ADVANCING EXCELLENCE!!!

Be an Advancing Excellence "Trailblazer"

Want to be a quality "Trailblazer"?  To date there are 3,300 nursing facilities nationwide that have committed to work on the Advancing Excellence campaign's goals.  These "Trailblazers" will be recognized in May by the campaign organizers and now is a good time to jump aboard and join the movement -- Advancing Excellence successes include the 100% sign up of provider members of the Georgia Health Care Association; and the 76% rate of member participation for the Arkansas Health Care Association.  But YOU need to register your facility to qualify as a "Trailblazer."

To be designated a "Trailblazer," a facility must register for Advancing Excellence no later than May 14, 2007.  The significance of May is that May 13 to 19 is National Nursing Home Week and the month of May is Older Americans Month.  Post May 14 the campaign will disseminate public information listing each state's "Trailblazers." 

For more information about the Advancing Excellence in America's Nursing Homes campaign, and to register, visit www.nhqualitycampaign.org.  For a quick overview at what the Advancing Excellence campaign is all about, please use the Facility Edition ToolKit. For questions or comments click to contact Cindy Luxem.

At the KHCA/KCAL conference in June, we will have representatives from the American Health Care Association in Kansas to discuss this campaign.  We would love to have 100% participation of Kansas membership by that time.  Sign up today!!

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  Nursing Home Week

President Bush Recognizes National Nursing Home Week
National Nursing Home Week will begin on Mother's Day, May 13 and continue through May 19, 2007. The American Health Care Association (AHCA) established the week-long celebration in 1967. Treasure Our Elders is the 2007 theme for National Nursing Home Week. President Bush has issued a Presidential Message on National Nursing Home Week:

President Bush Recognizes National Nursing Home Week
National Nursing Home Week will begin on Mother's Day, May 13 and continue through May 19, 2007. The American Health Care Association (AHCA) established the week-long celebration in 1967. Treasure Our Elders is the 2007 theme for National Nursing Home Week. President Bush has issued a Presidential Message on National Nursing Home Week:
 
Presidential Message:
 
I send greetings to those observing National Nursing Home Week as you celebrate this year’s theme, “Treasure Our Elders.”
 
Our Nation is blessed by our seniors.  These individuals teach us lessons of the past, set an example for younger generations, and demonstrate the generosity and love for which Americans are known.  In communities across our country, nursing home physicians, nurses, staff, and volunteers work hard to provide a place of comfort for senior citizens and people with disabilities.  These devoted caregivers enhance the quality of life for nursing home residents and bring peace of mind to the loved ones of those they serve.  By treating our senior citizens with the dignity and respect they have earned, Americans can honor the legacy and contributions of our greatest generation.
 
I appreciate nursing home caregivers and all those committed to the well-being of our Nation’s senior citizens.  Your efforts reflect the compassionate spirit of our country and help build a brighter future for all.
 
Laura and I send our best wishes.
 
George W. Bush 
 

Your KHCA staff will be visiting at least five homes during the week to deliver "goodies" for your staff.  Let us know what is going on so we can take part in the fun.

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  Legislative Actions

Since we have come to the first adjournment of the 2007 Legislative session it is a good time to take a big breath and review what has happened.

House Bill 2144- passed out of the House.  HB 2144 would amend existing law to change nursing facility reimbursement rate methodology from the three year average of 2003, 2004 and 2005 to be rebased at least once every seven years to the average of the three most recent calendar years, rebasing annually starting in FY 2009.  The house committee delayed implementation until FY 2009.  This means it will be figured into KDOA’s budget for next year.

Our strategy is to have the Senate address House Bill 2144 before they leave in May. If any of you see your Senator’s at home during the break please let them know this is very important to each of you.  Additionally, if you see your Representative’s, thank them for their support. 
The yes votes 107.  The no votes 16. 

The Representatives voting no were:  Beamer, Davis, Dillmore, Flora, Garcia, Gatewood, Huntington, Dan Johnson, Kuether, Lane, Menghini, Pottorff, Schwartz, Sharp, Tafanelli, Tietze.  These folks are all being taken off of our Christmas list for next year!  If you see any of them remind them you employ their voters…

Representative Bob Bethell and Representative Jerry Henry were both very responsible for HB 2144 getting out of committee and passed on the floor.  We cannot thank them enough.

