KDOA Secretary Shawn Sullivan has joined the KHCA/kcal lineup with an in-depth look at the future of Medicaid in Kansas. From managed care options to Medicaid waiver programs, session will provide insight into everything that is on the table for revision. Also, learn about the workgroups that your association has been participating in and how they will help shape the future of long term care in Kansas.

We're kicking off the convention with three fantastic sessions with nationally-recognized leaders in health care. We've moved the always inspirational Awards ceremony back to a luncheon event with no extra ticket needed. We've added a special "vendors only" lunch with Cynthia Morton. We've extended the trade show hours and added more prizes and give-aways. We've added a group of "fun vendors" to the registration area where you can shop to carry away your bargains from candles to jewelry. Our afternoon breakout sessions feature regulatory, financial, clinical and customer service tracks. The days wraps up with a special Denim and Diamonds party featuring comedian and motivational speaker Jack McCall. And that's just the first day!

What's the Future of State-Licensed Only Homes in Kansas?

No matter what type of state-licensed home you run in Kansas, you know changes are coming your way. Would you like to be one of the first to know which changes will affect you? At the KHCA/KCAL Annual Convention, we will hear from top officials and experts about what these changes could mean for you. Learn about state changes first-hand when Secretary on Aging Shawn Sullivan discusses the future of Medicaid in Kansas and KDOA staff discuss HCBS issues including care plans. Learn how you can best handle the changing expectations of quality and caregivers with Shelly Sabo, Director of NCAL's Workforce & Quality Improvement Programs, and Pat Giorgio, past Chair of NCAL. You will also learn how to make insulin management a reality in your home and enjoy fantastic general sessions with Neil Pruitt and Lt. Gov. Dr. Jeff Colyer, all while networking with your peers! You can't afford to miss this fantastic opportunity!

What's Your Most Frequently Occurring Survey Tag?
 
Did you know that, depending on your survey region, you have up to a 72% chance of receiving the F309 tag, Quality of Care? That is why we have brought one of the top Quality Care experts in the nation to our 61st Annual Convention & Trade Show. Mary Ousley has made such a significant national contribution to advancing quality performance in the long term care field that she was recently awarded the AHCA Friend of Quality Award.
Depending on your survey region, you also have up to a 62% change of receiving the F279 tag, Comprehensive Care Plans. If you join Master Trainer Becky LaBarge at our Convention, you will learn how to craft an effective care plan to avoid this tag and safeguard your reimbursements!

The Hyatt Wichita is sold out for our convention nights but the Drury Plaza Broadview is ready and waiting for your reservation. Call 1-800-378-7946 or click HERE. This room block closes Friday, October 7, 2011. This hotel is adjacent to our Convention, so don't worry about missing a thing!

Click here to register on line.

KHCA and AHCA having been providing you with resources for the impending changing to the CMS SNF PPS final rule. In case you missed any of the valuable tools to help manage your process, we are recapping some of the major ones below.

As a follow-up piece to the national training calls held toward the end of August and beginning of September, the Centers for Medicare & Medicaid Services (CMS) has released 10 pages of clarifications on the FY2012 SNF PPS rule published this summer.

The document provides general clarifications on the scheduling of assessments, as well as more detailed information on: the new Change of Therapy (COT) Other Medicare Required Assessment (OMRA), the allocation of group therapy time, the revised MDS assessment schedule, changes to the End of Therapy (EOT) OMRA—including the End of Therapy with Resumption—and a brief explanation of the revised student supervision requirements.

Transcripts and slides of the August national provider call are also available from CMS here in the Downloads section.

For a link to the AHCA reduction calculator, click here.

The Excellence in Action awards highlight the top 10 percent of facilities that scored “excellent” when asked about recommending a facility for care (residents and families) or as a place to work (employees). The Kansas homes receiving this recognition are:


Golden Heights Living Center - Garnett (C)
Medicalodges Columbus - Columbus (W)

My InnerView, a combined business unit with OCS and a division of National Research Corporation, yesterday recognized 593 nursing homes with 2010-2011 Excellence in Action awards. This honor recognizes nursing homes that achieve the highest levels of satisfaction excellence, as demonstrated by overall customer or workforce satisfaction scores that fall within the top 10 percent of My InnerView’s database—the largest skilled nursing facility database of its kind in the U.S.

“Celebrating the fifth year of Excellence in Action awards, it’s important to note that this year’s awards recipients were first recognized by their own customers and employees,” said Amanda Twiss, CEO of My InnerView-OCS. “There is no doubt that these nursing homes understand the value of measuring quality improvement over time, as evidenced not only by their outstanding scores, but the differences that they are making in the lives of their residents and employees.”

