The Legislature has finally left the StateHouse!!

Governor Sebelius signed SB 62 on May 23, 2006.  This legislation puts the reimbursement changes and the 85% occupancy issue into statute.  Click on this to look at SB 62. Section 11 deals with the reimbursement and Section 10  personal needs allowance increase many of our residents will receive.  These changes total over $13 million dollars All Funds.

The Medicaid Personal Needs Allowance will increase from $30 per month to $50 in 2007 and $60 in 2008 the amount Medicaid eligible nursing facility residents are allowed to keep.  These funds are all the income a Medicaid resident is allowed to keep.  These funds must be used to by for any personal expenses including haircuts, perms, slippers, lotions, long-distance phone calls, greeting cards, etc.

The funding part of the these two changes are provisions in the appropriations bill. 

What turned out to be a longer than usual session, and maybe a little more stressful than most of us would have liked, the issues relating to the elders of Kansas actually faired quite well.  

Medicaid Home and Community-Based Services for the Frail Elderly – A rate increase of 6 percent for Targeted Case Management to cover the expenses related to assisting seniors in coordinating their services. This is the first rate increase in nine years.

Increase monthly stipends to volunteer legal guardians from $20 to $30 per month to pay for expenses incurred.

Increase reimbursement for home health agencies that provide in-home care for elders with a supplement of $1 million from State General Fund, $2.6 million all funds.

Hb 2105 Abuse, Neglect and Exploitation- (Better known as the Kaufman Exploitation bill).

The Association, along with other members of a coalition made up of KAHSA, Interhab, State Independent Living Centers of Kansas, the Governor's office convinced the Legislative Conferees to remove  unfavorable provisions which referenced the protection and advocacy agency (DRC).  This entire situation was one of the most divisive and under-handed events I had ever seen happen with the legislature.   The legislation passed overwhelmingly and Governor Sebelius has already signed this into law.  Basically, it establishes a ANE unit within the Attorney General's office.  The departments of Health and Environment, SRS, and the department on Aging are to forward confirmed reports and those of reasonable suspicion of ANE to the AG's special unit. 

We will be meeting with the Kansas Department on Aging with the assistance of Kevin Fowler to discuss rules relating to the self-reports filed with the Department.

Governor Sebelius also established through Executive Order the Kansas Interagency Council on Abuse, Neglect, and Exploitation.   As the criteria is established for the "Council" we will make sure we have a seat at the table to discuss the issues. 

Overall it was a successful session for Kansas Health Care Association members.  We will remember this as the 2006 election cycle grows closer and look to help our friends who have helped us.

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  Reimbursement Specifics

Reimbursement Issues:  Changes moving forward, Legislation signed by Governor Sebelius...

The Reimbursement Subcommittee has been discussing several reimbursement issues with the Kansas Department of Aging regarding change of ownership and audit issues.  The Appropriations bill signed by the Governor, contains the following changes to the nursing facility reimbursement program:

1. Change the base year from 2001 cost data to the average of 2003,
2004, and 2005 cost data as the basis for nursing facility reimbursement.
In FY 2007, estimated cost of $8.7 million, including $3.5 million from the State General Fund.

2. Eliminate the 85 percent occupancy rate rule in regards to nursing facility reimbursement for facilities with 60 beds or less.
In FY 2007, estimated cost of $1.2 million, including $480,000 from the State General Fund.
       
3. Increase personal needs allowances from $30 to $50 at total cost of $2,788,000, including $1,238,000 from the State General Fund.

The Reimbursement Subcommittee has asked the State how they will handle facilities that experienced a change of ownership during 2003, 2004 or 2005?  These facilities, because of the change in ownership, would not have filed a cost report for all three years.  They asked will the 7/1/06 Medicaid rates be based on cost reports filed by the current owner or both the current and previous owners?  Kansas Department on Aging representatives will implement it as follows:

1. If the current owner filed a 2004 and 2005 cost report, the state will use the average of 2004 and 2005 cost data to set the 7/1/06 rates.

