Have You Been Cited?

A facility in Kansas was cited by the state fire marshal's office for not having a post indicator valve (PIV) outside their facility connected to the water supply line to the sprinkler system.  This was cited under K 056. According to Life Safety Code expert Tom Jaeger, an outside PIV is not required for a new installation no less for an existing installation.  This information was corroborated by Kathy Achor through CMS Region VI.

KHCA wants to know if your facility was cited for this and if so, has the citation been removed? Please contact us at khca@khca.org if you have been cited under K 056 for not having a post indicator valve.

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  CMS to waive ban on nurse-aide training program in some civil monetary penalty cases

The Centers for Medicare & Medicaid Services on Friday published a rule in the Federal Register that will permit a waiver in some cases of the two-year ban on nurse-aide training. This will apply to facilities assessed a civil money penalty (CMP) of at least $5,000 for noncompliance that is not related to quality of care.

The rule applies only to the CMP disapproval trigger. It does not cover other events that would trigger nurse aide training disapproval. CMS will evaluate submitted waiver requests on a case-by-case basis. The rule is set to take effect May 24.

Another provision in the rule would require states to establish a procedure to permit a nurse aide to petition the state to have a single finding of neglect removed from the nurse-aide registry. This would take place if the state determines that the finding was a single occurrence, and does not indicate a pattern of abuse or neglect. CMS said it will continue to evaluate this provision before deciding whether or not to implement it.

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  CMS, MDS 3.0 AND RUGS IV

During the Skilled Nursing Facilities/Long Term Care Open Door Forum conducted Thursday, April 22, CMS reaffirmed that  RUGs IV initially scheduled for implementation in October 2010 will be delayed until October 2011 although changes to Concurrent Therapy and MDS look-back period are being implemented October 1, 2010.   CMS is currently working on guidence for facilities to make a smooth transition to MDS 3.0 with RUGs III. KHCA will make providers aware how to join the next Open Door Forum call which is scheduled for June 3, 2010 when the instructions are published.  
 
Click here for a link to the recently posted ADL Decision Flowchart to assist with the completion of the ADL assessment with MDS 3.0. The file is called MDS 3.0 ADL Flowchart April 22, 2010. Additional resouces for MDS 3.0 can be found at that link as well.
  
 

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  NFPA Codes and Standards Available to AHCA Members

The American Health Care Association (AHCA) is pleased to announce that they have made arrangements with the National Fire Protection Association (NFPA) to provide electronic access to the codes and standards referenced in the current Medicare/Medicaid Regulations to regulate fire/life safety in nursing homes.  Included is a copy of the 2000 Life Safety Code and those important codes and standards referenced in the 2000 Life Safety Code. Our agreement with NFPA is that the below link directly to the NFPA website would be posted in the members’ only section of their website.  It is important to note that these documents are not applicable to assisted living facilities.

Go to NFPA via AHCA's website. Forgot your AHCA log in and password? Call KHCA at 785-267-6003.

The service is free to all members and you do not have to be a member of NFPA to obtain access to the link.  The codes and standards are in a read-only format and cannot be copied or printed in order to protect NFPA’s Copyrights.

Based on the review of deficiencies cited in nursing homes in the past few years, the documents below were selected. Please note that the Life Safety Code contains the requirements for fire/life safety systems and equipment that must be provided in the building and for the most part, the standards contain the requirements on how to install, test, inspect and maintain the systems and equipment.

•1998 NFPA 10, Standard for Portable Fire Extinguishers:  This standard contains all the requirements for the installation, inspection, testing and maintenance of portable fire extinguishers.
•1999 NFPA 13, Standard for the Installation of Sprinkler Systems:  This standard contains all the requirements for the installation of sprinkler systems.
•1998 NFPA 25, Inspection, Testing and Maintenance of Water-Based Fire Protection Systems: This standard contains all the requirements for the inspection, testing and maintenance of sprinkler systems and fire pumps.
•1999 NFPA 72®, National Fire Alarm Code®:  NFPA 72 is actually a standard and not a code and contains all the requirements for the installation, inspection, testing and maintenance of fire alarm systems and smoke detectors.
•1999 NFPA 80, Standard for Fire Doors and Fire Windows: This standard contains all the requirements for the installation, inspection, testing and maintenance of fire doors and fire windows.
•1998 NFPA 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations: This standard contains all the requirements for the installation, inspection, testing and maintenance of kitchen range hood and duct systems to include the hood extinguishing system.
•1999 NFPA 99, Standard for Health Care Facilities: This standard contains all the requirements for the installation, inspection, testing and maintenance of  emergency power systems,  the handling and storage of oxygen and emergency management plans.
•2000 NFPA 101®, Life Safety Code®:  The Life Safety Code contains all the requirements for construction features of the building, means of egress, hazardous area, interior finishes, furniture and furnishings, and operational requirements for smoking, evacuation in case of emergencies and fire drills.
•1999 NFPA 110, Standard for Emergency and Standby Power Systems:  This standard contains all the requirements for the installation, inspection, testing and maintenance of generators and emergency electrical systems up to and including the transfer switch.
Because CMS continues to enforce an older edition of the Life Safety Code, many of the standards referenced by the 2000 Life Safety Code are no longer available for sale or posted on the NFPA website.   AHCA wants to ensure that all members have access to these important documents and made arrangements for a special posting on the NFPA website.  Reviewing the requirements in these documents should assist each member in assuring that any Life Safety Code deficiencies that are cited are cited correctly.  As well, the codes and standards provide the requirements necessary to correct the deficiencies.  We recognize that the subject of fire/life safety can be difficult and we hope that providing access to these documents will assist you in the development of your Plans of Correction.

