5 Star Quality Rating System

The Centers for Medicare & Medicaid Services (CMS) will launch its “5 Star Quality Rating System,” which will be posted to Nursing Home Compare on December 18, 2008. The following provides many details of the new ratings system.

About 5 Star
A facility’s overall 5 Star rating incorporates ratings in three categories: survey results, Quality Measures (QMs), and staffing levels. The survey rating forms the base “star” rating with stars being added or subtracted depending upon a facility’s star rating for QMs and staffing respectively. The overall rating for a facility cannot be greater than 5 Stars or less than 1 Star; however, new facilities where there is insufficient data could receive a rating of “N/A.”

Here’s how CMS will calculate a facility’s 5 Star rating:

1. [Survey Rating] CMS calculates the survey star rating based on points that a facility accrues based on health citations noted in the past 3 years of standard and substantiated complaint surveys and survey revisits. CMS assigns more points to facilities with deficiencies of greater scope or severity (i.e., facilities with less serious deficiencies or isolated incidents will receive fewer points) and recent surveys are weighted more heavily (i.e., most recent survey accounts for half of the points, the previous survey accounts for one-third of the points and the next most recent survey accounts for one-sixth of the points for the survey rating category).

CMS takes each facility’s overall point score (between 0 and 136) and ranks it by state – not nationally – a step that the agency hopes will help to balance out known discrepancies among survey regions. The top 10% of each state’s facilities receive a 5 Star rating for Survey and the bottom 20% receive 1 Star ratings, while the remaining facilities within a state are assigned 2, 3 or 4 Stars for the survey component of  5 Star based on an even distribution of this middle 70% of facilities within a state.

2. [QM Rating] CMS calculates the QM component of 5 Star by assigning points based on 10 of the 19 QMs that are currently posted to Nursing Home Compare – including 7 long-stay and 3 short-stay measures (details for each of the 19 QMs remains posted to Nursing Home Compare). CMS averages the three most recent quarters worth of QM data. Performance related to the QMs for both ADL Decline and Mobility Decline accounts for 40% of a facility’s QM rating on the long-stay measures (i.e., these 2 QMs are weighted 1.6667 times as high as other QMs).

CMS compares these point totals according to a national average. The top 10% of facilities receive a 5 Star rating for QMs and the bottom 20% receive 1 Star ratings, while the remaining facilities are assigned 2, 3 or 4 Stars for the QM component of 5-Star based on an even distribution of this middle 70% of facilities nationwide. A QM rating of 5 Stars can “bump up” a facility’s overall score by 1 Star, whereas a 1 Star rating in the QM category will downgrade the overall rating by subtracting 1 Star.

3. [Staff Rating] CMS calculates the Staffing component of 5 Star by calculating the average number of hours and minutes of nursing care per resident per day (including registered nurses (RN), licensed practical nurses (LPN), and certified nurse aides (CNAs) – and those under contract to a facility). This average will be case-mix adjusted to account for variations in residents’ Resource Utilization Group (RUG) categories within a facility. Then, CMS will assign Staff ratings for both total staffing and RN staffing. Facilities cannot receive a 5 Star rating for the Staffing component unless it meets the threshold of 4.08 per resident day total staffing to include a minimum of .55 RN hours. Overall Staffing rates of 4 or 5 stars can “bump up” a facility’s overall score by 1 Star, whereas a 1 Star rating in the Staffing category will downgrade the overall rating by subtracting 1 Star.

4. Because 5 Star uses state-based comparisons for the survey component, consumers will not be able to use this system to compare facilities across states.

On December 18, USA Today will feature an exclusive day of story unveiling the new rating system. We anticipate that this high profile coverage and a CMS media call on Thursday will generate significant media coverage. In anticipation of questions and inquiries that AHCA members will receive from members of the media and consumer groups, AHCA has developed the following suggested talking points.

Suggested Talking Points

* Our first commitment – always – is to provide quality care to residents in a safe and secure environment.

* Delivering the highest quality of care and customer satisfaction is a top priority for those of us in the long term care profession—and the vast majority of nursing homes nationwide provide the type of high quality, compassionate care that patients, residents and their families want and deserve.

* The facts speak for themselves – quality is improving in our nation’s nursing facilities – a reality not reflected in the 5 Star program.

