ACA compliant health plans and a minimum essential coverage (MEC) health plan to members. 

The MEC plan was developed by Compass Total Benefit Solutions and offers two affordable options for providing many of the health insurance benefits that are important to long term care employees.  The plan was built to help AHCA/NCAL members recruit and retain frontline staff who cannot afford major medical health plans. 

Both MEC plans feature affordable premiums and co-pays for valued and commonly used services, including prescriptions, physician visits and free unlimited 24/7 access to TELADOC.  The Compass 1 plan costs about $1 per hour for a full-time employee or $161 per month.  The Compass 2 plan costs $182 per month.  The Compass 2 plan costs a little more because it includes higher indemnity payments for hospitalizations. Here’s the rate schedule:

  Monthly Premiums
Compass 1
Compass 2
EE
$161.29
$181.75
EE & Spouse
$264.70
$306.39
EE & Children
$244.19
$279.94
Family
$356.70
$417.20

The plan was designed to help those employees who cannot afford Affordable Care Act (ACA) compliant plan premiums or the high deductibles associated with many ACA plans.  Even though traditional ACA compliant plans are classified as “affordable,” they are not an option that many long term care employees can afford.  

Employers decide the level of contribution for plan expenses for coverage for employees, their spouses, their children or family coverage.  Employers can pay all the costs, share the costs with employees, or have employees pay for coverage completely as a voluntary option.  Or LTC employers can increase their employer contribution over time based on an employee’s length of service.  Both plans are flexible. In addition, employers have options such as covering all the costs for employee coverage but having the employee pay the premiums for their spouse and/or children. 

While this new AHCA/NCAL Insurance Solutions plan satisfies all 71 benefits required under the Affordable Care Act, it is not a fully compliant ACA plan.  It is considered a minimum essential coverage plan and should be offered alongside a traditional ACA compliant plan to avoid any ACA employer penalties. 

There is no additional underwriting for the Compass plan and no mandatory wait periods for new employees to join the Compass MEC plans.  Any wait periods are determined by the employer.  There is a minimum of five employees that must be enrolled to offer the plan to employees.

The ability to offer a health insurance plan at little to no cost to employees allows AHCA/NCAL members to market their facilities as superior employers in comparison to competing employers.   This plan is much less expensive to an employer compared to a traditional employee health benefit plan and costs less than the expense of an employee who turns over.

Read this Q&A document for more information about Compass plans for AHCA/NCAL members. Versions of the Compass Plan are available in all 50 states. Changes to the Hospital Indemnity benefit vary in a few states based on state approvals. To see what's available in your state, please contact Nick Cianci at 202-898-2841 or Dave Kyllo at 202-898-6312 or email ahcainsurancesolutions@ahca.org.

Wednesday, December 26, 2018

Government Shutdown Continues through Holiday

Drew Thies

The Federal Government remained partially shut down through the Christmas holiday due to disagreements between President Donald Trump and Democrats over funding for a border wall. The Senate is adjourned until Dec. 27, at which point negotiations will resume.

Trump reiterated his position on Christmas during conversations with the press. “I can’t tell you when the government is going to reopen,“ Trump said.

Nine departments are closed: Agriculture, Commerce, Justice, Homeland Security, Interior, State, Transportation, Treasury and Housing and Urban Development. Starting today, 800,000 government employees who are not deemed "essential" will either be furloughed or forced to work without pay until a funding bill is passed. A list of affected services can be found here.

Last week, the House approved a Trump-backed measure that would fund the government and include $5 billion for a border wall. The Senate passed a temporary funding bill that would keep government funding levels the same through February. The House never took up the bill with limited wall funding and the Senate adjourned before the two chambers could come to an agreement.

Trump tweeted that Senate Majority Leader Mitch McConnell should use the so-called “nuclear option” and eliminate the Senate filibuster for legislation, but no such rule change was ever made. Any government funding measure will at least need partial support of Democrats to pass the Senate.

Democrats will take control of the House on Jan. 3, at which point they could pass the Senate-approved funding bill or a similar compromise. Democratic Leader Nancy Pelosi, who is expected to become Speaker of the House under Democratic control, said the first priority for the new session will be funding the government.

Friday, December 21, 2018

Make Plans Now for the 2019 AHCA/NCAL Quality Summit

Register for the AHCA/NCAL 2019 Quality Summit today, which will be held March 18-20, 2019 in sunny Tampa, Florida on the waterfront.

The Summit agenda is packed with sessions and speakers who will challenge you to think in new ways about:

  • Providing stronger patient-centered care
  • Using quality improvement methodology to begin or advance change
  • Disruption and innovation to tackle workforce challenges
  • How PDPM will create innovation in patient care

Visit the Quality Summit website for detailed information on education sessions, networking events, and conference sponsors. Take advantage of discounted group rates and reserve your hotel by February 15. You must be registered for the Quality Summit before any hotel reservations can be made, and you may do both when registering online.

DoD Proposed Rule Published to add Physical and Occupational Therapy Assistants as TRICARE Authorized Providers

Dan Ciolek

On December 20, 2018, the Department of Defense published a proposed rule titled “TRICARE; Addition of Physical Therapy Assistants and Occupational Therapy Assistants as TRICARE Authorized Providers.”  The proposed rule summary states the following:

“The Department of Defense is publishing this proposed rule to add certified or licensed physical therapy assistants (PTAs) and occupational therapy assistants (OTAs) as TRICARE-authorized providers to engage in physical therapy or occupational therapy under the supervision of a TRICARE-authorized physical therapist or occupational therapist in accordance with Medicare's rules for supervision and qualification when billed by under the supervising therapist's national provider identification number. This rule will align TRICARE with Medicare's policy, which permits PTAs or OTAs to provide physical or occupational therapy when supervised by and billed under a licensed or certified physical therapist or occupational therapist.”

