Wednesday, January 30, 2019

Assisted Living Providers + Quality Improvement = The 2019 AHCA/NCAL Quality Summit

March 18-20, 2019
Marriott Tampa Waterside, Tampa, FL

Calling all assisted living providers, the Quality Summit has programming designed to meet your care and operational challenges! Register now and join us for sessions including:
  • We are a Gold AL. Here is How We Got Here. 
  • Fentanyl Fantasies: How Prudent and Problematic Pain Management Efforts Impact Quality 
  • Best Practices Related to the Press & Media 
  • Growing Effective Supervisors: A Critical Ingredient in Quality Care and Quality Jobs 
  • Administrator Round table: Disruptions Leading to Innovations in Operations 
  • Practical Strategies for Recruitment and Retention 
  • and many more 
Quality Summit faculty includes national subject matter experts who understand the professional development needs of practitioners along the long term care continuum.

Register now to join quality-focused providers from around the country for a Summit packed with content to help you begin, extend, or sustain gains in your quality program.

Don’t miss the opportunity to stay at the host hotel and save with AHCA/NCAL discounted rates. The hotel reservation deadline is February 15. You may register for the Quality Summit through March 5. You must be registered for the event before hotel reservations can be made.

Need Help Navigating the Ever-Changing World of Assisted Living?

Special Session at the IO Leadership Conference Will Answer Your Key Questions

March 20-22, 2019 
Marriott Tampa Waterside, Tampa, FL

Earn up to 12.75 CEs 

Assisted living is continuously changing and evolving. The IO Leadership Conference offers a one-of-a-kind setting for assisted living providers to network, share ideas, and learn the required strategies that will help you survive and thrive. It's three days of jam-packed education with your peers.

Part one of this crucial assisted living session focuses on Cyber Security with expert Vince Crisler, CEO and co-founder of Dark Cubed. Crisler will provide an overview of the current cyber security threat environment and explain why it is necessary to rethink how you protect customer data, networks, and other sensitive information.

Part two will help you navigate Risk Management to avoid litigation exposure. Topics include:
  • Developing written policies and procedures 
  • Ensuring billing and contract compliance 
  • Understanding the variety of legal requirements you face 
Learn more, see the complete agenda, and register. Deadline is March 5, 2019.

The hotel deadline is fast approaching. Secure your hotel room by February 15th to take advantage of room rate savings. 


Sponsors as of January 29, 2019:
CapitalOne, Compass Total Benefit Solutions, Drive DeVilbiss, Ecolab, Evans Senior Investments, Guardian Pharmacy Services, Kronos, MatrixCare, Navigator, Pharmscript, PointClickCare, Prime Care Technologies, Reliant Rehabilitation

PDPM and the Requirements of Participation are on Your Mind. We’ve Got You Covered

The 2019 AHCA/NCAL Quality Summit includes sessions designed to help you understand and implement aspects of the Patient Driven Payment Model (PDPM) and the phase 3 updates to the Requirements of Participation. Sessions include:
  • Connecting Restorative Nursing to PDPM
  • PDPM: Your Roadmap to Person-Centered Care
  • The Intersection Between Quality and the RoP’s Compliance and Ethics Program
  • Toward Better Behavior: Yours, Mine, and Everyone Else’s
  • and many more
Summit faculty includes national subject matter experts who understand the professional development needs of practitioners along the long term care continuum. Register now to join quality-focused providers from around the country for a Summit packed with content to help you begin, extend, or sustain gains in your quality program.

Don’t miss the opportunity to stay at the host hotel and save with AHCA/NCAL discounted rates. The hotel reservation deadline is February 15. You may register for the Quality Summit through March 5. You must be registered for the event before hotel reservations can be made.

Tuesday, January 29, 2019

The Number of Open LTC Jobs Nationwide Tops 43,000 in January

Dave Kyllo

There are 43,531 open jobs posted by direct employers in the nursing care facility (including SNFs), assisted living, and continuing care retirement community (CCRC) sectors this month according to the latest Gartner TalentNeuron statistics.  That represents an increase of more than 10,000 open jobs compared to typical monthly figures from last year. 
   
The Gartner TalentNeuron statistics also show an estimated 2,661,000 potential candidates in the nation’s workforce whose skills likely match the qualifications being sought by long term care employers. Figures show that 2,960 direct employers are competing for candidates this month. The average number of days a job was posted was 38 days in January.      

Finding qualified employees is one of the greatest challenges facing long term care providers and early 2019 statistics prove that the challenge is only growing in the strong economy with a low unemployment rate.  Lead them to your job vacancy through the AHCA/NCAL Long Term Care Career Center. 

