Tell Your Member of Congress to Support the Inclusion of Enhanced Medicaid Funding in any Stimulus Package!

AHCA/NCAL SUPPORTS the inclusion of Medicaid into a stimulus package and encourages ALL of our members to contact their Members of Congress TODAY in support of this temporary increase.

Currently, states are wrestling with a $50 billion shortfall and will struggle to fund their Medicaid programs. In an average nursing home, 67% of persons are on Medicaid and in an average assisted living facility, 12%of residents are on Medicaid.

In addition, long term care facilities directly employ 2.9 million individuals and contribute to the employment of an additional 5.2 million. A temporary increase in the Federal Medical Assistance Percentage (FMAP) for the Medicaid program would benefit each state - immediately - and help avert painful state budget cuts to Medicaid.  Therefore, inclusion of a temporary increase of Medicaid funding to states to any stimulus package will not only serve to stimulate this nation's economy, but will most importantly preserve long term care for this nation's frail and elderly.

AHCA/NCAL encourages you to contact your Members of Congress and urge them to support the inclusion of State Medicaid Relief into any Economic Stimulus Package. Send a letter now by clicking the following link "TAKE ACTION".

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  KHCA to Meet with CMS about LSC

The Kansas Health Care Association will be meeting with representatives from the Kansas State Fire Marshal’s office and CMS Region 7 in the next month to discuss the top ten life safety code deficiencies and why Kansas is cited at a level 2-3 times above the national average. Below is a listing of the top ten LSC deficiencies in Kansas as of March 2008. 

We are asking that providers who received any of the top ten deficiencies and believe you were cited in error to please copy the page of your 2567 where this K-tag is cited along with an explanation of why you believe you were cited in error. 

We will need the information by November 24th.  Please email or fax to Nancy at npierce@khca.org or fax: 785-267-0833. 

Ten Most Frequently Cited LSC Deficiencies in Kansas as of March 2008

K062	Maintenance / Testing sprinkler system
K147	Electrical wiring & equipment
K046	Emergency lighting
K018	Corridor doors
K029	Hazardous area separation
K025	Smoke barrier construction
K012	Building construction
K074	Combustible interior furnishings
K050	Fire drills
K038	Exit accessibility at all times

Also please let us know if you have been cited for range hood and duct systems, fire alarm system strobe lights, eye washes and incorrect interpretations of door locking.  We believe there are incorrect interpretations/requirements coming out of the CMS Kansas City Region office regarding these issues.

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  KHCA Statewide Teleconference Call

The Kansas Health Care Association plans to host regular statewide teleconference calls to discuss current issues affecting our membership.  We would like to have as many providers as possible participate and we look forward to discussing the issues that are affecting providers. 

Our first call will be held on November 12, 2008 at 1:30pm.  The purpose of this call will be to discuss Nursing Facility Life Safety Code concerns.  Please encourage those most knowledgeable about LSC issues to participate in the call.  This call will be specific to nursing homes.

Cindy, Nancy and Tom Jaeger have a meeting scheduled for December 2, 2008 with CMS Region 7 and the Kansas State Fire Marshal’s Office.  The agenda will include discussion of the top ten life safety code deficiencies and why Kansas is cited at a level 2-3 times above the national average as well as range hood and duct systems, fire alarm system strobe lights, eye washes and incorrect interpretations of door locking.  Below is a list of the top ten LSC deficiencies as of March 2008.

Ten Most Frequently Cited LSC Deficiencies in Kansas as of March 2008
K062
K147
K046
K018
K029
K025
K012
K074
K050
K038

Topic: Life Safety Code Discussion
Date: November 12, 2008
Time: 1:30pm
Conference line number: 800-917-9796, PIN # 658145
 
                           

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  Nursing Home Residents Eligible to Receive Converter Box Coupons

Below is a link to an article dated 9/16/08 that reports changes that will made in the next month to allow residents in nursing homes and assisted living facilities to obtain one coupon for a DTV converter box.  A special form must be completed and the box will be sent to the resident’s address at the facility.