The comments deadline in February 19, 2019.   As some AHCA members furnish therapy services under the TRICARE benefit, AHCA will be evaluating this proposed rule related to potential impact on SNF TRICARE therapy services.  Please contact AHCA’s Dan Ciolek, Associate Vice President, Therapy Advocacy if you have questions or comment recommendations.

A Painless and Profitable New Year’s Resolution: Stop Paying Utility Company Overcharges

Dave Kyllo

Most long term care facilities (about 75%) are being overcharged for one or more of their utilities.  Cleary Energy is a AHCA/NCAL preferred provider and has recouped on average 4% to 8% savings on utilities for long term care facility customers. That’s a significant savings! 

Cleary Energy performs utility bill audits by examining utility, supplier and government charges on utility bills to obtain refunds and/or credits and rate reductions.  Specifically, Cleary Energy audits a facility’s electric, natural gas, propane, heating oil, diesel fuel, water, sewer and telecommunications bills. 

The program is designed to save AHCA/NCAL members significant money on their utility bills without adding new expenses to their budgets.  Cleary Energy guarantees savings or its auditing services are free.  Cleary Energy’s fees are based on facility savings on their utility bills. 

AHCA/NCAL member facilities enter into an audit agreement with Cleary Energy, which is a shared savings agreement that lasts for a period of three years.  If no refund, savings or credits are received, the AHCA/NCAL member facility owes nothing to Cleary Energy for conducting the audit and AHCA/NCAL members will have the peace of mind of knowing that their facilities are not being overcharged for their utilities.   

The process for engaging Cleary Energy to conduct a utility audit is easy.  Most of the information Cleary Energy needs to complete an audit comes directly from the utilities or suppliers. 

Cleary Energy’s long term care experience sets the company apart. The founder of Cleary Energy has 40 years of long term care experience and has spent the last seven years specializing in finding energy cost savings for skilled nursing, assisted living and senior living centers.  That in-depth knowledge of long term care operations enables Cleary Energy to find the greatest costs savings on utility expenses for AHCA/NCAL members because Cleary Energy knows where to look for savings. 

Take advantage of this unique no-risk opportunity to save on utility costs.  Contact Cleary Energy today in one of the three ways listed below. 

Wednesday, December 19, 2018

Senate Considers Short Term Government Funding

Drew Thies

Senate Majority Leader Mitch McConnell indicated Tuesday that he is confident that lawmakers will pass a spending bill and avoid a partial government shutdown. McConnell said the White House is “flexible” on border security spending after President Donald Trump said last week that he’d be “proud” to shut the government down to secure wall funding.

While Trump did not personally admit to any deal, White House Press Secretary Sarah Huckabee Sanders said Tuesday the president could accept less than the $5 billion he previously demanded for a wall on the southern border. “When they do something, we’ll make a decision about whether we’re going to sign it,” she said on Fox News.

Senate Appropriations Chairman Richard Shelby said Tuesday that lawmakers were likely to pass a bill that would extend funding for a little over a month, into “early February.”

McConnell suggested that the Senate pass the bipartisan Senate homeland security funding bill which includes $1.6 billion for fencing as well as an extra $1 billion that could be used on a wall, though Senate Democratic Leader Chuck Schumer rejected this offer, calling the extra spending a “slush fund.”

Congress has until midnight Friday to avert a partial shutdown. The departments of Agriculture, Homeland Security, the Interior, State, Housing and Urban Development, Transportation, Commerce, Treasury, and Justice will all close if Congress fails to pass the seven remaining spending bills or a short term measure.

CMS Posts Calendar Year 2019 Medicare Part B Physician Fee Schedule File - Therapy File Posted on AHCA Website

Dan Ciolek

Thanks again to the efforts of Tony Marshall, President and CEO of the Georgia Health Care Association; AHCA is able to offer members the 2019 therapy fees for each CPT/HCPCS Code in each geographic area on our website under the “Medicare Part B Fee Schedules” heading. Please note that the fees effective January 1, 2019 are calculated based upon the Revisions to Payment Policies Under the Physician Fee Schedule (MPFS) and Other Revisions to Part B for Calendar Year (CY) 2019 Final Rule (CMS-1693-F) published in the Federal Register on November 23, 2018. 

Details about the Excel format 2019 therapy fees file workbook on our website are listed below under the heading “AHCA 2019 Medicare Part B Therapy Fees File Details”.

Background
On November 23, 2018, the Centers for Medicare and Medicaid Services (CMS) published the CY 2018 Medicare Physician Fee Schedule (PFS) Final Rule (CMS-1676-F) in the Federal Register.  This final rule reflects the requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which repealed the Sustainable Growth Rate formula and provisions related to Medicare payment contained in the Bipartisan Budget Act of 2018 (BBA of 2018) signed into law on February 9, 2018.

The CY 2019 conversion factor is $36.0391 which reflects the update adjustment factor of 0.25 percent and the budget neutrality adjustment of -0.14 percent. Further, the BBA of 2018, Section 50201 - Extension of Work Geographic Practice Cost Index (GPCI) Floor, extended a provision raising the Work GPCI to 1.000 for all localities that currently have a Work GPCI of less than 1.000 through December 31, 2019. Additionally, as required by the ACA, the 1.5 work GPCI floor for Alaska and the 1.0 practice expense GPCI floor for frontier states are permanent, and therefore, applicable in CY 2019.

You may note that after all required adjustments, the conversion factor has increased from $35.9996 for CY 2018 to $36.0391 for CY 2019. However, Table 94 in the Final Rule titled CY 2019 PFS Estimated Impact on Total Allowed Charges by Specialty indicates that, due to relative changes in the weights of various PFS procedure codes, the value of Part B physical and occupational therapy code payments in aggregate will decrease ~1% in 2018.