House Bill 2133- Establishes a two-tiered informal dispute resolution process for deficiencies cited in an adult care home or assisted living facility.  This passed out of the house and will now go to the Senate to be worked on.  If you would like to read about this legislation, go to www.kslegislature.org and insert Substitute for hb 2133 in the bill find space.
KHCA, KAHSA, KACE and the fire marshal’s office worked together towards a process that would be fair to all.

House Bill 2578- Utilization of Unused Medications Act. This passed out of the house and is in Senate Ways and Means.  This bill would create a voluntary program by which adult care homes may donate unused medications to be distributed by indigent health care clinics or federally qualified health centers to Kansas residents who are medically indigent. If this moves forward we will be at the table to work out guidelines.

House Bill 2237- Would amend the law regarding reciprocal licenses for adult care home administrators.  This would allow BACHA to grant a license to an individual already licensed as an adult care home administrator in another state if certain conditions are met.  HB 2237 passed out of the House and is in Senate Ways and Means.

House Bill 2530- An act concerning the consumer protection; relating to health care providers. This bill resulted from the Kansas Supreme Court decision, February 2007 which held that deceptive acts and unconscionable acts and practices come under the scope of the Kansas Consumer Protection Act.  The association is still working with all of the parties to gain an exemption because of this decision.

Kevin Fowler advised sending out the following information to all members:
Regardless of what happens in the Legislature, you might want to consider sending out an Information Alert informing members of the Kansas Supreme Court’s decision and cautioning them against making any affirmative claims, representations, promises, warranties or guarantees that residents, prospective residents or family members might consider to be false, fraudulent or otherwise untrue, especially in connection with the care to be given and expected outcomes.  Absent an exemption under the Kansas Consumer Protection Act, the best way for adult care homes to minimize exposure to liability under the Act is to refrain from any conduct, including acts or omissions, which violates the Act and be prepared to prove it.  In this regard, adult care homes should take appropriate precautions to the fullest extent possible, such as educating staff (especially those involved in marketing activities or responding to inquiries by potential residents or family members) to avoid making any verbal or written representations, promises, assurances, warranties or guarantees regarding care or outcomes, using a form of resident agreement that includes appropriate disclaimer and integration provisions, and similar measures.

As you can see it has been a very busy few months.  We will keep you posted as issues develop.  Do not hesitate to contact me anytime if you have concerns. cluxem@khca.org.

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  Assistant administrator needed

Assistant Administrator Position
 
Family owned 130 bed nursing facility in Southeast Kansas is looking for an Assistant Administrator. This is a full time position. Candidate should have a current Kansas Administrators license and have a background in accounting. We are a family owned and operated facility and have been in business for 40 years. We have an excellent occupancy rate and reputation in the community.
 
Candidates should reply to:
 
Kevin Knaup
Sunset Manor, Inc.
206 S. Dittman
Frontenac, KS 66763
1-620-231-7340
kevin@sunsetmanor.com
 

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  KDOA Grants Coming to You Soon!

The Kansas Health Care Association is proud to announce “An Oral Health Training Program for Nursing Home Staff “ sponsored by a grant from the Kansas Department on Aging.  This program is designed for unlicensed and licensed caregivers currently employed in a licensed long-term care nursing facility or a long-term care unit of a hospital. This includes CNAs, CMAs, nutrition aides, nurses and therapists. This program will be offered in Topeka and also Wichita.  For more information please go to www.khca.org to view brochures and register online.
 

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  CMS NPI Update

GET IT.                  The compliance date, May 23, 2007, is only 2 months away.  Covered health care providers have had 22 months to apply for their NPI – further procrastination could disrupt your cash flow.  Act now if you still don’t have your NPI! It’s easy and it’s free!

SHARE IT.           Have your NPI and don’t know what to do with it?  Share it.  Share it with health plans you bill and the colleagues who rely on having your NPI to submit their claims (e.g., those who bill for ordered or referred services).  You should also share it with your business associates, such as a billing service, vendor, or clearinghouse. Pay attention to information from health plans with which you do business as to when they will begin accepting the NPI in claims and other standard transactions.   

