Wednesday, May 29, 2019

NCDMPH/ASPR Webinar: Tools to Help Care for Older Adults in Disasters

Dana Halvorson and Erin Prendergast

The National Center for Disaster Medicine and Public Health (NCDMPH) and the Office of the Assistant Secretary for Preparedness and Response (ASPR) will be holding a webinar today at 2pm ET entitled, Tools to Help Care for Older Adults in Disasters, presented by Dr. Cheryl A. Levine, Senior Advisor for At-Risk Individuals at ASPR and Kandra Strauss-Riggs, MPH, Education Director, HJF, NCDMPH/USU.  Dr. Levine will be promoting the latest Capacity-Building Toolkit for including Aging & Disability Networks in Emergency Planning, which was authored by the National Association of County and City Health Officials (NACCHO) and the Association of State and Territorial Health Officials (ASTHO) in collaboration with the HHS office of the Assistant Secretary for Preparedness and Response (ASPR) and the HHS Administration for Community Living (ACL).  Ms. Strauss-Riggs will be promoting the Caring for Older Adults in Disasters curriculum. The purpose of this curriculum is to enable educators to teach health professionals about caring for older adults in disasters. This curriculum can be used by a wide range of health professions.  Registration is required to receive the event information. Visit the webinar information page to learn more and sign up. Dial-in instructions will be sent prior to the event start.  Just a reminder as well that hurricane season starts on June 1st. 

Tuesday, May 28, 2019

Pioneering Research Shows Increase in Home Health Among Assisted Living Residents

Rosa Baier

Research led by Dr. Kali Thomas at Brown University examines the use of home health among assisted living community residents, showing a slight growth in the share of home care being delivered in this setting between 2012 and 2014.

The study provides new data on home health in assisted living, including better understanding of the residents receiving home care and the agencies providing these services in this setting. For example, home health recipients in assisted living were more likely to have cognitive and activity of daily living impairments than those receiving home care in other settings. They were also less likely to have been recently discharged from acute care setting, which implies they are more likely to use home health for health maintenance vs. post-acute care services and is consistent with increasing acuity and length of stay in this setting.

This research uses a pioneering analytic approach developed by Dr. Thomas and her team to identify assisted living residents in national Medicare claims data. It is among the first studies to examine home health utilization in assisted living.

Learn about research from AHCA/NCAL’s research center at Brown: brown.edu/go/innovation.

Closing Soon: Nominate a Colleague for the Mary K. Ousley Champion of Quality Award

Erin Prendergast

Nominations for the 2019 Mary K. Ousley Champion of Quality Award will close on Friday, June 7 at 11:59 p.m. ET. AHCA/NCAL presents this award to an individual that has made a significant national contribution to advancing quality performance in long term care.

The recipient will be announced the week of July 24 and will be presented with the award on stage at the 70th AHCA/NCAL Convention & Expo, October 13-16 in Orlando, Florida. This year’s recipient will receive a complementary registration to Convention, round-trip airfare, and a one-night hotel stay.

Submit your nomination online here. For more information about the Champion of Quality Award, visit the award webpage here.

We look forward to receiving your nominations!

New LTC Trend Tracker Report

Lonnita Myles

LTC Trend Tracker has a new and improved report that gives AHCA/NCAL members a dynamic look inside the data that LTC Trend Tracker has to offer! The new SNF Quality Measures Report includes data from Discharge to Community, Quality Metrics, Five-Star, and so much more. Members can customize the report to show metrics that are of their specific interest, drill down to center-level data for each metric, and also customize the timeframe for the data they are viewing. This dynamic report is the first of many modern enhancements coming to LTC Trend Tracker, so stay tuned for updates!

Have additional questions about how to utilize this new feature? Feel free to reach out to the LTC Trend Tracker team at help@ltctrendtracker.com!

Updates to the OMHA Case Processing Manual

Lilly Hummel

The Office of Medicare Hearings and Appeals (OMHA) has published two revised chapters of the OMHA Case Processing Manual (OCPM). The revised chapters are Chapter 6: CMS, CMS Contractor, and Plan Roles and Chapter 11: Procedural Review and Determinations. Both went into effect May 24, 2019.

This manual standardizes the day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statutes, regulations, and OMHA directives, and gives OMHA staff direction for processing appeals at the OMHA level of adjudication. As part of an ongoing effort to make the manual more user friendly and reflect recent regulatory changes, OMHA is in the process of drafting new OCPM chapters and revising existing chapters under a new format.

New and revised OCPM chapters can be accessed at https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/index.html.

Chapters that were published before May 10, 2018, can be accessed at:
https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/2017/index.html.

AHCA Has the Solution for Teaching New Staff about SNF Value Based Purchasing

Dave Kyllo

Need to teach a new employee about value based purchasing?  AHCA has an education program designed to help skilled nursing facility staff 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 non-members.

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.

