Policy on Two Tiered Informal Dispute Resolution Process For LSC

Policy on Two Tiered Informal Dispute Resolution Process:

The Informal Dispute Resolution (IDR) process has been established as a two-tiered system to resolve conflicts arising from the inspection process, and is compliant with federal law pursuant to oversight by the Centers for Medicaid and Medicare Services.

After the State Fire Marshal (SFM) inspects a facility, the facility can make a request for an informal dispute resolution (IDR) to the State Fire Marshal.  This request must be made within ten (10) calendar days after they receive the statement of deficiencies.  A facility may only request one IDR per inspection.

First Tier process: 

When the facility requests an IDR, the request must be in writing and must include the specific deficiencies being disputed.  The facility must also include a detailed explanation and any supporting documentation, including information not available at the time of the inspection.

The IDR can either be done in writing or in a meeting setting.  If the facility prefers to meet face-to-face, this request should be listed in the original IDR request.  The meeting will be held in the Topeka Office.  It will take place within 30 days of SFM’s receipt of the written IDR request.  After the meeting, the facility will be notified in writing of the results.  This notification will take place on or before ten days of the final disposition.

After the facility receives the results of the first-tier disposition, they may challenge the decision of the first-tier IDR and request second-tier consideration.  This request must also be in writing.

Second Tier process:

The second-tier IDR will be conducted by a three (3) person panel appointed by the State Fire Marshal.  The panel will consist of one employee of the State Fire Marshal’s Office and two members outside the SFM office.

The second-tier will take place within 30 days of the request, and the facility will be notified of the results within ten days of the disposition being rendered. 

Since these facilities are governed by Centers for Medicaid/Medicare Service any decision made by the State Fire Marshal may be over ruled since CMS is the Authority Having Jurisdiction.

The State Fire Marshal will be authorized to charge any facility requesting the Second-Tier process a fee not to exceed $250.00. 

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  Civil Money Penalties in 2007

2007 CMP for Nursing Facilities and Assisted Living

Greg Reser Director of Licensure and Certification Division at the Kansas Department on Aging has released the following summary of CMP for nursing facilities and assisted living for 2007. In December, LCE received figures from CMS for federal fiscal year 2007 for the amount of Medicare or dually certified civil money penalties imposed.  When Medicaid facilities are included the total amount of federal civil money penalties imposed for nursing facilities was $248,150.  Because collection of the imposed amounts are dependent upon ongoing appeals, potentially reduced amounts, collections from more than one agency (CMS/KDOA/SRS), etc., the collected amount is less discernable at this time.

To give you a relevant comparison, the imposed amount for assisted living is created for the same time period (federal fiscal year) and equals $61,900. 

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  Average Nursing Home Rate Increase

The Kansas Department on Aging estimates that the average Nursing Home rate increase for the 7/1/08 Medicaid rates will be between 6-7%.  This increase will include the rebasing to the 3 most current cost years.  Contact Nancy at npierce@khca.org with any questions.

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  Proper Brushing
submitted by Letty Seidl

Click here for illustrated copy on proper brushing of teeth.

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  2008 Legislative Update

SB 585 is still in Ways and Means Committee, Senator Umbarger has decided at this time not to bring the Quality Assessment Fee Legislation back to the committee for a vote.  At this time, we are evaluating our options.  The state will still have a significant shortfall in their budget, so we want to make sure that the legislators are aware of the amount of dollars SB 585 would bring back to the state.

SB 544-reduced ignition propensity cigarettes, also referred to as fire safe cigarettes, remains in Senate Federal and State Affairs committee

SB 562- providing a procedure for mobile polling places in nursing homes and certain related facilities has passed the Senate and now will be heard in House Elections and Governmental Organization.  We will testify in favor of this in the House as we did in the Senate.

SB 566- asking the Secretary of Social and Rehabilitation Services to conduct a study as it relates to attendant care workers who provide home and community based services.  This would examine such items but not limited to identifying:
--an appropriate procedure or mechanism for pay rate increases
--an appropriate procedure or mechanism for travel and mileage reimbursement or allowance
--an appropriate procedure or mechanism for reimbursement for the employer's share of premium paid for attendant care workers participating in the state employee health care benefits program.

SB 657-this bill tightens up the fiduciary mistreatment and abuse of seniors.

HB 2671-transferring certain powers relating to nurse aides, medication aides and home health aides from the Kansas Department of Health and Environment to the Kansas Board of Nursing.  KHCA/KCAL testified against this legislation.  We believe KDHE has spent alot of time and effort into improving the system and now is not the time to give our administrators and homes one more hoop they have to go through to get a background check.

HB 2672 Long term care unit survey process will be moved to the Kansas Department on Aging.