Gutierrez: Nursing Homes, PO Boxes to Get Coupons
http://www.broadcastingcable.com/article/CA6596800.html?industryid=47171

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  KMAP Updates

The Kansas Health Policy Authority (KHPA) has implemented two new self-service options on the KMAP website.  Effective 11/3/08, Medicaid participants will be able to check their eligibility, coverage information, and spenddown and level of care information using an automated phone attendant and/or the internet.  Providers may find the following link useful in helping residents update information.

http://www.khpa.ks.gov/MedicalAssistanceProgram/Partners/download/Medicaid%20Partners%20Memo%2010-31-08.pdf

Contact KMAP customer service at 1-800-766-9012 with any questions.

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  The Kansas Center for Assisted Living website

The Kansas Center for Assisted Living (KCAL) has a new website at  www.mykcal.org.  The username is mykcal@mykcal.org and the password will be set the same as the monthly password for the KHCA website.  Please send any suggestions regarding the website to Nancy at npierce@khca.org.

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  CMS SNF Claims Processing Systems Problem

A systems problem has been identified with regard to CMS SNF claims processing and is causing SNF claims to reject in error.  The problem was caused by incorrect logic changes in CMS’ last system’s release.   We understand that there will not be another system’s release that can completely correct this until January – however, CMS is trying to provide a temporary fix now.   

The reason codes are 38067 and 38068 and apparently involve consolidated billing issues.  We have been told by CMS staff that they informed all contractors on the last CMS functional work group call that they needed either to work these claims manually or set up a system event to bypass the reason codes that these claims are hitting.   Thus, the problem can be resolved now in this temporary fashion.  However, some FIs and MACs have not implemented the fix as yet. To date AHCA has heard from providers with WPS, First Coast and Highmark as FIs and or MACs.  However, we believe that the problem may be nationwide. 

According to CMS, “Formal instruction to override these reason codes will be given to the contractors by day's end tomorrow.  Financial hardship and accelerated payment issues are to be dealt with and approved by the CMS regional offices. "  CMS in Baltimore has asked that providers who are experiencing this problem contact their Regional Office (RO) and provide the RO and also CMS in Baltimore with the following information.  If you send the information to Nancy at KHCA, I will forward it to the appropriate office at CMS immediately.

* the number of providers experiencing this problem;
* the contractors with whom providers are having a problem;
* the number of claims that are being held, rejected or returned;
* the amount of reimbursement on hold; and
* the amount of time these claims have been held 
 

The following link contains the map for ROs and contact numbers.
http://www.cms.hhs.gov/MyHealthMyMedicare/Downloads/regionalmap.pdf  

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  CMS Updates

Standing Orders in Hospitals – Revisions to S&C Memoranda (10/24/08)

Use of standing orders in hospitals: Clarification of a portion of S&C-08-12 and S&C-08-18, issued on February 8 and April 11, 2008 respectively, regarding use of standing orders in hospitals.  The use of standing orders must be documented as an order in the patient’s medical record and signed by the practitioner responsible for the care of the patient, but the timing of such documentation should not be a barrier to effective emergency response, timely and necessary care, or other patient safety advances.

Signatures on Order Sets:  Clarification of the circumstances under which signatures are required on pre-printed order sets.

 Use of Rubber Stamps:  While the Conditions of Participation do not prohibit the use of rubber stamps, CMS wants to make you aware that some payers, including Medicare, do not accept the use of rubber stamps for payment purposes.

Future Directions:  CMS expresses interest in working with the professional community to advance safe practices and develop a common understanding of both best practices and important operational definitions as they pertain to standing orders, preprinted order sets, and effective methods to promote evidence-based medicine.  Click here to read the entire document.

2008 Actuarial Report on the financial outlook for Medicaid

Medicaid spending is projected to rise much faster than the economy.  To view the entire report click on the following URL.
http://www.cms.hhs.gov/actuarialstudies/03_medicaidreport.asp?

