Congressional Scorecard for 2007

Bush Signs Medicare Package into Law-Preserves $690 Million Market Basket

S. 2499 also extends the Medicare Part B therapy caps exceptions process until June 30, 2008.  With Bush’s signature, the onerous therapy caps have been delayed for at least six months.  AHCA will take advantage of this delay to work with Congress, the Administration and CMS to establish a new, condition-based reimbursement system for therapy services. 

These were hard fought victories, particularly in light of the fact that earlier this year the House of Representatives passed legislation (CHAMP Act) which would have eliminated the SNF Medicare Market Basket Update for FY 2008.  AHCA reports that the grassroots effort opposing any Medicare cuts helped ensure that the profession's voice was heard loud and clear.

AHCA reports Congress intends to address Medicare once again as soon as they return for the second session of the 110th Congress in January, our fight will begin anew in the New Year.  As details become clearer as to Congress’ plan, they will provide timely updates.

Since the President signed the FY08 omnibus bill, the CMS revisit user fees are now dead.  

The legislation will freeze the inpatient rehabilitation facility (IRF) compliance threshold permanently at 60 percent, including comorbidities, retroactive to July 1, 2006 cost reports.

The House will return on January 15, 2008 and the Senate will return on January 22, 2008.  However, Democratic leaders will hold pro forma sessions during the recess to block recess appointments by President Bush.  The President's State of the Union Address will be given on January 28, 2008.
 
The President's FY2009 Budget will be released on February 4, 2008.

The staff at the American Health Care Association deserve many, many kudos for diligently fighting the Medicare battles on your behalf for what seems like forever!!  Take time over the holidays, if you can, to thank your members of Congress for their support on this bill when they are back in their home districts.

Senator Pat Roberts of Kansas was a great help to us during this process.  Please do not forget to thank him if you have a chance.

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  KHCA/KCAL Legislative Conference

The KHCA/KCAL Legislative Conference A Call to Action is right around the corner. The conference, once held in January, has now found a home in February to better accommodate the Legislative schedule and the KHCA/KCAL Legislative agenda. Highlights include specialized learning tracks for nursing homes, assisted living/residential health care and CNAs, one-on-one opportunities with elected officials, technology and resource fair, legislative reception and so much more. Look for registration information after the first of the year.

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  Psychiatric Services in MF/MH’s

If you are a Nursing Facility for Mental Health SRS has probably notified you that Medicaid will no longer pay for psychiatric services provided for your NF/MH residents as of 7/1/07.  The Association has been talking with SRS and the Kansas Health Policy Authority about this policy change.  KHCA spoke with Bobbie Graf-Hendrixson an SRS employee who oversees the Managed Care Organization, Kansas Health Solutions.  The Association has been told that the policy is on hold and currently being reviewed and that NF/MH’s should conduct business and billing as usual.  Psych services will be covered.  If you have any questions or problems please contact KHCA or Bobbie Graf-Hendrixson at 785-296-3471.

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  Has Your Facility Received a Notice of Medical Subrogation Claim?

Has Your Facility Received a Notice of Medical Subrogation Claim?  The “Notice of Medical Subrogation Claim” informs the facility recipient that the State will seek to recoup the cost of any medical services provided to a resident under the Medicaid Program for which the recipient or any third-party is legally responsible.  If a resident is injured in a fall or other incident which results from the negligence or other tortious conduct of the facility (including acts or omissions of facility staff within the scope of their employment) and the resident receives medical services under the Medicaid Program for such injuries, the facility (or its liability insurance carrier, if any) may be required to reimburse the State the amount of such medical expenses.  As explained by the United States Court of Appeals for the Tenth Circuit:

