The Kansas Department on Aging is in the process of developing a strategic plan that will guide its priorities in the next few years.  We encourage and welcome input from all stakeholders, partners and interested parties as the strategic plan is developed.  The foundation of the strategic plan will be centered on communication reform, regulatory reform, person-centered care, community program reform, and Medicaid reform.  Located within this document you will find a broad overview of each area.  
 
We greatly value your input as we develop plans to fulfill our mission and vision and to serve our state’s elders in new and better ways.  We ask that you send in your ideas by June 3, 2011.  The current solicitation of ideas is only the starting point for our strategic plan development.  Further feedback will be solicited through stakeholder meetings in the next few months.  Thank you for your dedication to our state’s elders and to improving the dignity, security and independence of those we serve.
 
Communication Reform
KDOA seeks to significantly increase the sharing of ideas between agency staff and stakeholders.  This will be accomplished by increasing the quantity and quality of communications to among seniors, providers, and advocacy groups, and agency staff.  Current suggestions to achieve communication reform include improving KDOA’s websites, increasing the use of social media, implementing forums for discussion, between the Department and stakeholders and making more site visits (meet and greet events) to providers.  KDOA also wishes to achieve a high level of customer through training initiatives which will be included in the strategic plan.  We also welcome your suggestions for significantly increasing the knowledge of seniors and consumers about the services available from providers.  Please send your feedback and ideas on communication reform to Public Affairs Director Sara Arif at mailto:sara.arif@aging.ks.gov or by mail to 503 South Kansas, Topeka, KS 66603.
 
Regulatory Reform
The Regulaory Commission, formerly Licensure and Certification Division, promotes excellence in health care and living conditions of the 18,000 individuals residing in Kansas nursing homes through the application of federal and state regulatory standards. State surveyors review a variety of aspects of nursing home care. KDOA surveyors ensure that strict guidelines are followed in the investigation and prosecution of abuse, neglect and exploitation. Currently, KDOA is working with the Centers for Medicaid and Medicare Services on implementing reforms to the survey and enforcement process. KDOA is seeking ideas from stakeholders on strategies for improving resident outcomes through innovation and suggestions from providers, residents and advocacy groups. Suggestions for modifying the current Informal Dispute Resolution process are also welcome.  Please send your feedback and ideas on regulatory reform to Regulatory Commissioner Joe Ewert at joe.ewert@aging.ks.gov or Public Affairs Director Sara Arif at mailto:sara.arif@aging.ks.gov or by mail to 503 South Kansas, Topeka, KS 66603.
 
Community Programs Reform
The Community Programs Commission is responsible for providing cost-effective, consumer-friendly access to a comprehensive and coordinated system of quality long-term care services.  KDOA, mostly through the 11 Area Agencies on Aging (AAA), has privatized services.  The AAAs provide case management services and generally award subgrants or contracts to other community organizations to provide other services.  The commission provides management of the technical assistance, training, and monitoring of community based providers.
 
The Community Programs Commission encourages transparent, open and timely communication with AAA’s, Case Management Entities, partners, stakeholders and the public.  Every effort is made to earn, build and maintain credibility with customers and stakeholders. Suggestions to achieve community program reform include increasing service options so individuals can maintain independence and remain in their homes as long as possible. Other suggestions include expanding the availability of service options integrating federal, state, local and informal services; thoroughly evaluating each grant opportunity; developing initiatives to make the CARE and Money Follows the Person programs more successful; and evaluating best practices and develop initiatives with the Home and Community Based Services Frail Elderly Waiver.  Please send your feedback and ideas on program  reform to Community Programs Commissioner Susan Fout at susan.fout@aging.ks.gov or Public Affairs Director Sara Arif at mailto: sara.arif@aging.ks.gov or by mail to 503 South Kansas, Topeka, KS 66603.
 
Person Centered Care Reform
Person centered care or culture change is a national movement for the transformation of nursing homes from an institutional based model to one based on person-directed values and practices where the voices of elders and those working with them are considered and respected. Core person-directed values include choice, dignity, respect, self-determination, and purposeful living.
 
For many years, the Kansas Department on Aging has encouraged nursing home providers to pursue culture change and adopt a more person centered approach to care.  Through the Promoting Excellent Alternatives in Kansas (PEAK) nursing home awards program, the agency has recognized more than 50 providers for their culture change efforts.  This has increased awareness of person centered care and changed the way services are provided to residents in these facilities.  The agency now seeks to make person centered care the standard for nursing homes. Please send your feedback and ideas on person centered care reform to Financial and Information Services Commissioner Dave Halferty at mailto:dave.halferty@aging.ks.gov or Public Affairs Director Sara Arif at mailto:sara.arif@aging.ks.gov or by mail to 503 South Kansas, Topeka, KS 66603.
 
