Swine Flu Update and Resources

The 2009-H1N1 flu, commonly known as swine flu, continues to be a national public health emergency. As of press time, the World Health Organization (WHO) has raised the level of influenza pandemic alert to a Phase 5 threat and the Centers for Disease Control and Prevention (CDC) have reported 1 fatality and a total of 109 confirmed 2009-H1N1 flu cases in 11 states.

There has been one reported case of swine flu in a long term care facility in New York. The resident, and any residents and staff who were in contact with the resident who may have contracted swine flu, are reported to be on Tamiflu®. It is critical that all care staff, visitors and residents are reminded of the importance of thoroughly washing hands and covering coughs.

In a hearing before the U.S. Senate Committee on Homeland Security and Government Affairs, one of four hearings on swine flu scheduled this week in Congress, Department of Homeland Security (DHS) Secretary Janet Napolitano noted that it is time to “dust off pandemic flu plans.” AHCA/NCAL encourages all of our member facilities to review their pandemic plans and consider how to keep fully staffed if schools in the community close temporarily. 

AHCA/NCAL has developed a swine flu resources page on its website. Please continue to view this site, which includes “real time” updates, for the latest developments. For the most up-to-date information on the number of Swine Flu cases and where they are, please visit the CDC’s website. For more information about influenza pandemics and their impact on long term care providers, please view the Provider article “Pandemic Preparedness, Plugging Into Community Networks.”

www.khca.org has flu resources available on the website.

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  Stimulus Payments to Social Security Recipients!

Stimulus Payments to SS and SSI Recipients.pdf

The American Recovery and Reinvestment Act of 2009 (ARRA) authorized the Social Security Administration to issue a one-time payment of $250 to anyone who gets a Social Security benefit, Railroad Retirement, or Veterans Administration (VA) disability pension. Also, most people who get Supplemental Security Income (SSI) will receive the payment (read 2nd bullet below for exclusions). 

The stimulus payment is not considered income and will not be counted as a resource for 10 months (including the month of receipt) in calculating benefits under Medicaid (or any other federal program or state program with some federal financing). The $250 will also not count as gross income for tax purposes. The checks will begin arriving in late May 2009.  Recipients can save the payment if they want to, but they should make sure that it will not put their savings over the asset limit for any program benefits they may receive as of February 2010.

*       Who is eligible for the one-time payment?
o       Nearly 55 million Social Security and some Supplemental Security Income (SSI) beneficiaries (see below for exclusions) will receive a one-time payment of $250 each.

o       Social Security and/or SSI beneficiaries with multiple sources of income will receive the $250.  This would include nursing facility “spend down” residents and “medically needy” residents.  Medically needy persons qualify for Medicaid categorically, but are "over income." These individuals can "spend down" to the Medicaid level by deducting "incurred" medical expenses.

*       Who is NOT eligible for the payment?

o       SSI beneficiaries whose only source of income is SSI and who reside in a medical treatment facility (such as a nursing home or hospital) and Medicaid pays the cost of their care.
o       Individuals who were not eligible for Social Security and SSI benefits at any time during the months of November 2008, December 2008, or January 2009 are not eligible for the one-time payment.

*       How can the payment be used?
o       The payment can be used as the beneficiary chooses.
o       If payment is received by a representative payee, the payee must use the payment for the beneficiary’s needs and has a duty to use his or her judgment about the best use of the payment.

We have received some questions regarding whether the $250 payment can be used by a long term care facility for the cost of resident care.  It is our current understanding that it cannot.  However, this issue is currently being explored by CMS and SSA and further guidance is expected.  We will communicate this additional guidance to you as soon as it is available.  Until such time, we advise that facilities do not apply the $250 payment to the resident’s cost of care, unless expressly directed to do so by the resident.

NCOA’s leaflet for LTC facility residents:

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  Quality of Life and Environment Tag Changes
effective June 17, 2009

In April 2008, CMS and the Pioneer Network sponsored a symposium on Culture Change and the Environment. That symposium was the catalyst for CMS proposing updates to surveyor guidance at tags related to Quality of Life and Environment. CMS has now issued those revisions, which will be implemented June 17, 2009.

While most modifications are modest, the intent is to both allow and encourage nursing homes to incorporate culture change elements in their delivery of care and in the physical environment.

SC09_31 QualLifetagchanges.pdf

final QL_Tag_Changes 2.pdf

AHCA/NCAL and the Pioneer Network are holding a two-part webinar to help you prepare for the above requirements.  This will be a unique opportunity to hear directly from CMS Division of Nursing Homes Deputy Director, Karen Schoeneman, and Debra Swinton-Spears.  Plan to join AHCA Thursday, June 11 and Thursday, June 18 from 11:00-12:30PM CDT.  Registration will be available soon on the AHCA website.  As soon as this is available KHCA will let you know.