2. If the current owner filed a 2005 cost report only, the state will use only 2005 to set the 7/1/06 rates.

3. If the current owner has not filed any cost reports in 2003, 2004, and 2005 the state will use the previous owner’s data for 2003, 2004, and 2005. The state will use any cost report data from 2003, 2004, and 2005 that is available for the immediately preceding owner. 

We also asked the state how they will handle auditing if the 7/1/06 rates are rebased using the average of 2003, 2004 and 2005 cost years.  The state believes the auditors will finish doing field audits on all 2001 cost reports before looking at audits on 2003, 2004 and 2005 cost years.  Please contact Nancy at npierce@khca.org if you have any questions.

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  Workers Comp Investment Trust Annual Meeting

A reminder to all  KHCA Workers Compensation Insurance Trust Pool members that our annual meeting will be held during Spring Conference, June 14, 2006.  A reminder to send your proxy forms and election ballots to Nancy by Wednesday June 7th.

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  Proposed Rates--July 1, 2006

Go to the www.khca.org website Member’s Only section for the 7/1/06 Nursing Facility Proposed Medicaid Rates.

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  NPI

What is NPI?

NPI will be the standard provider identifier throughout the national healthcare industry as
of May 23,2007. It will be 10 digits in length. The number can either be a Type 1 or a
Type 2. Type 1 NPIs are for individuals. Type 2 NPIs are for businesses or group
practices. The Type 1 NPI will be assigned to the provider and will not change regardless
of where he or she practices. The Type 2 NPI will not change if a business changes
ownership. A business that changes ownership will keep the same NPI.

To apply for your NPI:

Call the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 to
KMAP encourages you to include all of your provider numbers (including KMAP), the
carrier name, and the state, on your NPI application.

Why do I need to get an NPI?

All healthcare providers who are Health Insurance Portability Accountability Act
(HIPAA) covered entities will need to get an NPI to be able to file standard electronic
transactions (with KMAP, this means using the web site or the Provider Electronic
Solutions software) after May 23, 2007.

Examples of providers who must get an NPI if using standard HIPAA transactions:
Type 2 providers: Hospitals, Group practices, Pharmacies, Home Health Agencies, DME suppliers, Nursing Facilities, Assisted Living Facilities.

Frequently Asked Questions:
1) How should I notify KMAP of my NPI?
Notification can be done by mailing a copy of your NPPES confirmation letter to EDS at:
Provider Enrollment
PO Box 3.57 1
Topeka, KS 66601

Notifying EDS through this method requires the name, KMAP ID, and FEIN on a cover
letter as well as a "wet signature". This signature can not be a stamped signature.
You can also fax in the letter to 785-267-7687. This method will require the same
information as the mailed copy.

2) When should I get my NPI?
You can apply for your NPI now. Currently, KMAP is not requiring the NPI on claims
for processing, but we are able to accept it.

3) Do I need an NPI if I bill KMAP on paper?
Some Medicaid providers do not qualify under national rules for NPI because of the type
of non-medical services they provide. Those providers definitely will not be required to
bill with an NPI. For other providers, this issue is still under consideration. We will
notify providers of decisions on this and other issues as plans progress.

4) Will the KMAP Automated Voice Response System (AVRS) change with NPI?
This issue is still under consideration. We will notify providers of decisions on this and
other issues as plans progress.

5) Will KMAP and Medicare's implementation of NPI be the same?
Currently EDS is working on the system changes to allow for the dual use strategy. As
more information is obtained, providers will be notified.

For further questions regarding NPI please contact your KMAP NPI Provider
Representative, Jason Perkins at 1-785-267-0627 or by email Jason.perkins@eds.com

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  Workers Comp Newsletter
Are you signed up for SAFE-LIFT YET???

SAFE-LIFT Program:
Have You Signed Up Yet?