AHCA is extremely grateful to the NFPA for arranging this special posting on their website for the long term care profession.

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  AHCA Announces Record Number of Quality Award Nominations Received

AHCA/NCAL announced that a record number of applications for the 2010 National Quality Award program were received.  A total of 998 applications; 701 Bronze, 271 Silver and 26 Gold; represents an 11% increase from 2009. Kansas has 16 homes trying for Bronze and 4 moving toward Silver.
Applicants can expect to be notified by the following dates:

Silver Applicant Notification – June 15, 2010
Bronze Applicant Notification – June 30, 2010
Gold Applicant Notification – August 30, 2010
Feedback Reports Distributed – September 30, 2010 
 
2010 AHCA/NCAL National Quality Award Recipients will be recognized on Wednesday, October 13, 2010 during the Closing General Session/Awards Ceremony at the 2010 AHCA/NCAL Annual Convention & Expo.

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  CMS Proposes Policy and Payment Rate Changes for Inpatient Stays in Acute and Long-Term Care Hospitals in FY 2011

The Centers for Medicare & Medicaid Services (CMS) recently proposed the fiscal year (FY) 2011 policies and payment rates for inpatient services furnished to people with Medicare by both acute care hospitals and long-term care hospitals. 

The proposed rule does not address inpatient hospital related provisions of the recently enacted Patient Protection and Affordable Care Act, as amended by the Health Care and Education Affordability Reconciliation Act (collectively referred to as the Affordable Care Act).  CMS expects to provide further information on the implementation of health care reform provisions in these laws that affect FY 2010 and FY 2011 IPPS payments in the near future.

CMS is proposing to update acute care hospital rates by 2.4 percent for inflation, a slight increase over the FY 2010 inflation rate, and apply an adjustment of -2.9 percentage points to recoup one-half of the estimated excess spending in FY 2008 and 2009 aggregate payments, due to changes in hospital coding practices that did not reflect increases in patients’ severity of illness.

Under legislation passed in 2007, CMS is required to recoup the entire amount of FY 2008 and 2009 excess spending from changes in hospital coding practices by FY 2012.  CMS estimates that payments to general acute care hospitals under the proposed rule for operating expenses in FY 2011 will decline by 0.1 percent, or $142 million, compared with FY 2010, and taking into account all factors that would affect spending.

CMS is similarly proposing to update long-term care hospital (LTCH) rates by 2.4 percent for inflation and apply an adjustment of -2.5 percentage points for the estimated increase in spending in FYs 2008 and 2009 due to documentation and coding that did not reflect increases in patients severity of illness.  Based on these two proposed provisions and other proposed changes, CMS estimates that payments to LTCHs would increase by 0.8 percent or $41 million.

The projected inflation updates for both types of hospitals may be revised in the final rule based on more recent data. The proposed rule would apply to approximately 3,500 acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), and approximately 420 long-term care hospitals paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS), beginning with discharges occurring on or after October 1, 2010.  Proposed payment rates are based on the most recently available data and may be revised in the final rule to reflect more current data.

Under current law, hospitals that successfully report quality measures included in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program will receive the full update for 2011.  Hospitals that do not participate in the quality reporting program will get the update less two percentage points.  Based on the required reporting in 2009, 96 percent of participating hospitals are receiving the full update this year.

CMS will accept comments on this proposed rule until June 18, and will respond to them in a final rule to be issued by August 1, 2010.  For more information, please click here.

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