KHCA Annual Convention

The Kansas Health Care Association's 57th Annual Convention and Trade Show will be held on September 26-28, 2007.  Click here for a brochure and registration form.  Please fax your registration to 785-267-0833. Click on the list to see if your facility is registered!!!

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  2007 KHCA/KCAL Golf Tournament

Don’t forget to join members and legislators September 26, 2007 for an afternoon of golf at Auburn Hills Golf Course in Wichita.  Details and registration.

See you soon.

Cindy

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  Convention and Trade Show Special

“Household Matters” Tool Kit

$499.00

Special offer to all KHCA members…Limited Time offer

Household Matters toolkit was developed by Steve Shields and LaVerne Norton as a detailed guide for how an organization can shape itself to become a person directed service model with well trained, empowered, and satisfied workforce. 

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  KHCA 2007 Campaign for Quality Senior Care

The KHCA 2007 Campaign for Quality Senior Care began September 5th in Pittsburg, Kansas.  KHCA is inviting KHCA Member Administrators and industry experts to participate in a roundtable discussion of issues of critical importance to our Kansas seniors.  Seven Legislators from the area joined the eight members representing four homes in great conversation about our profession. 

Discussion involved 2008 legislative priorities including:  dependable and sustainable funding, including ltc and hcbs, workforce initiatives for the ltc health sector, regulations to support person centered care models of care, expansion of the dental benefit to all medicaid recipients, ltc insurance partnership implementation, and discussion concerning additional CE hours for the certified operators course.

If you could please take time to join us when we are in your KHCA/KCAL District it would be greatly appreciated.  The legislators like to see their constituents at these meetings.

Sept. 25- Wichita
Oct. 2- KC Metro area
Oct. 23- Topeka
Two dates in November to be held in western Kansas.

If you are interested in more information contact Cindy or Nancy at KHCA.

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  EDS-Medicare Updates

Medicare Cross-Over Claims

The following global message was posted to the KMAP Provider Web site  re: Medicare cross-over claims.

Medicare Crossovers

KMAP has been made aware of two issues that may affect providers' claims crossing over automatically FROM MEDICARE to KMAP.
 
1.  Medicare has published a bulletin outlining why some claims may not have crossed over automatically to beneficiaries' supplemental insurers. To access the bulletin click here.

2.  Medical Manager and Sage Software  Users: If you use Medical Manager software and have problems with Electronic Crossover Medicare claims, contact your Medical Manager software vendor directly or support at Sage Software at 1-877-932-6301. To fix this issue, your system must be set up properly for "Group Billing," and you need the data map Sage Software corrected on July 30, 2007. 
  
Contact Biillie Jo Shelton with EDS at 785-274-5407 or by email at billiejo.shelton@eds.com with any questions.
 

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  Kansas Activity Directors Update

 The Kansas Activity Directors Association is hosting their 17th Annual Conference - "Activity Professionals Create the Moments" October 15 & 16 at the Holiday Inn Select in Wichita, Kansas.  Topics include Resident Centered Care, Care Plans and Documentation for Culture Change, One to One Programming, Non Therapeutic Drug Interventions and much more.   Conference flyers have been mailed out .  For more information about the conference please contact Laurie Kloepper at kloepper63@hotmail.com or 913-360-6247.
 
 

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  Disaster Training

When Bad Things Happen:  Helping Put the Pieces Back Together

Tuesday, October 9, 2007

PROFESSIONAL CONTINUING EDUCATION EVENT
Location:  Coffeyville Regional Medical Center 4th Floor Conference Room,
1400 W. Fourth St., Coffeyville, KS12:00 p.m. - 5:00 p.m. Limited to 75 participants!

Continuing Education Credit:
Physicians, Nurses, EMS and Nursing Home Administrators.
Application has been made for KAAP credit. All other participants will receive a certificate of attendance.
There is additional content on the KRHIS website.

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  The Foundation for the Aging and Care of Elders of Kansas (FACE) receives grant.