Medicaid Reform
Governor Sam Brownback has made Medicaid reform a priority in order to improve the quality of care for Kansas recipients, control costs, and make long-lasting improvements to the wellness of all Kansans. KDOA is part of a Medicaid reform sub-cabinet led by Lt. Governor Jeff Coyler that asked stakeholders and citizens to submit pilot projects and reform ideas.  The call for proposals closed on February 28th with 64 citizens, stakeholders, and organizations submitting over 120 recommendations for redesigning the Medicaid program.  The Medicaid sub-cabinet has received a grant from an informal consortium of private health foundations called Kansas Grantmakers in Health to hire an outside contractor to assist with collecting data, organizing public meetings, researching, and analyzing proposals.  KDOA stakeholders will be asked to submit feedback on reform ideas during the next several months through this robust stakeholder process.
 
Other
Please submit  any other ideas and suggestions you would like to see incorporated into the KDOA strategic plan that do not fit within the five areas outlined in this document to Public Affairs Director Sara Arif at sara.arif@aging.ks.gov or by mail to 503 South Kansas, Topeka, KS 66603.

The mission of the Kansas Department on Aging (KDOA) is to serve and represent the interests of older Kansans in ways that allow them to maintain their dignity, security, and independence.  The agency’s philosophy is to carry out this mission by providing assistance to older Kansans while allowing them to remain active and contribute to their families and communities in the place they call home. 
 

Recently, KDOA, the Kansas Health Policy Authority and SRS released the proposed Nursing Homes rates and calculation methodology for FY2012.

Under the Medicaid program, 42 U.S.C. 1396 et seq., the State of Kansas pays nursing facilities, nursing facilities for mental health, and hospital long-term care units (hereafter collectively referred to as nursing facilities) a daily rate for care provided to residents who are eligible for Medicaid benefits. The Secretary of Aging administers the nursing facility program, which includes hospital long-term care units, and the Secretary of Social and Rehabilitation Services administers the nursing facility for mental health program. Both Secretaries act on behalf of the Kansas Health Policy Authority (KHPA), the single state Medicaid agency. As required by 42 U.S.C. 1396a(a)(13), as amended by Section 4711 of the Balanced Budget Act of 1997, P.L. No. 105-33, 101 Stat. 251, 507- 08 (August 5, 1997), the Secretary of the Kansas Department on Aging (KDOA) and the Secretary of the Kansas Department of Social and Rehabilitation Services (SRS) are publishing the proposed Medicaid per diem rates for Medicaid-certified nursing facilities
for State Fiscal Year 2012, the methodology underlying the establishment of the proposed nursing facility rates, and the justifications for those proposed rates. SRS and KDOA are also providing notice of the state’s intent to submit proposed amendments to the Medicaid State Plan to the U. S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) on or before September 30, 2011.

I. Methodology Used to Calculate Medicaid Per Diem Rates for Nursing Facilities.
In general, the state uses a prospective, cost-based, facility-specific rate-setting methodology to calculate nursing facility Medicaid per diem rates, including the rates listed in this notice. The state’s rate-setting methodology is contained primarily in the following described documents and authorities and in the exhibits, attachments,

Click here to view the whole report and to view your home’s proposed rate.

AHCA has completed a summary of the SNF PPS proposed rule for FY 2012, which was issued on April 28, 2011. The proposed rule offered two options—under option one, FY 2012 Medicare payments to SNFs would be reduced by $3.94 billion or a total of 11.3% lower than FY 2011. Under option two, CMS would increase rates 1.5% in the Medicare market basket for an increase of $530 million in FY 2012.

The unprecedented difference between the two proposed rules could put skilled nursing facilities and their residents at risk should the large cut be enacted. Our summary highlights key components of the proposed rule, including a more detailed discussion of the financial and regulatory matters to clinical and quality issues.

CMS’ analysis for this proposed rule is based only on data from the last quarter of 2010 instead of a full year of data. AHCA will work with CMS to find the solution that best protects patient quality of life and care.

We welcome member comments and feedback, ideally by  June 1, 2011. Please direct any question or comments to Peter Gruhn or Elise Smith.
 