* The long term care profession has helped to lead the nation's healthcare sector in terms of quality improvement, and we are committed to continuing our work with CMS to advance a transparent survey process that recognizes quality, and provides the resources for facility improvement, which will enhance efforts to further improve quality long term care.

* We support a rating system that accurately reflects the quality of care in our nation’s nursing facilities; however, we do not believe that a system based on the current survey system will provide consumers with accurate, up-to-date information.

* CMS claims that the survey component of its 5-Star Quality Rating System represents the most important dimension in determining a facility’s overall quality rating. We disagree—today’s survey system does not measure quality, but rather assesses compliance with federal or state regulations. We believe that customer satisfaction – how a resident and family members judge the care being provided in a particular facility – is a better indicator of the quality of care and quality of life residents enjoy.

* Quality improvement is a dynamic ongoing process – and its quantification must reflect the many variants that go into the delivery of care. We believe that consumer and staff satisfaction are two important components of quality care.

* In June, My InnerView, Inc. released its national report on customer satisfaction with nursing facilities. The report is based on surveys of more than 146,300 residents and family members and nearly 162,000 employees; 83% of the respondents rated overall satisfaction with their nursing home as “excellent” or “good” and fully 82% of the respondents said they would recommend the facility to others as “excellent” or “good.”

* Long term care providers are providing quality of care and quality of life for residents, and that the profession is clearly being part of the solution. We are helping lead the charge, changing the culture, turning a corner on quality care.

* AHCA is working closely in coalition with other long term care providers, quality improvement experts, medical professionals, and consumers on the Advancing Excellence in America’s Nursing Homes campaign, which builds on our efforts with Quality First and seeks to coordinate and leverage the various quality improvement initiatives already underway in nursing homes nationwide (see www.nhqualitycampaign.org).

* Government data indicates that quality is improving in several areas. A few examples include::

* Nationally, direct care staffing levels (which include all levels of nursing care: Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Certified Nursing Assistants (CNAs)) have increased 10.6 percent between 2000 and 2008 – from 3.12 hours per patient day in 2000 to 3.45 hours in 2008;

* The Quality Measure tracking pain for long term stay residents vastly improved from a rate of 10.7 percent in 2002 to 4.1 percent in 2008 – more than a 60 percent decrease;

* The Quality Measure tracking the use of physical restraints for long stay residents dropped by more than 50 percent over six years – from 9.7 percent in 2002 to 4.5 percent in 2008;

* The Quality Measure tracking pressure ulcers for post-acute skilled nursing facility patients (many of whom are admitted to the nursing facility with a pre-existing pressure ulcer) improved by nearly 22 percent over the course of five years, from 20.4 percent in 2003 to 16 percent in 2008; and

* Substandard Quality of Care Citations as tracked by CMS surveys were reduced by 35.5 percent over seven years – from 4.5 percent in 2000 to 2.9 percent in 2007.

* We know that getting the appropriate care in the appropriate setting is critical. That’s why we offer consumer-friendly information to help find a facility that will meet their specific needs like How to Choose a Nursing Home, which is available at www.LongTermCareLiving.com.

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  Updated Q & A Life Safety Code

1. K18-construction of doors and latching-Small hole in door frame? Correct in that it should have been cited since the hole would not resist the passage of smoke.

2. K62-automatic sprinkler-sprinkler system maintenance-
Storage 18 inches below or within of a sprinkler head? AHCA says yes as long as storage is along wall and not directly below sprinkler head.  Tom Jaeger says: The 18" rule does not always apply to storage along the perimeter of the room, see extract from 1999 NFPA 13 below.
A-5-6.6
The 18-in. (0.46-mm) dimension is not intended to limit the height of shelving on a wall or shelving against a wall in accordance with 5-6.6.  Where shelving is installed on a wall and is not directly below sprinklers, the shelves, including storage thereon, can extend above the level of a plane located 18 in. (0.46 mm) below ceiling sprinkler deflectors.  Shelving, and any storage thereon, directly below the sprinklers cannot extend above a plane located 18 in. (0.46 mm) below the ceiling sprinkler deflectors.

3. % or # of spare sprinkler heads Providers are required to have? Per CMS-need to follow NFPA 13. (up to 6) and at least one of every different type of sprinkler head you use.

4. K147-electrical wiring-
Clarification-Amount of area around the electrical panel needs to be clear?  A three foot area around the panel needs to be clear so that there is easy access to the panel.

