July 1, 2008, New DMEPOS Competitive Bidding Program requirements

 Ombudsman Program

 The Ombudsmen for the DMEPOS Competitive Bidding Program are now available to assist providers, suppliers, and beneficiaries by providing information and education and by facilitating the resolution of complaints and concerns. The ombudsmen's role is to investigate and address complaints by providers, suppliers, and beneficiaries specifically related to the Competitive Bidding Program.  There are eight ombudsmen who are located within the initial Competitive Bidding Areas (CBAs).

You may contact an ombudsman:

* For general information about the DMEPOS Competitive Bidding Program;
* To obtain assistance in locating a contract supplier;
* For educational programs and activities;
* To report concerns about the program, a supplier, or a referral agent;
* The quality of services or items, and/or suspected fraud or abuse; and
* For assistance with questions, issues, and complaints specifically pertaining to the competitive bidding program and policies.

 You may find a list of the ombudsmen with contact information on the DMEPOS
Competitive Bidding Implementation Contractor (CBIC) website at www.dmecompetitivebid.com

 DMEPOS Competitive Bidding Program Competitive Bidding Areas (CBAs) Are Defined by Zip Codes

Two CBA zip code files have been posted on the Competitive Bidding Implementation Contractor (CBIC) website: one file containing mail order zip codes per CBA and one file containing non-mail order zip codes per CBA.  These files will be updated on a quarterly basis, as needed, to reflect changes in zip codes included in the various CBAs.  Although the boundaries of a CBA will not change during a competitive bidding contract period, zip codes in general do change from time to time (e.g., when one zip code/area is subdivided into two or more new zip codes/areas, etc.).  

Zip codes contained in each CBA can be accessed through the CMS DMEPOS Competitive Bidding website at located at www.cms.hhs.gov/DMEPOSCompetitivebid/
Just click on the “Metropolitan Statistical Areas, Competitive Bidding Areas, and Zip Codes” tab and scroll down to “Related Links Outside CMS”.
 
Important Requirements of the “Grandfathered” Supplier Provision 

Non contract suppliers located in the 10 DMEPOS Competitive Bidding Areas (CBAs) should have taken the appropriate steps to notify beneficiaries whose permanent residence is in a CBA of their decision to become, or not to become grandfathered suppliers for each competitively bid item. These decisions should be conveyed through a written notification to the beneficiary before July 1, the start date of the new program.  IMPORTANT NOTE:  THIS NOTIFICATION SHOULD ONLY BE SENT TO BENEFICIARIES WHO MAINTAIN A PERMANENT RESIDENCE IN A CBA.  Suppliers can determine if a beneficiary resides in a CBA by comparing the beneficiary’s zip code to the zip code files on the Competitive Bidding Implementation Contractor’s web site.

Suppliers that choose to become “grandfathered” should maintain a record as to whether the beneficiary chose to continue to receive the item from the grandfathered supplier, chose to go to a contract supplier, or did not respond.

For suppliers that choose not to become grandfathered, the beneficiary will have to switch to a contract supplier.

CMS expects suppliers to work together to ensure there is no break in service or in the furnishing of medically necessary items (e.g. oxygen, enteral nutrition, CPAP). In order for this transition to occur, a coordinated effort including delivery and pick-up of supplies must take place.

For more detailed information on this  topic, please refer to the MLN Matters article MM5978 and the Medicare Learning Network’s Tip Sheet for “Grandfathered” Suppliers on the CMS DMEPOS Competitive Bidding website located at www.cms.hhs.gov/DMEPOSCompetitivebid/
Go to the “Provider Educational Products and Resources” tab and scroll to the “Downloads” section.
New/Revised Provider Educational Products

 DMEPOS Suppliers:  CMS issued CR 6112, "Payment for Complex Rehabilitative Power Mobility Device Services that Span the Implementation Date of DMEPOS Competitive Bidding Programs in Competitive Bidding Areas". The companion MLN Matters article is now available on the CMS DMEPOS Competitive Bidding dedicated website.

All Medicare Fee-For-Service (FFS) Providers: Due to the release of CR6119 - Phase 2 of Manual Revisions to Reflect Payment Changes for DMEPOS Items as a Result of the DMEPOS Competitive Bidding Program and the Deficit Reduction Act of 2005 – many of the DMEPOS related Medicare Learning Network (MLN) products have been updated to reflect the changes in this new instruction. The revised products are now available on the CMS dedicated website.

For all products, go to www.cms.hhs.gov/DMEPOSCompetitiveBid, click on the Provider Educational Products and Resources tab on the left, and scroll down to the "Downloads" section.  

DMEPOS Suppliers that are Physical and Occupational Therapists 

 As stated in MLN Matters article SE0807, physical therapists and occupational therapists in private practice who are enrolled DMEPOS suppliers may eventually have the option to furnish certain types of competitively bid items to their own patients and be paid the single payment amount for such items without being contract suppliers, provided the following requirements are met:

*         The items are limited to off-the-shelf (OTS) orthotics; and
*         The items must be furnished only to their own patients as part of the physical or occupational therapy service.

