Reimbursement Updates

Reimbursement Education Updates

Bill McDaniel and Dave Halferty from the Kansas Department on Aging presented an education session update to the Kansas Nursing Facility Medicaid reimbursement system in Topeka, Salina, Augusta and Chanute.

In Summary for the 7/1/06 Nursing Facility Medicaid Rates:

*Providers on average saw a 9.5% increase in Medicaid rates
* The 85% occupancy penalty was eliminated for homes with 60 beds or less
*The base year used to determine the 7/1/06 rates is an average of cost years 2003, 2004, and 2005.
* Cost Center limits are: operating- $26.04; indirect health care- $ 38.00; direct health care- $74.02, for a statewide average CMI of 0.9513; RPPF-$7.54.
* State regulations: http://www.kslegislature.org/legsrv-Kars/index.do
* Federal Regulations:  http://www.gpoaccess.gov/cfr/index.html

Several points made during the presentation include:

1. Keep the private pay registry up to date by submitting any changes to Dave Halferty.
2. The Resident Assessment listings are sent to facilities quarterly and all of the information should be checked and corrected if need be.  Remember if a resident was Medicaid one day out of the quarter, they should be listed as Medicaid for the payor source.  If you have a resident who is Medicaid Hospice, they should be listed as private pay for the payor source.
3. 4 of the 9 quality incentive points come from the Schedule J.  Please click on the preceding link to access definitions, questions and answers re: the Schedule J report.

Personal Needs Assessment (PNA) Update

The Health Policy Authority is in charge of working with the Social Security Administration in Kansas to implement the PNA increase.  Last session the Legislature increased the PNA from $30 to $50.  We asked their contact to explain where the process is at and when they think the PNA increase to SSI eligible individuals will take place.  Several of our providers have told us that their SSI residents have not received their increase as of yet.   According to the Health Policy Authority, for those who have no patient liability and are SSI eligible they will receive the $20/month increase but did not know if it would be retroactive or when it would occur.  They are in the process of setting the payments up now.  She said that for those residents who have a patient liability that their protected income will increase from $30 to $50 and that you should already be seeing the patient liability decreasing by $20.  When more information becomes available we will pass it along.  For any questions please contact Nancy at npierce@khca.org.

Medicaid Hospice  

Several Medicaid Hospice issues surfaced at the recent KHCA/ KDOA Reimbursement Education sessions.  At every education site the issue of Medicaid Hospice came up and how should providers list these residents on the resident assessment sheets.  KDOA said they consider Medicaid hospice clients as private pay.  This means that a providers Medicaid CMI, which is used to determine their quarterly direct health care cost center reimbursement, will not contain CMI's from residents considered Medicaid hospice.

The hospice providers though reimburse the facilities at 95% of their Medicaid rate.  The rate is already reduced because these residents CMI’s are not in the Medicaid CMI’s.  Depending on the number of residents per total beds, some of our providers are losing $4-5/ppd. 

KHCA will be getting a workgroup together to meet with Midland Hospice, KDOA, and Heart of America to discuss the following:

1. Hospice reimbursement rates to providers should be based on the Medicaid CMI of the client receiving their  services.
2. KDOA's classification of residents receiving hospice on the resident assessment listing.
3. Federal regulations governing hospice
4. CMS updates to hospice payment rates

Any questions please contact Nancy at npierce@khca.org.

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  Clarification about comments made at KACE convention by Rep. Bethell
by Cindy L.

Many of you in attendance heard Rep. Bob Bethell refer to a “proviso” about the budget enhancement Kansas nursing homes received during the 2006 legislative session.  Unfortunately, it was one of those times that his memory did not serve him so well.  Senate Bill 62 is where the language is about the reimbursement issue.  Click here to read the language about nursing facility reimbursement included in this legislation.  This is also the legislation where one would find the information about the personal needs allowance for our residents.  At some point we will have to adjust the cost report years but until that time it is in statute.

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  Annual Survey Trends for Nursing Facilities

Survey Trends- First Quarter 2006 and Previous Years Data Pertaining to NOTC and Enforcement Issues For Nursing Facility Health Surveys

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 (dec) 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 surveys	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.  During this same time frame there have only been 16 surveys completed under the new QIS system which should not be a factor in the increases.  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

According to LCE’s 1st Quarter CY2006 Report-A Comparison of 2006 to 2005 and previous years:

(Chart 1) The number of G+ surveys was up almost 40% resulting in a large increase in the percentage of all surveys that were G+. The current rate of 45% is higher than any of the annual rates since CY 2000.