5. K25-smoke partition construction-
Is it in regulation that access needs to be on both sides of the smoke barrier partition? Yes Providers should have an access panel on either side of the smoke barrier partition.

6. K50- Fire Drills-
What is the definition of unexpected times? Random? LSC states that FIRE DRILLS SHOULD BE HELD AT UNEXPECTED TIMES UNDER VARYING CONDITIONS.  KSFMO will cite providers for not random or unexpected times if you hold a fire drill the first day of the month every quarter and if you do not vary your time more than 2-3 hours.

Why do providers have to do a scenario? Important to have someone else help relay information back to the Administrator on how staff and residents performed during the fire drill and for the administrator to include this in his/her scenario.

Activation of fire alarm by employees? Staff should also activate the fire alarm system.

7. K144-generators inspected/tested-
Where do annunciator panels need to be if following 2000 code? At nurses station? They need to be in a place that is constantly attended so KSFMO recommends the nurses station.

If a generator was installed in 1988-2003 would they use 85 code?
If a generator was installed in 1903-present would they use 2000 code?
If a generator was installed in 1970-1976 would they use 67 code?
Per CMS, if a Provider is upgrading a generator they would need to follow 2000 code otherwise they would follow the code when their generator was installed.

8. K46-emergency lighting-
If you have a generator that supplies power to emergency lights, are battery operated lights required? YES. A battery operated light is required at the emergency generator.  Keep in mind if your emergency lighting is tied into the generator and you have not taken down your battery operated lights, KSFMO will expect you to maintain them and will cite you if you do not.  If you have a generator and a manual switch can you cover the switch with a hard plate or do you have to hard wire it to the generator? This is currently being reviewed by the KSFMO.

9. K134-Eyewash-Emergency shower
Should any eyewash documentation or other be cited by FM using K134?
If so then what specifically do providers need to comply with?  FM started writing eyewash and only documentation issues, now they write for tepid water, requires more than one motion to operate, being behind locked doors…?  CMS reported that they quit writing this tag 2 months ago. 

10. K12-Construction type-
Overhang and sprinklers?  Are sprinklers required under overhangs on the exterior of the building? Yes, if the overhang is of combustible construction and the overhang is 4 ft or greater in width. Can a waiver be submitted? Yes a waiver can be submitted or you can use the FSES to establish equivalence, but waivers or use of the FSES will not be allowed for sprinkler deficiencies after August 13, 2013.

MISC

1. Documentation cites-K69,K130,K62,K46-
Providers cited for documentation not being readily and immediately available?  Federal surveyors allow the provider to fax in documents why can’t the state?  Two providers were cited twice for this when the documentation was in the book but misfiled.  One of the providers IDR’d and KSFMO denied it. KSFMO said that all LSC surveys should start with an entrance interview.  It was brought to KSFMO’s attention that this was not happening.  KSFMO will instruct all their inspectors to begin with an entrance interview.  If during this interview you determine that some of your documentation is out of order, the inspector should allow you to gather this information by the exit interview and not cite you.  You have to have the documentation in order before the inspector leaves.

2. K69 documentation cite-what is the timeframe for maintenance to be done-if something needs to be checked every 6 months is there any leeway?  Per CMS they should give you a week or to after 6 months before they cite you for kitchen hood systems.  Any other maintenance checks needs to be completed within the time frame.

3. An assisted living facility-inspected by FM-Does kitchen hood suppression need to be connected to fire alarm system? Yes

Overhang is 50 inches does it need to be sprinkled?  It is attached to the building and no cars underneath it? Yes

Sprinklers in freezers? Yes

4. Waivers-Is CMS or KSFMO granting waivers?  Per CMS any waivers under 6 months can be handled by the KSFMO and any over 6 months will be handled by CMS Region 7.  We have asked CMS for the statute where this is cited.

5. IDR’s- In 2007 there were 23 IDR’s total and 23 total tags were IDR’d.  Of these, 61% were removed and 39% stand.

In 2008-Jan1 through Oct 1 there were 23 IDR’s initiated involving 35 total tags. Of these, 49% were removed and 51% stand.

KHCA will have the KSFMO update the membership on the LSC IDR process at Winter Conference.  KHCA will encourage all providers to use the IDR process.