Running the Compass MEC Health Plan Along Side Your Major Medical Plan Gives Employees More Options & Options Make Employees Happy

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 LTC 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.

Friday, May 24, 2019

House Panel Tackles Surprise Billing; Advocates Pushing for Observation Stays Inclusion

Dana Halvorson

On May 21, the House Ways and Means Subcommittee held a hearing on surprise medical billing and how to eliminate enormous charges for unsuspecting consumers.  A number of members of a coalition supporting changes to how observation stays are classified are urging the Subcommittee to include the issue in any comprehensive effort to curtail bills that cause sticker shock.  In a written statement from the National Observation Stays Coalition, which includes the American Health Care Association/National Center for Assisted Living as a member, that will be sent to the Subcommittee -- the group said it formed to address a surprise medical billing issue that affects Medicare patients in hospitals who are called observation status patients, or outpatients.  Although these individuals receive medically necessary care that is no different from the care provided to formally admitted inpatients, their classification as observation or outpatient is significant, “because the Medicare statute covers a post-hospital stay in a skilled nursing facility only if the patient was hospitalized for three consecutive days as an inpatient,” the coalition said.  The group is also noting to the Subcommittee, which is chaired by Rep. Lloyd Doggett (D-Texas), that eliminating surprise medical bills and the observation stays classification go hand in hand. 

You can read the full Provider article on this hearing here.  More on the observation stays issue can be found on the AHCA/NCAL webpage.  

Wednesday, May 22, 2019

NADRC Webinar: Caregiving for People with Non-Alzheimer’s Dementia


Tuesday, June 4, 2019, 2:00-3:00 PM ET

Register for the event

In recent years, research on Alzheimer’s disease has increased significantly, but there has been less focus on other types of dementias. Because less is known about non-Alzheimer’s dementias, under- and misdiagnosis is common, treatment protocols are lacking and it is not clear how best to support people with these dementias and their caregivers. 

This web seminar hosted by the National Alzheimer's and Dementia Resource Center (NADRC), will provide an overview of the three most common causes of dementia after Alzheimer’s disease, which include Lewy body dementia, frontotemporal degeneration and vascular dementia. Presenters will draw upon available information to describe caregiving for people living with these dementias. Special attention will be given to how caregiving for people with Lewy body dementia and frontotemporal degeneration may be different from Alzheimer’s disease. Case studies of caregiving for people with Lewy body dementia and frontotemporal degeneration will be highlighted.

Presenters:
  • Sharon S. Denny, M.A., is senior director of Programs at the Association for Frontotemporal Degeneration where she leads strategic development of support and education for people with frontotemporal degeneration, their families and healthcare professionals.
  • Angela Taylor is the senior director of Research and Advocacy for the Lewy Body Dementia Association, where she leads research, advocacy and educational activities of the organization.
  • Sari Shuman is a senior research public health analyst at RTI International, and serves as the co-director of the National Alzheimer’s and Dementia Resource Center.
Registration is required to receive the webinar information. Visit the webinar webpage to learn more, including CE credit information.

CMS Issues MDS 3.0 RAI Manual Updates that include Significant PDPM- Related Changes

Dan Ciolek

On May 20 the Centers for Medicare and Medicaid Services (CMS) issued an early release of several files associates with the MDS 3.0 RAI Manual v1.17 that contains many updates including information related to the Patient Driven Payment Model (PDPM), both which are effective on October 1, 2019.  CMS indicates that “this early release is being provided in response to stakeholder feedback.” CMA also encourages providers to check back to the MDS-RAI webpage prior to October 1, 2019 for a final posting which may contain additional updates.  Specific files on the CMS site that are applicable to the PDPM implementation include:
  • MDS 3.0 RAI Manual v1.16 October 1, 2018 – Which is a single PDF file of the entire RAI manual for use as an electronic version with bookmarks that you can click on to take you to each section of the manual.
  • MDS 3.0 RAI Manual v1.16 and Change Tables October 2018 – Which is a traditional set of zip files of the RAI manual and the change tables that crosswalk the changes made to this year’s manual. Note: This is the same material as the first item above, except there are separate files for each chapter or subchapter.
  • MDS 3.0 RAI Manual v1.16 Replacement Manual Pages and Change Tables October 2018 – Which includes replacement pages for this year’s manual changes for those who want to update their existing paper-based manual with just the pages that have changed. It also includes the change tables that crosswalk the changes made to this year’s manual.
  • MDS Forms (Item Sets) v1.16.1 October 2018 – Which included two folders separate the v1.16.1 MDS forms (MDS item sets) into those used in long term care facilities (SNFs and NFs) and those used in swing bed facilities.
  • MDS RAI Manual Appendix B – Which includes updated contact lists for the state and regional RAI/MDS contacts. 
Specific Chapters in the new MDS-RAI manual updates related to PDPM to pay particular attention to are Chapter 2- which addresses the new PDPM-related MDS assessments and assessment schedule, and Chapter 6 – which addresses the new PDPM resident classification process for the PDPM payment model.  Other changes related to the new PDPM MDS Items, such as the new diagnosis items in Section I, surgery type in section J, as well as the new PDPM HIPPS codes in Section Z should also be looked at closely. 

