Just a reminder that you should have received a billing for the provider assessment along with a rate worksheet.  You should complete  the private pay rate section and the days section at the bottom and return it with your payment before July 31, 2011.  This process will continue after the end of each calendar quarter while the provider assessment process is in place.
 
The private pay rate is required to be reported quarterly as part of the statute enacting the provider assessment.  The days data provides the basis on which the Medicaid share of the assessment is rebated to your facility.

Additional Clarification:
For the "room rate/resident" section, KDOA wants the last day of the quarter being reported.   Currently, it would be as of 6/30/11.

For any routine or LOC charges, that information needs to be reported for the entire quarter period.  For this time, it will be for April, May and June 2011 period.

KDOA will be putting out instructions for both the private pay worksheet and tax assessment form shortly.      

The online reporting form is "live" however some programming issues are still being address.

http://www.aging.ks.gov/Forms/RateSetting_Forms.html

If you have any questions please let us know or contact KDOA.

Kansas Governor Sam Brownback announced  the appointment of Terry L. Maple as the new acting State Fire Marshal.
 
“Terry Maple has distinguished himself as an experienced, intelligent and hardworking man.  I am confident he will do a great job in this position.  I appreciate his willingness to again serve the people of Kansas,” Gov. Brownback said.
 
Maple has more than 23 years of experience in Kansas law enforcement.  He began his career as a field trooper and pilot at the Kansas Highway Patrol (KHP).  During his years at KHP, he has served as researcher, special assistant to the superintendent, troop commander, assistant superintendent and, most recently, as the Superintendent/Colonel.  As Superintendent of KHP, Maple was responsible for the 900 person state law enforcement agency with a $90 million annual budget.  
 
Maple resides in Topeka and is married to Donna Maple.  They have two children.
 
Earlier today, the Department of Revenue announced Doug Jorgensen, the previous acting State Fire Marshal, as Director of Alcoholic Beverage Control.  Jorgensen appointed is subject to Senate confirmation.

SRS Secretary Rob Siedlecki announced that the agency is restructuring into four state regions instead of six, and that nine area SRS offices will be closed over the next few months to save money.  These offices include: Coffeyville, Fort Scott, Garnett, Lawrence, Lyndon, Marysville, McPherson, Pratt, and Wellington. There will be 33 SRS offices after the closures are final. Secretary Siedlecki said the closures were in response to the Legislature’s directive to cut $42 million from the SRS budget, including $1 million in administration costs for Fiscal Year 2012.

On Monday, July 18 from 1:30 to 2:30 PM, KHCA/kcal will present a one hour webinar on accessing benefits through the VA. Veterans and their spouses living in assisted living homes and nursing homes may be eligible for financial assistance from the Department of Veterans Affairs. But if you don’t know a DD 214 from a BB gun, you may not be in the best position to help them access those benefits. Join Benefit Brokers Kevin Brennan on Monday, July 18, 2011 at 1:30pm for this informative and timely webinar.

Please click HERE for more information and HERE to register online.

KHCA now hosts non-member job postings on the KHCA website! Job postings are displayed for 30 days. To post a job, please send the contract available HERE  and your check or credit card information to Miranda Metcalf. KHCA/kcal members can of course post for free.

ACT NOW - Negotiations Ongoing - Medicaid and Medicare on the Table 
Take Action!

 As debt negotiations continue in Washington, DC, there are many proposals on the table to cut spending. These include some $200 billion in proposed Medicaid cuts. CMS has also proposed a 12.8 percent reduction to Medicare rates.
This “perfect storm” of budget cuts threatens to destabilize the nursing home sector and put our patients at risk. As the nation’s 10th largest employer, it is extremely important that we share our concerns with Congress.
Last month, when we asked you to contact Congress on the proposed Medicare cut, you flooded the Hill with over 15,000 letters. The result? 152 Members of Congress, Republican and Democratic, wrote CMS asking it to slow down.
Now we need you to stand up for Medicaid. Please take action today! Click here to send a letter now.