USE IT.                  Once your health plans have informed you that they are ready to accept NPIs, begin the testing process.  Consider sending only a few claims at first as you test the ability of plans to accept the NPI.  Fewer claims will make it easier to keep track of status and payment, as well as troubleshooting any potential problems that may arise during the testing process. 

Revisions to the NPPES website are underway.  Revisions include some of the language on the NPPES NPI Application Help page that relates to the selection of the Entity Type.  Among other changes, the revision will remove a reference to “atypical services.”   This reference is being removed because entities who furnish only “atypical services” are not eligible to apply for NPIs.

A new guidance document is available at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPIdisclosures.pdf on the CMS NPI web page.  This guidance relates to the disclosure of health care providers’ NPIs by health industry entities for the purpose of using NPIs in HIPAA standard transactions.  

New Frequently Asked Questions (FAQs) Posted CMS has posted new NPI FAQs on its website.
Questions include:

• I have been told to protect my National provider Identifier (NPI) and I have been told to share my NPI - How am I to protect my NPI if I must share it with others?
• With whom should I share my NPI?
• Am I required to share my NPI with health plans, other providers and any other entity that requests it?
• Does the National Plan and Provider Enumeration System (NPPES) handle applications for health plan identifiers, as it does for health care provider identifiers?
• May a health plan require that an individual health care provider obtain two NPIs if that provider has two separate business roles – for example, as a physician seeing patients at a group practice, and as a durable medical equipment (DME) supplier?

To view these FAQs, please go to the CMS dedicated NPI web page at http://www.cms.hhs.gov/NationalProvIdentStand/ and click on Educational Resources. Scroll down to the section that says "Related Links Inside CMS" and click on Frequently Asked Questions. To find the latest FAQs, click on the arrows next to "Date Updated”.

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  Be Sure You are FLSA Compliant - The 8 and 80 Overtime System

Under the Fair Labor Standards Act (FLSA), nursing homes and residential care facilities may use two different fixed work periods for employees - either a fourteen consecutive day work period or a 40 hour workweek - for the purpose of computing overtime. To use this exception, the employer must inform all affected employees before the work is performed. This "8 and 80" exception allows employers to pay time and one-half the regular rate for all hours worked over eight in any workday and eighty hours in the fourteen-day period. It is important to note that an employer can use both the standard 40 hour overtime system and the 8 and 80 overtime system for different employees in the same workplace, but they cannot use both for a single individual employee.   To learn more about how to properly use the 8 and 80 system, please visit: http://www.dol.gov/esa/regs/compliance/whd/whdfs54.pdf.

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  LT Care Solutions Announces
David Landwehr CSA, CLTC

Money, Time, and Generations: Competing Priorities

Middle-aged baby boomers are in the middle of a push-me, pull-you situation, summarized by the descriptive phrase “sandwich generation.” They have both minor-aged children at home, and parents who need help as they advance in age and require long term care.

The baby boomers and their parents find that decisions regarding long term care are often difficult and unsatisfying. The grandparent who wants to leave an inheritance anguishes over spending money instead on long term care needs. The baby boomer who works long hours can resent spending precious free time on parents, instead of his or her children. It may be impossible to lessen the time burden by paying for professional care without compromising other priorities such as saving for children’s education and the boomer’s own retirement.

There are only two ways to get long term care: by a friend or relative who sacrifices his/her own time, or by getting professional, paid care.

The cost to volunteer (unpaid) caregivers is relatively easy to understand by reflecting on this question: what would they be doing otherwise?

In the world of professional (paid) caregiving, payment sources can be boiled down to two: 1) private pay options (personal cash or long term care insurance proceeds); or 2) government programs. The costs of each strategy include money paid; income never earned due to time spent caregiving, as well as other factors such as choice of caregiving options.

The cost of paying with personal cash is straightforward: it comes from wallets or their equivalent, such as the liquidation of investments, and/or use of income. This cash is no longer available for other priorities, including support of a spouse or inheritance for children and grandchildren. Privately paying for long term care insurance involves a less dramatic situation; by planning ahead and buying a policy before care is needed, an affordable premium is traded for a much larger benefit when care is needed.