AHCA has also included a link to the CMS MDS-RAI files webpage on the AHCA PDPM Academy and AHCA PDPM Resource Center web pages.   

Tuesday, May 21, 2019

Save the Date: Applications for 2020 AHCA/NCAL National Quality Award Available Aug. 1

qualityaward@ahca.org

The 2020 AHCA/NCAL National Quality Award Program cycle is just around the corner – application packets will be available August 1, 2019.

Based on the Baldrige Performance Excellence Framework, the AHCA/NCAL National Quality Award recognizes long term and post-acute care member centers and communities for quality care.

Participating in the Quality Award Program has many benefits:
  • The program provides a proven framework that organizations can use to make improvements in any clinical, quality or other operational issues (i.e. staff engagement, customer satisfaction, hospital readmissions).
  • It helps prepare organizations to meet regulatory requirements and navigate a changing market.
  • It serves as a team building activity to engage staff across all levels of the organization.
  • Organizations gain national recognition. 
  • It serves as a marketing resource for consumers, referral sources and other key stakeholders.
  • Participants receive customized feedback with their top strengths and improvement areas.
If you’re interested in other ways to get involved, consider becoming an Examiner for the 2020 program cycle. Examiners play a significant role in reviewing Quality Award applications and impacting quality improvement in organizations across the country.

It’s never too early to start preparing! For additional information, visit the Quality Award website at ahcancal.org/qualityaward or email qualityaward@ahca.org.

Study Highlights Need for Differing Prevention Strategies for Hip, Non-Hip Lower-Extremity Fractures

Rosa Baier

Prior studies have examined the incidence, risk factors, and outcomes of hip fractures among nursing center residents, but little is known about non-hip lower-extremity fractures. A national study involving researchers from Hebrew SeniorLife and Brown University looked at lower extremity fractures among long-stay nursing center residents, and found differences that suggest prevention strategies should differ for hip and non-hip fractures. 

The research team used national data to identify all long-stay nursing center residents aged 65 years or older who were enrolled in Medicare during a specific time period (2008 and 2009), and then looked at lower-extremity fractures for two years (as late as 2011). Compared with hip fracture residents, residents with non-hip fractures were more likely to be immobile, dependent in all activities of daily living, transferred mechanically, and to have diabetes.

These findings show that non-hip lower-extremity fractures often occur in severely functionally impaired residents, suggesting a different mechanism of injury than hip fractures. This highlights the need for distinct prevention strategies for hip and non-hip lower-extremity fractures.

Learn about research from AHCA’s research center at Brown: brown.edu/go/innovation.

Convention & Expo Preliminary Program is Available

Jon-Patrick Ewing

The AHCA/NCAL Preliminary Program is now available. You can download a copy or review it online. Watch your mailboxes this week for a copy. Get an overview of the exciting education sessions, guest speakers, networking events, and Expo Hall.

Don’t wait to register! Save $100 on all Premium/Full Meeting Registration packages when you do Early Bird Registration. Other Early Bird savings may apply depending on your registration type.

You can save an additional $100 on registration when you stay at a hotel in the AHCA/NCAL room block.

That's a minimum savings of $200 if you register by July 26th.

Learn more about all of your registration options and reserve your spot today.

You Must Be ICD-10 Ready To Be PDPM Ready

Dave Kyllo

The October 1 PDPM implementation date is rapidly approaching and training key staff now to be ICD-10 proficient is critical. The American Health Care Association (AHCA) and the American Health Information Management Association (AHIMA) are offering ICD-10 on-line training. Because staff needs differ based their coding responsibilities, two specific trainings have been developed – one training for coders and a shorter less intense course for non-coders. 

AHCA/AHIMA ICD-10 Training for PDPM – Coder is an in-depth course designed for SNF billing staff, MDS staff, Nursing and Therapy staff, and Admissions and Discharge staff.  The course contains seven modules and comes with 16 CNEs for nurses and 16 AHIMA CEs upon successful completion.  The cost is $499 for AHCA members and $599 for non-members.

AHCA/AHIMA ICD-10 Training for PDPM – Non-Coder is a four-hour course developed for individuals who need to lead a successful PDPM transition and is intended for Administrators, DONs, and other management staff.  The course for non-coders comes with 4 CNEs for nurses, 4 AHHIMA CEs or 4.5 NAB approved CEs upon successful completion.  The cost is $199 for AHCA members and $249 for non-members.