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

Further, the final rule updates the Medicare Part B therapy CPT code list for CY 2019 by deleting two codes (64550 and 96111).

While not impacting fee schedule pricing, the final rule also reminded providers that, effective for January 1, 2018, Section 50202 of the BBA of 2018 repealed the application of the therapy caps and the therapy caps exceptions process while also retaining and adding limitations to ensure appropriate therapy.

A separate provision of Section 50202 of the BBA of 2018 preserves the former therapy cap amounts as thresholds above which claims must include the KX modifier to confirm that services are medically necessary as justified by appropriate documentation in the medical record. Claims for therapy services above these amounts without the KX modifier are denied. These amounts are now known as the KX modifier thresholds. Just as with the incurred expenses for the therapy cap amounts, there is one KX modifier threshold amount for physical therapy (PT) and speech-language pathology (SLP) services combined and a separate amount for occupational therapy (OT) services. For CY 2019, the KX modifier threshold amounts are: (a) $2,040 for PT and SLP services combined, and (b) $2,040 for OT services. The targeted medical review process, now-termed Medical Review threshold, amount is $3,000 for PT and SLP services combined and $3,000 for OT services. Please see Transmittal 4178/Change Request 11055 and Centers for Medicare and Medicaid Services (CMS) MLN Matters article MM11055 for complete information on the KX modifier thresholds.

Finally, supporting documentation and downloads for Regulation #CMS-1693-F may be found here. An overview of the Physician Fee Schedule Payment Policies may be found here and an overview of skilled nursing facility consolidated billing and annual updates may be found here.
 
AHCA 2019 Medicare Part B Therapy Fees File Details
The 2019 therapy fees for each CPT/HCPCS Code in each geographic area are provided in the attached Excel file. The file contains the following information:
  1. The 2019 Medicare Part B Fee Schedule for Outpatient Rehabilitation for each Carrier and Locality (Part B Fees)
  2. The 2019 Medicare Part B MPPR Fee Schedule for "Always Therapy Services (50% MPPR Factor) for each Carrier and Locality (MPPR Fees)
  3. The 2019 Relative Value Units for each Outpatient Rehabilitation Therapy Code (RVUs)
  4. The 2019 Geographic Practice Cost Indices by Medicare Carrier and Locality (GPCI)
  5. The 2019 Counties Included in 2018 Localities (GPCI Counties) (Same as 2017)

The Part B Fee Schedule amounts are calculated as follows:
    
 ((A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor (Part B Fees), and
    
 ((A1 x B1) + ((A2 x B2) x (1-MPPR Factor) + (A3 x B3)) x Conversion Factor (MPPR Part B Fees), where:
        A1 = Physician Work RVU
        A2 = Non-Facility Practice Expense RVU
        A3 = Malpractice RVU
        B1 = Work GPCI
        B2 = Practice Expense GPCI
        B3 = Malpractice GPCI

        Conversion Factor = $36.0391

        MPPR Factor = 50%

Resources:
Medicare Expired Legislative Provisions Extended and Other Bipartisan Budget Act of 2018 Provisions

Physician Fee Schedule (MPFS) and Other Revisions to Part B for Calendar Year (CY) 2019 Final Rule (CMS-1693-F) – November 23, 2018 Federal Register

Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2019 – Regulation # CMS-1693-F

Summary of Policies in the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule – Transmittal 4176/Change Request 11063

Summary of Policies in the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule MLN Matters Article – MM11063

Annual Update to the Per-Beneficiary Therapy Amounts (KX Modifier Thresholds) for CY 2019 – Transmittal 4178/Change Request 11055

Annual Update to the Per-Beneficiary Therapy Amounts (KX Modifier Thresholds) for CY 2019 MLN Matter Article – MM11055

Physician Fee Schedule Payment Policies

Skilled Nursing Facility Consolidated Billing and Annual Updates

Make Plans Now for the 2019 AHCA/NCAL Quality Summit

Jon-Patrick Ewing

Don't be on the naughty list, register for the AHCA/NCAL 2019 Quality Summit today! Before you break for the holidays be sure your reserve your spot at the Quality Summit, March 18-20, 2019. The Quality Summit will be held in sunny Tampa, Florida on the waterfront.

The Summit agenda is packed with sessions and speakers who will challenge you to think in new ways about:
  • Providing stronger patient-centered care
  • Using quality improvement methodology to begin or advance change
  • Disruption and innovation to tackle workforce challenges
  • How PDPM will create innovation in patient care

Visit the Quality Summit website for detailed information on education sessions, networking events and conference sponsors. Take advantage of discounted group rates and reserve your hotel by February 15.  You must be registered for the Quality Summit before any hotel reservations can be made. You may do both when registering online.

Deliver the Amazing Gift of Music with Mood Media

Dave Kyllo

Dick Clark said “music is the soundtrack of your life.”  Members can create an inspiring atmosphere in their communities through music offered by Mood Media at AHCA/NCAL “Member Only” discounted rates.

Mood Media offers great musical variety for events or casual common area listening via the internet or streaming, and offers customized commercial free music options that allow facilities to tailor musical selections to meet changing resident preferences.  Mood customers enjoy freedom from music licensing worries on Mood Media’s huge collection of music selections played on Mood Media's portable devices.
Use Mood Media’s music to:
  • Improve the dining experience and set the mood in dining areas as residents gather for meals;
  • Provide a variety of background music in common areas;
  • Create a positive environment for activities; and 
  • Provide musical entertainment for social gatherings and happy hours.

AHCA/NCAL members receive exclusive discounted rates on Mood services and equipment with three-year agreements.  The core music package starts at $29.99 per month or about $1 per day with a three-year agreement.    