“Medicaid is a cooperative federal-state program through which the federal government provides financial assistance to states so that they may provide medical assistance to needy individuals. See 42 U.S.C. § 1396; see also Williams v. Kansas Dep't of Soc. & Rehabilitation Servs., 258 Kan. 161, 899 P.2d 452, 455 (1995). A state that chooses to participate in Medicaid must adopt and have approved a medical assistance plan which complies with the substantive requirements of 42 U.S.C. §§ 1396 et seq. and accompanying regulations. 42 U.S.C. § 1396a(a)(25) provides that the plan must require that the state agency administering the Medicaid program “take all reasonable measures to ascertain the legal liability of third parties” to pay for medical services received by Medicaid recipients, and, when legal liability is found, seek reimbursement for the medical assistance provided by the state to the extent of such liability. Consistent with this requirement, Kan. Stat. Ann. § 39-719a provides:

(a) Where medical assistance has been paid by the secretary [of SRS] and a third party has a legal obligation to pay such medical expenses to or on behalf of the recipient, the secretary may recover the same from the recipient or from the third party and shall be in all respects subrogated to the rights of the recipient in such cases.... Payment of medical assistance by the secretary shall be secondary to any other insurance coverage or third party with a legal obligation to pay such medical expenses to or on behalf of the recipient.

(b) Pursuant to this section unless otherwise agreed, the court shall fix attorney fees, which shall be paid proportionately by the secretary and the injured person, such person's dependents or personal representatives, in the amounts determined by the court. Attorney fees to be paid by the secretary shall be fixed by the court in an amount not to exceed 1/3 of the medical assistance recovered pursuant to subsection (a) for cases settled prior to trial, or in an amount not to exceed 2/5 of the medical assistance recovered pursuant to subsection (a) in cases when a trial is convened.

(c) In the event of a recovery pursuant to K.S.A. 60-258a, and amendments thereto, the secretary's right of subrogation shall be reduced by the percentage of negligence attributable to the injured person.’”

Copeland By and Through Copeland v. Toyota Motor Sales U.S.A., Inc., 136 F.3d 1249, 1253 (10th Cir. 1998) (emphasis added).

The right of “subrogation” means that the State Medicaid Agency stands in the shoes of the resident to the full extent of his or her medical expenses paid under Medicaid for which a third-party, such as the facility, is legally responsible or liable.  Even if the resident or the resident’s legal representative do not initiate a claim or civil action for damages against the facility, the State Medicaid Agency may do so for the purpose of obtaining reimbursement of the medical expense payments it made under Medicaid on behalf of the injured resident. If you receive a Notice of Medical Subrogation Claim, you should contact your liability insurance carrier immediately.  The facility should furnish the insurer all records relating to the resident and the incident, including any accident report, incident report and/or report of investigation for injuries of unknown origin.  The facility should also provide KHPA contact information for its liability carrier (or inform the agency that it has no insurance coverage) and otherwise comply with the agency’s request for information.  The facility should consult with its insurance carrier (if any) and legal counsel in framing any response to a KHPA request for information.

This new initiative by KHPA to reduce Medicaid expenditures by seeking reimbursement for medical expenses from third-parties, such a nursing facilities, that may be legally responsible for personal injuries and resulting medical treatment expenses based on some common law theory such as negligence and may be statutorily required to reimburse the State for such expenses under K.S.A. 39-719a.

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  Green Bean Recall Notice

This is to make you aware of an announcement posted on Friday, December 21, 2007 on the FDA-CFSAN web page in regards to a voluntary recall by the New Era Canning Company of canned green bean product because of possible health risk.
The product may be contaminated with Clostridium botulinum.  No illnesses have been reported as of December 21, 2007 in connection with this problem.

The firm's press release may be viewed CFSAN web page at:
http://www.fda.gov/oc/po/firmrecalls/newera12_07.html   FDA posts press
releases and other notices of recalls and market withdrawals from the firms involved as a service to consumers, the media, and other interested parties. FDA does not endorse either the product or the company.

It is highly recommended that you frequently monitor the CFSAN web page at http://www.fda.gov/opacom/7alerts.html for updates in information or status of the recall.  Alternatively, you can sign up for recall email updates at this same page.
This is a free subscription service and you will receive an email message each time there is an update on the FDA page(s) you select.