The cost of relying on government programs can be daunting. They can include a delay as you wait for services that are currently at capacity, or the fact that government programs often have an institutional bias, meaning that the system prefers to deliver services in nursing home. You may find it difficult to get the appropriate services needed, consistently, in your own home. Private payers are less likely to encounter these problems.

The federal government is also running into problems when it looks at funding long term care. A recent AARP report asked “Can we afford our aging society?” The report goes on to explain that entitlement spending has been fairly stable over the last 20 years as a percentage of gross domestic product (GDP), with one exception – health care, including Medicare and Medicaid. Is this to be expected, due to an aging population? The report claims no, saying the aging population accounts for only about one-sixth of Medicare’s growth since 1970. The federal government's new proposed budget includes reforms to cut federal Medicaid funding over $24.7 million from 2008-2012. These proposals, coupled with the Medicaid reform in the Deficit Reduction Act, leads many people to conclude that relying on government programs may not be the best option.

In the perfect world, we would all have lists of friends and relatives able and willing to be our caregivers. And, we would all have enough money that we didn’t have to rely on any of them! 

Modern long term care insurance can now make the highest-quality care within the financial reach of the middle class. Just as important, it can lessen the time burden of caregiving for friends and family, and provide a way to pay for the care we desire, regardless of what government programs may offer – or not!

About LT Care Solutions
LT Care Solutions, Inc. specializes in LTC planning for both companies and individuals since 1992. We believe that dabbling is dangerous and LTC is an important decision best made in consultation with an experienced advisor. Go to www.LTCare Solutions.com for more info.

Website: http://www.LTCareSolutions.com
LT Care Solutions
David Landwehr CSA, CLTC
President
email: dlandwehr@ltcaresolutions.com
phone: 316-945-2011

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  Quality Indicator Survey (QIS) Evaluation

Quality Indicator Survey (QIS) Phase I (Formative) Evaluation

The Quality Indicator Survey (QIS) is a revised long-term care survey process that was developed
under the Centers for Medicare & Medicaid Services (CMS) oversight through a multi-year contract.
It was designed as a staged process that surveyors use to systematically and objectively review all
regulatory areas and subsequently focus on selected areas for further review.

CMS contracted with Abt Associates Inc., together with the University of Colorado Health Sciences
Center (UCHSC) and the Borun Center of the University of California at Los Angeles (UCLA) to
evaluate a pilot test of the QIS in three states (Connecticut, Kansas and Ohio) and make
recommendations for ways to improve the QIS, particularly in the domains of time and efficiency.
This formative evaluation is based on QIS surveys implemented under realistic conditions under
which the QIS was the survey of record. This is the first test of the QIS under “real world”
conditions, as previous beta tests have largely been feasibility tests that focused on whether the QIS
could be implemented by surveyors. The formative evaluation will be followed by a summative
evaluation that examines how well the QIS achieves it primary objectives related to improving the
accuracy, consistency, and documentation of the nursing home survey process within existing survey
resources.

Overall, they found that surveyors who implemented QIS surveys of record generally saw the QIS as
an improvement over the standard long-term care (LTC) survey. Nonetheless, they also gathered data
showing that the QIS in its current form might take longer to complete than the standard survey, as
well as evidence that there are components of the current QIS that might be made more efficient and
timely.

To view the entire report go to the members only section of www.khca.org.

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  Updates

• The Kansas State Fire Marshals Office has added a section titled Health Care Facilities to their website at: http://www.accesskansas.org/firemarshal/FirePrevention/preventionhome.htm.
  This new section will be updated regularly with Q & A and CMS Updates as they become available.  Scroll down to the middle of the page and the section is titled Health Care Facilities (CMS).
  
• The link listed below is a faster way for your members to have access UL Certifications.  It’s the UL Online Certifications Directory
  You can use the UL Online Certification Directory to:
  * Verify a UL Certification
  * Verify a UL Certified product use
  * Verify a product safety standard
   
  http://database.ul.com/cgi-bin/XYV/template/LISEXT/1FRAME/index.htm
   
   

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  Quality Measures

Please click here to see the latest National and State Publicly Reported Quality Measures report from AHCA.