6. Clarification on keypad doors and posting of the code? Per CMS as long as you are giving cognitively aware residents the code, the staff the code and any visitors the code, you should not be cited for this deficiency.  Some providers have posted signs next to their keypad doors that state that any visitors need to check in at the front desk.  This is where they would get the code.  Some providers have stated that they give the code to their cognitively aware residents and document it in their chart.  Exception to the rule provider has delayed egress at the path of egress the above does not apply and provider must post appropriate signage reading push until alarm sounds door will open in 15 seconds.

7. Why do they think that Kansas is 2-3 times higher than the national average on the top ten deficiencies cited? Per CMS they think they are cited accurately in Kansas and it is the other regions that are inaccurate.

8. Tom Jaeger asked CMS about the high incidence of providers being cited for K62
Not having the 5 year obstruction investigation? Per Tom, under the 1998 NFPA  25 which applies to the 2000 Life Safety Code, an obstruction investigation is only needed if there is a known obstruction or when any one of the conditions exist per Section 10-2.1 (a) thru (l).  Only if one of the above conditions exists, is an obstruction investigation required.  An obstruction is NOT required solely based on a 5 year frequency.  Generally, your sprinkler contractor, during annual inspections and/or testing will note if a condition exists requiring an obstruction investigation.  Please note that the contractor that does your sprinkler system inspection and testing should not recommend that your system have an obstruction investigation and/or be flushed solely based on a 5 year frequency. CMS responded that providers would be cited if the inspector found evidence of decreased flow or pressure drops as well as if the sprinkler contractor's report said that an obstruction investigation needs to be done. Make sure if you are cited for this that you ask the inspector why? If they cite the contractors paperwork (in the absence of an obstruction) then be sure to IDR it.

Extract from 1998 NFPA 25

Chapter 10 Obstruction Investigation
10-1 General.
This chapter provides the minimum requirements for conducting investigations of fire protection system piping for possible sources of materials that can cause pipe blockage.
10-2* Obstruction Investigation and Prevention.
10-2.1*
To ensure that piping remains clear of all obstructive foreign matter, an obstruction investigation shall be conducted for system or yard main piping wherever any of the following conditions exist:
(a) Defective intake for fire pumps taking suction from open bodies of water
(b) The discharge of obstructive material during routine water tests
(c) Foreign materials in fire pumps, in dry pipe valves, or in check valves
(d) Foreign material in water during drain tests or plugging of inspector’s test connection(s)
(e) Plugged sprinklers
(f) Plugged piping in sprinkler systems dismantled during building alterations
(g) Failure to flush yard piping or surrounding public mains following new installations or repairs
(h) A record of broken public mains in the vicinity
(i) Abnormally frequent false tripping of a dry pipe valve(s)
(j) A system that is returned to service after an extended shutdown (greater than 1 year)
(k) There is reason to believe that the sprinkler system contains sodium silicate or highly corrosive fluxes in copper systems
(l) A system has been supplied with raw water via the fire department connection.
  
9.  Many providers were cited for green sprinkler heads. The brass oxidizes to form the green film and per CMS will only cite you if it is heavy.

10. Tom asked CMS about the high incidence of providers being cited for penetration of the ceiling. In general Tom stated that 84% of the homes are sprinkled in Kansas and are one story buildings and their ceilings would not be part of a fire rated assembly so therefore you should not be cited. You should only be cited for
penetration of the ceiling if the ceiling is part of a fire rated assembly. KSFMO will speak to their inspectors about this issue.

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  Lawrence Journal World Story About Pioneer Ridge
By Terry Rombeck

Tillie Dodson is sitting on her walker, striking her best pose.  Three feet away, Kyle Ostrom-Klaus is studying her every feature — yes, every wrinkle — and sketching her portrait.

Dodson laughs at the question: What’s it like to have her very first portrait done at age 91? “I’ll tell you after I see it,” she says. She might be joking. It’s hard to tell.