The LTC Career Center is designed to help AHCA/NCAL members be competitive in attracting qualified candidates to fill their health care positions.  Job postings receive far greater exposure than local ads and job boards because the LTC Career Center connects to a national network of nearly 300 national and state health care organizations and societies where serious candidates look for health care jobs. Employers are also able to post vacancies as they occur and search resumes on the network.

Rates for posting job vacancies are affordable at $350 for a 30-day job posting.  Employers who utilize the site also receive complimentary additional exposure through rotating new job listings on AHCA’s home page – the web site where long term care professionals go for news and information.  In addition, employers who post vacancies through the center receive free bonus rotating listings on the Long Term Care Career Center home page. 

Of course, the LTC Career Center is always free for job seekers and the LTC Career Center features many of the best positions the long term care profession has to offer.  Job seekers are using the site with more than 67,000 searchable resumes on the National Healthcare Career Network this month.  

Join the high profile employers that use AHCA/NCAL’s premier member resource to find top talent.  Check out the LTC Career Center or call Robin at 866-964-2765 x2736 for more information about posting job vacancies on the LTC Career Center and other discounted job listing packages.

Independent Owner Leadership Conference Heats Things Up

Hot Topics You Can’t Miss

REGISTER TODAY

Come warm up in sunny Tampa, FL March 20-22 with other Independent Owners (IOs) for priceless networking and educational opportunities you can’t get anywhere else.

This year’s IO Leadership Conference provides three days of focused learning on the issues that are most critical to you right now.
  • Patient-Driven Payment Model (PDPM)
  • Workforce Stability
  • Risk Sharing and Risk Bearing
  • Grassroots Advocacy

In addition, the popular Owner-to-Owner Town Hall discussion will tackle emerging trends as well as litigation, records requests, and risk management.

You can earn up to 12.75 CEs.

Set yourself up for greater success in 2019 by registering now.

Get all the details and see the complete agenda, social events, speakers, and more at IO.AHCANCAL.org.

Sponsors as of January 21, 2019:
CapitalOne, Compass Total Benefit Solutions, Drive DeVilbiss, Ecolab, Evans Senior Investments, Guardian Pharmacy Services, Kronos, MatrixCare, Navigator, Pharmscript, PointClickCare, Prime Care Technologies, Reliant Rehabilitation

CMS Final Rule Adjusting CMPs for Inflation

Lilly Hummel

Last week CMS published a memo summarizing the inflation adjustments to the CMP amounts that may be imposed for noncompliance by nursing centers. The new CMP amounts and ranges can be found in the Appendix of the memo. The adjusted amounts apply to CMPs assessed on or after October 11, 2018, which is when the rule was published that finalized the adjustments.

The Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 required CMS to make annual inflation adjustments to the CMP amounts. For 2018, CMPs have been increased by a multiplier of 1.02041.

The CMP Analytic Tool instructions and calculations will be updated to reflect these changes. The final rule only affects authorized CMP amounts and not other provisions in the CMP Tool, such as the factors for assessing CMPs.

Monday, January 28, 2019

Importance of Practicing Your Emergency Preparedness Plan

Dana Halvorson and Erin Prendergast

On January 28, 2019, McKnight’s released an article entitled, “‘This could have been a nightmare’ - evacuation plan succeeds during LTC facility’s gas disaster.” According to the article, St. Clare Newport in Rhode Island successfully evacuated all 87 of its residents last week when it lost its heat amid a regional gas outage, during single digit temperatures.  The continuing care retirement community had prepared for such circumstances previously, running drills twice a year.  You can read the full story here.

In addition to planning for natural disasters, staff and facilities must be prepared for other emergencies, such as pandemics, influenza, active shooters and more.  All emergency situations must be handled swiftly, diligently and with the utmost care for staff and patients.  AHCA/NCAL has a dedicated website page with emergency preparedness resources that we believe you will find of assistance. The page, which can be found here, includes resources by state to information on the CMS Emergency Preparedness Final Rule that was released in 2016.  If you have any questions on the work AHCA/NCAL is doing around emergency preparedness, please contact AHCA’s Erin Prendergast for SNF and AL focuses and AHCA’s Dana Halvorson for ICF/IID related questions.

OSHA Finalizes Rule Eliminating Some Reporting Requirements for Large Employers

Lilly Hummel

Last week the Occupational Safety and Health Administration (OSHA) finalized a regulation eliminating the obligation for employers of 250 or more employees to submit their forms 300 and 301. This reporting requirement was proposed under the Obama administration, but was never enforced. The final rule retains the requirement for them to submit their 300A annual summary. Employers with 20-250 employees in certain designated hazardous industries, including long term care, must also continue to submit 300As. 

In addition, the final rule adds a requirement for covered employers to electronically submit their Employer Identification Number with their information from Form 300A. Collection of Calendar Year 2018 information from the OSHA Form 300A began on January 2, 2019. The deadline for electronic submissions is March 2, 2019.