For more information about Mood Media’s services, call 800-345-5000 or go to   http://partner.moodmedia.com/ahcancal/ (password: moodpartner).

Learn How SNF VBP Will Impact Your Revenue with AHCA’s Online Training

Dave Kyllo

AHCA has an education program designed to help skilled nursing facilities succeed under the CMS value based purchasing payment program (SNF VBP) that took effect on October 1, 2018.  The course (Understanding SNF VBP in Detail) contains six modules that provide an in-depth description of each feature of the CMS SNF VBP program along with helpful tools, documents, and primary source references to the program. 

This training program is intended for nursing home administrators, directors of nursing and any other staff including corporate staff who are responsible for payment models and rehospitalization reduction efforts.   No specific license is required take the course and no contact hours or CEUs are awarded for completing the curriculum.
The training program is specifically designed to help long term care professionals:
  • Understand how CMS calculates the measures, risk adjustment, the facility score and payment adjustment.
  • Use and access the CMS SNF VBP feedback reports and the SNF Performance Score Report.
  • Apply the incentive payment multiplier.
  • Use the SNF VBP prediction calculator to estimate the financial impact different SNFRM rates have on your Part A revenue.
  • Adopt best practices to help either avoid a payment penalty or receive an increase in your Medicare Part A payments.
Possessing a detailed understanding of SNF VBP is critical to operational success.  SNF payment adjustments began on Oct. 1, 2018 for all SNF Medicare Part A claims ranging from a 2 percent cut to potentially a 1.5 percent increase based on rehospitalization rates in prior years. CMS will recalculate the payment adjustment annually every fiscal year (FY) hereafter for the next ten years.

The registration fee for AHCA’s SNF VBP online course is $25 for AHCA/NCAL members and $65 for nonmembers.

The individual who wants to take the SNF VBP course must login to ahcancalED and register for the course under their individual login.  To access ahcancalED, members will need to login with their AHCA/NCAL usernames and passwords.  For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail educate@ahca.org with your name and facility contact information. 

Payment is made in ahcancalED upon registration via credit card or check. If paying by check, an order is not complete until the check is received and approved by AHCA staff. You will not have access to the training until approval.  Registrations for SNF VBP cannot be done by another person or under another person’s ahcancalED login.

Know how to succeed under SNF VBP.  Follow this link to register today for Understanding SNF VBP in Detail or go to https://educate.ahcancal.org/p/snfvbp

Texas Judge Strikes Down Obamacare As Unconstitutional but the Law Remains in Effect for Now

Dave Kyllo

A federal judge in Texas ruled last Friday that the Affordable Care Act (ACA) is unconstitutional under tax law because of a change Congress made that reduces the individual penalty to zero in 2019.  The 55-page ruling said that the constitutional foundation of the ACA was removed when the individual penalty was effectively eliminated. 

By all reports, it seems certain that the ruling will be appealed.   Supporters and opponents of the ACA are gearing up for a battle over the ruling which could go up to the Supreme Court.  Until those appeals are decided, the ACA remains intact according to the White House. 

“We expect his ruling will be appealed to the Supreme Court,” said White House press secretary Sarah Huckabee Sanders.  “Pending the appeal process, the law remains in place.”

The Department of Health and Human Services echoed the White House’s comments in a statement this week saying “The recent U.S. District Court decision regarding the Affordable Care Act is not an injunction that halts the enforcement of the law and not a final judgment. Therefore, HHS will continue administering and enforcing all aspects of the ACA as it had before the court issued its decision.” 

AHCA/NCAL will continue to monitor developments with the ACA and will keep members apprised of any changes with the law. 

VA Mission Act Implementation Hearing Today

Dana Halvorson

On Wednesday, December 19, 2018, at 2pm ET, the Senate and House Veterans’ Affairs Committees will hold a joint hearing entitled, “Tracking Transformation:  VA Mission Act Implementation.”   The U.S. Secretary of Veterans Affairs, Robert Wilkie, will be testifying.  The committees will focus on VA’s progress with respect to implementation of title I of the law, which requires VA to institute a consolidated community care program governed by certain access and quality standards by no later than June 6, 2019, to replace the Choice program.  Prior to the VA MISSION Act, if extended care providers, including nursing care centers, accepted a veteran patient, they were considered to be a federal contractor and subjected to additional red tape – simply because the patient was a veteran.  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, adds cost and takes staff time away from these veterans at the bedside.  This disparity of contracting and reporting requirements has deterred many long term care providers around the country from accepting veteran patients. 

Provisions in the VA Mission Act will help remove some of the existing red tape that may prevent providers from being able to provide care to veterans.  More specifically, the VA Mission Act will ensure that extended care providers, including nursing center care, can legally enter into Veteran Care Agreements (VCAs).  AHCA submitted a statement for the hearing record on VCAs that can be found here.  Finally, more information on the joint hearing can be accessed here.  

Action Plan Response for Adverse Events

Sara Rudow

AHCA's Survey Regulatory Committee has developed two new sets of tools, for SNFs and ALs, to help providers put steps in place to address an adverse event or potential adverse event and link it with their QAPI process. Each set of tools includes an overview with the goals and purpose of the tools, a fillable Initial Mitigation Action Plan document outlining four key steps in the mitigation process, two sample mitigation action plans providing examples of how to use the action plan tool, and another fillable tool for linking the mitigation action plan with an organization’s QAPI process. Centers and communities should feel free to use and adapt these tools as best fits their organizational processes and cultures. We thank the members of the Survey/Regulatory Committee for their hard work in developing these tools and hope you find them useful in improving your organizations’ systems and responses to adverse events. Should you have any questions, please contact educate@ahca.org

Tuesday, December 18, 2018

Mark Parkinson Named a 2018 Top Lobbyist

Abby Barreto

AHCA/NCAL President & CEO Mark Parkinson has been named a Top Lobbyist by The Hill for the sixth consecutive year. According to the publication, the 2018 list includes “the most distinguished and accomplished professionals from the influence world who are on the front lines of the nation’s most consequential political and policy battles.”