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  Five Star Information

 
The Five-Star provider preview reports were available for providers beginning Thursday, April 16, 2009. Providers can access the report from the MDS State Welcome pages available at the state servers for submission of Minimum Data Set data using the following directions:

*       Visit the MDS State Welcome page available on the State servers where you submit Minimum Data Set (MDS) data to review your results.
*       Select the CASPER Reporting link located at the bottom of the login page.
*       Once in the CASPER Reporting system, 

 i.     Click on the 'Folders' button and access the Five Star Report in your 'st LTC facid' folder, 
ii.     Where st is the 2-digit postal code of the state in which your facility is located and 
iii.     Facid is the state assigned facid of your facility.

The Five-Star Helpline: 1-800-839-9290
There will be no Five-Star helpline access for the months of May and Juneto coincide with the release of each month’s preview data.  For Five-Star provider preview questions during these months use the
BetterCare@cms.hhs.gov email. 
The helpline will begin quarterly operation beginning in July. 

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  DEA Steps up Enforcement against LTC pharmcies

The DEA is surveying and citing LTC pharmacies for not being in compliance with the Controlled Substances Act.  The attached memo identifies the issues and the implication of the DEA position on LTC facilities.

AHCA is working with a group of LTC organizations lead by the consultant pharmacist.  We are in the process of arranging a webinar to discuss the issues and identify what facilities will need to do to ensure patients receive Class II (narcotic) medications for pain control on a timely basis.

DEAIssuePaper041609.doc

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  Medicare Proposed Rule: Includes $1.5 Billion Forecast Error Adjustment

Late today the Centers for Medicare & Medicaid Services (CMS) issued its Notice of Proposed Rule Making (NPRM) for FY 2010 (beginning October 1, 2009) payment updates for skilled nursing facilities (SNFs). Our initial analysis of this rule indicates there are three critically important components for our profession – a full market basket update for FY 2010, and a cut in the form of an adjustment of Resource Utilization Group payment rates. The proposed rule also invites comment on changes resulting from the Staff Time and Resource Intensity Verification (STRIVE) Project, which would not be implemented until FY 2011. 

Our initial review of the proposed rule finds that it includes a full market basket update of 2.1 percent, or approximately $660 million in additional Medicare funds for FY 2010. We anticipate that the Obama Budget and Congress may seek to eliminate this update altogether to generate additional budget savings.

The proposal cuts Medicare SNF payments to account for a budget neutrality “forecasting error” made by CMS in 2005 - similar to last year's proposal. This rule seeks to correct for the error and includes a proposed recalibration of case mix weights and non-therapy ancillary services that results in a decrease in SNF payments for FY 2010 of approximately $1.05 billion. The net result of the two proposals is a decrease of SNF Medicare payments from FY 2009 to FY 2010 of approximately $390 million.

We are very concerned with CMS’ efforts to reduce any Medicare funding for rehabilitation and nursing care in SNFs. We believe that the agency fails to take into account the expanding role SNFs play in treating medically complex post-acute patients, the higher costs associated with caring for those patients and, importantly, the desired impact that re-implementation of the 75 percent rule has had on SNF patient mix and overall Medicare expenditures. 

The rule also seeks comment on a proposal that would not be implemented until FY 2011, which is the development of a Resource Utilization Group (RUG) IV payment system. RUG-IV would include changes based on the STRIVE project and would recalibrate baseline indices creating a total of 66 RUG categories.

AHCA is reviewing the proposed rule and will provide a more detailed summary to our members next week. We will also be submitting – on behalf of our membership – comprehensive comments based on a more thorough analysis. We will provide updates and information as they are available.

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  Enforcement of the Red Flag "Creditor" Rule Delayed
Delayed until August 1, 2009

As we have previously reported, The “Red Flag” Regulations became effective November 1, 2008. AHCA/NCAL has learned that the enforcement of the second rule – the creditor rule - been delayed again until August 1, 2009.

The “Red Flag” Regulations have three parts, the first two of which pertain to the health care industry. The first applies to anyone who uses “consumer reports,” defined to include credit reports, and requires users of consumer reports to develop and implement reasonable policies and procedures to deal with an address mismatch. The second part pertains to the detection, prevention and mitigation of identity theft in relation to covered accounts by “creditors or financial institutions.”