Finally, this new regulation does not make any changes to the anti-retaliation provision.  That provision requires employers to have a “reasonable” program in place for employees to report injuries and safety violations, leaving open to interpretation what “reasonable” means. 

Don’t Miss the AHCA PDPM Training Academy

Dave Kyllo

AHCA has training teams traveling the country to help SNF providers build the foundation for a strong and successful transition to the Patient-Driven Payment Model (PDPM).

 
Don’t miss out on training provided by national experts that features information and exercises that will get you ready for implementation as well as access to the PDPM Online Academy, which provides post-training updates, information, and resources.

Check with your AHCA state affiliate for the date and time of the training in your state. 

Wednesday, January 23, 2019

IRS Finalized Rule Affecting Deduction Eligibility for Pass-Through Entities

Lilly Hummel

The Tax Cuts and Jobs Act enacted in 2017 allows the owners of pass-through entities like limited liability companies, partnerships, S corporations, and sole proprietorships to deduct 20% of their "qualified business income." Congress defined qualified business income as income from a "qualified trade or business," which, importantly, does NOT include a "specified service trade or business." Knowing this, AHCA/NCAL advocated that nursing centers and assisted living (AL) communities to be considered a specified service trade or business. The Internal Revenue Code defines specified service trade or business as:

"Any trade or business involving the performance of services in the fields of health, law, accounting, actuarial science, performing arts, consulting, athletics, financial services, brokerage services, or any trade or business where the principal asset of such trade or business is the reputation or skill of one or more of its employees or owners."

For several decades, the IRS has interpreted this language to include providing nursing services and physical therapy. Under that interpretation, it would be very difficult for any nursing centers and some AL communities to qualify for the tax deduction.

Since the Department of Treasury issued a proposed rule following IRS’s historical interpretation, AHCA/NCAL staff and members have met with Treasury and IRS officials, as well as key congressional staff. Despite these efforts, Treasury finalized a rule that stuck with the IRS’s 30-year-old definition of services in the field of health.

AHCA/NCAL’s initial analysis of the final rule indicates there is no across-the-board carve out for nursing centers or AL communities. The final definition of “providing services in the field of health” includes nursing and physical therapy, and therefore it will most likely be very challenging for nursing centers and some AL to take the 20-percent deduction. In its summary of comments and explanation released with the rule, the government notes:

The Treasury Department and the IRS agree that skilled nursing, assisted living, and similar facilities provide multi-faceted services to their residents. Whether such a facility and its owners are in the trade or business of performing services in the field of health requires a facts and circumstances inquiry that is beyond the scope of these final regulations. The final regulations provide an additional example of one such facility offering services that the Treasury Department and the IRS do not believe rises to the level of the performance of services in the field of health.

It is possible that certain AL communities will qualify for the 20-percent deduction based on a new example added to the regulations as a result of AHCA/NCAL’s comment letter. The new example included in the explanation reads as follows:

“X is the operator of a residential facility that provides a variety of services to senior citizens who reside on campus. For residents, X offers standard domestic services including housing management and maintenance, meals, laundry, entertainment, and other similar services. In addition, X contracts with local professional healthcare organizations to offer residents a range of medical and health services provided at the facility, including skilled nursing care, physical and occupational therapy, speech-language pathology services, medical social services, medications, medical supplies and equipment used in the facility, ambulance transportation to the nearest supplier of needed services, and dietary counseling. X receives all of its income from residents for the costs associated with residing at the facility. Any health and medical services are billed directly by the healthcare providers to the senior citizens for those professional healthcare services even though those services are provided at the facility. X does not perform services in the field of health within the meaning of section 199A(d)(2) and paragraphs (b)(1)(i) and (b)(2)(ii) of this section.”

In other words, a community or facility that meets the above description would fall outside the definition of a specified trade or business and qualify for the 20-percent deduction.

AL communities should consult their accountant or tax advisor to determine the applicability of the deduction to their taxes.

See relevant stories in Provider Magazine and McKnight's Senior Living

E-Verify Unavailable Due to Government Shutdown

Drew Thies

Due to the partial government shutdown, the online employment status verification system, E-Verify, is no longer operational. The system is under the authority of the Department of Homeland Security, one of the several departments that is currently unfunded.

Virtually all E-Verify functionality is unavailable, including the ability to enroll, create a case, take any action, and edit information.

As a result, several new interim policies are in effect to relieve the burden on employers and employees reliant on E-Verify. Several deadlines are extended while E-Verify is unavailable, including the time for resolving Tentative Nonconfirmations (TNCs) and the “three-day rule” for creating E-Verify cases.