In 2006, the KHCA WCIT Board unveiled an exciting and forward-looking initiative for members called the SAFE-LIFT program.

We introduced the SAFE-LIFT program to the KHCA WCIT membership during a seminar in Topeka in February. The initial response was much higher than anticipated. Many of your sister facilities have taken the opportunity to begin the process of review and training with the Loss Control Department at Thomas McGee L.C.

The 2006 SAFE-LIFT program is well-designed and an easily adaptable program for both Assisted Living and Long-Term Patient Care facilities. 

We strongly encourage you to sign up for the SAFE-LIFT program if you have not taken advantage of this opportunity. The program is available to all KHCA WCIT members free of charge. In doing so, you will be eligible for a significant discount on your Workers’ Compensation premiums and well on the way to preventing costly and debilitating back injuries due to patient/resident transfer.

Please call or write Senior Loss Control Consultant, Ken Zans, at Thomas McGee L.C. to set your training appointment. Ken may be reached at:

kzans@thomasmcgee.com
816-843-4468 Direct
913-907-0781 Cell

Congratulations to the following members who have completed SAFE-LIFT review and training:
 
* Brookside Retirement Community, Overbrook, KS
* Hilltop Lodge, Beloit, KS
* Homestead of Topeka, Topeka, KS
* Countryside Health Center, Topeka, KS
* Homestead of Lenexa, Lenexa, KS
* Lexington Park Nursing, Topeka, KS
* Stoneybrook Retirement Community, Manhattan, KS

The following facilities have signed up and set future training dates for the SAFE-LIFT program:

* Sharonlane Nursing, Topeka, KS
* Country Care, Easton, KS
* Applewood Rehabilitation, Chanute, KS
* Twin Oaks Nursing, Leavenworth, KS
* Rolling Hills Nursing, Topeka, KS
* Holiday Resort, Salina, KS
* Homestead of Leavenworth, Leavenworth, KS

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  ROSE Training Completed and CNA conference a success!!!

 The ROSE training the Kansas Department on Aging helped fund for the Kansas Health Care Association has now ended having trained over 85 unlicensed staff across the state of Kansas.  Thank you to all who participated and a special thank you to Judy Bagby who was the facilitator for the program.

On May 9th, the Kansas Health Care Association brought together over 90 members for the CNA Conference.  The day ended with a fabulous presentation by Lori Porter of NAGNA.

CNA participants working with the 'Secure Kit"

More CNA Conference Participants

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  Out and About with KHCA

KHCA staff travelled to Cottonwood Falls to attend the awarding of the "E"xcellence Award given to Chase County Health and Rehab Center.  The award was given out to thirteen members of the Beverly Organization nationwide.  Congratulations to Becky Burke and her staff.

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  National Nursing Home Week in Kansas

Senior Olympics held at Garnett Middle School during National Nursing Home Week.

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  DON/ADON Award

Darelyn Bearden receives award -- KHCA DON/ADON 2006 winner.  Kevin Knaup, administrator Sunset Manor, Phyllis Gish, KHCA and Karla Baum,  KHCA District 2 Vice-President.

Congratulations Darelyn everyone is proud of your service.

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  Lee Eaton, "AHCA Future Leaders of Long Term Care in America"

Lee Eaton, Midwest Health Management, Topeka has been selected as one the Future Leaders of Long Term Care in America by the American Health Care Association.  He received this nomination because he is a LTC professional and who exhibits leadership characteristics at the state level.  He will be active in the leadership program for the next year.

Congratulations Lee!

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  Just Released: Interpretation on Shower Accessibility

Go to the KHCA website, Member’s Only section to view the latest KDOA Long Term Care Regulation Interpretation from LCE on Shower Accessiblity. 

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  KDOA Licensure, Certification and Enforcement Organizational Chart

Please click here to view the Kansas Department on Aging LCE organizational chart.