Please notify those restaurants, retail food stores such as chain grocery stores and small independent stores and institutional food service operations for which you work with such as hospitals, nursing homes, schools, and trade organizations for the food service managers and administrators, and others that may be affected by this recall.

Customers with questions may contact New Era Canning at 1-800-282-9007, Ext.111

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  Webinar- Process Frameworks and Treatment of Pain

The Advancing Excellence Campaign is pleased to announce a series of webinars/teleconferences for nursing homes that are registered for the campaign!

The first webinar/teleconference will focus on the Process Frameworks, an evidence-based tool to work through a variety of technical assistance topics.  Dr. Steve Levenson will review the process framework for treatment of pain in chronic and acute care in nursing homes.

 When:
Tuesday, January 8th, 2008
1:00 p.m. CT to 2:30 p.m. CT

Who:
Administrators, Directors of Nursing, Assistant Directors of Nursing,
Staff Development, Quality Improvement Staff, Front Line Staff.

Topic:
Process Frameworks and Treatment of Pain

Where: 
Bring a cup of coffee or soda to your nursing home’s conference room!  You can use a telephone line and follow along with handouts, or if you have a computer, you can follow along that way too!

Call-in Number: 1-866-266-3378
Conference ID: 202-508-9407
Pass code: 23569

If you wish to view the Power Point Presentation online, go to http://IDTConnect.com, click on join conference and sign-in with the Conference ID (202-508-9407) and your name.

To obtain a copy of the presentation and to ensure that we have enough open lines foreveryone, please contact your KS LANE at kmilner@ksqio.sdps.org and let them know that you will be attending!

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  Senior Oral Health

Recent surveys show that ninety percent of adults have, on average, 23.5 teeth. Almost a third of adults have all 28 teeth, and fifty percent age 55 and older wear partial or complete dentures. But whether caring for original teeth or dentures, seniors face a range of special oral concerns, including root decay and periodontal disease. You can keep your smile healthy by following a routine of proper oral care and making regular visits to your registered dental hygienist and dentist.

If you have arthritis or limited use of your hands, try adapting the toothbrush for easy use. Insert the handle into a rubber ball or sponge hair curler; or glue the toothbrush handle into a bicycle grip. Toothbrush handles can be lengthened with a piece of wood or plastic such as a ruler, ice cream bar stick or tongue depressor.
For people who have dexterity problems and cannot use a manual toothbrush, an electric toothbrush may be easier to use. Numerous studies confirm that electric brushes are excellent plaque removing devices and are extremely effective in stimulating gums. Dental floss holders are also available.

Among other benefits, daily brushing and flossing protect older smiles from two common problems of getting older: Root decay--a condition that affects older adults if a great amount of root surfaces are exposed--and tooth decay caused by the weakening or chipping of older fillings.

Denture care and cleaning

Dentures—full or partial—should be brushed daily with a soft toothbrush or denture cleaning brush, using a commercially prepared denture powder or paste, hand soap, or baking soda. Toxic or abrasive household cleaners should never be used. Dentures should be brushed inside and outside, and rinsed with cool water.
Remaining natural teeth and gums, especially those teeth supporting a partial denture, should also be brushed. 

When not in use, dentures should be covered with water or a denture cleaning solution to prevent drying.

Information provided by the American Dental Hygiene Association

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  Career Center

KHCA/KCAL is currently working on adding a Career Center to the KHCA/KCAL website.  This will allow members to post open positions as well as search for job openings online.  Look for this in the next couple of months.  Contact Nancy at KHCA with any questions.

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  Fire Marshal Updates

50% Inspections

Starting January 1, 2008 KSFMO Inspectors will no longer be conducting 50% inspections on a project remodel or addition. 

Facility owners remember you will need to stay in touch with your Licensed Architect/Engineer to make sure the general contractor is following what has been approved on the Code Foot Print.