Under Mark’s leadership, the Association continues to improve the lives of millions of long term and post-acute care residents by delivering solutions for quality care. This year’s success included the permanent repeal of Medicare Part B outpatient therapy caps and authorization of VA Provider Agreements for long term and post-acute care providers – among many others.

The Hill publishes the Top Lobbyist list annually. See the full list here.

Updated List of Excluded Individuals and Entities (LEIE) Database File

Lilly Hummel

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 November 2018. This new file replaces 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.

As a best practice, long term care providers should check the LEIE on a regular basis.

Wednesday, December 12, 2018

Knowledge is a Powerful Weapon in the War on Germs

Dave Kyllo

AHCA/NCAL has a comprehensive program to help nursing facilities meet the infection prevention and antibiotic stewardship requirements being enforced by CMS. While originally designed for nursing facilities, the program is an equally effective training tool for assisted living settings.

The Infection Preventionist Specialized Training (IPCO) course provides education for any healthcare professionals who want to lead infection prevention efforts and prepares individuals to play an active role in the antibiotic stewardship efforts. Antibiotic stewardship is an overarching goal and priority among all health care professionals and is receiving a lot of attention from physicians and state and national health care regulators.       

The methods for preventing and controlling infections and managing antibiotic use are universal, so what works in the nursing facility setting will work in the assisted living setting. AHCA/ NCAL’s course is an online, self-study program with 23 hours of training. It includes online lectures, case studies and interactive components taught by subject matter experts who have real life experience working in long term/post-acute care.

The course addresses both clinical and organizational systems, processes and cultural aspects of infection prevention and control that are fundamental to effectively leading and administering successful infection prevention and control programs and antibiotic stewardship programs. Strong and effective infection prevention programs and antibiotic stewardship efforts can set an assisted living center apart from the competition, especially when working with social workers and discharge planners who help seniors with their post-acute decisions

Upon successful completion of this program, participants will receive certificates including 23 ANCC contact hours. The training course registration fee is $450 for AHCA/NCAL members and $650 for non-members. There are no refunds and no transfers.

Payment and registration must be made online in ahcancalED . The IPCO course can be accessed here or at: https://educate.ahcancal.org/p/ipco

Discounted group purchase rates are available for groups of 25 or more. Those interested in making a group purchase should email AHCA/NCAL at educate@ahca.org

To access ahcancalED and the IPCO course, members will need to login with their AHCA/NCAL usernames and passwords. For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail update@ahca.org with your name and facility contact information.

New LTC Trend Tracker 101 Course

Lonnita Myles

Interested in learning about LTC Trend Tracker? Visit ahcancalED to access the new LTC Trend Tracker 101 course to learn all about how skilled nursing facilities can utilize this tool for quality improvement, peer comparisons, and supporting metric data for Quality Award applications. Click here to access this free resource! Are you an assisted living community interested in learning more about LTC Trend Tracker? Click here to access a free course in ahcancalED that walks through all of the features available to you in this tool.

Have questions about LTC Trend Tracker? Feel free to contact our team at help@ltctrendtracker.com.

Government Shutdown Prospects Loom After Democrats Meet with President

Drew Thies

President Donald Trump clashed with Democratic Leaders Nancy Pelosi and Chuck Schumer in a rare, televised Oval Office meeting.

The meeting was set to address a government funding bill, which Trump has indicated should include $5 billion for a border wall. Government funding runs after Dec. 21.

In perhaps the most definitive terms he has used, President Trump said he would “be proud” to shut the government down if it meant getting concessions on border security.

House Republicans are considering passing a stopgap spending bill that includes the $5 billion Trump requested, but such a bill would need Democratic votes in the Senate for it to pass. On the prospect of the Senate failing to pass a spending bill, Senate Majority Leader Mitch McConnell said, “I hope that's not where we end up."

Pelosi said that if the government does shut down, the House, when it returns under Democratic leadership in January, will pass a bill that funds the government and border security at current levels.

Tuesday, December 11, 2018

Knowledge is Key to Avoiding the #1 Cited F Tag in Nursing Facility Inspections

Dave Kyllo

The most frequently cited F-Tag in standard nursing facility health inspection surveys under the new survey process is F880 – Infection Prevention & Control.  Since November 2017 when the new survey process began, more than one-third of surveys conducted across the nation have included a F880 Infection Prevention & Control citation. 

AHCA’s Infection Preventionist Specialized Training (IPCO) program is specifically designed to prepare individuals to effectively implement and manage an Infection Prevention & Control program in skilled nursing centers. It addresses both clinical and organizational systems, processes and cultural aspects of infection prevention and control which are fundamental to effectively leading and administering a center’s Infection Prevention & Control program. 

AHCA’s course is an online, self-study program with 23 hours of training that meets the educational requirements outlined by CMS. It includes online lectures, case studies and interactive components taught by subject matter experts who have real life experience working in long term/post-acute care.  The AHCA program gets rave reviews with 96 percent of health care professionals who have completed the course recommending IPCO to their colleagues. 

The course addresses both clinical and organizational systems, processes and cultural aspects of infection prevention and control that are fundamental to effectively leading and administering successful infection prevention and control programs and antibiotic stewardship programs.   Upon successful completion of this program, participants will receive certificates including 23 ANCC contact hours. 

The training course registration fee is $450 for AHCA/NCAL members and $650 for non-members.  There are no refunds and no transfers.  Payment and registration must be made online in ahcancalED. The IPCO course can be accessed here or at: https://educate.ahcancal.org/p/ipco.  