We encourage our members to visit www.ahca.org  to review our Identity Theft Tool Kit with explanations of the two rules that apply to long term care facilities.

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  AHCA Requests YOUR Help in a Quality Self-Assessment
due May 8, 2009

The American Health Care Association has requested your assistance with a Quality Self-Assessment to help measure the profession improvements.  Please take the time to complete the survey.  Find the information below.  If you have any questions, contact cluxem@khca.org.

A crucial component of this Quality Report will be a self.doc

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  Angela Moore selected for AHCA Future Leader Program

The Kansas Health Care Association announced today that Angela Moore, the administrator of Sharon Lane Health Care Center in Shawnee Kansas, has been chosen by the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) as a future leader in long term care. Angela Moore will participate in AHCA/NCAL’s “Future Leaders of Long Term Care in America” symposium on July 21 – 23, 2009, in Washington, DC.

The symposium kicks off a year-long program that offers training and guidance for long term care professionals, who have demonstrated leadership potential and an aptitude for representing the interests of long term care providers at the state and national levels. The program covers the latest theories in quality management, customer satisfaction, and leadership. 

“By participating in this program, Angela Moore and the other members of our 2009 – 2010 Future Leaders class will be better prepared to serve vital roles within the association and on behalf of the entire profession,” commented AHCA/NCAL President & CEO Bruce Yarwood. “By honing their knowledge and leadership skills,” continued Yarwood, “these future leaders will surely help to advance quality and promote the profession’s mission of providing the highest quality, resident-centered care for frail, elderly, and disabled Americans.”

“Angela is an exemplary leader in Kansas,” said KHCA/KCAL President & CEO Cindy Luxem.  She serves on the KHCA board of directors.  "Kansas is proud to share Angela with other identified leaders in the senior care profession."

AHCA and NCAL are committed to taking a proactive role in creating opportunities for long term care leaders to improve their understanding of quality management systems, and in promoting a culture of quality within their facilities. 

“The overall quality of long term care will continue to improve as we cultivate strong, skilled leaders within the long term care profession,” stated Yarwood.  

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  Kansas First Quarter Deficiency Reports

The Association attended the quarterly meeting today with KDOA to discuss survey and deficiency data.  We will have this information posted at www.khca.org by Monday for members.

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  Notice of FY 2010 Rates and Methodology Available on Line

http://www.kssos.org/pubs/register/2009/Vol_28_No_17_April_23_2009_p_487-550.pdf

You can find the Notice of proposed nursing facility Medicaid rates for FY 2010 in the document above On page 497.  If you have any questions, do not hesitate to contact Cindy at cluxem@khca.org.   The association will have a reply to the proposed Medicaid rates but all providers and corporations are urged to respond directly to the Kansas Department on Aging.

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  Kansas State University Center on Aging Request

Very soon - you will be receiving information from Kansas State University Center on Aging on an important survey on Sexuality in the Nursing home. We truly hope that you take the time to participate.

Here are three important things you need to know:

1. the survey is completely confidential 2.  survey results will be given to participants and should help them avoid deficiencies and/or penalties related to sexual incidents 3. as an incentive for participating the Center on Aging will send participants a free sexuality in the nursing home training module and family guidebook ($75 value). 

If you need more information, call
Laci Cornelison
KSU Center on Aging
785-532-2776

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  LTC Joint Workforce Summit

Kansas Health Care Association and the Kansas Association of Homes and Services for the Aging would like to invite you to attend a joint discussion on workforce needs for LTC Nurses.  Sandra Fitzler, American Health Care Association, Mary Tellis-Nayak, My Innerview and Mary Harahan, AAHSA will be a part of the very important day.  We will discuss core competencies and begin to address the need for nurses in long term care settings.

Flyer Workforce Summitt.pdf

If you have questions, please contact Cindy.

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  Transportation Survey

Do You Provide Transportation to Community Dwelling Individuals?

Over the past year KAHSA and KHCA has been participating in the Money Follows the Person Project Statewide Steering Committee.  As part of our work, we are trying to address barriers for persons who wish to receive services in their own homes.  One of the most significant barriers is lack of transportation. 

KAHSA and KHCA would like to learn about our members' current transportation services for community-dwelling individuals, and about interest in and perceived barriers to providing community transportation.  KAHSA and KHCA will synthesize the information and make it available in the Aging Update in the coming months.

http://www.surveymonkey.com/s.aspx?sm=2LzW1dHNHhwEyyBoqx4EKQ_3d_3d

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  National Nursing Home Week

Let us know if you have any special events planned for National Nursing Home Week. 

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