With thousands of codes and changes based on the new Patient Driven Payment Model (PDPM), accurate ICD-10 coding is essential. PDPM relies on accurate patient assessments and diagnosis on the MDS and ICD-10 coding to determine payment for each patient. Inaccurate coding can negatively impact a facility’s bottom line and resident care.
To learn more or register for either on-line training, please visit the websites below.   
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. 
  

Cleary Energy Can Show You How Much You’re Donating to Utility Companies in Unnecessary Over Payments

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. A midwestern assisted living facility reported last month that it received $5,800 from utility overpayments that Cleary Energy recently found.       

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. 

Cleary Energy has been finding huge savings for AHCA/NCAL members, so now is the time to 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. 

Take Advantage of the Pre-Sale Registration for AHCA’s Virtual PDPM Training

Dave Kyllo

The new Patient Driven Payment Model (PDPM) for skilled nursing facilities begins October 1, 2019. The PDPM system will rely on more than 180 MDS item fields and completely transforms the existing system Medicare Part A payment system for skilled nursing facilities. Staff roles and facility processes must be substantially modified to operate effectively under PDPM.

AHCA’s Virtual PDPM Training prepares AHCA members for PDPM and will mirror the in-person trainings that have been held for AHCA members in almost every state in recent months. The virtual training allows AHCA members who missed their state training to learn about the critical steps necessary on the pathway to success under PDPM. It is also a perfect opportunity for those members who have indicated interest in attending the training again to solidify what they learned during their day-long training.

Pre-registration for the online training program is now available to AHCA provider members only. The cost for the training is $350. NAB CE credit has been requested.

While the virtual training won’t go live until mid-June, AHCA members who pre-register now will have access to all materials on AHCA’s PDPM Academy within 48 hours of their purchase. The PDPM Academy is where updates, tools, webinars and other supporting materials are housed. AHCA members who pre-register for the Virtual PDPM Training will also be able to join in free monthly PDPM webinars hosted by AHCA. 

Pre-sale registration for AHCA’s Virtual PDPM Training is available here or by going to https://educate.ahcancal.org/p/virtualPDPM. Pre-sale registrants will be notified when AHCA’s Virtual PDPM Training goes live.

Wednesday, May 15, 2019

Centers Celebrate National Skilled Nursing Care Week

Cristina Crawford

The American Health Care Association (AHCA) kicked off the annual National Skilled Nursing Care Week (NSNCW), taking place this week through May 18.

Established by AHCA in 1967, NSNCW, formerly known as National Nursing Home Week, recognizes the essential role of skilled nursing care centers in caring for America’s frail, elderly, and disabled.

“National Skilled Nursing Care Week is a time to shine a spotlight on the important role nursing care providers have in improving the lives of those they care for every day,” said AHCA/NCAL President and CEO Mark Parkinson. “We hope community members take the opportunity to participate in the celebrations and experience this commitment first-hand.”

Centers across the country will celebrate their residents and staff this week, with the theme “Live Soulfully,” by showcasing how they achieve happy minds and healthy souls. Whether it’s planting, cooking, reading or listening to music, staff at our nation’s centers pay it forward by dedicating themselves to quality care and improving quality of life for residents.

Centers are encouraged to participate by hosting activities that display how they “Live Soulfully” and share their stories and experiences on social media using the hashtag #NSNCW. 

For more information, visit www.ahcancal.org/NSNCW.

DOJ Guidance on Evaluation of Corporate Compliance Programs

 
The Department of Justice (DOJ) has updated its guidance for Evaluation of Corporate Compliance Programs. This guidance is aimed at assisting prosecutors in making decisions as to whether and to what extent a compliance program was effective at the time of the offense. The 2019 Guidance Document is organized around three central questions:
  1. Is the corporation’s compliance program well designed?
  2. Is the compliance program being applied earnestly and in good faith? In other words, is the compliance program being implemented effectively?
  3. Does the corporation’s compliance program work in practice?
Earlier guidance from 2017 focused more on the design of a compliance program, while this updated guidance indicates that prosecutors will also be focused on a deeper dive into whether the program is effective.

The American Health Care Association (AHCA) has resources for nursing center member to support creating or updating a Compliance and Ethics Program per 42 CFR § 483.85 in the Requirements of Participation (RoP) Phase 3. The new resources that are now available here. It’s important to be aware of this guidance from DOJ, as well as other guidance from the Office of Inspector General, because they offer best practices for compliance programs and the Centers for Medicare and Medicaid Services may incorporate these principles into their survey process.

New Optimism for Observation Stays Bill

Dana Halvorson

On May 14, 2019, McKnight’s released an article entitled, New optimism for hearing on ‘observation status’ bill.  The article focuses around Congressman Joe Courtney’s (D-CT) recent comments on the observation stays issue at the Center for Medicare Advocacy’s annual summit in Washington, D.C. The article includes reference to the Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753).  Introduced by Congressmen Courtney and Glenn 'GT' Thompson (R-PA) and Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Sheldon Whitehouse (D-RI) and Shelley Moore Capito (R-WV), the legislation ensures that time spent under “observation status” in a hospital counts toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing care services under Medicare.  AHCA/NCAL strongly supports this bill along with several other national organizations.  For more information about the observation stays issue, please visit the AHCA/NCAL website.         