E-Verify is a voluntary program for most employers but is mandatory for federal contractors and employers in Arizona and Mississippi. In South Carolina it is encouraged for all employers; in Idaho, Minnesota, and North Carolina it is required for state agencies; and in Colorado, Georgia, Missouri, Nebraska, Oklahoma, Rhode Island and Utah it is required for public contractors and state agencies.

Additional information can be found on the E-Verify website and at the Society for Human Resource Management.

Learn About the Highly Popular Minimum Essential Coverage Health Plan in 97 Seconds

Dave Kyllo

AHCA/NCAL Insurance Solutions offers a minimum essential coverage (MEC) health plan to members.  The 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.  This short video explains the MEC plan for AHCA/NCAL members in less than two minutes and highlights the features that make the MEC plan so popular with employers and employees. 
 
Both Compass 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 difference in the two plans is based on the level
of hospital indemnity benefits.  Here’s the exclusive AHCA/NCAL “Member Only” 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 is designed to help AHCA/NCAL members recruit and retain frontline staff who cannot afford major medical health plan premiums or high deductibles.  Employers determine their level of contribution for plan expenses for coverage for employees, their spouses, their children or family coverage. 

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.

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. Hospital indemnity benefits vary based on state approvals, which is why some states have different hospital indemnity benefit levels.

For more information, please contact Nick Cianci at 202-898-2841 or Dave Kyllo at 202-898-6312, visit www.ahcabenefits.org or www.ncalbenefits.org or email ahcainsurancesolutions@ahca.org.
 

Look to ACHCA to Advance Your Long Term Care Administrator Career

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. 

Come to Tampa and Lead. Engage. Discover.

Stories You Don’t Want to Miss! At the 2019 Quality Summit, Provider Magazine is again curating LED Talks. LED stands for LEAD. ENGAGE. DISCOVER, and this year’s talks feature short, targeted talks focusing on:
  • The ways long term care providers respond to depression
  • Stories detailing residents coming out of comatose states
  • Saving a company through courage, persistence, and innovation
  • How a disaster played out in real time for one SNF, and how fast-acting and determined administrators, staff, and volunteers drove residents to safety under extreme risk of peril

 The LED Talks provide a unique experience through provider-to-provider sharing of challenges, triumphs, innovation, and much more. Register now for the 2019 Quality Summit (March 18-20) and be inspired by the warmth of compelling, inspirational and relevant content and learn and network in the warm Tampa sunshine.

Don’t miss the opportunity to stay at the host hotel and save with AHCA/NCAL discounted rates. The hotel reservation deadline is February 15. You may register for the Quality Summit through March 5. You must be registered for the event before hotel reservations can be made.

CMS Promotes the New Electronic System for Provider Reimbursement Review Board Appeals

Dan Ciolek

In a January 18, 2019 MLN Matters Article, the Centers for Medicare and Medicaid Services (CMS) promotes the use of a new electronic system for provider reimbursement review board appeals.  The new system, the Office of Hearings Case and Document Management System (OH CDMS) went live on August 16, 2018.  CMS encourages Part A providers such as SNF to learn more about the benefits of using OH CDMS by attending the upcoming MLN event. Register for the New Electronic System for Provider Reimbursement Review Board Appeals Call scheduled for Tuesday, February 5 from 1:30 to 3 pm ET.

Background
The PRRB gives Medicare providers an independent forum for resolving Medicare Part A reimbursement disputes. The PRRB publishes its rules, current alerts, final substantive decisions, and many jurisdictional decisions on the PRRB website. 

To file a PRRB appeal, Part A providers must:
  • Be dissatisfied with a final determination by CMS or a MAC
  • Demonstrate that the amount in controversy is $10,000 or more (or $50,000 for a group)
  • File a request for a hearing within 180 days after receiving the final determination.

Most of the final determinations appealed to the PRRB relate to the Notice of Program Reimbursement (NPR) or revised NPR for the Medicare cost report, but may include other final determinations, such as:
  • Exception decisions
  • Quality reporting program payment reduction decisions
  • Certain provider reimbursement issues addressed through the Federal Register

OH CDMS – The New Electronic System
The OH CDMS is a web-based portal for parties to submit all their appeal materials and for the Board to issue all outgoing correspondence including notices and decisions. The system provides 24/7 real-time access for parties and their designated representatives to view and manage their own cases. Initial entry into OH CDMS requires registration through the CMS Enterprise Portal.

The OH CDMS captures all filings made directly into the system in a Confirmation of Correspondence that is emailed to the parties involved. Confirmations serve two purposes:
  • Summarize the data entry and document uploads for the submitter
  • Notify the opposing party of new actions on the case

All government contractor organizations that participate in appeals before the PRRB (MACs, Cost Report Audit and Appeals Contractor (CRAA) and the Appeal Support Contractors (ASC)) are registered in OH CDMS. System-generated confirmations for portal-based submissions fulfill the requirement for service on these contractors. As such, provider representatives using OH CDMS will no longer have to send a separate copy of the correspondence to the relevant contractor(s).