Dodson lives at Pioneer Ridge Retirement Community, 4851 Harvard Road. She’s one of 57 residents getting their portraits done in the next few months by young artists employed by Van Go Mobile Arts.  The students, in Van Go’s Life JAMS program, are 18- to 22-year-olds who are aren’t in school and are considered at-risk — they are low-income, lack a high school diploma, have a disability or have some other barrier to employment. Usually, the group is working on commercial projects, such as painting a van for Cottin’s Hardware or a new mural for Kansas University’s new Multicultural Resource Center. This would prove to be a new challenge.
•••
Serendipity brought the two generations together.  Employees at Pioneer Ridge were thinking how great it would be if they could find a group willing to take photos or do artwork of residents. The Van Go artists were looking for a community service project and decided they’d like to work with the elderly.  Paige Blair, who works at the United Way’s Roger Hill Volunteer Center, heard of both wishes and connected the retirement home with the artists.  “I had no idea what to expect when they came,” says Maren Santelli, social worker with Van Go. “Some had never done portraits before.”  Both the residents and the artists are loving the experience.
•••
So far, the artists have gone to Pioneer Ridge three times, with each of the six artists completing a portrait apiece during the 60 to 90 minutes they’re there. They’re drawing in pencil and oil pastels.  “Every person is different,” says Sarah Garlow, a 22-year-old artist. “Some people are really responsive, and some people don’t even know we’re there. But everybody’s been really sweet.”  From an artistic point of view, Garlow says, the biggest challenge is getting the colors in the face, the facial lines and the hair to look just right.
“Their hair is so fine, and it has lighter colors,” she says.  For many of these residents, this is the only artist portrait they’ll ever sit for in their lives. There’s some pressure to make it look good, says Andrew Padilla, another 22-year-old artist.  But he adds: “With this age group, they’re not going to care if it’s not great. They’re not criticizing our artwork.”  In fact, Garlow says, every one of her models has been appreciative of the final result.  “Most of them don’t know what to expect,” she says. “They’re happy with what they get.”
•••
And Angelina Sterrett, who helped conceive of the project, says the residents’ families have been happy, too. She’s activities director at Pioneer Ridge.  “The styles are all so very different,” Sterrett says. “All the residents have been pleased.”  Sterrett is encouraging families to pay to frame the portraits, with hopes of exhibiting them around April. For now, many of the residents have the artwork hanging in their rooms.  Jean Kitchen, whose husband, Bill, had his portrait drawn, was pleased with the results.  “I thought they captured a fair likeness,” she says. “They did a good job with his eyes.”
•••
Tillie Dodson sits down for lunch among her fellow residents.  There’s a dull hum of conversation in the room. She’s glowing about her portrait experience. It was fun, she says.  But she notes: “A lot of older people — and I’m one of them — feel you shouldn’t have your portrait sketched. Maybe when you’re 18, but not now.”  So how did she think her portrait turned out? Well, sometimes the truth hurts a bit.  “It didn’t look like me,” she says with a smile. “It looked like my great-grandmother.”

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  CMS Medicare Updates

Fee-for-Service Provider Web Pages Update
The Centers for Medicare & Medicaid Services (CMS) is continually updating and improving the FFS provider web pages to make it easier for FFS providers to find important information on the CMS website.  Most of the Medicare FFS provider web pages can be found on the Medicare page (http://www.cms.hhs.gov/home/medicare.asp).  The following Medicare FFS provider web pages are a sample of what's been updated: 

1.    These sections have been improved by adding dynamic lists for provider specific regulations & notices and transmittals for Inpatient Psychiatric Facilities (http://www.cms.hhs.gov/InpatientPsychFacilPPS/) and Hospice (http://www.cms.hhs.gov/Hospice/) providers.

2.    The Educational Resources section of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting web page (http://www.cms.hhs.gov/HospitalAcqCond/) has recently been updated to include the agenda for the Hospital-Acquired Conditions and Hospital Outpatient Healthcare-Associated Conditions Listening Session scheduled for Thursday, December 18, 2008. 

3.    Effective for dates of service on or after 01/01/09, the National Correct Coding Initiative (NCCI) edits will not categorically exclude any types of services. For more information, go to the Hospital Outpatient PPS and Therapy NCCI Web Page at (http://www.cms.hhs.gov/NationalCorrectCodInitEd/02_hoppscciedits.asp).  These institutional NCCI edits will be available on or about 01/01/09 at: (http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEHOPPS/list.asp).  To review the types of NCCI edits that were previously excluded from the institutional version but are currently included in the physician version for these categories, refer to the NCCI files on the following page: (http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp).  

4.    See the updates to the Competitive Acquisition for Part B Drugs & Biologicals (http://www.cms.hhs.gov/CompetitiveAcquisforBios/) web pages which reflect the major changes to this program.