The Excellence in Action awards are presented exclusively to My InnerView clients. Qualifying nursing homes (almost 5,500) must have completed a customer (resident or family) or workforce (employee) satisfaction survey in 2010, achieved a minimum of 10 responses with a minimum 30 percent response rate, and scored in the top 10 percent of qualifying facilities on the question “What is your recommendation of this facility to others” or “What is your recommendation of this facility as a place to work?” in terms of the percentage of respondents rating the facility as “excellent.”

My InnerView and OCS partner with more than 12,000 post-acute providers.
For more information, please visit the My InnerView and OCS websites, write to info(at)myinnerview.com or info(at)ocsys.com, or call 800.601.3884 and 888.325.3396.

When I talk about data management systems, the idea of “making time” comes to mind. That is, “You can never find time for anything; if you want time, you must make time.” And that, coincidentally, is what AHCA’s facility LTC Trend Trackersm service can do for your staff: make time.

Making time is not rocket science, though solving the lack of time conundrum can give great pleasure to any administrator. Like Einstein, I also have a “Theory of Time.” But I express mine as a recipe: stir in a dash of “efficiency,” add a pinch of “effectiveness;” then blend in AHCA’s incredibly easy-to-use virtual LTC Trend Tracker. The result is better decision making because knowledge – data – is more accessible when you need it. With LTC Trend Tracker, your staff has a data management tool that allows them to work faster, smarter and achieve better results for the team.

All-in-One: TRACK, ORGANIZE, IDENTIFY, BENCHMARK, EXAMINE & COMPARE
LTC Trend Tracker is an online tool that puts at your fingertips facility performance reports so you can -- TRACK, ORGANIZE, IDENTIFY, BENCHMARK, EXAMINE and COMPARE -- almost anything you can imagine about your facility’s clinical and operational performance.  

With well over 4,000 users nationwide, LTC Trend Tracker is Administrator- and DON-proven.  I’ve highlighted three areas that show the agility of the LTC Trend Tracker tool in preparing management and quality reports you’ve probably had problems compiling in the past or did not even try to.

1.Quality Assurance Meetings:
Prepare efficiently for the quarterly QA meeting.  With a few clicks of the mouse you get multiple CASPER reports -- Staffing, Survey History and Resident Characteristic Reports; NH Quality Measures; Five Star Staffing Report; Cost Report;  and Medicare Utilization Report.
 
2.Budgeting:
Looking for historical information on your seasonal Medicare Utilization? Need insight into your staffing patterns? Problems solved with LTC Trend Tracker. With only a few clicks of the mouse you get these reports quickly: Cost Report, Medicare Utilization Report and CASPER Staffing Characteristic Report.   

3.SURVEY PREPAREDNESS:
You have your State Survey Entrance Notebook ready, but do you know the top 15 tags in your state for Health and Life Safety Code Inspections? Ask LTC Trend Tracker for the CASPER Survey Citation Reports to prepare your team for survey. 
 
There are three questions I will preemptively answer concerning LTC Trend Tracker data.
LTC Trend Tracker provides benchmarking based on ALL Medicare certified nursing homes, not just those registered for LTC Trend Tracker.

AHCA “uploads” data from CMS. (Uploading is the transfer of a file or program from one computer to another.) When you log onto the LTC Trend Tracker secure server, your data is already there based on your predetermined schedule
. 
For members of the Kansas  Health Care Association, the service is FREE. 
So whether you bake it or brew it, my recipe for making time to achieve productivity gains and improved management decision making is an all-around winner. To ask questions or to get more information, contact me at mailto: pconnorton@ahca.org or 202-898-2833. Or, visit the LTC Trend Tracker booth at the trade show. To log on or register, visit www.ltctrendtracker.com.

________________
For nearly 15 years, Peggy Connorton, LNFA, MS in Applied Gerontology, has focused on aging issues as an administrator of nursing homes and assisted living residences. Her commitment to AHCA and its Affiliated Organizations is as a change agent with deep knowledge about facility operations. Ms. Connorton fosters a culture of success through improved health care management and resident centered care.
 

The American Health Care Association says a recently introduced bill that purports to expedite the administration of painkillers to nursing home residents is “fundamentally flawed.”

AHCA argues that nurses should be designated “agents of prescribers” and be given the same power to function as nurses in physician's offices and hospitals do when ordering pain medications.

Earlier this month, AHCA took issue with Sen. Herb Kohl's (D-WI) Nursing Home Resident Pain Relief Act of 2011 (S. 1560), which eases regulations that claims to restrict nurses from ordering and administering controlled substances to residents based on a physician's verbal orders. Instead, Kohl's bill, as drafted, adds undue and excessive paperwork, according to David Gifford, M.D., AHCA's vice president for quality and regulatory affairs.