As debt ceiling negotiations dominate Capitol Hill this week, long term care leaders are encouraging legislators to remember the impact that cuts in funding of the nation’s largest public health programs can have on the frail and elderly. More than 400 health care leaders, nurses and administrators participated in the AHCA/NCAL Congressional Briefing on behalf of the 1.5 million residents and patients they care for in today’s skilled nursing and rehab facilities.

“We’re here to defend the quality care that our residents deserve. They should be encouraged in knowing we’re going to knock on every door and share their stories,” said Governor Mark Parkinson, President and CEO of AHCA/NCAL. “This is about preserving and improving the quality of life of those people who need it most.”

Governor Parkinson today opened the session by calling on the long term care profession to be the leader in defense of quality health care. This week’s briefing will focus largely on two central issues: the Notice of Proposed Rulemaking (NPRM) for reductions in payments to skilled nursing facilities (SNFs), and potential Medicaid cuts through block grants currently debated in the debt ceiling talks.

Earlier this summer, the Centers for Medicare and Medicaid Services (CMS) issued an NPRM regarding reductions of funding to Medicare payments to SNFs rates by 12.8 percent. Economic impact models suggest that the total effect of the proposed cut could put over 100,000 jobs at risk and reduce wages and salaries by about $5.0 billion.

AHCA and its advocates this week will also caution against Medicaid cuts through block grants, which would shift a heavy burden to states to cover the costs of the already underfunded Medicaid program. According to an independent national study released earlier this year, Medicaid payments were $5.6 billion short of covering allowable nursing home costs in 2010, paying an average of only 91 cents on every dollar of allowable costs incurred for each Medicaid patient. States, which are still struggling to recover from the current economic stresses, may opt to cut the program to help ease budgetary strains.

“There is no time more important than now to ensure the future of this nation’s health care programs,” said Bob Van Dyk, Chair of AHCA’s Board of Governors. “Washington will hear our message loud and clear this week on behalf of seniors and those who care for them.”

CMS released a Survey & Certification (S&C) Memo, “Reporting Reasonable Suspicion of a Crime in a Long-Term Care Facility: Section 1150B of the Social Security Act,” which was established under section 6703(b)(3) of the Affordable Care Act of 2010 (ACA), and requires specific individuals in applicable long term care facilities to report any reasonable suspicion of crimes committed against a resident of the facility.

According to the CMS memo, reports to state survey agencies (SAs) and law enforcement must be submitted to at least one law enforcement agency of jurisdiction and the SA. Further, SAs should process these reports in accordance with existing CMS and State policies and procedures for reporting incidents and complaints to SAs. Long term care facilities should also have policies and procedures to comply with this law. To obtain a copy of the S&C Memo, as well as access AHCA materials and templates to help with compliance click here.

There was a 50% increase in the percentage of nursing facilities cited for infection control since 2009. This citation ranked number 8 in 2009, and has now become the most frequently cited tag in the nation.

Tag F441: Investigates, control/prevents infection has been cited in nearly 37% of nursing facilities across the nation, up from 26.5% at this time last year. This tag has been cited among the ten most frequently cited tags in 46 states. Click here to see the trend over time in the percentage of nursing facilities cited for infection control.

To learn the frequency of other health citations overall and in your state, check out The LTC Stats: Nursing Facility Standard Health Survey Report. To learn the number and percent of all health citations, check out the LTC Stats: Nursing Facility Standard Health Survey Citation Report. These reports will provide members with citation results to then apply a practical approach to target areas of improvement prior to their next health inspection.

To review the latest Nursing Facility Standard Health Survey Report, or the Nursing Facility Standard Health Survey Citation Report, go to www.ahcancal.org select Research and Data and then scroll down to the LTC Stats section. Then, select the current and previous reports at the state and national level. To review other reports from the LTC Stats series, select Research and Data and scroll down to LTC Stats.
 

AHCA received the attached update from Dr. Robert Petzel, Dept. of Veterans Affairs (VA) Undersecretary for Health, in response to our April 2011 inquiry.  It states the following:
•         The proposed rule to implement the new VA/Civilian NF “agreement” will be released in 6 months.
•         For all NFs under the old “contract” (often still reimbursed under RUG II)—reimbursement will automatically be converted to RUG IV upon contract renewal at the end of the 5th year.
•         In the interim, NFs under “contracts” may approach their local Contracting Officer to request a contract modification to use RUG IV.
 
