Happy New Year everyone! The KHCA/kcal office will be closed Friday, December 31, 2010 for the New Year Holiday. Have a safe and Happy New Year and we will see you in 2011.

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

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 Benefits for your Residents
And so much more...

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

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

Click HERE to download the brochure.

You can also register online by clicking HERE.

 The Office of Inspector General (OIG) is alerting the public to the latest scheme to defraud the government and steal money from the American people. 

This scheme involves contact (by phone, email or letter) from someone pretending to be from a government agency, such as the U.S. Department of Health & Human Services (HHS). Although the precise message may vary, the caller or writer provides his or her name and a fake employee ID, and then typically tells you that you will receive "government grant money" as an incentive for paying taxes on time. The caller will then ask for personal or financial information, such as a Social Security number or bank account number. The caller may also ask you to send a check or wire transfer to cover a "processing fee."

If you receive such a call, hang up immediately! If you receive such an email or letter in the mail, do not respond! Call 1-800-HHS-TIPS (1-800-447-8477; TTY 1-800-377-4950) or email the HHS fraud hotline at HHSTips@oig.hhs.gov .
 

Remember: do not respond to these criminal schemes.  Alert others about
this scheme, and remind teenagers and children living in your household
not to provide strangers with family or personal information.
 

Be smart.  Do not respond to this and other schemes that try to obtain
your personal information.  If you receive such a call or message, call
1-800-HHS-TIPS or contact another law enforcement agency.

Rita Fitch, RN,  retired as Regional Manager of the South Central District effective December 10, 2010.  Rita  served the state since 1990 when she became a surveyor at the Kansas Department of Health and Environment.  She had been the Regional Manager in Wichita since 2003. 

Debra Cable, RN, has accepted the position of Regional Manager in the South Central District Office, Wichita.  Debra has a BSN degree from Bethel College, Newton and over 15 years of RN experience.  Debra has held  nursing management positions in a number of settings and has been a Health Facility Surveyor at both KDHE and KDOA.

Debra has demonstrated an enthusiasm and commitment to the mission of nursing facility survey and certification, and has an excellent understanding of the QIS process both technologically and procedurally.

AHCA is pleased to report that the Centers for Medicare and Medicaid Services (CMS) has delayed the implementation of the requirement for a health care provider’s signature on all Medicare laboratory requisitions until the end of the first quarter of 2011; the requirement was to have been effective on January 1, 2011.

This action was taken after substantial efforts by AHCA and other members of the Clinical Lab Coalition to fight this change. As previously reported, CMS initiated this new regulatory requirement as part of the 2011 Medicare Physician Fee Schedule Final Rule. The agency plans to enforce the regulation once substantial provider, physician, and laboratory outreach and education has taken place.  AHCA will provide members with additional information as it becomes available and will continue efforts to overturn the regulation entirely.

 The following statement was issued by Bruce Yarwood praising aging Committee Chairman Herb Kohl (D-WI) for his tireless efforts to address delays with the dispensing of critical pain medications for patients and residents in nursing homes and assisted living communities:

“The long term and post-acute care community commends Senator Kohl for his steadfast commitment to ensuring the frail and elderly in nursing facilities nationwide have access to critical pain medication. This solution brings real relief to our patients and residents who require medication to manage pain. For the past several months, Senator Kohl has made this his personal mission, and we thank him for his leadership.”

BACKGROUND:
Special Committee on Aging Chairman Herb Kohl received assurances from Attorney General Eric Holder that the US Drug Enforcement Agency (DEA) would address and remedy the delivery of pain medications in nursing homes and assisted living facilities. As a result, Senator Kohl lifted his hold on the nomination of Michelle Leonhart to be the next head of the DEA.

AHCA/NCAL has worked closely with Senator Kohl for over a year on this issue,highlighting the negative impact enforcement of DEA’s policies under the Controlled Substances Act (CSA) are having on patients, their families, and caregivers. The outdated regulations made the timely management of pain for patients and residents both challenging and frustrating.
Bruce Yarwood is President and CEO of the American Health Care Association and National Center for Assisted Living.