Flu Season Is Here!
Medicare provides coverage of the flu vaccine without any out-of-pocket costs to Medicare patients. No deductible or copayment/coinsurance applies. For quick information to assist with filing claims for the influenza vaccine and it’s administration, the Centers for Medicare & Medicaid Services (CMS) has prepared The Quick Reference Information: Medicare Part B Immunization Billing Chart (Feb. 2008) - This two-sided laminated reference chart gives Medicare fee-for-service physicians, providers, suppliers, and other health care professionals a quick reference to coding and billing information. To view, download, and print the quick reference chart, go to http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf on the CMS website. To order a copy, free of charge, go to the MLN Products Ordering web page at http://cms.meridianksi.com/kc/pfs/pfs_lnkfrm_fl.asp?lgnfrm=reqprod&function=pfs .


Medicare Payment and Supplier Requirements for Oxygen and Oxygen Equipment
The Centers for Medicare & Medicaid Services (CMS) has released an MLN Matters article that emphasizes important information on Medicare payment and supplier requirements for oxygen and oxygen equipment.  To assure proper implementation of these policies, the MLN Matters article focuses on significant supplier requirements for furnishing oxygen and oxygen equipment to our beneficiaries.  The article (# SE0840 entitled, Changes in Medicare Payment for Oxygen and Oxygen Equipment) is available on the CMS website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0840.pdf .

New Institutional NCCI Edits to Be Applied to Claims
To review the types of NCCI edits that were previously excluded from the institutional version but are currently included in the physician version for these categories, refer to the NCCI files on the following site: http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage .  One may use anesthesiology, evaluation and management, or mental health services CPT or Level II HCPCS codes to search these files.  A subset of the corresponding edits in the physician version is being added to the institutional version.  Consistent with longstanding practice, CMS makes specific decisions about NCCI edits that are appropriate for facilities, incorporating comments on potential edits from relevant professional associations and, therefore, the institutional NCCI edits may differ from the physician NCCI edits. 
Affected providers should begin immediately to educate their staff about the application of the additional categories of NCCI edits to their claims.  Note that at this time no additional providers will be subject to NCCI edits.
 

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  Internet-Based Medicare Enrollment Is Available

MEDICARE PHYSICIANS AND NON-PHYSICIAN PRACTITIONERS
INTERNET-BASED MEDICARE ENROLLMENT IS AVAILABLE
in 24 STATES and the DISTRICT OF COLUMBIA
 
Now there’s a better way for physicians and non-physician practitioners to enroll or make a change in their Medicare enrollment information.  The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will allow physicians and non-physician practitioners to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, or check on the status of a Medicare enrollment application via the Internet.

Last week, CMS announced that Internet-based PECOS is available to physicians and non-physician practitioners in District of Columbia and the following States:
 
       Delaware                      Minnesota                    New Jersey                 
       Idaho                           Missouri                       North Carolina            
       Illinois                           Nebraska                     Pennsylvania
       Iowa                            Maryland                      Tennessee
       Kansas                         Michigan                      Wisconsin
 
Physicians and non-physician practitioners in the States shown and the District of Columbia who wish to access Internet-based PECOS may go to https://pecos.cms.hhs.gov.

CMS will expand the availability of Internet-based PECOS for physicians and non-physician practitioners to all States over the next 2 months.  In addition, CMS will make Internet-based PECOS available next year to all providers and suppliers (except durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers).

Fast
By submitting the initial Medicare enrollment application through Internet-based PECOS, a physician or non-physician practitioner’s enrollment application can be processed as much as 50 percent faster than by paper.  This means that it will take less time to enroll.

Physicians and non-physician practitioners are required by regulation to report certain changes in their enrollment information within specified timeframes.  Internet-based PECOS will allow them to update, make corrections, and check on the status of their Medicare enrollment applications —again, as much as 50 percent faster than by paper.  Changes include a change in practice location, ownership, or final adverse action (e.g., medical license suspension or revocation.)  For additional information about the types of changes that must be reported, go to the download section of www.cms.hhs.gov/MedicareProviderSupEnroll.

Secure
Internet-based PECOS meets all required Government security standards in terms of data entry, data transmission, and the electronic storage of Medicare enrollment information.  Only authorized individuals can enter enrollment information into PECOS or view PECOS data from the Internet.  Authorized individuals include physicians and non-physician practitioners.  Their User IDs and passwords protect the access to their enrollment information. After physicians or non-physician practitioners create User IDs and passwords or change their passwords, they should keep this information secure and not share it with anyone. By safeguarding their User IDs and passwords, they are taking an important step in protecting their enrollment information. CMS does not disclose Medicare enrollment information to anyone except when we are authorized or required to do so by law.