Updated Conscience Rights in Health Care

Lilly Hummel

The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) finalized regulations updating conscience requirements affecting recipients of federal funds, including Medicaid and Medicare dollars. Specific to long term and post acute care providers, this rule affects conscience protections related: to assisted suicide and related counseling; performance of advanced directives; specified programs such as hearing screening, occupational illness testing, vaccination, and mental health treatment; and religious nonmedical health care providers and their patients from certain requirements under Medicare and Medicaid that may burden their exercise of their religious beliefs regarding medical treatment. Providers are encouraged to consult with legal counsel to determine the applicability of the rule to their organization and any new policies or actions required. The rule will go into effect in approximately 60 days.

AHCA Convention Offers Not for Profit Education Program

Jon-Patrick Ewing

AHCA/NCAL Convention & Expo education sessions have been designed to give you exactly what you need to reach your goals and answer your pressing questions. Tuesday, October 15, offers special programming to Not for Profit providers.

Keynote Speaker Commander Kirk Lippold, USN (Ret.) will talk about Leadership and Accountability When It Matters.

Commander Lippold will show how the principle of integrity can create an environment for leadership, describing the harrowing experience in which he and his crew responded to a devastating suicide terrorist attack on their ship. Their own sense of personal accountability and leadership proved to be a guiding principle in the crucible of combat. Lippold will also share why his “Five Pillars of Leadership” are must-have business tenets for any team.

Additional programming follows:

Workforce Challenges Discussion for LTC Providers: A panel of experts will lead a moderated discussion to examine workforce policies and issues impacting the LTC world.

CMS Update for LTC Providers: CMS expert Evan Shulman, Acting Director, Division of Nursing Homes Centers for Medicare and Medicaid Services, will review survey and certification issues, delve into SNF/NF Interpretive Guidance, and talk about CMS' work on various initiatives.

The Not for Profit Reception caps off the day from 6:00 to 7:00 pm and is an excellent opportunity to network and catch up with other providers from around the country. It is just one of many special events taking place over the four-day convention in October.

Registering online is easy! Early Bird Discount registration ends July 26.

Higher-Rated Nursing Centers Better Able to Adopt Advance Care Planning Video Education

Rosa Baier

Nursing centers’ Medicare 5 star ratings are associated with their ability to integrate a novel advance care planning video education program into routine care, according to a Brown University study involving 119 facilities across the US.

Advance care planning helps to ensure that residents receive end-of-life care aligned with their goals. While research already shows that video interventions can improve advance care planning, understanding how nursing centers adopt such programs is an important next step to promoting widespread adoption. In the Brown study, nursing center staff adopted an advance-care planning video intervention as a new standard of care, while researchers examined process measures. This included how often staff offered residents a chance to view the videos.

Overall, staff offered to show the video to 69% of short-stay and 56% of long-stay residents. After taking into account different facility characteristics, the researchers found that centers with better 5-star ratings had higher “offer” rates than centers with 1 star rating. These findings suggest that nursing centers with lower star ratings may need support to successfully adopt this intervention.

Learn about research from AHCA’s research center at Brown: brown.edu/go/innovation.

Put Some Swing in Your Spring with Music from Mood Media

Dave Kyllo

Whether its Frank Sinatra’s “It Might as Well be Spring” or the Beach Boys’ “Spring Vacation,”  members can help residents celebrate the spring season through the 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).

The Number of Open LTC Jobs Nationwide Holds Steady in May

Dave Kyllo

There are 49,295 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 figure is virtually identical to the number of open jobs in April.     
    
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 3,148 direct employers are competing for candidates this month – a decrease of 136 employers over last month.  The average number of days a job was posted was 30 days in May.
      
Finding qualified employees is one of the greatest challenges facing long term care providers and the latest 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

Now through May 31, open positions can be posted on the AHCA/NCAL Long Term Care Career Center for $250 per 30-day posting when employers use promo code GRAD100.  That’s $100 off the regular low AHCA/NCAL rate of $350.    

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.

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 61,000 searchable resumes on the National Healthcare Career Network this month. 

Make the smart, low-cost employee recruitment choice.  Check out the LTC Career Center today and don’t forget to use promo code GRAD100 to save $100 on your job postings.  Employers may use the code an unlimited number of times between now and May 31 on any number of postings.