HB 2752-Enacting a Geriatric Mental Health Act

HB 2846- Medical facilities relating to patient safety.  We have been assured by the Chairwoman of the committee she has no intentions of having a hearing on this bill.  We do NOT support this legislation.

Any questions do not hesitate to contact Cindy, cluxem@khca.org.

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  The NPI is Here

The NPI is here.  The NPI is now.  Are you using it? 
  
Effective March 1, 2008, all 837P and CMS-1500 claims must have an NPI or
NPI/legacy pair in the required primary provider fields.  Failure to include an
NPI will cause the claim to reject! 
 
One of the Administrative Simplification provisions of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA, Title II) required the
Department of Health and Human Services (HHS) to establish unique national
identifiers for providers. The purpose of these provisions is to improve the
efficiency and effectiveness of the electronic transmission of health
information.  On March 1, 2008, Medicare claims submitted by physicians and
other practitioners, laboratories, ambulance company suppliers, DMEPOS suppliers
and others that bill Medicare are required to include the new National Provider
Identifier (NPI).  Providers must use this information when they submit their claims to
Medicare carriers, A/B Medicare Administrative Carriers (MACs), and DME MACs when they
use certain electronic and paper Medicare claims (specifically the X12N 837P
electronic claim and the CMS-1500 paper claims).  Hospitals, skilled nursing facilities,
home health care agencies and other such institutional providers were required to begin
using their NPI beginning on January 1, 2008. 
 
The deadlines for submitting Medicare claims using the NPI are necessary to help
the Centers for Medicare & Medicaid Services (CMS), the Medicare contractors and
health care providers prepare for the final May 23, 2008 deadline for full NPI
compliance.  While the final NPI Rule required compliance on May 23, 2007, CMS
stated in the NPI National Contingency Guidance that it will not take
enforcement action against covered entities that deploy contingency plans
through May 23, 2008, provided that conditions in the Guidance were met.
 
CMS is anticipating that some providers will experience some problems with
claims submitted after March 1 – problems could arise in the following
situations:
  The provider does not have an NPI
  The provider does not submit their NPI on their claim
  The provider has already received an NPI, but the NPI is not consistent with
  the provider’s enrollment information received by the contractor. 
 
Providers whose claims are rejected and returned to them should immediately
contact their contractor before resubmitting that claim or submitting new claims
for services provided to Medicare beneficiaries.  Contact information for the
Medicare contractors can be found at www.cms.hhs.gov/MLNGenInfo/ under
“Downloads.”  The file is named, “Provider Call Center Toll-Free Numbers
Directory.” 
 
What to do if your 837P and CMS-1500 Claims are Rejected 
  
* Check  your record in the National Plan and Provider Enumeration System
  (NPPES)
* Validate that the legacy identifier sent on the claim is reported in the
provider/supplier’s NPI Registry record. If the legacy identifier is not there,
instruct the provider/supplier to add it.
* Validate that the Legal Business Name (if the provider/supplier is an
organization) or the Legal Name (if the provider/supplier is an individual or a
sole proprietorship) is correct.
* Validate that the correct Entity type was selected by the
provider/supplier when applying for the NPI.  Individuals obtain an NPI as
Entity Type 1.  Organizations obtain an NPI as Entity Type 2 NPI. 
(Note: If you enumerated through the EFI alternative, you should use the NPI
Registry to check the content of the NPPES file.  Make sure to have the Customer
Service Representative at your Medicare contractor verify your TIN/EIN as the
NPI Registry does not list this information.) 

 If these claims are still rejecting, call your Medicare Contractor.
* Have a copy of the NPPES record in hand. A copy of the NPPES record can
be obtained online at https://nppes.cms.hhs.gov . The Employer Identification
Number or Social Security Number will not be shown on this print out.
* Have the claim reject number and message
* Be prepared to give the following information:
1.     Legal Business Name of the Organization
2.     Contractor Tracking Number (if known)
3.     Approximate date (month/year) when the 855 enrollment application was
submitted
4.     Provider/Supplier Tax Identification Number or Social Security Number
(SSN)
5.     National Provider Identifier (NPI)
6.     Medicare legacy Identifier
7.     Practice location on claim (i.e. where is the practice located (e.g. 100
Main St. New Orleans, LA)
8.     Contact Information where Provider/Supplier can be reached if further
discussion is needed 
 

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  Nominate Your Nurse for 2008 Nurse of the Year

NOMINATE YOUR NURSES FOR THEIR CONTRIBUTIONS!!

Honor a nurse who has enhanced the quality of care and life of the elderly!!

Long Term Care Nurse of the Year Award

Director of Nursing/Assistant Director of Nursing of the Year Award

Assisted Living Nurse of the Year Award

These awards will be announced during a luncheon on Wednesday, April 23, 2008, during the 16th Annual KHCA/KCAL LTC Nurses Conference in Wichita.