KSFMO will conduct final inspections with a 30 day advance notice required. If you have any questions please contact Brenda McNorton,
Chief Fire Prevention at 785-296-3401.

Smoke Barrier Walls

A question has been asked concerning smoke barrier walls and if a smoke barrier wall must have sheet rock on both sides to obtain the proper rating?

According to the Fire Marshals Office if you have a smoke barrier wall that has sheet rock on one side only and studs are exposed (unprotected) on the other side, you have a smoke barrier wall that has a 0 hourly rating, the sheet rock must be on both sides to form a 1 hour rating if the wall was originally constructed to meet the one hour rating.

The UL directories do not recognize or have a listing for a 30-minute rated wall and the architects will look at this the same way because a studded wall that has one side exposed does not provide any type of fire rating.
KSFMO can no longer accept sheet rock to be provided on one side only with penetrations sealed with the proper fire caulking.  Smoke barrier walls must be sheet rocked on both side and penetrations sealed with the proper fire rated caulking to obtain the proper rating.

Plan of Correction:
If your facility has this situation and an inspector cites this violation, your facility can apply for a waiver to allow time to complete the work.  Remember when you apply for the waiver give your self enough time to be able to accomplish this task. If you have any questions please contact Brenda McNorton,
Chief Fire Prevention at 785-296-3401.

New Fire Marshal Public Education Officer

Kenya Patzer recently accepted the new Program Consultant II position in the Fire Prevention Division within the Kansas State Fire Marshal's Office.  Kenya has filled a variety of roles in the State Fire Marshal's Office, most recently in the position of Fire Prevention Inspector/Enforcement Officer.  She completed undergraduate and graduate work at both the University of Denver and Rice University and has been a certified firefighter/EMT with Soldier Township Fire Department for more than four years.  Kenya’s duties will include working with KHCA to produce educational programs for providers as well as one on one with providers needing help with non-technical problems.  She can be reached at 785-296-4321 or by email at: patzerik@ksfm.state.ks.us.

Click here to view a map of Fire Prevention Division Health Care Inspectors and their territories. 

CMS Updates

Generator Fuel in Type I/Level I systems for Life Support
 
There have been a few questions lately about the fuel source for generators in facilities that provide life support. If a facility cares for anyone on life support, the facility must have a type I generator and the fuel must be kept onsite.  Piped in natural gas is not a dependable source of fuel.  The lines break and if there is a leak or other issue that requires repair, then the fuel source will be shut down – sometimes affecting entire neighborhoods and small towns.  The only time it is acceptable to use natural gas for a type I system is if the utility company will put in writing that the fuel source will not be affected by natural disasters. That is very different than saying the fuel supply is continuous.  Any facility providing life support in an earthquake zone should not have piped in natural gas.  If in doubt check the following website:
http://earthquake.usgs.gov/regional/states.php
 
This is not a new requirement and can be cited at K145, with the following regulatory references:
 
NFPA Standard:  The following energy sources shall be permitted for use for the emergency power supply (EPS): liquid petroleum products at atmospheric pressure or liquefied petroleum gas (liquid or vapor withdrawal) or natural or synthetic gas. Exception:  For Level 1 installations in locations where the probability of interruption of off-site fuel supplies is high (e.g., due to earthquake, flood damage, or a demonstrated utility unreliability), on-site storage of an alternate energy source sufficient to allow full output of the emergency power supply system (EPSS) to be delivered for the class specified shall be required, with provision for automatic transfer from the primary energy source to the alternate energy source. Or the utility company can provide, in writing, a guarantee that their service would never be interrupted. 1999 NFPA 110, 3-1
 
NFPA Standard: The fuel supply for the generator set shall comply with 3-1.1 and 3-4.2 of NFPA 110, Standard for Emergency and Standby Power Systems. 1999 NFPA 99 3-4.1.1.13.  Contact Kathy Achor (816) 426-6480 with any questions.
 
 
CMS Updates

Click here to view CMS Updates on Common FSES Issues as well as CMS Region 7 data.