AHCA Offers Hybrid Nurse Assistant Training to Address Workforce Challenges

Danielle Levitan

http://www.cnaonline.com/

The nurse assistant shortage is impacting long term care all over the country, and to help address this workforce problem, AHCA has a new CNA training program available. CNAonline.com combines online coursework with in-person clinical and skills training. It uses the renowned How To Be a Nurse Assistant curriculum in full e-book and audio book formats. Other features of the hybrid program include:
  • Practice tests, study guides, and quizzes to ensure student success
  • Competency-based skills checklists, videos, and visual aids
  • Professional instructors for online and in-person clinical training
Students can begin training any time, and the online portion is accessible 24 hours a day.

This flexibility and convenience is key to training quality nurse assistants who will make a real difference in the care you can provide in your centers.

For more information, please visit CNAonline.com or call 502-221-7765.

Changes to the Medicare Claims and Medicare Prescription Drug Coverage Determination Appeals Procedures

Nisha Hammel

On May 7, the Centers for Medicare & Medicaid Services (CMS) published the final rule titled Changes to the Medicare Claims and Medicare Prescription Drug Coverage Determination Appeals Procedures that provides Medicare beneficiaries, providers and suppliers clarifications on changes to the appeals process for adverse determinations under Medicare Part A and Part B and the prescription drug coverage under Part D.  CMS’ stated intent is to “…help streamline the appeals process and reduce administrative burden on providers, suppliers, beneficiaries and appeals adjudicators”.  AHCA/NCAL submitted comments on this very technical rule and CMS finalized most of the proposals supported by AHCA/NCAL including the removal of requirements that appellants sign appeal requests, change of timeframe for vacating dismissals from 6 months to 180 days and removal of redundant appeals processes.  The rule will go into effect July 8, 2019.

New SNF PEPPER Webinar Available

Lilly Hummel

The RELI Group, which is a contractor for the Centers for Medicare and Medicaid Services, has released a transcript, slides, and recording of a recent webinar on the new 2018 fourth quarter skilled nursing facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) data. That most recent SNF PEPPER report was released April 5, 2019 and includes data from 2016 fourth quarter through 2018 fourth quarter.

The SNF PEPPER is a free Microsoft Excel file summarizing provider-specific Medicare data statistics for targeted areas often associated with Medicare improper payments. The SNF target areas include: Therapy RUGs with High ADL; Nontherapy RUGs with High ADL; Change of Therapy Assessment; Ultra High Therapy RUGs; 20 day and 90+ day episodes of care. During the webinar, the presenter noted that new target areas have not been finalized for once the Patient Driven Payment Model goes into effect, but gave insight on what current target areas could be kept or phased out.

To obtain more information go to the PEPPER Website. The website includes a lot of training materials to support providers using the data.

Monday, May 13, 2019

What's Your Story?


Grab your ticket for the 13th Annual NCAL Day in Orlando, Florida. NCAL Day will be held on Sunday, October 13 from 7:30 AM – 4:00 PM EST, for a full day of learning.

NCAL Day will help you see your assisted living community with fresh eyes, so you can identify its strengths and unique qualities to better tell its story.                        

Opening Keynote Brett Culp is an award-winning documentary filmmaker and founder of the not for profit, The Rising Heroes Project. His films explore the power of heroic stories and the individuals who inspire us to believe in a better tomorrow. He encourages audiences to find the superhero within and to forge their own path to everyday leadership.






Mitch Hagins with the Studer Group will give the closing keynote. Using its Evidence-Based Leadership TM Studer Group partners with organizations to build a sustainable culture that promotes accountability, fosters innovation, and consistently delivers a great patient experience and the best quality outcomes over time. 








Spend the day with other senior living professionals focusing on the issues and concerns that are most important to you:

  • Workforce recruitment and retention
  • Leadership development
  • Preparing for the next generation of residents
  • Collecting and using date effectively
  • Collaborating with third parties
  • Improving transparency with customers


NCAL Day includes five different learning sessions and the opportunity to earn CEUs for administrators as well as CEs for nurses.

Find out more about NCAL Day and start making your plans!

NCAL Day is a separate ticketed event. Make sure to select it when you register for convention.

LEARN MORE ABOUT CONVENTION

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 April 2019. 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.

Tuesday, May 7, 2019

Registration Open – Upcoming Population Health Management Webinar

Jill Sumner

A Population Health Management webinar has been scheduled for Friday, May 17 and will be led by Jill Sumner. Population Health Management is becoming a common term to describe the evolution of Accountable Care Organizations (ACOs) and Bundled Payments. Learn to how to identify the models operating in your market and how this knowledge can help position your organization for success.

AHCA/NCAL members may register by clicking on the below link.

Friday, May 17: Population Health Management 

This webinar will also allow participants to learn about the different population health models and their relevance to long term care providers.

Registration for this webinar is for AHCA/NCAL members only.

Kool & the Gang Performs at the AHCA/NCAL Convention

Jon Patrick Ewing

This year’s 70th AHCA/NCAL Convention & Expo promises to be extra-ordinary, out-of-this-world event. Registration is now open with early bird discounts through July 26.

