KHCA/KCAL Holiday Office Hours

Merry Christmas from your staff at KHCA/KCAL. The office will be closed Thursday, December 24th and will return to normal business hours Monday, December 28th. We wish you all the blessings of the season.

Cindy, Linda, Karla, Carol, Joleen, Letty and Andy

[ Return to top]

 
  Provider Assessment Gains Momentum

The likelyhood of a provider assessment  bringing in millions of  matching federal dollars to the state's crippled Medicaid program gained momentum last week with a statement from Governor Mark Parkinson.  Quoted from an interview he did with the Kansas Health Institute published 12/18/2009, Govenor Parkinson said,  “I believe implementing a provider tax is one of the best ways to help the nursing homes that actually take Medicaid residents,” Parkinson said. “That’s what I have told our Secretary on Aging and he and I are on the same page on this. If the provider tax can successfully make its way through the Legislature,” the Governor said, “we’ll be supportive.  That doesn’t solve the general fund problems, but it is very helpful to the nursing homes.”

The Medicaid Provider assessment is a bona fide legal funding mechanism for federal matching funds to be used for reimbursement of Medicaid covered services.

36 states, plus the District of Columbia, currently have a Medicaid Provider assessment program in place, including Iowa, passed in the 2009 legislative session.

The Kansas Department on Aging presented a model to implement a Medicaid reimbursement program using the Provider Assessment.  This was presented to the Kansas Health Policy Authority Board, at their November 17th, 2009 meeting.  Action was deferred until January 2010.

You will receive an action alert in the next week.  At that time we will ask you to contact your Kansas Senators and Houses members.  Please wait until then because we will be sending corresponding information to them about the 10% Medicaid cuts and reimbursement issues for you to discuss with your legislators.

The Board of Directors and Government Affairs Committee believe we must  evaluate along with other providers and KDOA whether or not we are maximizing enough dollars. There is an opportunity to increase the provider assessment and correspondingly generate a greater amount of federal funding that might cover provider costs as well as provide for some rate relief.

In response to the 10% Medicaid cuts it would be beneficial to try and draw down more federal dollars especially while the matching rate for Kansas currently is around 70%.

The Provider assessment is a reimbursement program that covers all providers equally.  For profit and not for profit homes are treated the same.  The difference in how homes are assessed is all about their Medicaid residents.  The more Medicaid per patient days billed, the more the reimbursement system will benefit your home.

If you have questions, please call Cindy Luxem at 785-267-6003 cluxem@khca.org or Steve Hatlestad, KHCA Board Chairman, 816-810-8881 shatlestad@americareusa.net.

[Return to top]

 
  KHCA Staff attends CMS Region 7 Meeting

On December 16 and 17, 2009 KHCA CEO Cindy Luxem and Education Director Linda MowBray attended a summit with state affilates from Iowa, Missouri and Nebraska before meeting with officials from CMS Region 7. Issues ranged from RAC audits and QIS survey to Life Safety Codes and the Special Focus Program.

 KHCA members Angela Moore, Sharon Lane Health Services and Stan Johanning, Golden LivingCenters, joined the meeting December 17th to hear first hand from Paul Schumate, Jennifer King, Kathy Achor, Robert Epps and Jackie Stanard from CMS. KHCA will be providing you with additional information from this very productive and informative meeting in the coming weeks.

[Return to top]

 
  CMS Life Safety Code Waiver Form

During the recent CMS Region 7 meeting in Kansas City, Mo Life Safety Code Expert Kathy Achor provided the following waiver form for facility seeking exemptions to current Life Safety Code requirements. Contact the KHCA office at khca@khca.org for an original copy of this form.

Name of Facility________________________________________________________________________ 
           
City/State____________________________________________

CCN#_____________________________   Phone # __________________________

Contact Name/Title_________________________________________
           
Survey Date ________________ K-Tag ____________   Annual or Temporary

Requested Waiver End Date________________   Please use one form per K- tag waiver request

Temporary Waivers; Allow a nursing home time to implement an acceptable POC without the imposition of mandated remedies. Progress reports regarding the advancements or problems should be made to the State Agency Fire Authority. Extensions must be requested prior to a RV and limited to extreme circumstances. Failure to achieve compliance by the end-date will result in the recommendation of an appropriate enforcement remedy which will be imposed as outlined in 7410F3 of the SOM.