Note: More information about OH CDMS is available here. To resolve any technical issues, please contact the OH CDMS Help Desk at (833) 783-8255, or email helpdesk_ohcdms@cms.hhs.gov.

Wednesday, January 16, 2019

New Medicare Card Tips to Pass Along to Residents

The Centers for Medicare & Medicaid Services (CMS) recently completed a large-scale effort to provide new Medicare cards without Social Security numbers to people with Medicare. Over the past nine months, CMS sent new cards to more than 61 million people with Medicare across all U.S. states and territories. The agency touts completing the mailing ahead of schedule.

Each new Medicare card features a unique, randomly assigned Medicare number known as a Medicare Beneficiary Identifier (MBI). The MBI is a combination of letters and numbers that helps protect against personal identity theft and fraud. CMS mailed the new cards to all people with Medicare beginning in April 2018, as part of the legislation passed under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

CMS offers a number of tips and resources regarding the new Medicare cards:

Assistance Available 
For anyone with Medicare who has not received a new card by now, CMS offers these tips: 
  • Call 1-800-MEDICARE for assistance. They will verify your identity, check your address on record, and help you get your new card. 
  • Log into your gov account to get your new Medicare number or print your official card. The new Medicare number is now available in your account, even if you didn’t receive your card in the mail. Accounts are password-protected and secure. To access or create an account, visit MyMedicare.gov
  • Ask your healthcare provider. Providers may be able to look up your Medicare number through a secure portal when you come in for healthcare services. 
Prioritizing Security
Although the new Medicare cards are designed to protect against identity theft, people with Medicare should continue to look out for scams. CMS offers these tips: 
  • Destroy your old Medicare card so no one can get your personal information
  • Start using your new Medicare card right away. Carry it when you need healthcare. Medicare coverage and benefits are the same. The new card does not impact or change your healthcare benefits. 
  • Keep your other plan cards. If you’re in a Medicare Advantage Plan (like an HMO or PPO) or a Medicare Drug Plan, keep using that plan ID card whenever you need care or prescriptions. However, please carry and protect your new Medicare card too — you may be asked to show it. 
  • Protect your Medicare number just like a credit card. Only give the new Medicare number to doctors, pharmacists, other healthcare providers, insurers, or people you trust to work with Medicare on your behalf. Medicare will never call uninvited for your Medicare number or other personal information. 
Tips to Prevent Fraud

Video: Destroy Your Old Medicare Card

New Medicare Card webpage

Tuesday, January 15, 2019

Get Your PDPM Answers at the Quality Summit

Jon-Patrick Ewing

The Patient-Driven Payment Model (PDPM) is going to change the future of long term and post-acute care! Get the information and answers you need by attending the AHCA/NCAL Quality Summit, March 18-20, in Tampa, FL. The Quality Summit is packed with three days of education session and speakers to help you excel in quality improvement for your organization and resident care. Several sessions at the Quality Summit will focus on PDPM, especially the impact it will have on resident care.

Escape the dregs of winter for the warm Tampa, FL sunshine. REGISTER NOW and attend sessions, connect with sponsors and network and share your successes and your challenges with like-minded colleagues from across the country. We know you will return home with solutions that will show results in your organization!

Don’t miss the opportunity to stay at the host hotel and save with AHCA/NCAL discounted rates. The hotel reservation deadline is February 15. You may register for the Quality Summit through March 5. You must be registered for the event before hotel reservations can be made.

Facility Overpayments to Utility Companies are not Tax Deductible Charitable Contributions

Dave Kyllo

Most long term care facilities (about 75%) are being overcharged for one or more of their utilities and these overpayments are wasted dollars out the door. Providers don’t receive better service or any other benefit for over paying utility companies. The good news is that putting an end to the overpayments is easy.

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. 

Read This If You Remember the F-880 Tag From Your Last 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!

Toward Better Behavior: Yours, Mine, and Everyone Else's


As the long-term care demographics continue to shift and diversify, the greater the need to understand people as individuals. Achieving such understanding presents new challenges and considerations in assessment and care planning. While long-term care facilities once cared almost exclusively for the frail elderly, many of whom had also been diagnosed with dementia, today’s populations are far more varied in age, disability, and psychosocial circumstances. That makes understanding “what makes someone tick” more complicated, at best. This session provides professional caregivers a framework for developing an assessment process that results in a deeper understanding of what motivates someone to do what they do. With greater understanding comes a more focused, personalized plan to accommodate the complicated needs of every individual.