When registering for the Convention & Expo, don’t forget to purchase tickets to the Gala Dinner & Show*. This night of celebration, caps off the four-day convention with a unique opportunity to relax with colleagues, spend more time networking, and have fun enjoying good food and a great show. This year’s entertainment is the legendary Kool & the Gang. With iconic songs like Celebration, Cherish, Jungle Boogie, Summer Madness, and Open Sesame, the band has earned two Grammy Awards, seven American Music Awards, 25 top ten R&B hits, nine top ten pop hits, and 31 gold and platinum albums.

The Gala is a popular event , so purchase your tickets early. See you in Orlando!

*The Gala is a separate ticketed event.

Opportunity to Participate in Research Project

As you plan for this coming fall’s influenza season, there is an opportunity to participate in a research project with the AHCA sponsored research center at Brown University working with Insight Therapeutics, LLC. The research project will compare two FDA-approved vaccines and their effectiveness in preventing respiratory-related hospital admissions in nursing home residents.  Consent is not necessary since this study was approved as minimal risk and compares two CDC-recommended and FDA-approved vaccines.

If you participate, you will receive a supply of influenza vaccine at no cost for use with your residents and staff for the 2019-2020 fall’s flu season. Each participating facility will also receive a small honorarium for monthly data reports on vaccination rates throughout the flu season.

We encourage you to contact Insight Therapeutics, LLC, at NHFlustudy@inther.com or 757-625-6040. 

For additional information on the participation requirements go to  https://join.nhflustudy.com/.

Online Registration Deadline Extended



Danielle Levitan

If you have not yet registered for this year's Congressional Briefing, it is not too late. The online registration deadline has been extended to May 13th.

Plan to attend!

June 3-4
Hyatt Regency Washington on Capitol Hill

Congressional Briefing provides two invaluable days of
  • Networking with your colleagues
  • In-person meetings with your Members of Congress
  • Updates on what's happening in Washington
  • Excellent speakers and guests
You can also earn CEs.

See the complete agenda and register today.

Official Sponsor: Medline
Supporting Sponsors: Navigator, Reliant Rehabilitation, Zimmet Healthcare Services Group

PDPM Success is Grounded in ICD-10 Coding Know-How

Dave Kyllo

The October 1 PDPM implementation date is rapidly approaching and training key staff now to be ICD-10 proficient is critical. The American Health Care Association (AHCA) and the American Health Information Management Association (AHIMA) are offering ICD-10 on-line training. Because staff needs differ based their coding responsibilities, two specific trainings have been developed – one training for coders and a shorter less intense course for non-coders. 

AHCA/AHIMA ICD-10 Training for PDPM – Coder is an in-depth course designed for SNF billing staff, MDS staff, Nursing and Therapy staff, and Admissions and Discharge staff.  The course contains seven modules and comes with 16 CNEs for nurses and 16 AHIMA CEs upon successful completion. The cost is $499 for AHCA members and $599 for non-members.

AHCA/AHIMA ICD-10 Training for PDPM – Non-Coder is a four-hour course developed for individuals who need to lead a successful PDPM transition and is intended for Administrators, DONs, and other management staff.  The course for non-coders comes with 4 CNEs for nurses, 4 AHHIMA CEs or 4.5 NAB approved CEs upon successful completion. The cost is $199 for AHCA members and $249 for non-members.

With thousands of codes and changes based on the new Patient Driven Payment Model (PDPM), accurate ICD-10 coding is essential. PDPM relies on accurate patient assessments and diagnosis on the MDS and ICD-10 coding to determine payment for each patient. Inaccurate coding can negatively impact a facility’s bottom line and resident care.

To learn more or register for either on-line training, please visit the websites below:   

• AHCA/AHIMA ICD-10 Training for PDPM – Coderahcancal.org/icd10pdpmcoder
• AHCA/AHIMA ICD-10 Training for PDPM – Non-Coder: ahcancal.org/icd10pdpmnoncoder

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. 

Pre-Sale Registration is Now Open for AHCA’s Virtual PDPM Training

Dave Kyllo

The new Patient Driven Payment Model (PDPM) for skilled nursing facilities begins October 1, 2019. The PDPM system will rely on more than 180 MDS item fields and completely transforms the existing system Medicare Part A payment system for skilled nursing facilities. Staff roles and facility processes must be substantially modified to operate effectively under PDPM.

AHCA’s Virtual PDPM Training prepares AHCA members for PDPM and will mirror the in-person trainings that have been held for AHCA members in almost every state in recent months. The virtual training allows AHCA members who missed their state training to learn about the critical steps necessary on the pathway to success under PDPM. It is also a perfect opportunity for those members who have indicated interest in attending the training again to solidify what the learned during their day-long training.

Pre-registration for the online training program is now available to AHCA provider members only. The cost for the training – whether first time or repeated – is $350. NAB CE credit has been requested.