May 18, 2011 – 1:00pm -3:00pm eastern time
Description : Accountable Care Organizations: What They Are and Why You Need to Know!
Despite the uncertainty surrounding many aspects of health care reform, most health care providers are moving forward with efforts to improve care, reduce costs, and assure that elders have access to services.  The latest addition to the stream of innovation is CMS’ issuance of the proposed rule on Accountable Care Organizations (ACOs).  ACOs were instituted by Congress in the Affordable Care Act (ACA) to further CMS’ “triple aim” of better care for individuals, better health for populations, and lower growth in expenditures.  Under the ACA’s Shared Savings Program (SSP), ACOs that succeed in helping CMS reduce costs for Medicare fee-for-service beneficiaries and that meet certain quality requirements will have an opportunity to share in the savings to the Medicare program.

However, ACOs under the SSP also will be required to bear downside risk for costs in excess of a predetermined benchmark, and will be subject to extensive up-front and ongoing investment and reporting requirements.  Accordingly, many organizations may find it too costly or too uncertain a proposition to participate in an ACO under the SSP.  However, whether or not an organization participates in an ACO, the model of care CMS has articulated under the SSP indicates that the Medicare program is shifting toward a risk-based reimbursement model that rewards quality and cost savings across the continuum of care. 
Such a shift will implicate post-acute providers’ operations and reimbursement, and may require post-acute providers to consider innovative organizational alliances and structures to remain successful under Medicare.
This webinar will provide an overview of the proposed rules on ACOs and the potential role for post acute care providers. 
The ACO webinar will cover the following topics:
* Short history of the demonstrations leading to the development of the ACO concept and the lessons learned.
* Detailed discussion of the ACO proposed regulations, including who can participate, the minimum requirements for participation, the beneficiaries who may participate, and the services to be offered.
* The potential organizational models that might evolve and how SNFs and home health agencies may be  nvolved.
* The proposed reimbursement methodologies and how payments will be made to the ACO and other participating providers.
* Overview of ACO-like markets that are already developing and their experience in working with aging services organizations to achieve cost reductions, care model changes and the payment models they are using.
* How hospitals are considering and approaching ACOs: the difference, if any, between urban and rural hospital centers in thinking about ACOs.
* The operational and workforce implications of moving to an ACO or ACO-like environment, particularly to increased expectations about quality performance, acceptance of risk and training required to prepare staff for a changing resident.
* The steps that nursing facilities should take now to prepare to deal with ACOs, either as contractors or participants.

Presented by:  Mark Reagan, Hooper Lundy Bookman
   Nancy Rehkamp, LarsonAllen
   Paul Deeringer, Hooper Lundy Bookman
  
   REGISTRATION INFO:
   To register: go to http://webinars.ahcancal.org/ and click on the webinar title under Upcoming Webinars (right column).  There is no fee to participate and there are no CEUs offered. 
   If you cannot join us, we will record the webinar and it will be available in the On Demand Section of the webinar site. 

 
Register for AHCA/NCAL's 2011 Congressional Briefing, July 13-14, 2011 at the L’Enfant Plaza Hotel, Washington, D.C., and have your voice heard by members of Congress and key staff. Get involved and make your advocacy efforts count! Your presence and your voice make a difference in shaping the direction of long term care. This is a unique opportunity to meet face-to-face with members of Congress and discuss long term care legislative issues. Make your hotel reservations NOW! Washington, D.C. is very busy in the summer and hotel spaces are limited.

Register for AHCA/NCAL's 2011 Congressional Briefing, July 13-14, 2011 at the L’Enfant Plaza Hotel, Washington, D.C., and have your voice heard by members of Congress and key staff. Get involved and make your advocacy efforts count! Your presence and your voice make a difference in shaping the direction of long term care. This is a unique opportunity to meet face-to-face with members of Congress and discuss long term care legislative issues. Make your hotel reservations NOW! Washington, D.C. is very busy in the summer and hotel spaces are limited. Book your housing reservations now to receive the discounted or call the L’ Enfant Plaza Hotel directly at (800) 635-5065 and reference to group code: AHC712. The housing deadline is June 14, 2011. Reservation requests made after the housing deadline will be based on availability and at the prevailing rate determined by the hotel. Register today!

The Government Accountability Office has released a report calling on the Centers for Medicare & Medicaid Services to implement more oversight into nursing home complaint investigations.