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  TOP 10 "G" Deficiencies

Click on the following link to view the top ten resurvey G+ deficiencies for CY 2000-2005. For more information please go the the KHCA website at www.khca.org under the Member's Only page.

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  Survey Trends- First Quarter 2006 Health Survey Results

Survey Trends- First Quarter 2006 Health Survey Results

The Kansas Department on Aging, Licensure, Certification and Evaluation Commission reported 92 annual nursing facility and long-term care units of hospitals were surveyed during the first quarter of 2006.  The table below illustrates the sharp increase, 22% in the average number of deficiencies per survey from 2004 to 2005 and another 21.6% increase from 2005 to the first quarter of 2006.  You can also see a steady increase in the percentage of G+ surveys and a decrease in the percentage of zero deficiency surveys.

	2004 Base	2005	% increase base	1Q2006	% increase 2005
# surveys	387	372	(3.8)	92
ave # def/survey	7.2	8.8	22	10.7	21.6
%G+ surveys	27%	35.5%	31.5	45%	26.7
% zero def survey	10.1%	7.3%	(27.7)	4.3%	(58.9)
NOTC*	66	85	28.8	24

*No opportunity to correct-double G situation –enforcement actions taken

KHCA staff meets quarterly with the LCE Commission to review annual survey trends.  One factor that that could be affecting the sharp increases in G+ surveys and average number of deficiencies is CMS’s release of new surveyor guidance beginning in June 2005.  There were only16 surveys completed under the new QIS system during this time frame so they should not be factor in the increase in deficiencies.  Since June of 2005, CMS has released guidance on incontinence, Medical Directors, foreign acquired drugs, immunization, activities, psychosocial severity and quality assessment and assurance.  Later this summer CMS will release guidance on unnecessary drugs, nutrition, safe food handling, and pain and palliative care.

The chart below shows increases beginning in the third quarter of 2005 which coincides with CMS’s surveyor guidance release.
  

	2Q2005	3Q2005	4Q2005	1Q2006
ave # def/survey	7.8	10.1	9.9	10.7
%G+ surveys	29%	48%	43%	45%
% zero def surveys	10.5%	4.7%	5.7%	4.3%
NOTC*	15	25	16	24

 

*No opportunity to correct-double G situation –enforcement actions taken

Complete reports can be found on the member’s only section of the KHCA website.  Also listed are summaries and detail reports, by survey region, by quarter, and by year for all annual surveys.  Contact Nancy at npierce@khca.org with any questions.

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  Oxygen Regulator Fires Resulting from Incorrect Use of CGA 870 Seals

Oxygen Regulator Fires Resulting from Incorrect Use of CGA 870 Seals

FDA and NIOSH (National Institute for Occupational Safety and Health) notified healthcare professionals that twelve incidents have been reported in which regulators used with oxygen cylinders have burned or exploded, in some cases injuring personnel. Some of the incidents occurred during emergency medical use or during routine equipment checks. FDA and NIOSH believe that improper use of gaskets/washers in these regulators was a major factor in both the ignition and severity of the fires, although there are likely other contributing factors. FDA and NIOSH recommend that plastic crush gaskets never be reused, as they may require additional torque to obtain the necessary seal with each subsequent use. This can deform the gasket, increasing the likelihood that oxygen will leak around the seal and ignite.
http://www.fda.gov/cdrh/safety/042406-o2fires.html