Nominations must be received at the KHCA Office by 5:00 p.m. on April 11, 2008.

Click here for Nomination Forms.

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  Online Job Posting on the KHCA Website

The KHCA website has added another member benefit with the Career Center located on the home page at www.khca.org.  The Career Center allows member homes to post and view job openings from member providers.  Contact Nancy at npierce@khca.org with any questions.

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  National Center for Assisted Living Award Time!

Nomination forms for NCAL’s 2008 awards are now available.  Last year’s award winners set a high standard, and we are very much looking forward to continuing the tradition. Nominations for the Noble Caregiver in Assisted Living Award, NCAL Administrator of the Year, National Assisted Living Week Programming Award must be submitted through the state affiliates - not individual facilities. The deadline for nominations is Friday, June 6, 2008.

The materials for the following awards are now available:
* NCAL’s Noble Caregiver in Assisted Living Award
* NCAL’s Administrator of the Year Award
* National Assisted Living Week Best Programming Award

  Click here for more information     http://www.ahca.org/members/assisted/ncal_awards/index.cfm. 

Please forward your nominations to Cindy at the KHCA/KCAL office to be submitted. 
Questions?  cluxem@khca.org

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  KCAL 2008 Assisted Living Nurse of the Year

The KCAL Board of Directors is pleased to accept the nomination for the AL Nurse of the Year Award.  Nominations must be returned to the KHCA/KCAL office by April 11, 2008.  The winner and honorable mentions will be recognized at the KHCA/KCAL Nurses Conference Awards Luncheon on Wednesday, April 23, 2008.

Nomination Form

Questions contact Linda at lmowbray@khca.org

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  State By State Proposed Medicare Cut Impact

Click here to view the estimated impact of proposed FY 2009 skilled nursing facility Medicare cuts.  Contact Susan Feeney at  AHCA with any questions.

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  AHCA update

AHCA will be sending KHCA/KCAL a monthly update on issues pending in Washington DC.  Click here for the current update.  If you have any question please let Cindy know.  cluxem@khca.org

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  CMS Response on Secured Egress

Recently there has been discussion regarding magnetic locking devices and whether doors in a nursing home can routinely be locked. CMS has reviewed the Life Safety Code requirements and discussed the issue with our Central Office.
 
At issue is NFPA 101 Life Safety Code, 2000 Edition, Sections 19.2.2.2.4 and 18.2.2.2.4, which states:  “Doors within a required means of egress shall not be equipped with a latch or lock that requires the use of a tool or key from the egress side.”  There is an exception (Exception No. 1) that indicates that “Door-locking arrangements without delayed egress shall be permitted in health care occupancies, or portions of health care occupancies, where the clinical needs of the patients require specialized security measures for their safety, provided that staff can readily unlock such doors at all times.”
 
The nursing home environment is considered to be a home and residents have the right to come and go freely. CMS does not believe all nursing home residents have clinical needs regarding their safety, particularly that would justify restrictions on their egress from various locations of the facility. CMS requires a comprehensive and individualized assessment of each resident’s needs to determine what care and services are necessary to meet his/her highest practicable well-being. It would be a rare occasion to have an entire patient population with clinical needs requiring locked means of egress, since one approach is usually not the right course of action for all residents.
 
The NFPA 101 Life Safety Code, 2000 Edition, Sections 19.2.2.2.4 and 18.2.2.2.4 did not change the determination of clinical need under exception 1. Rather, the language was updated in an effort to broaden the use of the code, not to become more restrictive. It is CMS’s expectation, that during a Life Safety Code survey, K38 will be cited if egress doors on a floor are locked and there is evidence that all cognitively aware residents, staff and visitors do not have access to the method of opening the doors. If staff is not aware of how to open the doors or are unable do so, it is very likely an immediate jeopardy situation. In cases where a health and Life Safety Code survey are done at the same time, we would expect health surveyors to investigate and cite this issue, under resident rights or another appropriate regulation, unless there is evidence that it is not a deficient practice. 
 
 

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  LT Care Solutions

Setting the Record Straight: Parade Magazine Article on LTC Insurance

As a long-term care insurance agent, when I read an article in a popular publication that contains inaccurate information about long-term care insurance, I feel an obligation to set the record straight. In the February 16, 2008 issue of Parade magazine, a magazine with a circulation of 32 million, there was just such an article, entitled "Do You Need Insurance for Long-Term Care?" While there was much good information, below I clarify some of the areas where the article was mistaken, incomplete, or difficult to interpret.