Our foundation  (FACE) received notification we have been granted for two years, beginning November 2007- the end of 2009.  The grant is for $50,000 and will help us implement our Long-Term Care Oral Health Training program.  This program is being implemented by Loretta Seidl, RDH, MHS a licensed dental hygienist.  The program allows us to conduct trainings for long-term care providers in 15 homes the first year. 

If you are interested in looking at being in the cuttling edge of person centered care relating to their oral health care please contact Letty at lseidl@khca.org.  We will be talking about this program more at convention next week and we will have a brochure soon to send out to members.

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  Life Safety Code Updates

Reacceptance Test Documentation

Brenda McNorton with the Kansas State Fire Marshal's Office would like to remind providers to ask for reacceptance test documentation if your fire alarm company makes a change to your fire alarm system (see attached form).  KSMFO Inspectors will be asking for the reacceptance test form and will no longer accept a letter stating the system is acceptable.  
 
NFPA Standard: Reacceptance testing shall be performed after any of the following: Added or deleted system components; Any modification, repair, or adjustment to system hardware or wiring; Any change to site-specific software; All components, circuits, systems operations, or site-specific software functions known to be affected by the change or identified by a means that indicates the system operational changes shall be 100 percent tested. In addition, 10 percent of initiating devices that are not directly affected by the change, up to a maximum of 50 devices, also shall be tested, and correct system operation shall be verified. A revised record of completion in accordance with 1-6.2.1 shall be prepared to reflect any changes. 1999 NFPA 72, 7-1.6.2.1
 
NFPA Standard: Changes to all control units connected or controlled by the system executive software shall require a 10 percent functional test of the system, including a test of at least one device on each input and output circuit to verify critical system functions such as notification appliances, control functions, and off-premises reporting. 1999 NFPA 72, 7-1.6.2.2
 

Eye Wash Stations

Click here to view the ANSI Standard guide for weekly testing of eye wash stations.  
 
It states under Maintenance – plumbed systems must be flushed weekly and documented as required by ANSI Z358.1-2004
 
Another issue with eye wash stations is the word “Tepid” which is defined in the following attachment.
 
In the attachment the temperature range of "tepid" water is mentioned. The ANSI standard states that each application and situation must be evaluated on a case by case basis. However, as a general rule, 100-degrees Fahrenheit is probably the highest temperature water should be, while the lower end should be 60-degrees Fahrenheit. The appendices indicate that temperatures over 100 degrees may intensify chemical burns to the skin and eyes, and hypothermia becomes a concern on the lower end of the scale.  Please contact Brenda McNorton at 785-296-3401 with any questions.

UL Warns of Counterfeit Surge Protectors

Underwriters Laboratories (UL) is notifying consumers and retailers that surge protectors bearing the brand name “Fussion” bear a counterfeit UL Mark for the United States. The surge protectors have not been evaluated for safety by UL and are not eligible to bear the UL Mark.

Units: Unknown quantity
Manufacturer: Unknown
Date of Manufacture: Unknown
Identification:
On the packaging:
The surge protectors have six outlets and display a counterfeit UL Mark on the packaging. Model PBR-4506 appears on the package with the brand name “Fussion”.

On the Product:
A molded marking on the back of the surge protector identifies the unit as Model MDE-28.

Hazard: The product does not contain a ground wire or surge protection. It has undersized wire and insulation that does not meet UL’s Standard for Safety for surge protectors. Using the product could pose a potential electric shock or fire hazard.

What you should do: UL recommends that users stop using these surge protectors immediately and return them to the place of purchase.

Known to be sold at the following locations:

City Trading
220 Cook Street
Brooklyn, N.Y. 11206

Lucky Star Trading
8 Evergreen Ave
Brooklyn, N.Y. 11206

Underwriters Laboratories is an independent, not-for-profit product safety certification organization that has been testing products and writing Standards for Safety for over a century. UL evaluates more than 19,000 types of products, components, materials and systems annually with 21 billion UL Marks appearing on 71,000 manufacturers’ products each year. UL’s worldwide family of companies and network of service providers includes 66 laboratory, testing and certification facilities serving customers in 104  countries.
For more information, visit:http://www.ul.com/newsroom/newsrel/nr082107.html.  Contact Brenda McNorton , Chief Fire Prevention at 785-296-3401 with any questions.