However, this exception is not relevant in the first phase of the DMEPOS Competitive Bidding program beginning July 1, 2008. OTS orthotics are not included in the first phase of the Competitive Bidding program.
 

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  CMS Surveyor Guidance Updates

Click here to CMS revised surveyor guidance  and revisions to Appendix PP for F tag 325 and F tag 371.

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  Medicare Bill Passes House; Moves on To Senate

AHCA reports on Tuesday, the House of Representatives overwhelmingly passed a Medicare bill, The Medicare Improvements for Patients & Providers Act (H.R. 6331), by a vote of 355 to 59, and will now move to the Senate with a threat of a Presidential veto just prior to the scheduled July 4 recess. The bill prevents a 10 percent reduction in payments to physicians and extends the current Medicare Part B therapy exceptions process for 18 months. The legislation does not cut payments to SNFs, would permit Medicare telehealth services in SNFs under Part B, and delays the competitive bidding program for durable medical equipment for two years. Both the cut in physician payments and the imposition of a monetary cap on outpatient therapy services will become effective if the President does not sign a bill into law prior to July 1, 2008. Senate Majority leader Harry Reid (D-NV) has pledged to keep the Senate in session until a final vote on the package is held. AHCA will provide updates on any new developments from Capitol Hill. For more information, please contact AHCA.

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  ALERT: $1,810 Therapy Caps Begin on July 1

Efforts to Delay Exceptions Process Failed

Only four days remain before the Medicare Part B Therapy Caps exceptions process expires on July 1, 2008.  As we have been reporting, this means that an annual cap of $1,810 for occupational therapies, and a separate $1,810 cap for both physical and speech/language therapies will go back into effect.  According to the Centers for Medicare and Medicaid Services (CMS) any such services that were provided between January 1, 2008 and June 30 will count towards the $1,810 cap. 

What Does This Mean for Providers?

On July 1, skilled nursing facilities will have patients needing continued Part B rehabilitation services, however depending on the outpatient therapies provided earlier this year, they may have already exceeded the cap. In accordance with federal regulations, the SNF must continue to provide necessary therapies. This presents a financial difficulty for facilities with dual-eligible residents who are unable to pay privately for such services. 
CMS has published an article explaining this issue for providers: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0815.pdf.  

Why Is The Exceptions Process Expiring?

As AHCA reported yesterday the House of Representatives voted earlier this week overwhelmingly, 355-59, to pass the Medicare Improvements for Patients and Providers Act of 2008, H.R. 3101, which would have extended the current therapy cap exceptions process until December 31, 2009.  Unfortunately, the Senate was unable to pass the bill last night.

What Happens Next?

The House and Senate will be out of session next week for a Fourth of July recess. AHCA continues to work with our Congressional champions, and we anticipate that this issue will be revisited as soon as Congress returns to Washington, DC, on July 8.  AHCA will provide updates as this situation continues to develop.  For more information, please contact Francesca Fierro O'Reilly.

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  Jack Vetter greets visitors at Wheatridge Care Center in LIBERAL!
corrected story

In the last newsletter we incorrectly stated Jack Vetter greeted visitors in Garden City.  Jack visited Wheatridge Park in Liberal during National Nursing Home Week. 

We apologize for this misstatement! 

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  Five Minutes to Fire Safety

Welcome to the inaugural edition of “Five Minutes to Fire Safety”!  With this first edition, we’re taking a look at exit doors, door locks, and delayed egress.  This is a pretty big topic, so the first several editions will be dedicated to working through egress and security.  As these are released, you can find “Five Minutes to Fire Safety” on our website: http://www.accesskansas.org/firemarshal.  The Healthcare edition will be found in our CMS information section.
 
If you have any questions or suggestions for future topics, please feel free to email:
 
Kenya Patzer
Education Consultant
Fire Prevention Division – Kansas State Fire Marshal’s Office
(785) 296-3401
 

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  Money Follows the Person (MFP) Update

MFP is a 5 year demonstration grant from CMS  This past year representatives from KDOA, SRS, KHCA, KAHSA, AAA and other advocacy groups have worked together to develop an operational protocol for MFP which was recently approved by CMS with implementation beginning 7/1/08.  MFP is a 5 year demonstration grant from CMS to help nursing home resident’s transition back into the community.

According to Deb Schwarz, Director of Transition and CARE, KDOA, “MFP is associated with the Federal Reduction Act and New Freedom Initiative.   The basic design concept by the Centers for Medicare and Medicaid Services (CMS) is to reduce the states LTC spending by shifting the costs from institutional settings into the community.  The goal is to address barriers people face to returning to the community from an institutional setting.  Approximately 1000 Kansans will have an enhanced opportunity to live in their home communities, in their own homes versus nursing homes or ICFsMR.  This is five (5) year grant with the first date of entry into the demonstration program to occur July 1, 2008.