Discounted group purchase rates are available for groups of 25 or more.  Those interested in making a group purchase should email AHCA at educate@ahca.org.  

While CMS has announced plans to offer a free infection prevention training course some time in Spring 2019, AHCA/NCAL recommends investing in staff training now rather than waiting to train staff on the requirements that already are in effect.  Despite the CMS training announcement, facilities will continue to be surveyed on all the new infection prevention and control requirements and the antibiotic stewardship requirements – the same requirements leading to the most commonly cited F-Tag since November 2017 under Phase I and Phase II of the CMS Requirements of Participation and the implementation of the new survey process.

To access ahcancalED and the IPCO course, members will need to login with their AHCA/NCAL usernames and passwords.  For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail update@ahca.org with your name and facility contact information. 

Prepare your center and staff now for a successful survey and avoid the F880 tag. Register for IPCO!

Check Out the Employee Health Plan That Delivers Highly Valued Benefits and 24/7 Unlimited TELADOC® Services for Just $161 a Month

Dave Kyllo

AHCA/NCAL Insurance Solutions offers a minimum essential coverage health plan to members.  The new plan was developed by Compass Total Benefit Solutions and offers two affordable options for providing many of the health insurance benefits that are important to long term care employees.  The plan is designed to help AHCA/NCAL members recruit and retain frontline staff who cannot afford major medical health plan premiums or high deductibles.
 
The new plans feature affordable premiums and co-pays for valued and commonly used services, including prescriptions, physician visits and free unlimited 24/7 access to TELADOC®.  Benefits are instantaneous with no deductibles.  The Compass 1 plan costs about $1 per hour for a full-time employee or $161 per month.  The Compass 2 plan costs $182 per month.  The Compass 2 plan costs a little more because it includes higher indemnity payments for hospitalizations. Here’s the rate schedule:

  Monthly Premiums
Compass 1
Compass 2
EE
$161.29
$181.75
EE & Spouse
$264.70
$306.39
EE & Children
$244.19
$279.94
Family
$356.70
$417.20

Employers determine their level of contribution for plan expenses for coverage for employees, their spouses, their children or family coverage.  Employers can pay all the costs, share the costs with employees, or have employees pay for coverage completely as a voluntary option.  Or LTC employers can increase their employer contribution over time based on an employee’s length of service.  Both plans are flexible. In addition, employers have options such as covering all the costs for employee coverage but having the employee pay the premiums for their spouse and/or children. 

While this new AHCA/NCAL Insurance Solutions plan satisfies all 71 benefits required under the Affordable Care Act, it is not a fully compliant ACA plan.  It is considered a minimum essential coverage (MEC) plan and should be offered alongside a traditional ACA compliant plan to avoid any ACA employer penalties. 

There is no additional underwriting for the Compass plan and no mandatory wait periods for new employees to join the Compass MEC plans.  Any wait periods are determined by the employer.  There is a minimum of five employees that must be enrolled to offer the plan to employees.

The ability to offer a health insurance plan at little to no cost to employees allows AHCA/NCAL members to market their facilities as superior employers in comparison to competing employers.   This plan is much less expensive to an employer compared to a traditional employee health benefit plan and costs less than the expense of an employee who turns over.

Read this Q&A document for more information about Compass plans for AHCA/NCAL members. Versions of the Compass Plan are available in all 50 states. Changes to the Hospital Indemnity benefit vary based on state approvals. To see what's available in your state, please
contact Nick Cianci at 202-898-2841 or Dave Kyllo at 202-898-6312 or email ahcainsurancesolutions@ahca.org.

AHCA/NCAL Supports the BOLD Infrastructure for Alzheimer’s Act

Dana Halvorson

AHCA/NCAL has added its name to the list of national organizations that support the bipartisan Building Our Largest Dementia Infrastructure for Alzheimer’s Act, or BOLD Infrastructure for Alzheimer’s Act (S. 2076/H.R. 4256), which would apply a public health approach to Alzheimer’s disease.  Headed by the Centers of Disease and Prevention (CDC), it would create a modern infrastructure for the prevention, treatment, and care of Alzheimer’s and related dementias.  More than five million Americans are living with Alzheimer’s, and the United States spends more than $277 billion per year, including $186 billion in costs to Medicare and Medicaid.  Without further action, the number of Americans with Alzheimer’s is expected to triple to as many as 14 million by 2050, costing the nation more than $1.1 trillion per year.

Senators Susan Collins (R-ME), Catherine Cortez Masto (D-NV), Shelley Moore Capito (R-WV) and Tim Kaine (D-VA) introduced S.  2076, and it is co-sponsored by 56 Senators.  Reps. Brett Guthrie (R-KY), Paul Tonko (D-NY), Maxine Waters (D-CA), and Christopher Smith (R-NJ) introduced a companion bill in the House of Representatives, and it is co-sponsored by 251 members.  It is also supported by 181 organizations and individuals. The bill was approved by the Senate Health, Education, Labor and Pensions (HELP) Committee on November 29, 2018, and it now goes to the full Senate for consideration. 

2019 Independent Owner Leadership Conference Provides Unique Opportunities for Learning and Networking

This year’s conference is an essential gathering that will tackle key challenges that Independent Owners (IOs) face. Emphasis will be on new strategies and best practices for staying competitive and adapting in the evolving marketplace. At the forefront is helping you understand the Patient-Driven Payment Model (PDPM).

March 20-22
Marriott Tampa Waterside
Tampa, FL
 
 
In addition to the PDPM, other education topics include:
  • The Ever-Changing World of Assisted Living
  • Creating a Strong and Stable Workforce
  • Risk-Sharing
  • Grassroots Advocacy

LED Talks, curated by Provider magazine, will kick off the conference. These short, targeted sessions designed to lead, engage, and discover will showcase five different speakers specifically chosen for their fresh ideas and exciting perspectives.