(Chart 2) During the period, 8.9% of all deficiencies were G+ considerably higher than the same period in 2005. The rate was slightly higher than the 6 year CY 2000 – CY 2004 rate of 8.7%. The average number of G+ deficiencies per resurvey was .96 more than double the comparable 2005 rate and approaching the 1.1 rate recorded in 2000.. The number of all deficiencies per survey was 10.7 up almost 2 deficiencies per survey from CY 2005 and up about 3 deficiencies per survey from the 6 year average.

(Chart 3) Data regarding Double G facilities continues to be drawn from CMS’ pilot PDQ reporting system. During the period 24 facilities were in Double G status up 50% from the 16 reported in CY 2005. None of the 24 facilities were in Double G status more than once during the period. 

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  My InnerView

My Innerview is hosting a series of FREE Web-based seminars for provider/facility members and affiliate staff to learn about the benefits, process and timeline of the 2006 Satisfaction Surveys.  Providers need to make final arrangements with My InnerView for satisfaction surveys on or prior to OCTOBER 16 to be part of this year’s national and state-specific reports. 

Satisfaction surveying is a fundamental tool that facility leaders can use to create, inform and sustain a continuous quality improvement program and a positive work environment as envisioned in our Quality First program and the soon-to-begin quality initiative called “Advancing Excellence in America’s Nursing Homes.”  Participation in the national and state-specific reports will allow providers to benchmark their performance against all facilities in the national and state reports. 

Register for the free Web tutorial on satisfaction surveying with My InnerView at www.myinnerview.com or call 715-848-2713.

Day/Date/Times       (ALL EASTERN TIME)
Wednesday,  September 27,  1 p.m. & 5 p.m. (ET)
Thursday,   September 28,  1 p.m. & 5 p.m. (ET)
Tuesday,   October 3,              1 p.m. & 5 p.m. (ET)

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  EDS Reports

EDS produced the following report of Medicaid claims in Kansas covering the time period August 2005 through July 2006.  According to EDS once they receive the claim from the provider it takes EDS 7.88 days to process.  Also 86% of all claims process with no problems.  On average it takes the provider 22.31 days to send the claim into EDS from the date of service (DOS). 

How long on average does it take for the majority of claims to be processed for payment from the DOS to the DOP?  EDS reports that the majority of claims on average take 30.13 days from date of service (DOS) to date of payment (DOP).  Contact Nancy at npierce@khca.org with any questions.

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  EDS Update

According to EDS, the current Adult Care Home Provider Manual has been revised and renamed and is now referred to as the Nursing/Intermediate Care Facility Manual on the KMAP website.  There will be an RA banner message and global message for the providers.  EDS will also mail notices to the providers letting them know of the revision to the manual.  Any questions contact Nancy at npierce@khca.org. 
 

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  KHCA Survey Reports

In the next two weeks the KHCA staff, on behalf of the Resident Satisfaction Committee, will be mailing each KHCA member facility a report produced by KHCA of your compiled annual survey deficiencies for 2005.  This report is a compilation of your survey for 2005.  The information tracked includes date of survey, survey region, tag and scope and severity level received.  This committee tracks annual survey results for nursing facilities statewide by survey region.  In the past you have received this same information for 2002-2004.  Direct any questions to Nancy at npierce@khca.org.

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  Clinical Capacity Study

KHCA staff is currently working with the Kansas Board of Regents and the Kansas Board of Nursing on a clinical capacity study to determine if clinical nursing education sites in Kansas could and would accommodate more nursing students, specifically, RN as well as LPN students. 
    
The Committee’s first meeting was Thursday, September 7, 2006 and the following is a list of items discussed:

I. Study Methodology: Group agreed an electronic questionnaire to identified clinical sites would be the most accepted methodology. Concerns centered around issues of ease of use, access to survey instrument program by everyone, time to fill out the survey instrument by recipients, getting a good return percentage, and getting good, valid information that will be informative and useful for future planning. One methodology discussed was the use of Survey Monkey, which is web- based. Sites targeted included hospitals, long term care facilities (public and private), and specialty hospitals.

II. Timeframe: It was felt that questionnaire could be send out by the first week of December, with responses due back before Christmas. Depending on specific methodology used, data tabulation and write-up of findings would be done by the end of February.

III. Survey Questions: The Committee is in the process of drafting the questions.    

If you have any question please contact Nancy at npierce@khca.org or Cindy at cluxem@khca.org.           
 