PREMIUM COST The article says that, for people between ages 60 and 70, the premiums can range from $1,500 - $8,000 a year. When such a wide range is referenced, it's important to understand that premium is a function of both policy design and age of the applicant. A policy that provides $250 in daily benefit will cost much more than one that provides $100 a day. A policy that provides for 5 years (or even an unlimited) benefit period will cost much more than one with a 2 year benefit period. It's helpful to note that the average annual premium is between $1300 and $2,000. A good long-term care insurance agent can easily help you determine what a variety of plans will cost, taking into account your age and your local cost of care.

PREMIUM INCREASES Premium rate increases on policies bought now are not an inevitable conclusion, as the article insinuates. The insurance industry was granted rate increases by Divisions of Insurance on many policies over the last few years. These increases were justified by several factors, including inaccurate pricing assumptions regarding how long people would keep their policies, and actual claims experience outpacing actuarial projections. Modern LTC insurance policies have only been around for 20 years; today, insurers have a much better handle on claims cost and duration than they had even 5 or 10 years ago.

As a result, today's policies are priced reflecting actuarial risk, and many regulators have adopted guidelines that make it much tougher for rate increases in the future. That said, flat premiums are not guaranteed. There are three lessons for consumers: only buy from reputable insurance companies, think hard before you buy a policy that is much cheaper than other comparable policies, and make sure your premium has a clear funding source. Then, even if rates do increase, you'll likely be able to afford the policy.

HOW TO COLLECT The article said that benefits are paid by meeting a definition of incapacity, which is determined by the inability to perform "activities of daily living". Not mentioned is the fact that a second trigger, tied to cognitive impairment, has been included in virtually all policies for decades. Someone needing care because of Alzheimer's disease, for example, would usually be eligible for benefits under the cognitive impairment trigger.

A long-term care insurance agent is your best source of information on policy design, policy selection, policy cost and whether you are likely to qualify from a health point-of-view. When you have questions regarding an existing policy or you may be looking into getting new coverage in place, please consider me a resource.

About LT Care Solutions
LT Care Solutions, Inc. specializes in LTC planning for both group programs for companies and for individuals since 1992. We believe that dabbling is dangerous and LTC is an important decision best made in consultation with an experienced LTCi advisor.

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

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  Webinar: Reducing Pressure Ulcers in Nursing Homes

The audio and handouts from the February 21st Webinar, Reducing Pressure Ulcers in Nursing Homes: An Interdisciplinary Process Framework, are now available on the Advancing Excellence Campaign website.
 
Click on the link below, and this will bring you to the Campaign's Resources page, and the Webinar is located at the bottom of the page.
 
http://www.nhqualitycampaign.org/star_index.aspx?controls=nhTechAssist
 
Coming Soon - The audio and handouts will also be available on these sites, as well:
 
Kansas Culture Change Coalition: http://www.kansasculturechangecoalition.org/resources.html
 
Kansas Foundation for Medical Care:
http://www.kfmc.org/providers/nh/nhqi/index.html
 

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  Resident Satisfaction Committee Links

The Resident Satisfaction Committee has been working on compiling links of helpful documents for providers use.  Send any comments or suggestions to npierce@khca.org.

Advancing Excellence is a new coalition based, two-year campaign that launched in September 2006. The campaign is reinvigorating efforts to improve the quality of care and quality of life for those living or recuperating in America's nursing homes.
http://www.nhqualitycampaign.org/.

My InnerView’s  Quality ProfileTM tool assists leaders in monitoring pressure ulcers and physical restraints within their nursing homes as well as sets organizational targets for clinical quality improvement. Our Satisfaction Surveys allow facilities to measure resident, family and staff satisfaction.
http://www.myinnerview.com/

Kansas Culture Change Coalition is a group that provides support to long-term care organizations striving to develop systems that value the dignity of each individual who lives and works within their setting.  It is an organization of diverse interest groups that combine their talents to effect change that is hard to do as individuals.  The Kansas Culture Change Coalition maintains the vision of the Pioneer Network that supports a culture of aging that is life affirming, satisfying, humane, and meaningful.  Culture Change can transform a "facility" into a "home, a "patient/resident" into a "person", and a "schedule" into a "choice".
http://www.kansasculturechangecoalition.org/.

KFMC’s work with KS nursing homes assists nursing home staff with improving care processes on the clinical quality measures. Nursing homes who have committed to working with KFMC over the past five years have made significant progress in reducing quality measure rates.
http://www.kfmc.org/.

QIS Updates- click on tab 9 to access the Critical Element Pathways at
http://www.aging.state.ks.us/Manuals/QIS/TabIndex.html.  Click here for the Resident Interview and Resident Observation forms. http://www.aging.state.ks.us/Manuals/QIS/Tab05/CMS-20050_Resident_Interview_and_Observation.pdf. 

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