Annual Waivers; Allow a facility to achieve compliance when it is difficult to correct a requirement. Waivers will be re-evaluated during subsequent recertification surveys.

Additional Safety Measures:  The POC must address increased fire safety awareness as required by SOM 7410F1 and the documentation of the additional safety measures shall be kept on-site and provided to surveyors.

Create or choose from additional safety measures below to compensate for the deficiency:
Circle items chosen and attach details.
1. Additional Fire Extinguishers
2. Additional smoke detection
3. Additional sprinklers/water curtain
4. Infrared inspection of motors and electrical panels
5. Additional inspections
6. Local fire department: monthly inspections
7. Additional maintenance
8. Local fire department: quarterly inspections
9. Install additional/horizontal exit
10. Local fire department: review of emergency plans
11. Additional fire drills
12. True fire watch
13. Safety rounds (dedicated, all areas inspected for  fire safety issues)
a. Once per shift/per day                                          b. Once per day      
14. HVAC shut down tied to fire alarm
15. Practical and/or competency skills testing
16. Hands-on fire extinguisher training
17. Emergency procedure training
18. Hire a structural/electrical/ fire protection engineering firm to develop a plan of action
19.
20.

Due Dates
                                                         

Justification

Send information to your Fire Authority on the following dates

Milestones

Evidence of Correction
(within 15 days of end date)
      

Evidence the deficiency does not pose a hazard to the occupants

How correction poses a hardship to the facility 

Construction milestones (NA for annual waivers)

Administrator (Signature)

Title
Date
Corporate Office  (Signature)

Title

Date
Failure to follow the plan may result in waiver revocation and enforcement actions
Waiver Request of Specific Life Safety Code Provisions  7/2/2009

Katharine Achor | Health Quality Review/LSC Specialist | Centers for Medicare & Medicaid Services Midwest Consortium Division of Survey, Certification & Enforcement | 601 East 12th Street, Room 235, Kansas City, Mo 64086 | phone (816) 426-6480 | fax (816) 235-7361 | katharine.achor@cms.hhs.gov

[Return to top]

 
  KDOA and KU School of Social Welfare Conduct Study

Study on Discharging Medicaid Nursing Facility Residents with Mental Health Diagnoses to the Community

The Kansas Department on Aging is collaborating with the Office of Aging and Long Term Care (OALTC) at the University of Kansas, School of Social Welfare to conduct a study.  The purpose of the study is to determine successful strategies that have been used to discharge Medicaid nursing facility residents with mental health diagnoses to the community. 

The OALTC will be sending out letters requesting participation in the study to a number of nursing facilities who have discharged Medicaid residents with mental health diagnoses to the community.  This information will be gathered from submitted MDS data. Then, OALTC staff will call administrators to provide further information about the study and discuss participation possibilities.  For questions, please contact Skye Leedahl, with the OALTC, at 785-864-4778 or skyel@ku.edu.

[Return to top]

 
  Acceptable Language for Natural Gas Generator Backup Fuel Source

Examples of Acceptable Language for Natural Gas Generator Backup Fuel Source Letter 
Midwest Consortium Division of Survey and Certification
October 28, 2009

On May 29, 2009 CMS RO V released information regarding Natural Gas Generator Backup Fuel Source Letter Requirements which stated:

Natural Gas Generator Backup Fuel Source Letter Requirements

We want to pass on to you some clarifications related to the backup fuel source for natural gas generators. These clarifications resulted from discussions between Midwest Consortium staff and Jim Merrill and Cindy Graunke of CMS Central Office.