Use of Extension Cords

Recently the fire marshal's office  have been receiving questions concerning the use of extension cords in buildings they inspect, this has been a growing concern for those doing inspections.  As they are aware facilities were never built with enough fix wiring to be able to handle what everyone wants to have.  Some of the problems they are currently running into are the overloaded usage of power cords.  Below will out line the NFPA standard to hopefully answer so of those questions.

Substitute for adequate wiring for new and existing:  NFPA standard: Flexible cords and cables shall not be used: as a substitute for the fixing wiring of a structure; run through holes in walls, ceilings or floors, doorways o windows; attached to building surfaces; or concealed behind building walls, ceiling floors.  1999 NFPA 70, article 400-8

Splices for new and existing:  NFPA standard:  Flexible cord shall be used only in continuous lengths without splice or tap where initially installed in applications permitted by Section 400-7(a). 1999 NFPA 70, article 400-9

Pull at Joints/Terminals for new and existing: NFPA standard:  Flexible cords and cables shall be connected to devices and to fittings so that tension will not be transmitted to joints or terminals.  199 NFPA 70, 400-10

Overloaded for new and existing:  NFPA standard:  In no case shall the load exceed the branch-circuit ampere rating.  An individual branch circuit shall be permitted to supply any load for which it is rated.  A branch circuit supplying tow or more outlets or receptacles shall supply only the loads specified according to its size as specified in (a) through (d) and as summarized in Section 210-24.  A 15 – or 20-ampere branch circuit shall be permitted to supply lighting units or other utilization equipment, or a combination of both.  The rating of any one cord- and plug-connected utilization equipment shall not exceed 80 percent of the branch circuit ampere rating.  The total rating of utilization equipment fastened in place, other than lighting fixtures, shall not exceed 50 percent of the branch –circuit ampere rating where lighting units, cord- and plug-connected utilization equipment not fastened in place, or both, are also supplied. 199 NFPA 70, 210-23

K-62

During a recent presentation the presenter stated that a 5 year internal pipe inspection was not required unless there was evidence that one was needed. One of presenters statements to the industry has to do with the chapter 10 of NFPA 25 and the indicators of a need for an obstruction investigation. After a system has been in service for 15 years (this does not apply to a domestic system with 6 or less heads tied to the normal water supply) the obstruction investigation should be completed if the conditions listed in chapter 10 exist.

These items shall be listed on a checklist from the person who is conducting the inspection that none of the following has occurred. Documentation must be presented to the inspector. 

Click on the following to view what NFPA 25 - 1998 Edition states for obstruction.  In order for KHCA Members to comply with the state's requirement to document whether any of the items (a) thru (l) occurred in the past year, we have added a place for providers to record a Yes or No next to these items. 

10-2.2 – Obstruction Prevention:

Systems shall be examined internally for obstruction where conditions exit that could cause obstructed piping.  If the condition has not been corrected or the condition is one that could result in obstruction of piping despite any previous flushing procedures that have been performed, the system shall be examined internally for obstruction every 5 years.  This investigation shall be accomplished by examining the interior of a dry valve or preaction valve and by removing two cross main flushing connections.

10-2.3 – Flushing Procedure:

If an obstruction investigations carried out in accordance with 10-2.1 indicates the presence of sufficient material to obstruct sprinkler, a complete flushing program shall be conducted.  The work shall be done by a qualified personnel.

Here are some other indicators that could show that a 5 year internal pipe inspection is needed:

* Look at the time it takes for the water flow – if the flow time becomes significantly slower, this could be a sign of an obstruction.
     