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  AHCA Updates

CMS Special Focus Facility List Now Publicly Available

As reported in last week's Capitol Connection and today's Associated Press story, CMS has posted its Special Focus Facilities (SFF) list which includes 54 facilities in 33 states and the District of Columbia. The abbreviated list, is a subset of facilities from more than 120 SFF nationwide that have "not shown significant progress." 

Working closely with CMS, AHCA succeeded late yesterday in having 4 facilities removed from the SFF list before it became public on the CMS website. AHCA coordinated with each of the 4 facilities to obtain sufficient documentation reflecting the facility's progress and most recent survey with nothing higher than an "E" level deficiency. AHCA submitted this information and worked with our key contacts at CMS, who reviewed our submissions and agreed with our assessments, thereby removing these 4 facilities from the abbreviated SFF list.

While encouraged by CMS' willingness to respond so quickly to our requests regarding these 4 facilities, AHCA continues to press CMS for greater transparency around this initiative by disclosing the formula used to identify potential Special Focus Facilities, as well as the exact criteria necessary for a facility to be removed from both the posted list and the Special Focus Facility program. We remain concerned about notification and lag time issues that impact the accuracy and timeliness of the SFF list.    

Initially, CMS had planned to link the Special Focus Facility list from its Nursing Home Compare web site; presently, the list appears on the Certification & Compliance section of www.cms.hhs.gov. Please click to contact Lyn Bentley with any questions.

Immigration Update

As reported earlier, the U.S. Citizenship and Immigration Services Department published a new Employment Eligibility Verification Form I-9 on November 26.  This new form will be mandatory for all new employees starting on December 26 and reduces the number of documents that employers may accept from newly hired employees to prove work eligibility and identity.

In other immigration news, Department of Homeland Security (DHS) abandoned its attempt to enforce its proposed "no match" rule that would improperly use social security records for immigration enforcement. In a late Friday afternoon court filing the day after Thanksgiving in federal court in San Francisco, DHS requested that a lawsuit challenging the rule be put on hold until March 2008. Last month, U.S. District Judge Charles R. Breyer issued a preliminary order stopping the government from enforcing the proposed rule - which would affect more than eight million workers - finding that it would cause irreparable harm to both innocent workers and employers. The government plans to publish a revised rule in December 2007 that it claims will pass legal muster.  For more information, contact Ken Preede at AHCA.

Satisfaction Assessment and the Short Stay Customer

Greater numbers of nursing facilities are actively seeking short stay customers.  As part of AHCA’s Satisfaction Assessment Initiative, the survey experts at MyInnerView (MIV) Inc. offered key points regarding assessing these customers’ satisfaction at the time of discharge. 
Neil Gulsvig, president of MIV, suggests that facilities collect continuous feedback in important short stay satisfaction areas such as overall satisfaction, recommendation to others, quality of service and quality of rehabilitation services, as it is critical to perform at their best. Differentiating between the experiences of traditional longer stay residents and the short stay customer can be very revealing and a great boost to accurately adjust a continuous quality improvement program for each category of customer.
We urge facility members to assess the “voices of all customers and staff.” For more information on satisfaction surveys and implementation matters, click here or send an email to info@myinnerview.com.

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  For Sale by Owner

For Sale by Owner

Easily accessible site for nursing home or retirement community.
4300 square foot brick home
Built by Roe Messner
On 7 acres, 1-acre stocked pond with sidewalk, tennis court, heated pool, gazebo, approximately 50 trees and adjacent to Terradyne golf course
1405 West Central, Andover, KS 67002
Price on request; contact owner at (316) 733-7182 or (580) 327-2117

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  New Opportunities with 2008 Association Committees

Members will be receiving their 2008 membership packets and in the packet will be a sign up sheet for association committees. 

We really do want to increse the participation in all of our committees.  Please consider this opportunity.  The association is only as strong as the members who participate.  We will post a description of the committees on the our website for members to review.

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