All nursing homes are required to have an on-site backup power source.  If a facility uses a natural gas generator to provide backup power to LSC required systems (i.e., emergency lights, exit lights, fire alarm system, etc.), the facility may obtain a letter from its natural gas vendor to demonstrate the fuel source is reliable and to meet the requirements for an on-site backup power source.  A facility with a natural gas generator may use other means to meet the requirements for an on-site backup power source that do not require a letter from its natural gas vendor.

The letter of reliability from the vendor regarding the fuel supply must contain all of the following:

1. A statement of reasonable reliability of the natural gas delivery
2. A brief description that supports the statement regarding the reliability
3. A statement that there is a low probability of interruption of the natural gas
4. A brief description that supports the statement regarding the low probability of interruption
5. The signature of technical personnel from the natural gas vendor.

Examples of acceptable language for each criterion include, but are not limited to:

Criterion 1:  A statement of reasonable reliability of the natural gas delivery

Example 1:  The natural gas service we provide has been, and continues to be reliable in the areas we serve. 

Example 2:  The gas system has been and should continue to be very reliable.

Example 3:  This supply and regulation assists the vendor’s natural gas distribution system to operate in a reliable, safe and economical manner.

Example 4:  The vendor’s delivery of natural gas is consistent with the reasonable reliability required by your facility.
Criterion 2:  A brief description that supports the statement regarding the reliability

Example 1:  On an annual basis, natural gas service has historically been maintained 99.9 percent of the time to our customers. 

Example 2:  Over the past five years, the vendor has annually experienced an average of four unscheduled gas system disturbances affecting 100 or more customers. Each outage affected an average of 252 customers.  This means, on average during each of the past five years, 99.64% of the vendor’s gas customers were not affected by a reportable unplanned gas system outage.

Example 3:  In 2008, the vendor provided uninterrupted service to 99.64% of our over 1.2 Million customers.

Example 4:  The vendor’s natural gas system is served from two different sources.  Each source is capable of serving the entire system.  After checking our records and local knowledge for the last 25 years, we have found no information indicating that the system was ever shut down or that it lacked the capacity to serve the system.

Example 5:  Our system has been designed to operate continuously, even in the coldest of temperatures, when the demand for natural gas is at “peak day demand”.  In addition, our system has been designed to operate during major widespread power outages such as the one that occurred on August 14, 2003 that interrupted electrical power to most of our service area while not impacting gas deliveries to our customers.

Example 6:  From an engineering and operational perspective, the vendor has a very sophisticated pipeline system model that is used to proactively identify areas where system reliability could be a concern. Once areas of potential reliability concern are determined, construction and operations plans are developed and implemented to address the concerns.
Example 7:  The vendor’s natural gas system has been designed and sized to accommodate your natural gas needs using the equipment at your facility including your natural gas emergency back-up generator to ensure the reliability of the system when it is required under full fuel load under all circumstances.
Criterion 3:  A statement that there is a low probability of interruption of the natural gas

Example 1:  Occasionally, construction dig-ins or other situations occur and can affect small portions of our distribution system for a limited time.  If we need to schedule required maintenance that may affect your natural gas service, we notify you in advance and try to make arrangements to accommodate your specific needs.

Example 2:   We do have “dig-ins” on occasion which can affect small portions of the system for a limited amount of time.  We also periodically do system upgrades that can require outages.  These are planned and coordinated with affected customers. 

Example 3:  We do experience system disturbances on occasion including “dig-ins”, meaning excavators sometimes damage our underground distribution system while digging.  This can affect portions of a local distribution system for a period of time while repairs are made.

Example 4:  The vendor periodically performs system upgrades that can require outages for a limited amount of time.  These outages are planned and coordinated with affected customers.

Criterion 4:  A brief description that supports the statement regarding the low probability of interruption

Example 1:  Our natural gas system was installed in compliance with Federal and State Gas Safety Standards.  Gas mains and services are installed below grade at approved depths specified in Federal and State Gas Safety Standards.  This provides significant protection to our facilities from floods, storms and damage from freezing.  In addition, the risk of damage to gas facilities by earthquakes in this state is low.
 