While the virtual training won’t go live for several weeks, AHCA members who pre-register now will have access to all materials on AHCA’s PDPM Academy within 48 hours of their purchase. The PDPM Academy is where updates, tools, webinars and other supporting materials are housed. AHCA members who pre-register for the Virtual PDPM Training will also be able to join in free monthly PDPM webinars hosted by AHCA. 

Pre-sale registration for AHCA’s Virtual PDPM Training is available here or by going to https://educate.ahcancal.org/p/virtualPDPM. Pre-sale registrants will be notified when AHCA’s Virtual PDPM Training goes live.

The Compass MEC Health Plan Delivers the Benefits Employees Want with No Deductibles, Low Copays and Unlimited Free 24/7 access to TELADOC®

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 LTC 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.

Collaboration Between Hospitals and Nursing Centers Can Improve Outcomes

Rosa Baier

A Brown University team led by Dr. Vincent Mor examined the nature and degree of hospitals’ efforts to collaborate with skilled nursing centers and associated patient outcomes. They found that collaboration  is associated with positive outcomes for people transitioning from hospitals to nursing centers.

The study involved interviewing staff in 16 hospitals and 25 nursing centers in eight markets across the US, as well as examining Medicare claims data for nearly 300,000 patients discharged from those same 16 hospitals in a seven-year period (2008-2015). The team used the interview data to classify hospitals’ collaboration efforts with nursing centers into “high” versus “low” collaboration groups and to understand collaboration activities. These included establishing partnerships, transition management initiatives, and conducting hospital staff visits at nursing centers. Compared to low-collaboration hospitals, high-collaboration facilities were more likely to discharge patients to nursing centers (vs. other post-acute care settings, home, or home with home health); discharged a higher share of patients to high-quality nursing centers; and reduced nursing center readmissions from sooner and more.

Although the Brown researchers recognize that collaboration been hospitals and nursing centers requires significant investment in administrative and clinical time, they conclude that such relationships can improve patients’ transitions and outcomes.

Learn about research from AHCA’s research center at Brown: brown.edu/go/innovation.

Wednesday, May 1, 2019

U.S. Senate Hearing and Implementation of Veterans Care Agreements

Dana Halvorson

Yesterday, at a hearing of the U.S. Senate Military Construction and Veterans Affairs Appropriations Committee, Senator John Hoeven (R-ND) urged the U.S. Department of Veterans Affairs (VA) Secretary Robert Wilkie to ensure his long-term care (LTC) legislation is properly implemented, allowing veterans to access more of these services closer to home. Key provisions of the senator’s legislation, the Veterans Access to Long Term Care and Health Services Act, were signed into law last year as part of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act.  The senator’s legislation allows the VA to enter into Veterans Care Agreements with qualified LTC providers, including nursing care centers.  The VA is expected to roll out proposed regulations relating to Veterans Care Agreements before the June 2019 implementation date, and Senator Hoeven is working to ensure the VA’s new LTC regulations remove duplicative layers of review and match the standards under the Centers for Medicare and Medicaid Services (CMS).  Aligning with CMS rules would provide relief from onerous and often times costly federal contracting requirements and enable more LTC providers to accept veteran patients.

The American Health Care Association (AHCA) worked with Senator Hoeven and other key Congressional champions on the Hill to get Veterans Care Agreements signed into law last year.  At yesterday’s hearing, Hoeven received commitment from the VA to hold a webinar in the near future for AHCA’s members and other LTC providers educating them and answering questions on these new agreements and the Community Care Network (CCN).  If you have any questions relating to this matter, please contact AHCA’s Senior Director of Not for Profit & Constituent Services, Dana Halvorson, at dhalvorson@ahca.org.        

High-Dose Flu Vaccine is Cost Effective for Nursing Center Residents

Rosa Baier

Nursing center leaders seeking to reduce hospital transfers may want to consider the type of influenza vaccine they offer their residents, according to research from Brown University. Flu is one of the leading causes of avoidable hospitalizations.

A team led by Vincent Mor and Stefan Gravenstein randomized more than 800 nursing centers across the country to use one of two FDA-approved flu vaccines, high dose or standard dose. A 2017 paper from this research study showed that fewer residents were hospitalized at nursing centers using the high-dose vaccine. Now findings published in February go one step further, to examine the cost benefit of using this more expensive vaccine.

Despite the fact that high-dose vaccine costs nearly $20 more per dose than low-dose vaccine ($31.82 vs. $12.04), the Brown team found a net benefit of $526 per resident offered the high-dose flu vaccine. Medicare benefits most directly, because the savings result from lower healthcare expenditures in this group. But these findings will be important and actionable for nursing centers seeking strategies to improve care delivery and to avoid payment penalties associated with hospital transfers.

Learn about research from AHCA’s research center at Brown: brown.edu/go/innovation.