 The following statement from Bruce Yarwood today addresses the Office of Inspector General (OIG) report, “Questionable billing by Skilled Nursing Facilities.”

 “Now more than ever, the long term and post-acute care community is working in a coordinated manner with other providers to ensure patients and residents are in the most appropriate, most cost-effective and least restrictive care setting.

"Our patient population consists of more medically complex patients, and often necessitates placing their care in a higher RUG designation. We have and will continue to work cooperatively with CMS to optimize an alignment of incentives, and RUG-IV was designed to achieve this.

"Our 2010 Quality Report finds over 50% of Medicare patients treated in nursing facilities are categorized as having “major extreme severity of illness,” and that nursing facilities represent the lowest-cost institutional setting. In addition, since 2003, there has been an annual increase in the percentage of Medicare beneficiaries discharged to the community in 100 days. 

"Moving forward into 2011, we intend to work cooperatively with providers, lawmakers and the regulatory community to ensure this positive trend continues.”

Click here for a copy of the full OIG report.

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

If you help people with Medicare get certain medical equipment and supplies, such as oxygen or power wheelchairs, you should know about a new Medicare program, called the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program, that may change the suppliers people with Medicare will need to use.  

The new program will begin January 1, 2011 in 9 areas around the country, including Charlotte-Gastonia-Concord, NC-SC; Cincinnati-Middletown, OH-KY-IN; Cleveland-Elyria-Mentor, OH; Dallas-Fort Worth-Arlington, TX; Kansas City, MO-KS; Miami-Fort Lauderdale-Pompano Beach, FL; Orlando-Kissimmee, FL; Pittsburgh, PA; Riverside-San Bernardino-Ontario, CA.   

People with Original Medicare who live in or travel to one of these 9 areas with a prescription for any of the items listed below will almost always need to get these items from contract suppliers if they want Medicare to help pay for the item, unless their current suppliers become grandfathered suppliers (non-contract suppliers that choose to continue to provide certain rented equipment under the terms of the program).

So people will need to find out which suppliers are Medicare contract suppliers to make sure their medical equipment and services will be covered by Medicare. You can find a list of suppliers included in the program by calling 1-800-MEDICARE or by using the online supplier locator tool at www.medicare.gov/supplier.  The online supplier locator tool has been updated recently with new features for the competitive bidding program.  From www.medicare.gov/supplier, here’s how to access a list of Medicare DMEPOS Competitive Bidding Program contract suppliers for a particular beneficiary’s area: 

1. Enter the Medicare beneficiary’s zip code and click “Submit”
2. A list of product categories will appear; those product categories with a star icon next to them are included in   the competitive bidding program
3 After selecting a competitive bidding product category, click “View Results”
4. A page will display stating you’ve selected a competitive bidding product category and briefly explain the program; click “Continue”
5. A list of all Medicare contract supplier locations in the competitive bidding area will appear.
 

The 9 product categories that are included in the program are:

1. Oxygen, oxygen equipment, and supplies
2. Standard power wheelchairs, scooters and related accessories;
3. Complex rehabilitative power wheelchairs and related accessories (Group 2 only);
4. Mail-order diabetic supplies;
5. Enteral nutrients, equipment, and supplies;
6. Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies and accessories;
7. Hospital beds and related accessories;
8. Walkers and related accessories; and
9. Support surfaces (Group 2 mattresses and overlays in Miami-Fort Lauderdale-Pompano Beach, FL only).
 

You can find more information on the Medicare DMEPOS competitive bidding program by visiting http://www.cms.gov/Partnerships/03_DMEPOS_Toolkit.asp.
 

If you help people with Medicare who live in or travel to one of the 9 designated areas and who need one of the items included in the program, please make this information available to them.

The Red Flag Program Clarification Act of 2010 (S. 3987) has now been signed by the President. It appears to relieve health care providers from classification as creditors under the Red Flag Program and thus not be subjected to the mandated processes, procedures and enforcement connected with such classification. However, as explained more in this memo, 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 as creditors due to the predominance of Medicare, Medicaid and insurance as the payers for the services. We will continue to oppose such classification.