Example 2:  Our system has a very low probability of interruption as our lines are installed at a depth that is in compliance with company, local and national standards/codes.  Furthermore any construction within the area requires a 72 hour notification of the dig safety network to insure all public utilities are properly marked, prior to digging, in an effort to avoid interruption of service

Example 3:  Of the 0.36 % that were interrupted, over 43% of those interruptions resulted from third-party construction damage, which are outside of the vendor’s control.
Example 4:  Our distribution pipeline system is subject to two types of outages – planned and unplanned.
* With planned outages, the vendor notifies customers of the reason for the outage in advance so arrangements can be made by the customer if they are required during the scheduled outage. For interior equipment upgrades, an appointment is scheduled at the customer’s convenience. Company records indicate that the average length of time for a planned outage is between two and four hours.
* Unplanned outages occur due to circumstances beyond our company’s control; e.g., a contractor damages a distribution pipe during road repair work. The length of time before gas service is restored due to an unplanned outage is dictated by the magnitude of the damage; however, the vendor makes its best effort to minimize the outage time in these cases. While we cannot anticipate such unplanned outages,   we track our response time performance on a monthly basis for these emergencies. In July 2009, for instance, we arrived within 60 minutes at the sites of unplanned outages 98% of the time and in 2008, we arrived within 60 minutes 97.3% of the time.

Criterion 5:  The signature of technical personnel from the natural gas vendor.

Example 1:  P.E., Supervising Engineer, Gas Operations Planning, Gas Distribution Asset Management
Example 2:  Manager – Gas Distribution Design 
Example 3:  My technical job responsibilities have included the design, maintenance and management of gas distribution systems over the past 23 years.

1

[Return to top]

 
  CMS clarifies Life Safety Plan of Correction

Plans of Correction (POC)

At a recent CMS Region 7 meeting in Kansas City, Mo CMS Life Safety Specialist Kathy Achor provided clarifiation on Life Safety Plan of Correction.

What corrective actions will be accomplished for those residents found to have been affected; Include specific corrective actions you will take to correct each deficient practice, including timetables and staff positions assigned to accomplish the corrections.

How you will identify other residents having the potential to be affected by the same deficient practice and your corrective actions; Explain the steps you will take to identify other occurrences of the same practice throughout your facility (in addition to those cited by the LSC surveyor). Include timetables and identify responsible facility staff.

What systemic changes you will make to ensure that the deficient practice does not recur; Describe the measures established to ensure the deficient practice is eliminated. Some measures that may satisfy this element: training, consultants, interdisciplinary quality improvement team, environment or staff changes.

How the corrective actions will be monitored to ensure the deficient practice will not recur/what QA program will be implemented; describe how you will monitor your corrective actions to ensure they are implemented, address the identified problems, and continue to be effective. Describe what will happen to the monitoring information: how often it will be collected, who will see it, where it will be kept, and what will trigger additional action.

A written credible allegation of compliance; A POC cannot be accepted unless it includes a written allegation of substantial compliance: “This plan of correction constitutes a written allegation of substantial compliance with federal Medicare and Medicaid requirements.”

Your POC can document the correction of deficiencies such that a Federal revisit will not be necessary. Therefore your POC must include evidence of correction, such as:

* Bids/Purchase orders/Receipts/Invoices/Contracts
* Specification sheets regarding fire properties (Not the MSDS)
* Pictures/Drawings/Code Footprint/Plan Review
* Development or Revision of Policies & Procedures
* Provision of New Equipment
* New Forms/Tickler systems
* Training outlines/Staff sign-in sheets
* Change in staff assignments
* Inspection, testing and maintenance results

 Compliance dates beyond 30 days ~ Please request a temporary waiver

 Please provide a copy of your POC to your State Fire Marshal

Appeals:  Informal Dispute Resolution (IDR)
Long-term care facilities may appeal the findings of noncompliance; Submit your written request to our office with an explanation of the specific deficiencies that are being disputed within the same 10-day period for submitting a POC. The IDR will not stop the imposition of remedies and a delay in submitting a POC for contested items is done at your own risk. The IDR cannot be used to challenge scope and severity or the remedies imposed. Deficiencies upheld must be immediately addressed in a POC. An immediate imposition of remedies will occur if this POC is not acceptable.