ICD-10-Clinical Modification/Procedure Coding System Fact Sheet 

The ICD-10-Clinical Modification/Procedure Coding System Fact Sheet, which provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9CM and ICD-10-CM/PCS, and implementation planning recommendations, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2008.pdf.


New From the Medicare Learning Network ~ Revised Medicare Physician Guide

The revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (October 2008), which offers general information about the Medicare Program, becoming a Medicare provider or supplier, Medicare reimbursement, Medicare payment policies, evaluation and management services, protecting the Medicare Trust Fund, inquiries, overpayments, and appeals, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/physicianguide.pdf .

Update Notice for HH PPS

The Centers for Medicare & Medicaid Services (CMS) issued a notice to update the Home Health Prospective Payment System (HH PPS) for calendar year (CY) 2009.  Medicare payments to home health agencies will increase by an estimated additional $30 million next year as a result of a 2.9 percent increase in the annual market basket calculation of the cost of goods and services included in providing services under the HH PPS.  The update also accounts for a 2.75 percent reduction to the HH PPS rates (the 2nd year of a 4-year phased in reduction) to account for the changes in case-mix that are unrelated to patient’s health status, and an updated 2009 wage index. A copy of the notice (CMS-1555-N) is available on the CMS website at: http://www.cms.hhs.gov/center/hha.asp .

Announcement of New Oxygen Payment Rules and Supplier Responsibilities

The Centers for Medicare & Medicaid Services (CMS) has announced new oxygen payment rules and supplier responsibilities required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).  These final rules are found in the regulation titled “Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B (CMS-1403-FC),” which is now on display at the Office of the Federal Register. Visit the CMS website at www.cms.hhs.gov/center/dme.asp to view the rule and obtain additional information.

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  CMS Releases New Draft of MDS 3.0 and Data Specifications

CMS recently released a new draft of MDS 3.0 and the data specifications. The new draft shows some changes from the draft released last January. CMS stresses that all of the materials including the specifications are currently in draft form and are subject to change prior to implementation. The release, approximately one year before MDS 3.0 implementation, is to provide nursing home and swing bed software developers as much lead time as possible to prepare for implementation.

The draft MDS 3.0 and specifications can be found here, under Downloads and select Draft MDS 3.0 Data Specifications. The data specifications zip file contains the Data Specifications Report, Item list by Type, Item List Report by Item, Item Subset Code Report, MDS 3.0 Data Specifications Document, Supplemental Information Report, Unduplicated Edits Report by ID, and Unduplicated Edits Report by Type.  Contact Nancy with any questions.

http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp

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  CMS Update on Transition to Part D in 2009

CMS is trying to achieve a smooth transition to ensure continued prescription drug coverage for all Medicare beneficiaries who received extra help in paying their prescription drug costs in 2008.  Specifically, CMS is continuing to reach out to the beneficiaries receiving the low-income subsidy (LIS) who are facing a change in their Part D premiums in 2009, including providing information to beneficiaries about these changes via two letters. 

These beneficiaries may include some nursing facility dual eligible residents.  CMS had already in the past provided a longer transition period for nursing facility beneficiaries and has indicated that they believe the longer transition period will provide the protection needed in long term care.  

The Transition Process

CMS is sending color coded letters to  beneficiaries receiving subsidies who selected a plan, but who will be responsible for paying a portion of their plan premium beginning in January 2009 unless they join a new plan.  CMS will mail these letters in November.

I.  Re-assignment Notices (Blue) 

Medicare will mail re-assignment notices to people who qualify for the full extra help and will be reassigned to a new plan in 2009.  

* About 133,000 people will be reassigned because their 2008 Medicare Prescription Drug Plans are terminating (Publication No. 11208). This notice specifies that their current plan is leaving and also provides information about their new plan, and alternative options.