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  Waiver Information

          
* Evidence that the deficiency does not pose a hazard to the health, safety and welfare of the building occupants
* How the correction of the deficiency poses a hardship to the facility;
* Construction milestones; and additional safety measures that will be implemented to compensate for the deficiency
* Documentation of additional measures and progress of work should be maintained onsite and sent to the State Agency (weekly, monthly, or quarterly). Please designate how often you will forward documentation to the State Agency in your POC.
Potential ideas for ADDITIONAL fire safety measures
* Additional smoke detection and/or fire extinguishers
*  Safety rounds once per shift /day – dedicated person, all areas of the facility observed and inspected for fire safety issues
* Infrared inspection of motors and electrical panels
* Additional inspections or maintenance
* Local fire department completes monthly/quarterly inspections and reviews  emergency plans
* True fire watch in accordance with the LSC – recommended for fire alarm and sprinkler outage only.
*  HVAC shut down tied to the fire alarm system (exhaust system throughout the building, with the exception of the kitchen exhaust system), smoke detector system at smoke doors and complete corridor, and/or complete sprinkler system
* Hire a structural or fire protection engineering firm to develop a plan of action and additional safety measures.
* Install a horizontal exit.
* Emergency procedures and/or hands-on fire extinguisher in-service, practical and/or competency skills test regarding emergency procedures
* Additional fire drills for performance issues (not recommended for extensive time periods to avoid poor performance and complacency)

Failure to follow the POC can result in revocation of the waiver and implementation of enforcement actions.

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  Mark your Calendars- July 19-July 20 Joint Training with Fire Marshal Office

July 19 and July 20, 2006

The Kansas Fire Marshal Office along with KHCA, KAHSA, and KACE will be providing a Joint Training Opportunity for members.   More details to follow, trainings will be held in Topeka and Wichita.

 Mark you calendars to attend one of these very important meetings.

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  Pandemic Flu Checklist

HHS, CDC Release Checklist to Help Long Term Care Facilities
Assess, Prepare For Pandemic Influenza
AHCA/NCAL and Other LTC Stakeholders Played Key Role in Developing Checklist

The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) — with substantial input from the American Health Care Association (AHCA), the National Center for Assisted Living (NCAL), the Alzheimer’s Association, the American Medical Directors Association (AMDA), the National Association of Directors of Nursing Administration in Long Term Care (NADONNA), and the American Association of Homes and Services for the Aging (AAHSA) — have developed and released today a comprehensive checklist to help long term care and other residential facilities assess and improve their preparedness for responding to pandemic influenza.

 “This new checklist should be very valuable to long term care facilities as one tool in developing a comprehensive pandemic influenza plan, and we thank HHS, the CDC, our membership, and all of the involved stakeholder organizations for their input, help, and expertise,” stated Janice Zalen, AHCA senior director of special programs.

“Based on the many differences between facilities, and their different patient populations, each facility will need to adapt this checklist to meet its unique needs and circumstances,” continued Zalen.  “This is a very helpful exercise because working with this checklist will help facilities better plan for other emergency situations.”

 The checklist identifies key areas for pandemic influenza planning, and long term care and other residential facilities can use this tool to self-assess the strengths and weaknesses of current planning efforts.

 “We’re pleased to have been involved on the team that developed the checklist, which is a powerful planning instrument for a potentially critical time,” said Jane Tilly, DrPH, director of quality care advocacy at the Alzheimer’s Association.  “We’re now working with AHCA on developing a helpful tool that is specific to Alzheimer’s and dementia care as an add-on to the checklist, and it should be available this summer.”

Additional information can be found at www.pandemicflu.gov.  

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  Latest on Regulatory Updates from AHCA

 For the Latest Regulatory Updates go to  American Health Care Association and then go to Regulatory Updates- April 2006.  The update is a document all members should be checking monthly because AHCA does a great job in making sure we have all of the information as current as it is available.

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  Deficient Reduction Act

The Association recently met with Scott Bruner the Director of Medicaid Services for the state of Kansas to discuss the Deficit Reduction Act signed into law by President Bush in February of 2006.  The DRA makes several major changes to long-term services policies in Medicaid that the state will need to implement.    Reed Smith, the American Health Care Association's (AHCA)  outside counsel, recently distributed a memorandum which highlights key provisions in the Deficit Reduction Act of 2005.  It's expected to reduce net Medicare spending by more than $6 billion over five years, and cut Medicaid spending by more than $4.7 billion over five years.  To read key provisions of the DRA of interest to long term care providers go to  http://www.ahca.org/members/finance/medicare/general/wu060505-1.htm

Scott also did not have any specific recommendations yet about the guidance he will receive from CMS on Citizenship Documentation, but did believe that the current state data exchange would still be used to verify citizenship.  But he was still waiting for direction on this issue.  As always it appears that the details have not been worked out.  Is anyone surprised???

