Merry Christmas and Happy New Year!!
The KHCA/kcal office will be closed December 23 & 24 as well as December 31, 2010.
Have a safe and happy holiday from your staff at KHCA/kcal!

Under the design management of KHCA/kcal staffer Andrew Schafer, the KHCA/kcal website is lean, mean and ready for use. Go to www.khca.org and check out some of these features:

For pictures from some of the latest KHCA/kcal events, click on the the “About Us” tab and scroll down to "Photos."  From there you will be able to browse through an event library. Then, click on an event to view a slidesow. See a picture you like? Just click on it and instructions for a free download will guide you through the simple process of saving the picture on your computer.

Are you ready for some organization? Just click on the Events Calendar on the right side of the home page and enlarge to full view. There you will find important dates for KHCA/kcal members – from committee meetings to educational offerings. Click on the individual event and more information will appear. This includes meeting times and places as well as brochure and registration information.

Don’t forget to log in for your KHCA/kcal member prices for education events.

Need help with the log in? Contact Andrew Schafer at aschafer@khca.org.

Contact any KHCA/kcal staff member by clicking on “About Us” and scrolling down to the staff tab.
Do you have suggestions for your website? We are ready to listen and serve! Send your comments to khca@khca.org.

KHCA/kcal’s Winter Conference is January 25 & 26, 2011 in Topeka at the Ramada Inn Downtown.

Room reservations can be made by calling 1-800-432-2424.

This year’s conference features:
PPACA (Patient Protections and Affordability Care Act)
Provider Assessment update
Meet Your New State Leaders
Assisted Living Programming
Fall Prevention
Staff Injury Prevention
Accessing Veteran's Benefits
And so much more

Back by popular demand:
Legislative Reception and Facility Showcase
Statehouse visits
Vendor Showcase - Click here for sponsorship information 

Click here to register. Look for full brochure in your "In Box" in the coming days.

Are you planning a trip to Topeka? Perhaps for an IDR or to visit with regulators? The KHCA/kcal office 117 SW 6th Ave is your association headquarters and a great place to stop and refuel, have a cup of coffee, use the Internet or make some copies. Our office, after all, is your office. Stop by and see us.
Your staff at KHCA/kcal.

Be on the Lookout - 2011 KHCA/kcal Membership Contracts are in the mail.
Click here for a sneek peak at the committee sign up sheets and be the first on your team to "Commit to a Committee." 2011 promises to be an exciting year and we look forward to seeing you all back in membership.

The American Health Care Association is nearing the completion of its 2009 Nursing Facility Staffing Survey.  If you have not completed the survey, please take the time to complete it for receipt by Monday, December 20, 2010.  The goal of this survey is to provide statistics on retention, and turnover for advocacy purposes.  If the response rate for each state is sufficient, AHCA will be able to generate these statistics on a state level basis.  Please note that individual results will not be disclosed to any party.

A PDF version of the survey may be found at:

http://www.ahcancal.org/research_data/staffing/Pages/default.aspx

Here are a few hints for completing the survey.  In Column A, the data for the total number of current employees as of December 31, 2009 can be obtained from the payroll report that includes the date of December 31, 2009.  In Column B, the total number of employees who had worked in the facility for 12 months or longer can be obtained from the final payroll report for 2009.  This payroll report may include the date of hire.  If the individual was employed in the last payroll report for 2009 (or on December 31, 2009) and had a hire date prior to January 1, 2009, then they would be included in the number provided in Column B.  In Column C, the total number of employees (whether full-time or part-time) during calendar year 2008 can be obtained from the W-2 information for 2009.

Any questions regarding the completion of this survey may be directed to Mr. Jeffrey Liu at 202-898-2818, Ms. Lisa Matthews-Martin at 202-898-2824 or Mr. Bill Hartung at 202-898-2841.

Thank you for your assistance.

William W. Hartung, CPA
Vice President, Research
American Health Care Association
1201 L Street NW
Washington, DC  20005
(202) 898-2841 (office)
(202) 731-9332 (cell)

President Obama signed into law the Medicare and Medicaid Extenders Act of 2010 (H.R. 4994), which contains the repeal of the RUG-IV implementation delay and an extension of the therapy exceptions process until December 31, 2011. AHCA/NCAL applauds both Congress and the President for addressing these critical issues before the end of the year to ensure that  high quality patient care is not compromised.

Click here for a summary of the bill. AHCA appreciates all of your grassroots efforts over the past year on these critical issues; you spoke and Congress listened.

Other issues of interest to post-acute and long term care in the law include year-long extensions of the Medicaid Qualifying Individual Program and the Medicaid Transitional Medical Assistance Program until December 31, 2011.

The Qualifying Individual Program permits Medicaid to cover the Part B premiums for those Medicare beneficiaries with incomes between 120% and 135% of the poverty level. The Transitional Medical Assistance enables Medicaid beneficiaries to maintain their coverage as their incomes increase due to changes in employment.

The Red Flag Program Clarification Act of 2010 (S. 3987) has now been passed by both the Senate and House and awaits signing by the President.  It appears to relieve health care providers from classification as creditors under the Red Flag Program and thus not subject to the mandated processes, procedures and enforcement connected with such classification.  However, as explained in the attached memorandum, further clarification from the Federal Trade Commission (FTC) pertaining to health care providers may be needed.  AHCA had met with the FTC and adamantly opposed the classification of skilled nursing facilities (SNFs) as creditors due to the predominance of Medicare, Medicaid and insurance as the payers for the services.   We will continue to oppose such classification. 