Background:
 
As many of you are aware, AHCA has been pressing VA Central Office for many years to release a proposed rule that would make available nationwide a new VA/Civilian NF contract vehicle, known as an “agreement”, to replace current VA contracts.  VA/NF “contracts” have the following provisions that many civilian NFs have difficulty complying with:
 
•   Extra privacy requirements beyond HIPAA—(some issues have been rectified, but not all);
•   Requirements to have DOL affirmative action plans in place;
•   Compliance with life safety code requirements beyond those mandated by CMS, etc.
 
Conversely, the new VA/NF “agreement”: 
•   Clearly states that HIPAA compliance is adequate;
•   Does not mandate extraneous DOL requirements;
•   Uses CMS’ mandated version of the life safety code, etc.
 
Unfortunately, thus far, only about 13 VA Medical Centers nationwide use the new VA/NF “agreement” when placing veterans in civilian NFs.  The remaining civilian NFs-- that only have the option to serve veterans through a VA/NF “contract”--are subject to the extraneous contractual requirements.  As many of these NFs are unable to comply,  providers may have to cease serving veterans.
 
Reimbursement:
 
Another complication has been that for civilian NFs that are reimbursed by VA under RUG II, payment for services has been inadequate.  In conjunction with the new MDS 3.0 and RUG IV used by CMS, discrepancies in administrative protocols between CMS and VA have proven difficult for NFs that serve veterans.
 
Next Steps:
 
•   AHCA will seek member feedback when the proposed rule is released.
•   We will follow up with VA on behalf of members as specific issues arise.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) today proudly announced this year’s Joe Warner Patient Advocacy Awards: Angelo Rotella of Rhode Island, Dion Sena of Florida, and Sally and Roland Rapp of California.

AHCA/NCAL bestows this prestigious award on association members who have worked directly to educate Members of Congress about the needs of long term care patients and residents, and to advance quality long term care. The annual award recognizes caregivers who possess the same compassion for, and commitment to, our nation’s frail elderly and those with disabilities that exemplified the work of former president and CEO of Illinois-based Heritage Enterprises, Joe Warner.

This year’s honorees are outstanding individuals and community leaders. Angelo Rotella, who has more than 20 years of experience as a long term care provider, is president and administrator of two skilled nursing facilities in Rhode Island. Dion Sena, a second generation provider, is the owner and operator of Southlake Nursing & Rehabilitation Center in Jacksonville, Florida. Sally and Roland Rapp, a married couple from California, are dedicated to their individual roles at the Skilled Health Care Group, which operates nursing facilities, assisted living residences, hospices and rehabilitation therapy in seven states. Sally, a licensed nursing home administrator, oversees the company’s nursing facilities, and Roland serves as both General Counsel, Executive Vice President, and Chief Administrative Officer of Skilled Health Care Group.

“The AHCA/NCAL members we honor with the Joe Warner Patient Advocacy Award are reaching well beyond their daily responsibilities. Each has worked tirelessly to advance quality long term care, and continues to take an active role in advocating for those we serve,” remarked AHCA Chair Robert Van Dyk. “As providers, we know that families are entrusting the care of their loved ones to us. These extraordinary individuals – like our former colleague and friend, Joe Warner – are deserving of that trust as they care so passionately about the people they serve,” concluded Van Dyk.

CMS announced three new important initiatives to better align Medicare and Medicaid as follows:

A demonstration to test two new financial models designed to allow states to share in the lower costs that result from better coordinating care for dual eligible individuals;

A demonstration to help states improve the quality of care for nursing home residents by allowing these residents to be treated in the nursing facility instead of having to unnecessarily go to a hospital; and

A technical resource center for states to help them improve care for high-need, high-cost beneficiaries.
New Financial Model Demos

The two new financial models demonstrations that would allow states to share in lower costs are as follows:

A state, CMS, and health plan enter into a 3-way contract where the managed care plan receives a prospective blended payment to provide comprehensive coordinated coverage. This model will  target aggregate savings through actuarially developed blended rates that would provide new savings, as a result of improvements in care delivery,  for both states and the federal government.
   