Included you will also find a time line which to see what items in the DRA take effect and when. 

We will be following this issue very closely and will keep everyone updated as possible.

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  Status Update on New Federal Survey Guidelines

CMS issues new guidance effective June 1, 2006

In separate letters dated March 10, 2006 CMS issued guidance to state survey agency directors on the following issuances:
1. New Psychosocial Outcome Severity Guide
2. Revised Activities Guidance (Tags F248 and F248)
3. Compliance Date for the Installation of Emergency Lighting and the Replacement of Existing Roller Latches in Corridor Doors
4. Revised Surveyor Guidance for Quality Assessment and Assurance (Tags F520 and F521)

The complete information and training packages can be found on the Member’s Only section of the web at www.khca.org. Forgot your password? Contact Nancy Pierce at npierce@khca.org

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  CEAL Summit, NCAL Resources, National AL Week

CEAL Summit to Focus on Assisted Living’s Future

The Center for Excellence in Assisted Living (CEAL) will host its second summit on quality in assisted living on Nov. 30-Dec. 1 in Arlington, Va.

The summit, “Assisted Living: The Next Generation Opportunities and Challenges,” will bring consumers, providers, professionals, researchers, regulators, and policymakers together for this landmark event.

Attendees can exchange information and learn about quality opportunities, discuss challenges in assisted living, and explore the latest developments in the field. Topics include:

* Regulation
* Leadership
* Resident Care
* Affordability
* Assistive Technology

Early registration is $245. For more information, please contact CEAL at (202) 465-1893 or visit http://www.theceal.org/summit.shtm. To make hotel reservations at the special summit rate, please contact the Hyatt Regency Crystal City at (703) 418-1234 and indicate you are attending the CEAL Summit.

Kansas Center for Assisted Living will anticipate sending a representative to the CEAL Summit.  Let Cindy know if you have an interest in going... cluxem@khca.org

NCAL/Senior Living University Offer Resources for Managers

Help train your managers and staff trainers to learn how to establish an effective environment for learning, discover how teaching and learning styles affect training, and find best practices for motivating staff. This publication offers the skill and confidence builder managers need to become effective trainers. Members and non-members can purchase “Effective Staff Training Strategies in Senior Living: A Train-the-Trainer Program for Assisted Living,” through the bookstore. To order, use product number 6923. The cost for NCAL Members is $95 and $125 for non-members.

An additional resource, “Supervising Front Line Staff: The Manager's Guide for Leading Caregiver Staff” is also available. The resource contains best practices for training, motivating, and retaining staff, improving care delivery, and reducing the high cost of turnover. This certificate course is an excellent guide for administrators, front line managers, and nurses and caregivers preparing to assume supervisory roles. To order, use product number 6924. The cost for NCAL Members is $95 and for non-members is $125.  www.ahca.org

NCAL Releases National Assisted Living Week Logo

The logo for National Assisted Living Week ® (NALW) has been released.  "Hearts in Harmony" is the theme for this year’s event, to be held Sept. 10-16, which recognizes the special bond between caregivers, residents and their friends and families.
NCAL, in collaboration with the American Association of Homes and Services for the Aging (AAHSA) and the Assisted Living Federation of America (ALFA), is celebrating and promoting the week that recognizes the special role assisted living and residential care facilities play in caring for more than one million seniors and people with disabilities. NALW was created in 1995.

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  AHCA Convention and Exposition

Members will find everything they need to know about the AHCA/ NCAL/ THCA 57th Annual Convention and Exposition being held in San Antonio, Texas, October 8-11, 2006 on www.khca.org web site.

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