Following inquiries from Congressional leaders, the GAO conducted an analysis of CMS's complaints database, where state agencies report complaints and document their investigation results. In looking at data collected during fiscal year 2009, the GAO found that state survey agencies received 53,313 complaints about nursing homes. The number varied significantly from state to state: 11 states received 15 or fewer complaints per 1,000 nursing home residents while 14 states received more than 45, according to the report.

The GAO report says 19 state agencies had trouble investigating harm-high complaints and incidents within the timetable required. Additionally, the report reveals that CMS oversight of state agencies' complaint investigation processes is flawed due to unreliable data. 

The GAO made several recommendations. It suggested that to ensure reliability, the CMS administrator should identify issues with data quality and clarify guidance to states about how particular fields in the database should be interpreted. This could be as simple as defining what it means to substantiate a complaint, the report says. Another suggested strategy encourages state survey agencies to prioritize complaints based on their level of egregiousness.

Article from McKnight's Long Term Care News & Assisted Living

On March 31, The U.S. Department of Health and Human Services (HHS) released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower health care costs while meeting performance standards on quality of care and putting patients first.  Patient and provider participation in an ACO is purely voluntary.
 
CMS has worked closely with other federal agencies, including the Department of Health and Human Services Office of Inspector General (OIG), the Department of Justice (DOJ), the Federal Trade Commission (FTC), and Internal Revenue Service (IRS) to ensure that providers and suppliers have the clear and practical guidance they need to form ACOs without running afoul of the fraud and abuse, antitrust, and tax laws. Concurrently with the publication of this proposed rule, the following documents were issued: a joint CMS and OIG notice and solicitation of public comments on potential waivers of certain fraud and abuse laws in connection with the Medicare Shared Savings Program; a joint FTC and DOJ proposed antitrust policy statement; and an IRS notice requesting comments regarding the need for additional tax guidance for tax-exempt organizations, including tax-exempt hospitals, participating in the Medicare Shared Savings Program.
 
The proposed rule and joint CMS/OIG notice are posted at: www.ofr.gov/inspection.aspx.
 
For more information, read the fact sheet at: http://www.HealthCare.gov/news/factsheets/accountablecare03312011a.html.
 
Comments on the proposed rule will be accepted until Mon Jun 6, 2011 at: www.regulations.gov.  CMS will respond to all comments in a final rule to be issued later this year.
 
The CMS dedicated website for providers of services and suppliers is: www.cms.gov/sharedsavingsprogram.
 
The Proposed Antitrust Policy Statement is posted at: www.ftc.gov/opp/aco/.

The IRS Guidance and Solicitation of Comments will be posted at: http://www.irs.gov/pub/irs-drop/n-11-20.pdf.

Questions? Contact Lisa Goschen Associate Regional Administrator
Division of Financial Management and Fee for Service Operations
Centers for Medicare & Medicaid Services 
601 East 12th St, Rm 235, Kansas City, MO 64106

The recent release of the OIG report on the use of antipsychotic drugs in nursing homes has created many headlines and news stories. Click here for  a brief summary with link to the full OIG report. Also in that document is a summary of AHCAs conclusions and a set of "talking points" to use if should you get questions about this report.

Are you interested in learning about the fundamentals of health care compliance?
Do you know what to do when a compliance issue arises?

OIG will offer a free, live webcast of their HEAT Provider Compliance Training to be held at the U.S. Department of Health & Human Services on May 18, 2011, from 8:30 a.m.---1 p.m. eastern time.

For those unable to watch the live webcast, a video of the training will be available for online viewing on or before May 31, 2011.

Hear from Inspector General Daniel Levinson and other government experts as they educate local health care providers and compliance officers about the realities of Medicare fraud and the importance of implementing an effective compliance program.

For information about viewing the free webcast and to download program materials, see http://www.oig.hhs.gov/heat.

Fire protection systems occasionally get damaged in routine use, and the damage should be repaired in a timely fashion. Today’s training vignette, “Fire Protection System Repairs” describes the importance of fixing damaged systems.

Coffee Break Training provides an overview of fire protection topics and does not include all details, requirements or exceptions to the topics that are described. Always refer to nationally recognized design and installation codes and standards, the product manufacturer, or listing details for specific information.  
Download Your Coffee Break Training (PDF) by clicking here. 

Previous Coffee Breaks may be found on the USFA website.

The Coffee Break Training quarterly self-assessment exams have been moved to NFA Online.  There you will find links to the previous Coffee Break exams and other Fire Prevention: Technical training.