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  Nursing Facility Financial Analysis Study

Attention Independent and Regional Multi Nursing Facilities. Participate in the Nursing Facility Financial Analysis Study. Final Deadline Extended to April 13th.

Protecting critical Medicare and Medicaid funding for long term care continues to be a top priority for AHCA. In support of this, AHCA has retained the Lewin Group to update our nursing facility “hydraulic” study. The study examines reimbursement and costs related to providing long term care services in 2006.  The study supports AHCA’s efforts to inform policymakers about complex payer funding relationships and to advocate for the ongoing viability of the nursing facility sector. 

Past data collection efforts have not included as much data from independently owned or small regional multi facilities as we would have liked.  Therefore, we particularly encourage facilities in these categories to take part in our current effort. The corporate office of national and larger regional multis have been requested to submit data for all of their facilities.

For more information about the study and the data being requested please click on the following link (http://www.ahca.org/research/nffas2007.htm) .

Please click http://www.ahca.org/research/LewinDataCollectionTool2006.xls to download the electronic version of the data collection tool. All data that are being requested will be kept confidential. Data are to be submitted to the Lewin Group by Friday, April 13th, 2007. Should you have any questions, please contact Namrata Sen with the Lewin Group at (703) 269-5747 or Margin.AHCA@lewin.com or AHCA’s Peter Gruhn at (202) 898-2819 or pgruhn@ahca.org.

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  AHCA News

The March Regulatory Update includes AHCA comment letters to CMS, transportation during emergencies, assisted living regulatory trends, preventing falls in assisted living, pressure ulcers, shingles, Part D retroactive coverage, delays in Medicaid eligibility determinations and much more.

False Claims Act & The U.S. Supreme Court

Earlier this week, the US Supreme Court ruled that a private person who sues under the False Claims Act must be an "original source" as defined in statute as "an individual who has direct and independent knowledge of the information on which the [false claim] allegations are based."  This decision is beneficial to the long term care profession because limiting those able to file as whistleblowers may protect health care providers and others from lawsuits lacking merit.  We are very pleased with this ruling as it supports the "friend of the court" brief AHCA filed last year in which we asserted that relaxing the whistleblower standard would "divert enormous resources away from providers' core responsibility: caring for patients."
On Monday, March 26th AHCA and the National Association of Long Term Care Services (NASL), filed a "friend of the court" brief requesting the U.S. Supreme Court clarify the determination for a false claim.  Specifically, our brief supports the University of Phoenix's assertion that a false claim should be based upon a violation of condition of government payment rather than a violation of a requirement for program eligibility.  Counsel for AHCA and NASL is Malcolm Harkins of the DC firm of Proskauer Rose, LLP.  For more information about either of these cases, click to contact Priscilla Shoemaker.

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  NCAL Updates

Releases 2007 Assisted Living State Regulatory Review

NCAL has released its highly anticipated 2007 Assisted Living State Regulatory Review, which is available at www.ncal.org. It is the only resource of its kind that is published in the country on an annual basis, and is critical to state and federal policymaking.  It is widely used by policymakers, researchers, and assisted living professionals, as well as other industry groups.  To obtain a printed copy, call (202) 898-2855 or send an e-mail to Martece Yates and be sure to include your name, address, and phone number.

NALW Logo Released         

The new logo for National Assisted Living Week (NALW), September 9-15, 2007, has been released.  The theme, Legacies of Love, highlights the privilege, value, and responsibility of passing the legacies of our elder's lives down through the generations.  Each assisted living resident has a unique story to tell, a proud heritage to celebrate, or mementos and keepsakes that can be acknowledged and shared.  To download a copy of the logo and for more information on NALW visit www.NALW.org.

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  VA Pension Benefit Available for Long Term Care Services

The Department of Veterans Affairs (VA) is publicizing a little known pension benefit that could help eligible war-time veterans and their surviving spouses obtain financial aid for assisted living and skilled nursing care.

Click on VA Benefit to learn more for your residents.  (You will have to enlarge the document to read it.)

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