Alternative Measures:  FSES (Fire Safety Evaluation System)
The FSES (NFPA 101A, Chapter 4, 2001 edition) can be used to assess the level of safety in a facility that does not conform to the Life Safety Code. The FSES may be applicable when a facility has deficiencies that may be cost prohibitive/impossible to correct. This option is required to be completed annually after each survey and submitted as part of your plan of correction. The facility may hire a qualified contractor to complete the FSES.

All weather Path to Safety & Canopy Sprinklers; Facilities that do not have an all-weather path to safety may choose to use the FSES. Facilities may also use the FSES option to comply with unsprinklered canopies until 8/13/2013, at which time every facility must have a complete, automatic sprinkler system installed in accordance with §483.70(a)(7)(iii)(B).

Alternative Measures:  Performance Based Design
Performance-based design is an engineered alternative to the prescriptive requirements. This is used in unique situations and requires hiring a qualified contractor to perform fire modeling in accordance with the provisions of Chapter 5 of NFPA 101, 2000 edition.

Alternative Measures:  Waivers
Temporary Waivers; Allow a nursing home time to implement an acceptable POC without the imposition of mandated remedies. The POC must address increased fire safety awareness as required by SOM 7401 and the documentation of the additional safety measures shall be kept on-site and available to surveyors. Progress reports regarding the advancements or problems should be made to the State Agency and the CMS Regional Office. Extensions must be requested prior to a RV and limited to extreme circumstances. Failure to achieve compliance by the end-date will result in the recommendation of an appropriate enforcement remedy which will be imposed as outlined in 7410F3 of the SOM.

Annual Waivers; Allow a facility to achieve compliance when it is difficult to correct a requirement. The POC must address increased fire safety awareness as required by SOM 7410F1 and the documentation of the additional safety measures shall be kept on-site and available to surveyors. Waivers will be re-evaluated during subsequent recertification surveys.

Federal LSC Survey Plans of Correction, Appeals and Alternatives       July 1, 2009

Katharine Achor | Health Quality Review/LSC Specialist | Centers for Medicare & Medicaid Services Midwest Consortium Division of Survey, Certification & Enforcement | 601 East 12th Street, Room 235, Kansas City, Mo 64086 | phone (816) 426-6480 | fax (816) 235-7361 | katharine.achor@cms.hhs.gov

[Return to top]

 
  Flu Season is Here!!

Flu Season is Here!

Annual outbreaks of the seasonal flu usually occur from late fall to early spring.  Typically, 5 to 20 percent of Americans get the seasonal flu, resulting in approximately 36,000 flu-related deaths.[1]  

If you have Medicare patients who haven’t yet received their flu shot, you can help them reduce their risk of contracting the seasonal flu by recommending an annual seasonal influenza vaccination.  Medicare provides coverage of the seasonal flu vaccine and its administration.  And don’t forget to immunize yourself and your staff.  Protect yourself, your staff, your patients, and your family and friends.

Remember - Influenza vaccine plus its administration are covered Part B benefits.  Note that influenza vaccine is NOT a Part D covered drug.

For information about Medicare’s coverage of the seasonal influenza virus vaccine and its administration as well as related educational resources for health care professionals and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website.  You will find a variety of resources that explain Medicare coverage and claims submission policies related to the seasonal influenza vaccine.

For information on Medicare policies related to H1N1 influenza, please go to http://www.cms.hhs.gov/H1N1 on the CMS website.

[1] Flu.gov. 2009. About the Flu [online]. Washington DC: The U.S. Department of Health and Human Services, 2009 [cited 30 November 2009]. Available from the World Wide Web:
(http://www.flu.gov/individualfamily/about/index.htm )
Note:  If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. 

[Return to top]