February 20, 2019
2:00 PM EST

Learning Objectives:
  1. Understand the concept of culture change and the expectations of regulators and consumers with regard to applying these principles;
  2. Develop a keener insight into human behavior and be able to apply that knowledge in creating an environment in which everyone thrives;
  3. Create person-centered, innovative interventions as alternatives to pharmacologic remedies in response to the behavioral health needs of residents with dementia.
Speaker: Barbara Speedling, Quality of Life Specialist

Independent Owner Leadership Conference Invites You to Attend Special Session on Patient-Driven Payment Model

Danielle Levitan

The new PDPM goes into effect October 1, 2019. Get ready with this special session at the IO Leadership Conference.
 
March 20-22, 2019
Tampa, FL
 
Get all the details and register today: IO.AHCANCAL.ORG

PDPM changes the payment model to one based on patient characteristics instead of therapy. The session will provide an overview of PDPM, and answer all your questions. You’ll also get guidance on tools to align your building operations to the new payment model, as well as better prepare your staff.

In addition, the IO Leadership Conference will address other key challenges such as workforce stability, risk bearing and sharing.
  • Earn up to 12.75 CEs at numerous education sessions
  • Network with your peers from across the country
  • Hear from inspiring speakers
  • Enjoy exciting activities

Deadline: March 5, 2019

Sponsors as of January 14:
Compass, Drive DeVilbiss,  Ecolab, Evans Senior Investments, Guardian Pharmacy Services, Kronos, MatrixCare, Pharmscript, PointClickCare, Reliant Rehabilitation

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 December 2018. This new file replaces the updated LEIE database file available for download. 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, January 9, 2019

E-Verify Unavailable Due to Government Shutdown

Drew Thies

Due to the partial government shutdown, the online employment status verification system, E-Verify, is no longer operational. The system is under the authority of the Department of Homeland Security, one of the several departments that is currently unfunded.

Virtually all E-Verify functionality is unavailable, including the ability to enroll, create a case, take any action, and edit information.

As a result, several new interim policies are in effect to relieve the burden on employers and employees reliant on E-Verify. Several deadlines are extended while E-Verify is unavailable, including the time for resolving Tentative Nonconfirmations (TNCs) and the “three-day rule” for creating E-Verify cases.

E-Verify is a voluntary program for most employers but is mandatory for federal contractors and employers in Arizona and Mississippi. In South Carolina it is encouraged for all employers; in Idaho, Minnesota, and North Carolina it is required for state agencies; and in Colorado, Georgia, Missouri, Nebraska, Oklahoma, Rhode Island and Utah it is required for public contractors and state agencies.

Additional information can be found on the E-Verify website and at the Society for Human Resource Management.

The Key to SNF Value Based Purchasing Success is Knowledge

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

New HHS Report Addresses Health Care Industry Cybersecurity

Dave Kyllo

The Department of Health and Human Services (HHS) issued a new publication in late December providing guidance and voluntary recommendations related to cybersecurity for health care providers.  The publication, titled “Health Industry Cybersecurity Practices:  Managing Threats and Protecting Patients,”  explores the five common threats facing health care providers and details 10 practices to mitigate the threats. 

The five threats explored in the new HHS report include:
  • E-mail phishing attacks;
  • Ransomware attacks;
  • Loss or theft of equipment or data;
  • Insider, accidental or intentional data loss; and, 
  • Attacks against connected medical devices that may affect patient safety.

Cybercrime is rampant in the United States and the need for health care providers to be proactive and protect themselves against losses due to cybercriminal activity only increases.  Before purchasing cyber liability insurance, it’s important to understand critical cyber risks facing businesses today and what risks long term care providers should insure against.  Below are examples of key components of a comprehensive cyber liability insurance policy: 
  • Security & Privacy Liability – A cyber thief hacks your facility’s computer system and steals the personal data of past and current residents/patients.  Your facility gets sued for $1 million on behalf of several resident families for the negligent unauthorized release of personal information.   
  • Breach Event Costs – The cost of notifying all the victims of the data breach and their families can be staggering as can the public relations expense of explaining what went wrong.
  • Regulatory Fines and Proceeding Coverage – Regulators will likely be interested in the cause of your data breach and whether your response followed state and federal laws.   Coverage includes paying for your legal counsel, hearing expenses and any fines where insurable under the law. 
  • Multimedia Liability – This includes protection should your facility’s logo be similar to another company’s logo or should your website contain content that is copyrighted or trade-marked by others. 
  • Network Asset Protection – Hackers may destroy software and the information/data stored in your computers.  This coverage pays for the expenses to replace or restore software and data.
  • Business Interruption Income Loss – Facility revenue may be impacted through a tainted reputation following a data breach.  Insuring against this risk pays for the reduction in profit and extra costs such as renting a replacement computer system.
  • Cyber Extortion – Possibly one of the most talked about cyber security risks is “ransomware” – a computer virus that freezes your computer system until the demanded ransom is paid.  The insurance pays for expert advice on how to retrieve your system, negotiate with the hackers and pay any ransom if necessary.