To qualify for MFP an individual must:
* have resided in a qualified institutional setting for at least 6 months
* qualify for Medicaid 30days prior to MFP services
* qualify for one of the following HCBS waiver services.
Developmental Disabilities waiver (MR/DD)
Frail Elderly Waiver (FE)
Physical Disability Waiver (PD)
Traumatic Brain Injury Waiver (TBI)

While in the MFP demonstration project people will receive:
* traditional waiver services
* targeted case management (TCM) prior to transition and ongoing for 365 days
   Plus access to the following based on individual need and population:
* Transition services (start up costs)
* Increased allowance for home modification and adaptive services
* Supplemental services that could include therapeutic support
or administrative services to include 1) community bridge building 2) licensed facility bed buyback (ICF/MR only using SGF dollors).”

Nursing home residents will be self-identified through MDS Section Q or directly self-refer.  Once identified and upon permission of the resident, a Community Bridge Building Team (CBBT*) will meet with the resident and legal representative to discuss options for community living and available services. (*The CBBT includes Area Agency on Aging and Independent Living Center staff, plus a professional employed by the nursing home in which the resident resides.)  

KHCA, KAHSA, and KDOA held a free webinar on June 27th for nursing home providers to explain the Money Follows the Person (MFP) Project that will kick off on July 1.   Click on the following links to view the webinar presentation handouts and read below the Q & A from the webinar session.

 MFP Powerpoint.pdf
 MFP Flow Chart # 1
 MFP Flow Chart # 2

1. Can residents move from a nursing home into an assisted living, RHHC, Board and Care, or Homes Plus with MFP?  No, CMS prohibits this but will allow nursing home residents to move from a NF into independent housing on a campus setting.

2. If an individual moves into the community what type of setting can they live in?
For the frail elderly they can move into their own home, live with a family member, or an apartment with a lease and lockable egress.

3. Who will monitor these individuals once they move into the community? The targeted case managers will monitor these individuals.  TCM have completed a 6 hour training program specific to this project. 

4. When will the state send out its first letters to MFP candidates? We hope to have the letters will be sent out in the next 30 days. 

5. What happens after a resident transitions into the community? After 365 days in the community, which need not be consecutive (allows for brief hospital stays) the individual will transition seamlessly over to their respective 1915c waiver and receive services.  These include the FE, PD, MR/DD and TBI waivers.

6. What are the qualifications to be a MFP candidate? They must be Medicaid eligible and have a medical card 30 days prior to qualifying; be a current resident of a NF or ICF/MR with 6 months continuous stay; must meet the functional eligibility for waivered services; express an interest in moving back into the community. 

7. Will skilled days count towards the 6 months continuous stay requirement? NF days will count and brief hospital stays will count.  KDOA is checking to see if skilled days will count.

8. What if a resident in a NF wants to move into an assisted living unit and MFP does not apply?  TCM will work with the individual to move them into an assisted living unit even though MFP will not apply, the MFP case would be closed.

9. Can the $2500 for transition services be used for rent or food?  No CMS will allow transition service dollars to be used for utility and rent deposits but not for food or day to day living expenses.

10. If an Ombudsman participates at the resident’s request will the Ombudsman be a paid or volunteer ombudsman? Both will be participating.

11. If the TCM can not write a safe plan for transitioning, but the resident still wants to move into the community, will they be allowed to under MFP?  No the resident will not be a MFP candidate if a safe POC cannot be written for them to return to the community.  The resident can appeal through the administrative appeal process. 

12. How will duplication of services be avoided? This will be monitored by the TCM.  HHA Skilled nursing care and attendant care are allowed as long as they are doing different things.  HHA skilled nursing care must get prior authorization if the customer is receiving HCBS services.

13. For safety reasons can two service providers go to a persons home and be reimbursed?  CMS says no unless you need a two person transfer.

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  KHCA/KCAL Nursing Scholarships Available
deadline extended!

The KHCA Nursing Advisory Committee has extended the deadline for applicants to the Joan Hamel Nursing Scholarship.  Please click here for the information.

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  Kansas Center for Assisted Living News
AALNA Chapter

The Kansas Center  for Assisted Living is looking for a few good people to begin the building of an American Assisted Living Nurse Association State Chapter.  The KCAL Board is meeting July 10, 2008 and we will begin to look at getting the AALNA chapter off the ground for Kansas.  Click for information about the AALNA state chapter.  Let Cindy know if you would like to be on the core group to begin the chapter.  cluxem@khca.org or 785-267-6003.  We would like to have the roll-out of the state chapter at the KHCA/KCAL convention in September 2008.

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  Invite Legislators into your homes!

Summer is a good time for state and national lawmakers to return to their districts and hear from constituents.  It's also the perfect time for long term care providers to inform their respective legislative leaders on the issues important to us.  Schedule a facility tour for your representative or senator, and be sure to invite the local media.  Coverage of these events provide you invaluable publicity.  Let anyone at the association know if you would like help in arranging the media coverage. 

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  Resident Satisfaction Committee Links

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. 

Click here for Provider Manual Updates from the KMAP website.

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