As also explained in the attached memorandum , please note that the  first part of the rule – the Address Discrepancy Rule -- appears to remain intact and still applicable to SNFs.  This only applies to SNFs if facilities use certain consumer reports  -- for example, in connection with employment.   

AHCA will leave its Identity Theft/ Red Flag Tool Kit posted on the AHCA web site until they have complete clarification of the remaining issues and are able to provide you with that clarification.

A new Medicare home health law goes into effect on January 1st that affirms the role of the physician as the person who orders home health care based on personal examination of the patient.   Effective in January, a physician who certifies a patient as eligible for Medicare home health services must see the patient. The law also allows the requirement to be satisfied if a non-physician practitioner (NPP) sees the patient, when the NPP is working for or in collaboration with the physician.   

As part of the certification form itself, or as an addendum to it, the physician must document that the physician or NPP saw the patient, and document how the patient’s clinical condition supports a homebound status and need for skilled services. The face-to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care. 

While the long-standing requirement for physicians to order and certify the need for home health remains unchanged, this new requirement assures that the physician’s order is based on current knowledge of the patient’s condition. In situations when a physician orders home health care for the patient based on a new condition that was not evident during a recent visit, the certifying physician or NPP must see the patient within 30 days after admission.  

The new requirement includes several features to accommodate physician practice.  In addition to allowing NPPs to conduct the face-to-face encounter, Medicare allow a physician who attended to the patient but does not follow patient in the community, such as a hospitalist, to certify the need for home health care based on their face to face contact with the patient in the hospital and establish and sign the plan of care. Medicare will also allow such physicians to certify the need for home health care based on their face to face contact with the patient,  initiate the orders for home health services, and “hand off” the patient to his or her community-based physician to review and sign off on the plan of care.  Finally, in rural areas, the law allows the face-to-face encounter to occur via telehealth, in an approved originating site.  

Medicare home health plays a vital role in allowing patients to receive care at home as an alternative to extended hospital or nursing home care.  Additional guidance will be available next week via a Special Edition article on our Medicare Learning Network website at: http://www.cms.gov/MLNGenInfo.  Questions and answers regarding this requirement will be available the week of December 13th via Medicare’s home health agency website,  http://www.cms.gov/center/hha.asp. Finally, we expect a video training module describing this new requirement to be released within the next few weeks.

The Centers for Medicare & Medicaid Services (CMS) would like to remind Medicare Fee-For-Service physicians, providers and suppliers submitting claims to Medicare for payment, as a result of the Patient Protection and Affordable Care Act (PPACA), effective immediately, all claims for services furnished on or after Jan 1, 2010, must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service – or Medicare will deny them.
 

If you have Medicare Fee-For-Service claims with service dates from Oct 1, 2009, through Dec 31, 2009, those claims MUST be filed by Dec 31, 2010, or Medicare will deny them. Claims with service dates from Jan 1, 2009, to Oct 1, 2009, keep their original Dec 31, 2010 deadline for filing.
 

In general, the start date for determining the 1-year timely filing period is the date of service or “From” date on the claim.  For institutional claims that include span dates of service (i.e., a “From” and “Through” date on the claim), the “Through” date on the claim is used for determining the date of service for claims filing timeliness.  For claims submitted by physicians and other suppliers that include span dates of service, the line item “From” date is used for determining the date of service for claims filing timeliness.

 
For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor, or review the MLN Matters articles listed below related to this subject:

MM6960 – “Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months” – http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.

MM7080 – “Timely Claims Filing: Additional Instructions” – http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website.

You can also listen to a podcast on this subject by visiting http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp on the CMS website.                                                                    

In addition, for a discussion  and analysis of the PPACA statutory provision  see the  AHCA Policy Memo at:

http://www.ahcancal.org/advocacy/pages/Section6404ppacareductiontimelyfilingmedicareclaims.aspx

CMS has re-evaluated the guidance outlined in the "MDS 2.0 to MDS 3.0 Transition Document" dated October 2010 for the coding of item A0310E. The transition document indicated that the item should be coded as "1" for the initial MDS 3.0 assessment for all existing residents; however, this guidance was overlooked on many of the assessments that were submitted.

During the November 9, 2010 National Provider Call direction was provided indicating that assessments that were coded as a "0" would need to be corrected and resubmitted.

CMS has reconsidered the matter and has concluded that providers Do Not need to submit corrected assessments where item A0310E may have been miscoded. Providers should follow the directions outlined in Chapter 3 Section A of the MDS 3.0 RAI Manual for the coding of A0310E from this point further.

The information can be found at the following link: MDS 3.0 Training Materials, http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp

Twas the night before Christmas - Another year had flown by

MDS 3 0 landed with new regs from on high.

The interviews conducted again and again

And our heads are still spinning - when will it sink in?

Is it blue - is it red, a sock or a shoe?

Did she miss it by one year? Or could it be two?

And me with my coding - the rates to uphold

Were they OMRAs or Short Stays or Trackers to load?

Do I schedule an extra assessment today?

Or wait til tomorrow - What RUG rate will pay?

And on to the software my fingers did fly

I know I can learn this - at least I will try.

The ADL Index is lower - oh no!

There are holes in the flowsheets as big as my toe!

But wait - is that resident smiling at me?

She really likes sharing her dreams I can see.

I think this might be worth it to see that sweet smile

And I think I'll stick with it - at least for a while!!!