* Some people will be reassigned because their 2008 Medicare Prescription Drug Plan’s premiums are increasing for 2009 (Publication No. 11209). This includes about 1.15 million people who will be moved to a new plan outside their current organization. The reassignment notice they receive will provide information about three options: moving to the new plan, staying in the current plan, or selecting a different plan.  Details about their new zero premium plan (including co-payment amount, and yearly deductible) are provided, along with the name of their new organization and a phone number that can be used to get additional information about prescriptions covered, drug coverage rules (like prior authorization), and local pharmacies that can be used.  The notice also provides information about the person’s current plan, and a list of all the zero premium plans in the area.

* An additional 335,000 people will be moved to a new plan within their current organization. These people will receive the same reassignment notice described above; the only difference is that the name of their organization may remain the same, even though their plan is changing.

All reassignment notices are printed on blue paper and inform beneficiaries that that they will be reassigned to a new plan if they don’t tell their current plan they want to stay or join a new plan on their own by December 31, 2008.

II. “Chooser” Notices (Tan)

* Medicare will mail chooser notices (Publication No. 11267) to a total of about 620,000 people who qualify for the full premium subsidy and who chose to join a Medicare Drug Plan that was “free” (no premium liability) when they first joined, but whose premium will be above the regional low-income premium subsidy amount in 2009. 

* To respect individual choice, Medicare does not reassign LIS beneficiaries who joined plans on their own or switched to different Medicare Prescription Drug Plans than the plan Medicare enrolled them in. These letters are printed on tan paper and inform beneficiaries what their out-of pocket payment will be in 2009, lists the zero premium plans available, and provides a list of important things to think about when considering plan options such as pharmacy networks, drugs covered, and satisfaction with current plan. 

III. Material Available Online

The following materials related to these two mailings have been or will soon be posted to the Limited Income and Resources web page <http://www.cms.hhs.gov/limitedincomeandresources/>:
 
* Guide to LIS Mailings for CMS, Social Security and Plans
* Re-assignment Data of Beneficiary Notifications by state, county and zip code (coming soon)
* Re-assignment Notice Sent to Those with a Plan Not Available in 2009 (blue)
* Re-assignment Notice Sent to Those with a Premium Increase in 2009 (blue)
* Re-assignment Partner Tip Sheet - Information Partners Can Use on: Re-assignment
* Chooser Data of Beneficiary Notifications by state, county and zip code (coming soon)
* Choosers Notice Sent to Those with Drug Cost Changes in 2009 (tan)
* Links to other helpful information, including locating local resources in your area

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  Advancing Excellence Webinar Focuses On Satisfaction

The Advancing Excellence in America's Nursing Homes campaign's fifth Webinar will focus on satisfaction and help participants learn the value of the opinions of residents, families and staff in your facility. You will learn how to integrate this information into your quality improvement program to improve care, services, and the work environment. The webinar will be held Wednesday, December 10 from 2 pm to 3:30 pm ET. For complete details about this free resource from the Advancing Excellence campaign, please click here.

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  Metlife Releases Annual Report on NF and AL Rates

A private room in a nursing facility in Kansas costs on average $147 ppd in 2008 well below the national average of $212.  Below is an excerpt from Metlife's Annual Report. 

MetLife recently released their annual report on nursing facility and assisted living residence rates, The MetLife Market Survey of Nursing Home & Assisted Living Costs. The report found that the national average rates for a private room in a nursing home remained essentially unchanged from 2007, while a semi-private room increased modestly by 1.1%, from $189 daily or $68,985 annually in 2007, to $191 daily or $69,715 annually in 2008. National average assisted living rates increased by 2.1%, from $2,969 monthly or $35,628 annually in 2007, to $3,031 monthly or $36,372 annually in 2008. AHCA/NCAL will use the new report to reemphasize the need for long term and post acute care financing reform - and further encourage every American that they should begin planning for their own long term care needs and take more personal responsibility for their retirement.  To view the entire report click here.  Contact Nancy with any questions.

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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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