The water flow tests dated XX/XX/2004 and XX/XX/2007 revealed that the flow times have become slower from 60 seconds to 120 seconds, indicating a potential obstruction

* Another indication of a problem would include pinhole leaks in the system – an indication of MIC.

* The quarterly and annual inspections did not list the condition of the water or the presence or absence of materials in the water.

* The discharged water is a rusty color

* The sprinkler system located in the attic revealed the system had been leaking and the piping was heavily rusted, indicating the potential presence of a microbe that causes obstructions.

* The annual sprinkler inspection, dated XX/XX/2007, stated in the comments section that the system was due for an obstruction investigation

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  Revisit User Fees Go Into Effect

The final regulation for the Revisit User Fee was published in the Federal Register on September 19, 2007 and becomes effective on that date.  It is important to note that because the law for the revisit user fee was created in a Continuing Resolution (a mechanism used by Congress to temporarily fund government programs when they are unable to pass permanent appropriations bills), and therefore the Continuing Resolution and the revisit user fee both expire at the end of the fiscal year – September 30, 2007.  In order for the user fee to continue beyond September 30, Congressional action is necessary.  AHCA continues to work in opposition to this revisit user fee and its implementation in fiscal year 2008 and we will keep members advised of this activity. 

The final regulation is very similar to what was originally proposed.  AHCA submitted comments on the proposed regulation, with significant input from members.  Unfortunately, the final regulation contains very few changes to the proposed regulation. 

The regulation applies to health care facilities that have been cited for deficiencies during initial certification, recertification, or substantiated complaint surveys and require a revisit to confirm that corrections to previously identified deficiencies have been corrected.

The preamble reflects that there were numerous comments expressing concern that these fees will divert funds needed and more appropriately used for patient care.  The Centers for Medicare & Medicaid Services (CMS) response to these concerns is “…the prospect of fees for revisits will result in greater compliance with quality of care requirements.”  Additionally, they state “The cost of a revisit fee can be compared favorably to the larger cost to beneficiaries from poor quality of care, or to the larger financial cost to providers from serious non-compliance with federal requirements.” 

The fees will be a set amount of $168 for off-site revisits (sometimes referred to as desk reviews) and $2,072 for on-site revisits.  Fees will be deducted from amounts otherwise payable to the provider or supplier.  The regulation also allows for CMS to devise other collection methods it deems appropriate.  The preamble states that for the immediate future, CMS will utilize a bill pay system.  Providers or suppliers who are assessed a fee will receive a notice in the mail which will include the amount of the assessed revisit fee and the revisit survey for which the fee is assessed.  The facility must remit the payment within 30 calendar days of the date of the notice.

There is a reconsideration process for revisit user fees that applies only when the provider believes an error of fact has been made – such as clerical errors, billing for a fee already paid, or assessment of a fee when there was no revisit conducted.  A request for reconsideration must be received within 14 calendar days from the date identified on the revisit user fee assessment notice.

If after reading the regulation, which can be found at http://www.ahca.org/members/operate/survcert/index.htm, you have additional questions, please contact Lyn Bentley at lbentley@ahca.org.

KHCA has had discussions with the KDOA concerning this implementation and it was reported that CMS Regional office will be responsible for billing facilities and collecting these fines.  Please keep us posted as to what you hear.  If you have any questions direct them to Nancy or Cindy at KHCA.

AHCA comments made on your behalf--

In comments submitted to CMS AHCA strongly disagreed with the underlying policy rationale of imposing revisit user fees on Medicare providers and also expressed doubts about the legal authority for the Secretary of the Department of Health and Human Services to impose a fee on health care providers given the clear provisions in the Social Security act prohibiting such fees.  AHCA asserts that the net effect of the fees is a reduction in resources available to care for Medicare beneficiaries.  Additional concerns were raised about many elements of the proposed regulation, including allowing use of revisit fees following a complaint survey; and assessing a flat fee for revisits based on an "average" number of hours for a revisit.  