The popular Owner-to-Owner Town Hall discussion will focus on emerging trends as well as litigation, records requests, and risk management.

The IO Leadership Conference offers you the chance to earn up to 12.75 CEs.

You can see a detailed agenda with descriptions of all the education sessions at IO.AHCANCAL.org.

The keynote speakers will also offer interesting and inspiring lessons not to be missed. Opening Keynote David DeLong, MIT AgeLab Research Fellow, is the author of Lost Knowledge: Confronting the Threat of an Aging Workforce and an expert on workforce management. His talk will help IOs to understand the importance of closing skills gaps, learn solutions for evaluating talent-related risks, identify talent problems that kill profits, and accelerate knowledge transfer in the multigenerational workplace.




The Closing Keynote is Green Beret Commander Captain Mark Nutsch who led the first 12-man Special Forces A-team on horseback as they infiltrated the mountains of Northern Afghanistan immediately following the September 11th attacks. His story of unyielding dedication to one’s country demonstrates the importance of loyalty and dependability in achieving success.







Before you close out the year, make plans to attend the 2019 IO Leadership Conference. You’ll enjoy three days of face time with your IO peers from across the country while getting your crucial questions answered.
Sponsors as of December 10, 2018:
Drive DeVilbiss Healthcare, Ecolab, Evan Senior Investments, Guardian Pharmacy Services, Kronos, MatrixCare

Long Term Care and the Law Conference February 27-March 1, 2019

Lilly Hummel

Register to attend the Long Term Care and the Law program February 27-March 1, 2019 in Phoenix, AZ. This informative program brings together some of the leading in-house and external counsel to discuss legal, compliance, and operational issues that long term care providers face. This year’s conference features many sessions useful for nursing centers and assisted living providers, such as Medicaid managed care contracting, sexual harassment, accounts receivable, HIPAA, and the Fair Housing Act—just to name a few. Provider members of AHCA/NCAL receive a discounted rate of $695 registration fee.

The morning of February 27 before the conference begins, the National Center for Assisted Living will host a FREE round table open to all assisted living in-house counsel. This is a unique opportunity for in-house counsel peers to discuss their concerns and how to manage emerging issues. Email Lilly Hummel at LHummel@ncal.org to attend. The American Health Lawyers Association (AHLA) offers CLE, CPE, NHA, and CCB credits for the conference. Don’t miss this excellent educational opportunity.

The Impact of Quality Incontinent Products on Incontinence Associated Dermatitis and Operational Costs in Skilled Nursing Facilities- Clinical Research Study

Join Michele Mongillo, RN, BSN, MSN RAC-CT, Global Clinical Leader at First Quality and adjunct faculty member at the University of North Carolina Chapel Hill School of Nursing for a timely education session. 

January 25, 2019 at 2pm

Michele will discuss the measurements and outcomes of a third party clinical research study conducted at three skilled nursing facilities, and the impact of quality products and education on IAD rate, laundry costs and wound care. The presentation will include specific interventions that can be utilized to improve key clinical and operational outcomes in a facility’s incontinence management program. IAD is a precursor to pressure ulcer development and it is essential for nursing staff to implement steps to prevent IAD by utilizing incontinent products appropriately with essential education.

Check Out the New AHCA/NCAL Workforce Resource Center!

Lindsay Schwartz

The new AHCA/NCAL Workforce Resource Center is a one stop shop for workforce resources. Discover resources to improve your organization’s overall workforce efforts to ensure staff stability. The center includes resources to recruit and retain staff, leadership, recognize staff, comply, train staff, and data. Make sure to check out the updated toolkit to reduce turnover and the Guiding Principles of Leadership. LTC Professionals can find links for training and developing new skills including IPCO, Gero Nurse Prep, and CNA Training.

The 2019 AHCA/NCAL National Quality Award Application Deadline

Erin Prendergast

Did you know that Quality Award recipients perform consistently better than the rest of the nation in key areas of quality care? Get started with your application today for the 2019 AHCA/NCAL National Quality Award Program. The deadline to apply is quickly approaching!

All applications and payments for all three award levels must be submitted through the Quality Award Portal by January 31st at 8 p.m. EST.

All applications must be submitted by a Primary Center Contact or a Center Contact, which are the only two roles that have access to start, write and submit an application. Additionally, only center level staff can be assigned as Primary Center Contacts or Center Contacts. If these contacts have not been set up for your center, please have them log into the Quality Award Portal and request access to be connected. This must be completed prior to the deadline.

The Quality Award Program will also be hosting a first-ever Bronze Early Submission Day on January 14!  Join the Quality Award staff for a step-by-step, how-to on submitting your Bronze Quality Award application and payment, including a live Q&A. Bronze applicants who submit their application on or before January 14 will be entered into a raffle for a waived application fee. Click here to register today.

More information about the AHCA/NCAL National Quality Award Program and resources, such as the criteria series, to help streamline your application process are available at ahcancal.org/qualityaward.

We hope you will take the next step to continue your quality journey this coming year by submitting an application. If you have any questions, please feel free to contact the AHCA/NCAL Quality Award team at qualityaward@ahca.org

Learn from the AL Gold Recipients – In More Ways Than One

qualityaward@ahca.org

In 2018, AHCA/NCAL recognized four organizations with a Gold – Excellence in Quality Award, the highest of three distinct levels possible through the AHCA/NCAL National Quality Award Program. Two of those organizations, Maine Veterans Home–Machias and Sunrise of Gurnee, are the first free-standing assisted living communities to ever attain Gold in the history of the program.