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  Upcoming CMS Webcasts

Click on the following CMS Webcast link for the latest schedule.  Please note the December 15, 2006 edition discussing the revised surveyor guidance for FTag 329, unnecessary drugs and pharmacy services.

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  Disaster Planning Guide

Disasters Can Happen At Any Time. Have You Developed Your Emergency Plan?
Hurricanes, tornadoes and fires are natural disasters that can happen at any time. Make sure your facility has a plan to respond to natural and other types of disasters. The American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) offer several resources that can assist you and your staff in preparing emergency action plans.

Disaster Planning Guide: A Resource Manual For Developing A Comprehensive Preparedness Plan
This manual was developed as a reference tool to assist in the development and implementation of a disaster procedure and an emergency operations plan for your facility. It also contains information on disaster plans, with or without evacuation; transportation; housing; insurance; finance; and legal and legislative issues. Order your copy toady from KHCA/KCAL by downloading the order form or you may contact kendra Poole at 785-267-6003, kpoole@khca.org.

Member Price:
Non - Member Price:
$75.00 + tax & S/H
$100.00+ tax & S/H

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  Book Orders

Use this form to order any books from KHCA.  Contact Kendra at kpoole@khca.org with any questions.

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  Check on-line for RAI Manual Updates

CMS has made significant changes to the RAI (MDS) Manual in the last several years. Make sure your MDS Coordinator’s manual is up-to-date. CMS now has a zip file that contains all the revisions back to 2003.  Recently only the last five revision sets had been available.  This file also includes the June 2005 revisions which had not been readily available. For download instructions, follow the link below and scoll down to “Downloads”:
 
http://www.cms.hhs.gov/NursingHomeQualityInits/20_NHQIMDS20.asp#TopOfPage 
 
New RAI Manuals are available from KHCA at great “Member Only” prices. Contact khca@khca.org for details.

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  2007 PEAK Award Timeline

The 2007 PEAK Award timeline will be changed according to the Kansas Department on Aging.  The Secretary of Aging would like to host the award winners and recognize them at the Governor’s Conference on Aging which is held in May.  We will notify providers when dates become available but KDOA anticipates that this fall or winter providers will submit their applications, award winners will be recognized in May 2007 at the Governor’s Conference and the Secretary will do sight visits in the summertime.

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  KHCA WCIT

KHCAWCIT SAFE-LIFT Program Continues to Grow

At the time of publication, nearly 70% of the Trust membership have completed the orientation and training and are actively participating in the SAFE-LIFT program.

Our facilities are experiencing a reduction in frequency of injuries related to resident transfer, lowered severity and injury costs, reduced employee turnover, a healthier workforce, and a safer environment for residents through their participation in the program.
 
In addition to the benefits described above, the savings in costs associated with these debilitating injuries will allow the trust membership to enjoy lowered premiums in the future. 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

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  Act Now to Avoid Medicare Payment Hold

There will be a nine-day payment hold for Medicare Part A and Part B claims starting Sept. 22.  These payment delays were legislated in the Deficit Reduction Act to shift an estimated $5.2 billion in Medicare expenditures from FY 2006 to FY 2007.  To minimize the impact of the payment delay, it’s recommended that facilities file their claims as promptly as possible.  For more information or questions, please contact Elise Smith at AHCA at esmith@ahca.org.  

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  Medicare Head Confirms He’ll Resign

(By Robert Pear, The New York Times, Sept. 6)

Dr. Mark B. McClellan announced yesterday that he will resign his post as Administrator of the Centers for Medicare and Medicaid as of Oct. 1. Forty-three-year-old McClellan, who holds both an MD and a Ph.D. in economics, was a member of the President's Council of Economic Advisers and served as commissioner of the Food and Drug Administration for several years before accepting his appointment at CMS. (Boston Globe: www.boston.com/news).  The “doctor-doctor,” as his colleagues call him, plans to move on to a Washington think tank, such as the American Enterprise Institute or Brookings Institution. McClellan oversaw the massive switch this year from Medicaid to Medicare Part D, incurring the wrath of detractors who criticized the move for harming seniors who experienced gaps in prescription drug coverage during the changeover.

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  AHCA Submits Comments to CMS on Proposed Guidance to F371: Sanitary Conditions

The Centers for Medicare and Medicaid Services (CMS) requested AHCA to submit comments on proposed guidance for surveyors to F371: Sanitary Conditions. With input from members, AHCA submitted comments that focused on:

* the need to provide clear, succinct guidance to surveyors without unnecessary extraneous information;
* the need to ensure surveyor guidance does not exceed what is required by law and regulation; and
* the importance of providing guidance that does not place an expectation for surveyors to assess practices that should be assessed by individuals with different expertise.