Easy
Internet-based PECOS is a scenario-driven application process with front-end editing capabilities and built-in help screens. The scenario-driven application process will ensure that physicians and non-physician practitioners complete and submit only the information necessary to enroll or make a change in their Medicare enrollment record.  In contrast to the information collected on the CMS-855I, physicians and non-physician practitioners will no longer see questions that are not applicable to their enrollment scenarios when using Internet-based PECOS.

Additional Information
For information about Internet-based PECOS, including important information that physicians and non-physician practitioners should know before submitting a Medicare enrollment application via Internet-based PECOS, go to www.cms.hhs.gov/MedicareProviderSupEnroll.
 
 

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  AHCA Updates

 Kohl Workforce Bill Introduced
Yesterday, Senate Special Aging Committee Chairman Herb Kohl (D-WI) introduced a comprehensive workforce development bill, Retooling the Health Care Workforce for an Aging America Act of 2008 (S. 3730). AHCA/NCAL endorsed this bill, which seeks to expand vital education and training opportunities in long term care as well as geriatrics for nurses, physicians, psychologists, social workers, nurse aides, and family caregivers among others. Click here for a summary of the bill. We were pleased to work with Chairman Kohl's staff during the drafting process.

IRS Releases Proposed Regulation on 3% Withholding
The IRS has released a notice of proposed rulemaking regarding the Tax Increase Prevention and Reconciliation Act of 2005 (TIPRA). Section 511 of TIPRA requires that government agencies making any payments to individuals shall deduct and withhold an amount of 3% of such payment. These payments will apply to Medicare payments, but not Medicaid. This provision will become effective to payments made after December 31, 2010. The 3% withholding will not only deprive nursing homes and other providers of critical funds, it will impose new administrative burdens, and may create cash flow problems.

AHCA is part of a coalition working to repeal this provision. To view the coalition whitepaper on this issue, please click here. Senator Larry Craig (R-ID) and Representative Kendrick Meek (D-FL) have introduced legislation to repeal this provision and it is expected that legislation will be reintroduced in the 111th Congress. AHCA is in the process of reviewing the proposed rule and will file comments prior to March 5, 2009.

CMS Final Rule on State Flexibility for Medicaid Benefit Packages
CMS released a final rule to implement Section 6044 of the Deficit Reduction Act (DRA) that allows states flexibility to define the scope of covered Medicaid medical services by offering benchmark benefit packages or benchmark-equivalent packages in place of the standard Medicaid benefit package. The impact for individuals in long term care facilities is lessened because these vulnerable populations are exempt from mandatory enrollment in a benchmark or benchmark-equivalent benefit package. 

AHCA/NCAL commented on the proposed rules, asking CMS to strengthen the requirements relating to the exemption of vulnerable populations. CMS revised the final rule to require states to "effectively" inform individuals that enrollment is voluntary and amended the final rule to clarify that "informed choice" must take place before enrollment in the benchmark plan and requires an individual's file to be documented to reflect that they were fully informed and had ample time for an informed choice. 

AHCA/NCAL Joins Request To Fund Lifespan Respite Care Act
AHCA/NCAL recently signed on to a letter to Congressional leaders
hip requesting funding for the Lifespan Respite Care Act in the FY 2009 Labor, HHS and Education Appropriations bill. The Act authorizes competitive grants to Aging and Disability Resource Centers in collaboration with a public or private non-profit state respite coalition or organization to make quality respite available and accessible to family caregivers regardless of age or disability. The Act has board bipartisan support. 

OSHA Final Rule On Personal Protection Equipment
OSHA will publish in the Federal Register the "Clarification of Employer Duty to Provide Personal Protection Equipment and Train Each Employee" final rule. AHCA/NCAL commented on this rule and are pleased with some of the clarifications made. The contents of the final rule which most apply to long term care are:

* Employers will be required to provide personal protective equipment (PPE,) to every employee whose position requires, and can be cited for noncompliance on a per-employee basis. 

* Employers shall institute a training program for PPE for every employee whose position requires it, and ensure employee participation in the program. Failure to train an employee may be considered a separate violation.

* The above requirements also apply to temporary workers. 

* The employer can argue that employee non-compliance led to lack of/inappropriate PPE use, and that per-employee violations are not appropriate. 

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