HealthCap is the AHCA/NCAL endorsed carrier for liability insurance and cyber liability coverage.  The company’s sole focus is serving the needs of long term care providers, including assisted living.  HealthCap® carrier partners offer cyber liability insurance and it is not necessary for a long term care provider to have General or Professional liability insurance through HealthCap to purchase cyber liability insurance through HealthCap’s carrier partners.

For more information about HealthCap’s comprehensive suite of data security and privacy insurance solutions and to find a local agent, contact Stephanie Hale at Stephanie.Hale@chelsearhone.com
 

Harness the Power of Excellence: 2019 AHCA/NCAL Quality Summit

Jon Patrick-Ewing

The 2019 AHCA/NCAL Quality Summit is an event that harnesses the energy and passion of assisted living, post-acute, and skilled nursing quality practitioners and turns them into the foundation for a must-attend three days. This year the goal of the Quality Summit programming is to highlight the power and limitless possibilities that come from the pursuit of excellence as well as to shine a spotlight on the results that come from disruption and innovation, as well as practical approaches to care and operational challenges. The Summit programming is designed for quality practitioners at all levels. From sessions showcasing the innovative practices of providers across the county, to short, targeted LED talks designed to challenge your thinking, to peer-to-peer idea exchanges, new solutions from sponsor partners, and informative keynote speakers; you will leave with information and ideas that you can implement as soon as you return to your centers and communities.

Program topics include:
  • We Are a Gold AL. Here is How We Got Here
  • Best Practices to Avoid Your Resident Being “Lost in Transition”
  • PDPM as a Vehicle to Advance Person-Centered Care
  • No One Told Me That the Skills I Learned Playing Clue, Chutes and Ladders and Candy Land, Would Be Needed to Be A Leader of Healthcare
  • Competent Geriatric RNs – The New Driver of Financial Performance
  • Transforming an Organization One Neighborhood at a Time
  • The Value of Occupational Therapy: Implementing AOTA Quality Improvement Resources
  • Practical Strategies for Recruitment & Retention 
  • And much, much more!

Escape the dregs of winter for the warm Tampa, FL sunshine. REGISTER NOW and attend sessions, connect with sponsors, and network and share your successes and your challenges with like-minded colleagues from across the country. We know you will return home with solutions that will show results in your organization!

Don’t miss the opportunity to stay at the host hotel and save with AHCA/NCAL discounted rates. The hotel reservation deadline is February 15. You may register for the Quality Summit through March 5. You must be registered for the event before hotel reservations can be made.

Use the hashtag #QSUMMIT19 to follow the conversation on social media.

Tuesday, January 8, 2019

Resolve to Attend the 2019 IO Leadership Conference

 
https://www.ahcancal.org/events/io_conference/Pages/Registration.aspx

It's a rewarding way to network, gain insights into your toughest challenges, and review best practices to ensure success in the coming year.

Attend the Patient-Driven Payment Model (PDPM) session to get your questions answered. Other topics include assisted living challenges and solutions, workforce stability, risk-sharing, and more. The Owner-to-Owner Town Hall rounds out the value-filled must-attend three-day conference.

You can earn up to 12.75 CEs.

Click here to get more details on all the education sessions, social events, speakers, and more.

IO.AHCANCAL.ORG

Sponsors as of January 5, 2019:
Compass, Drive DeVilbiss Healthcare, Ecolab, Evans Senior Investments, Guardian Pharmacy Services, Kronos, MatrixCare, PointClinckCare, Reliant Rehabilitation

AHCA/NCAL’s ID/DD Hill Fly-in Event Set for March 6, 2019

Dana Halvorson

AHCA/NCAL’s Intellectual and Developmental Disabilities (ID/DD) Residential Services Providers will be in Washington, D.C., for AHCA/NCAL’s annual Hill Fly-In event on Wednesday, March 6, 2019. Participants will hear from Congressional speakers and others.  The event runs from 8 am – 10:15 am ET.  After the morning event is over, the ID/DD providers will head to Capitol Hill to discuss critical issues, including Medicaid.  If you have any questions relating to this event or would like to attend (it is free to attend, and breakfast and lunch are provided), please don’t hesitate to contact AHCA’s Senior Director of Not for Profit & Constituent Services, Dana Halvorson.   

Friday, January 4, 2019

Your Predicted Survey Score in Your Top-Line

Lonnita Myles

The 2018 fourth quarter Your Top-Line was released on January 3, 2019 for Skilled Nursing Facility (SNF) members. This issue included a projection on what the SNF’s survey rating would be if the survey freeze was lifted today and the survey scoring rules used before the freeze were kept the same. For further information on how we created these projections, we have created a help document that can be accessed here to answer all your questions!