A state and CMS enter into an agreement by which the state would be eligible to benefit from savings resulting from managed fee- for- service initiatives designed to improve quality and reduce costs for both Medicare and Medicaid.

All states that meet established standards and conditions and would be ready to implement its proposed demonstration by the end of 2012  have the option to pursue either or both of the above models.  The CMS Center for Medicare and Medicaid Innovation (Innovation Center) will work with interested states to combine Medicare and Medicaid authorities to test these new payment and service delivery models to determine whether the new models save money while preserving or enhancing quality of care for dual eligible individuals. The demonstrations are limited to no more than three years.  
CMS issued a state Medicaid director letter providing preliminary guidance for these two models in sufficient detail to allow states to determine their interest in testing these models.  Interested states would submit a Letter of Intent by October 1, 2011.

Nursing Facility Demonstration

The CMS Innovation Center in collaboration with the Medicare-Medicaid Coordination Office (MMCO) will establish a demonstration that focuses on reducing preventable inpatient hospitalizations among nursing facility residents.  CMS will competitively select and partner with independent organizations that will provide enhanced clinical services to people in approximately 150 nursing facilities.  Interventions could include using nurse practitioners in nursing facilities, supporting transitions between hospitals and nursing facilities, and implementing best practices to prevent falls, pressure ulcers, urinary tract infections, or other events that lead to poor health outcomes and expensive hospitalizations.   Nursing facilities with high hospitalization rates and a high concentration of residents who are dual eligible will be targeted for this demonstration.  More information on this demonstration is not yet available.

Technical Assistance Resource Center

The Technical Assistance Resource Center will provide assistance to states to deliver coordinated health care to high-need, high-cost beneficiaries.  It also will assist MMCO and the Center for Medicaid, CHIP and Survey & Certification as they work with states to promote innovated approaches to delivering coordinated care for dual eligibles.  Examples of the types of assistance include: conducting needs assessment and gap analysis to identify opportunities for improvement, facilitating sharing of best practices across states, and assisting in program design, stakeholder engagement, data and health information technology.
 

 
Please find the new Transmittal (Change request 7339) and the new related MLN Matters article on billing occurrence Code 16 and coding PPS bills for ancillary services.  In speaking to knowledgeable providers and member therapists, AHCA has come to understand that CMS, historically, left some discretion to the providers whether they wanted to report Units or Visits.   AHCA was told that most  providers reported units because it was data that is generally easy to get out of a system, and CMS until last year had never defined a “visit” or “session” in any meaningful way.
 
The bottom line  appears to be that “unit” means one thing under Part B and another under Part A.  For Part A, for therapy services, units  represent the number of sessions of therapy provided (MLN matters article.)  Jason Kerr of CMS explained it to AHCA  thusly:   “The answer is that 1 unit equals 1 day. So, if PT was given 10 days in a month then units are 10, if OT given 3 days then units are 3, etc.”

For more information please contact us.

Changes to the Minimum Data Set Version 3.0 (MDS 3.0) Assessment Modification & Formatting Policies & Nursing Home Compare as a result of MDS 3.0 Implementation (7/1/11)

• Effective April 1, 2011, nursing home and swing bed providers may not modify existing MDS  3.0 records to correct an event date or a reason for assessment.

• Effective February 1, 2011, Resident Assessment Validation and Entry system (jRAVEN)   version 1.0.5 provides for more signature lines in Section Z of the MDS. In addition, the   Centers for Medicare & Medicaid Services made a decision that the print format provided   by jRAVEN for a MDS 3.0 assessment is acceptable for review in the nursing home survey   process.

• On April 23, 2011 CMS “froze” Quality Measure data and the Quality Measure (QM) ratings   currently on the Nursing Home Compare website for a period of six months as a result of   MDS 3.0-derived Quality Measure data not yet being available for display.

The memo is attached.