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  AHCA Updates

AHCA Keeps the Pressure on to Stop Medicare Cuts

As we have continued to report in recent weeks, AHCA is fully engaged in efforts to remove Medicare cuts to skilled nursing facilities from the Children's Health and Medicare Protection Act of 2007 (CHAMP).  These efforts have included advertising in thirteen states as well as grassroots efforts targeting select Members of Congress throughout the August recess.  We have also been successful in highlighting these unwarranted and unfair Medicare cuts in news articles across the country, with articles and opeds appearing in newspapers including the Austin-American Statesman, Florida Today, and the Post Star among others.
As Congress returns to Washington DC next week after their month-long recess we will redouble our efforts - including lobbying, grassroots, and media outreach - to illustrate that these Medicare cuts totaling nearly $3 billion over five years are wrong and should be removed from any package addressing the State Children's Health Insurance Program (SCHIP).  For more information about the advertising and earned media efforts, click to contact Susan Feeney at sfeeney@ahca.org.

New Implementation Date for F373 - Paid Feeding Assistants

The original effective date for the new guidance for F373 - Paid Feeding Assistants - was originally September 28.   That date has changed!  The guidance became effective August 17.  Remember, this tag and the guidance are only applicable in those states that allow for paid feeding assistants.  For additional information, contact Lyn Bentley at lbentley@ahca.org.

Long Term Care's IT Concepts Featured on Expo's Technology Track

Explore technology's advancement in long term care by attending seminars from the Technology track at this year's AHCA/NCAL/MECF 58th Annual Convention and Expo, October 7-10 in Boston, MA.  This year's Technology highlight:  The Interactive Nursing Home Showcase.  This must-see model facility displays real-time simulations of technology working in a nursing home. Attendees can earn 1 CEU by completing a tour of the model which can be found in the Health Information Technology Expo Hall A. Time is running out register today! Make your plans to attend now by visiting www.AHCAconvention.org, or www.NCALconvention.org.

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  LT Care Solutions
David Landwehr

The 60/40 Rule and Long-term Care Planning

We know that when we retire, we will need money. That's why we pay attention to the balance in our 401Ks and IRAs. After all, if we weren't convinced that we'd need more money than our social security retirement benefit provides, why would we bother to save for retirement in the first place?

A growing minority of people are convinced that they need to plan for long-term care in retirement. They are buying long-term care insurance to protect their pensions and nest eggs against the expenses of home care, assisted living facilities and nursing homes.  However, most people who are eligible for AARP membership (age 50+) still haven't considered how they will pay for long-term care if such care is needed. Experts speculate this is a primary reason: these individuals see statistics on people living longer, they read about advances in medicine, and they leap to the conclusion that they are unlikely to need long-term care.

The facts suggest otherwise. The President's Council on Bioethics reports in "Taking Care: Ethical Caregiving in Our Aging Society" Americans have a 60% chance of many years of physical and/or mental limitations before they die. The report said that roughly 20% of all deaths follow "several years of increasing physical limitations, punctuated by intermittent acute life threatening episodes." Roughly 40% of all deaths now follow "prolonged dwindling usually lasting many years with steady decline, enfeeblement, and growing dependency, often lasting a decade or longer."

Physical or mental limitations are exactly why one would need long-term care. Long-term care lasts more than 90 days by definition, and consists of help with either activities of daily living (such as eating, dressing, bathing, transferring, toileting, continence), or care needed due to severe cognitive impairment (Alzheimer's or other dementia, for example).  Americans are living longer than ever. The average American life expectancy at birth was 47 years in 1900, and is now over age 77. However, the same medical and nutritional advances that allow us to live longer make us susceptible to the illnesses of old age, such as Alzheimer's disease and Parkinson's disease.

If you are planning for a long retirement, it's not enough to save for traditional living expenses. Just as you must plan for bull and bear markets and the possibility of high inflation, you must plan for the 60% possibility that you will need long-term care. If your retirement plan doesn't include how to pay for long- term care, it's incomplete.

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. Call us at 316-945-2011 or Go to our website: http://www.LTCareSolutions.com

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