To access AHCA’s comments, go to: http://www.ahca.org/members/operate/survcert/survey/F371_Sanitary_Conditions_Comments.pdf.  To access the draft guidance, go to: http://www.ahca.org/members/operate/survcert/survey/F371_Sanitary_Conditions_July06.pdf.

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  Assisted Living: New Obstacles

(By Jeff Opdyke, Wall Street Journal, Sept. 2)

Demand for assisted living in the U.S. is soaring, waiting lists are growing, and prices are rising sharply, with average costs of $35,000 a year in 2005, not counting health expenses, according to a recent MetLife survey: http://www.metlife.com/WPSAssets/14346585201156517210V1FAlzheimersCostStudy.pdf
There are currently about 36,000 assisted living facilities in the U.S., offering a range of different options packages, “making price comparisons tricky.”

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  NCAL Nominees Announced for Officers and At-Large Members

NCAL will elect its four officers (Chair, Vice Chair, Secretary, and Treasurer), and 14 at–large members at the AHCA/NCAL annual convention in San Antonio. This is the first time NCAL will hold its elections at the convention. The NCAL Candidates’ Forum and Elections will take place on Tuesday, October 10, from 8 a.m. to 10 a.m.  The meeting will open with floor nominations, then move into the candidates’ forum, and end with the elections.

Those interested in being nominated from the floor will need to be nominated by an NCAL member in good standing, an NCAL State affiliate executive or staff member, and have a completed candidate’s application package ready to submit at the time of the nomination. This includes the application, candidate’s questionnaire, two personal reference letters, and two professional reference letters.

All NCAL candidates listed below have been reviewed and certified by the AHCA’s Ethics Committee and are currently running for NCAL office.

The nominees for NCAL’s four executive officers are Van Moore (Ore.) for NCAL Chair, Marjorie Shell (Ind.) for NCAL Vice Chair, Howie Groff (Minn.) for NCAL Secretary, and Nicolette Merino (N.J.) for NCAL Treasurer.

The following nominees are seeking At–Large Member positions:

  Jim Birchem (Minn.)                          Jeffrey Hyatt (Wash.) 
  Ruth Channels (Kan.)                       Chris Mason (Ore.) 
  Deb Choma (Vt.)                                 Mike Shepard (Ark.) 
  Vickie Cox (Del.)                                  Dean Solden (Mich.)
  Michele Donahue (Ariz.)                     Faun Spencer (Minn.) 
   Pat Giorgio (Iowa)                              Mike Williams (Ohio)

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  New Enrollment Period Opens In November for Medicare Prescription Drug Plans

Residents looking to enroll in Medicare’s Prescription Drug Benefit for the first time will have the opportunity to enroll with a prescription drug plan beginning Nov. 15, 2006. Residents who have not enrolled in Part D may want to consider whether the Medicare drug benefit is right for them and if so, which drug plan to choose and when to sign up.

Residents who already have Medicare Part D coverage also have the opportunity to review their plans as the open enrollment period allows them to switch plans if they wish.  The Centers for Medicare & Medicaid Services (CMS) established a time line of key dates. NCAL has provided more information and that time line on its “Members Only” Web site http://www.ahca.org/members/assisted/part_d/060914.htm.

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  CMS Announces Medicare Part B Premium Increases

Providers may want to inform their residents about an expected increase in their Medicare Part B premiums, especially those beneficiaries making more than $80,000 in annual income.

The Centers for Medicare & Medicaid Services (CMS) announced Medicare Part B monthly premiums for 2007 would rise to $93.50 and beginning next year beneficiaries with higher incomes will pay more for the Medicare Part B services.

Medicare Part B covers physician and outpatient services. The new 2007 rate is an increase of $5 or 5.6 percent from the current Part B premiums of $88.50 per month.

Starting in 2007, under the Medicare Modernization Act, Medicare beneficiaries with annual incomes of more than $80,000 and married couples with annual incomes of more than $160,000 will pay a higher percentage of the cost of Medicare Part B based on their income.

The income-related Part B premiums for 2007 will be $106.00, $124.70, $143.40, or $162.10, depending on the extent to which an individual beneficiary’s income exceeds $80,000 or a married couple’s income exceeds $160,000.

For more information visit http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1958   

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