Can’t find Your Top-Line in your email? Not to worry! You can access current and past Top-Lines through LTC Trend Tracker by following these easy steps here

Have questions about LTC Trend Tracker? Visit our home page or email help@ltctrendtracker.com.

Wednesday, January 2, 2019

The CDC Needs Your Help!

Lindsay Schwartz

The most reliable information comes directly from providers like you. In order for policy makers to make solid, evidence-based decisions about long-term care in the U.S., it is essential that the CDC’s National Center for Health Statistics (NCHS) collect data from the 2,090 residential care communities invited to participate in the 2018 National Study of Long-Term Care Providers (NSLTCP).

If your residential care community was randomly selected, you’ve been asked to represent not only your residential care community, but also other comparable residential care communities across the United States. With your help, we will have more accurate estimates about the amount and types of care provided to residents in residential care communities like yours. NSLTCP data will provide benchmarks, which will allow you to compare your residential care communities with other communities like your own. AHCA/NCAL and the Center for Excellence in Assisted Living (CEAL) support this research and regularly use data from the study.

If providers have questions about NSLTCP, they can feel free to contact the NSLTCP Help Desk today at (877) 256-8029.  For more information about the survey visit the NCHS website. To the 25% of residential care communities that participated in the 2018 NSLTCP—thank you! To the 75% of providers that were invited to participate and have not completed the 2018 NSLTCP questionnaires, we encourage you to do so and make your voices heard!

One Month Left to Apply for the 2019 AHCA/NCAL National Quality Award

qualityaward@ahca.org

The 2019 AHCA/NCAL National Quality Award application deadline is January 31 at 8 PM EST. Don’t miss out on the opportunity to recognize your center’s success, dedication, and improvement in quality care.

The AHCA/NCAL National Quality Award Program recognizes long term and post-acute care organizations across the nation for quality and excellence. The program has three levels of awards: Bronze - Commitment to Quality, Silver - Achievement in Quality, and Gold - Excellence in Quality, each of which set progressively higher standards for performance. AHCA/NCAL data has found that Silver and Gold recipients perform better than the national average on key quality metrics, like the off-label use of antipsychotics, hospital readmissions and more. By moving through the three award levels, organizations improve the quality of the care and services they provide.

AHCA will also host the 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 session. Bronze applicants that submit their application on or before January 14 will be entered into a raffle for a waived application fee.

For any questions on the application process, feel free to reach out to the Quality Award team at qualityaward@ahca.org.

U.S. Congress Approves the BOLD Infrastructure for Alzheimer’s Act

Dana Halvorson

AHCA/NCAL is a supporter of 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 in 2017, and 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.  The bill passed in the Senate on December 12, 2018, and it was approved in the House shortly thereafter on December 19.  It has been sent to President Trump to be signed into law. 

All Cause Harm Prevention in Nursing Homes: Applying Strategies from the New CMS Change Package

All Cause Harm Prevention in Nursing Homes:
Applying strategies from the new CMS Change Package

Date: Thursday, January 24, 2019
Time: 3:00pm-4:00pm ET
Location: WebEx

One-third of SNF residents experience an adverse or temporary harm event, and the majority of those are preventable. As part of CMS’s focus on raising awareness of nursing home safety and to support safer nursing home care across the nation, CMS and the Quality Innovation Network National Coordinating Center released a new resource: a Change Package to prevent all cause harm in nursing homes. The Change Package is a compendium of successful practices of high-performing nursing homes, illustrating how they prevent harm while honoring each resident’s rights and preferences.

Please join us to learn more about the development of the Change Package and how you can use it to improve the quality of life and quality of care for those living in nursing homes and other long-term care settings. 

REGISTER for the event: https://qualitynet.webex.com/qualitynet/onstage/g.php?MTID=efe52a812df425e04d326423a2bae4cb7

GET the Change Package:
 https://qioprogram.org/all-cause-harm-prevention-nursing-homes

VA Awards Community Care Network Contracts

Dana Halvorson

On December 28, 2018, the U.S. Department of Veterans Affairs (VA) awarded contracts to manage provider networks for Regions 1, 2 and 3 of VA’s new Community Care Network (CCN), the department’s direct link with community providers.  The contract award for Region 4 is expected by early April 2019.  The contract award for Regions 5 and 6 are expected by end of calendar year 2019. 

According to a press release from the VA on these contracts, the network will be the standard contract vehicle allowing VA to purchase care for Veterans from community health care providers (including skilled nursing centers) using industry-standard approaches and guidelines in support of the VA MISSION Act of 2018 to administer services and manage the network to its full potential.  VA will provide care coordination under this new contract.  TriWest Healthcare Alliance has expanded its network to support Veteran and provider care coordination across the nation until CCN is fully implemented.  More details on these contracts and what states are included in each Region can be found here.