They demonstrate that if an independent, rural non-profit and a more urban community belonging to one of the nation’s largest companies can achieve the Gold, any assisted living community can. Take their advice on why to set out on the Quality Award journey and how to navigate it successfully—in more ways than one.

The executive directors from both Maine Veterans Home–Machias and Sunrise of Gurnee recently shared their insights for an AHCA/NCAL webinar, “Perception vs. Reality: The Quality Award Program for Assisted Living Providers.” The webinar also breaks down the commonly cited barriers preventing assisted living communities from participating in the program and talks about the many free resources available to help assisted living providers succeed. Access the webinar on ahcancalED anytime, on-demand.

Also check out their spotlight profiles, tribute videos, and blog posts for a synopsis of their journeys.

Maine Veterans Home—Machias
Sunrise of Gurnee

Ready to take the plunge? Quality Award applications at all levels (Bronze, Silver and Gold) are due January 31, 2019 by 8:00 PM Eastern. Find resources, applications and how to apply on our website.

The Membership Advantage in the AHCA Quality Initiative

Kiran Sreenivas

The AHCA Quality Initiative is able to use publicly reported measures to compare the success of members to non-members. As opposed to self-reported measures, publicly reported measures reduce the possibility of bias when gauging results and allow us to measure progress on a larger population than we could otherwise.

With that said, 62 percent of skilled nursing centers in the nation are AHCA members. Looking at the comparison of members and non-members that meet the AHCA Quality Initiative goals for hospitalization and off-label antipsychotics, a higher proportion of members meet the goals compared to non-members. (See Figures below)

Currently, the AHCA Quality Initiative uses public measures from Nursing Home Compare and AHCA’s Research Department for the hospitalization and antipsychotic goals, and AHCA is working on releasing nationwide public measures for functional outcomes in the near future.

AHCA is committed to helping members improve lives by delivering solutions for quality care. Expect this to continue in 2019 through additional ahcancalED courses, enhancements to LTC Trend Tracker, and dynamic meetings, like the upcoming Quality Summit on March 18-20, 2019 in Tampa, FL.




































Source: Nursing Home Compare and LTC Trend Tracker

Wednesday, December 5, 2018

CMS Posts Annual Update to Part B Therapy Modifier and Targeted Review Dollar Thresholds

Dan Ciolek

CMS recently posted a MLN Matters article describing the annual per-beneficiary incurred expense amounts now known as the KX modifier thresholds, and related Medicare Part B therapy policy updates for CY 2019. These amounts were previously associated with the financial limitation amounts that were more commonly referred to as “therapy caps” before the application of the therapy limits/caps was repealed when the Bipartisan Budget Act of 2018 (BBA of 2018) was signed into law. Another provision of the BBA of 2018 lowered the threshold of the targeted medical review process as listed below.

For CY 2019:
  • The KX modifier threshold amount for physical therapy (PT) and speech-language pathology (SLP) services combined is $2,040. For occupational therapy (OT) services, the CY 2019 threshold amount is $2,040. 
  • The Targeted Medical Review (MR) threshold amount is $3,000 for PT and SLP services combined and $3,000 for OT services.

Make sure that your billing staffs are aware of these updates

Congress Proposes Plan to Fund Government for Two More Weeks

Drew Thies

House leaders released a bill Monday morning that will extend government funding through December 21st, giving lawmakers just days before the Christmas holiday to reach a long-term deal.

Senate Majority Leader Mitch McConnell said the Senate will take up the extension if the House passes it. House Democrats initially wanted a one week deal but accepted the two week proposal.

A key sticking point in negotiations on a broader deal is President Trump’s desire for $5 billion in funding for a wall on the southern border. Senate Democratic leadership offered some concession on wall funding, but not the full amount the President wants.

The short-term deal also comes after the death of President George H. W. Bush, which stalled negotiations this week while the President lies in state at the Capitol.

Democratic House Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer were scheduled to meet with the President privately on Tuesday, but the death of President Bush delayed the meeting until December 11. Negotiations are said to be on hold until Trump meets with Democratic leadership.

Advance Your Long Term Care Career with ACHCA Administrator Credentialing

Dave Kyllo

Administrators are key leaders on long term care teams and are entrusted with the responsibility of caring for residents and patients.  They touch the lives of residents and families, and most importantly, ensure that their staff provides the highest level of quality care to a vulnerable population.

AHCA/NCAL partners with the American College of Health Care Administrators (ACHCA) for its administrator certification programs.  The goals of the partnership are to increase awareness of advanced certification and professional growth opportunities and to encourage independent professional certification for nursing facility and assisted living administrators/directors. 

ACHCA has established eligibility criteria prior to taking the exam, including two years of licensure (other options exist for assisted living administrators in states without administrator licensure) and continuing education requirements.  Both must be established before an individual is authorized to sit for the credentialing exam. While ACHCA membership has many benefits for administrators/directors, ACHCA membership is not a requirement for ACHCA certification.

The application fee for either the nursing facility or assisted living certification exam is $150.   AHCA/NCAL members should use AHCA/NCAL members should use code AHCANCAL when they complete their initial ACHCA applications. The single credential fee (the fee paid after an individual passes the exam) is only $300 for AHCA/NCAL members, a $50 discount off the regular non-ACHCA member price when AHCA/NCAL members use promo code AHCANCAL at checkout. 

Credentialing through ACHCA lasts five years.  Recertification involves obtaining 150 hours of continuing education in five areas during the five-year certification period and paying a recertification fee.

ACHCA certification can provide State licensure reciprocity with certain states.  Licensing rules and requirements vary by state. Check with your state licensing board for your state’s reciprocity requirements. A list of state licensure boards and contact information is maintained on the NAB website at www.nabweb.org.

For more information about ACHCA certification, go to www.achca.org/certification or call 800-561-3148.