AHCA also argues in a statement released Wednesday that Kohl's legislation does not go far enough to prevent the diversion of controlled substances. More needs to done with efforts to prevent sales and theft of prescription medications, the group says.

“AHCA would welcome the opportunity to discuss this legislation in detail with Sen. Kohl and other Senators interested in helping us treat those patients who are suffering with pain,” Gifford said in a statement

Reprinted from McKnight's Daily Update

On Oct. 3, the US Supreme Court begins its 2011 term, which continues until late June or early July.  During this period, the Supreme Court justices hear arguments and deliver opinions.  The very first case on the docket this year, is Douglas v. Independent Living Center, which is a case that AHCA/NCAL has supported with time and financial resources.  Subsequently, AHCA is holding an important and free webinar on Friday, Oct. 5th, from 2:00-3:30PM, ET, led by Mark Reagan (Past AHCA Legal Committee Chair, and CAHF General Counsel) Lloyd Bookman and Craig Cannizzo, - all from Hooper & Lundy, to explain the underlying issues in the case and help you respond to media  and other requests.  To register for the webinar, go to http://webinars.ahcancal.org/index.php (select the webinar from the column on the right).

The key question the US Supreme Court will answer is whether Medicaid providers and beneficiaries can file suit (under the Supremacy Clause ) to enforce the Medicaid Act.  The webinar will not only provide background and status of Douglas v. Independent Living; but more importantly provide a forum to discuss the options the LTC provider community truly has post-Douglas (whether we win or lose at the US Supreme Court level) to hold States accountable for Medicaid ratemaking.  These options include CMS advocacy and the effective use of “champions” on proposed state plan amendments, and specific litigation strategies.  Each of these options will be discussed in a practical and common-sense manner on the call.  We look forward to having you join us and welcome any interested parties to the webinar.

Douglas v. Independent Living Center
Presented by: Mark Reagan (Past AHCA Legal Committee Chair, and CAHF General Counsel) and Craig Cannizzo, Lloyd Bookman - all from Hooper & Lundy
October 5th – 2:00pm – 3:30pm eastern time (1:00pm central, 12:00pm mountain, 11:00am Pacific)
Registration link: http://webinars.ahcancal.org/index.php (select the webinar from the column on the right)
The webinar is free, will be recorded and no CEUs are available. 

CMS issued an advance copy of the surveyor guidance for F322 – Feeding Tubes. The revision will be implemented on later this year. It is important to note that revisions to this guidance are extensive and F321, which contained language about not using feeding tubes unless unavoidable, has been deleted and the language incorporated into F322. AHCA and its members provided extensive comments to CMS as this revised guidance was developed. The KHCA Nursing Advisory Committee will begin reviewing the guidance at their November 2011 meeting. 

HHS Secretary Kathleen Sebelius says political pressures to cut budgets have the potential to set back efforts to shift the Medicaid program away from nursing homes and toward home and community-based services.

Following a speech to the National Association of States United for Aging and Disabilities, Sebelius said it may seem appealing to cut those services because they’re not a benefit states are required to provide under Medicaid, unlike nursing homes. But nursing homes can be more expensive than providing services to keep people at home, Sebelius argued.

“Governors have gone after home and community-based services as a way to cut Medicaid spending,” she said. “What they will end up doing is spending a whole lot more on those same individuals who will run out of [home-based] services, end up in the nursing home and then [their costs will] be mandatory.”

Home and community-based services are also potentially on the chopping block as Congress looks for opportunities to rein in spending, Sebelius said, with potentially the same consequences.

“We’re going to engage in that same discussion at the national level, too. Yes, it might save the FY '12 budget, but, boy, you're going to pay for it in the long run,” she said. “And to get someone back out of a nursing home is a much more complicated and sometimes expensive process than to keep them out in services and supports on the front end.”

Sebelius said the department had yet to engage heavily in state discussions about cutting the services, but is taking steps to stave off cuts, including providing support to states through the office of dual eligibles.

“We’re putting into place federal supports to say to states, ‘Don’t look just at what can happen next week. We have resources to help you build that workforce, to help you build those services, to give you incentives to use your Medicaid dollars to keep people in the community [and] not send them into a nursing home, because in a long run it's going to drive budget costs up,’” she said.

Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment by reviewing the MLN Article SE1107 .   If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule.  A Quick Reference Guide is available to help you understand the changes that the eRx Final Rule made to the 2011 Medicare eRx Incentive Program.  As a result of changes to the program, eligible professionals and group practices have until November 1, 2011 to submit  a significant hardship exemption request and rationale.  Individual eligible professionals must submit their hardship exemption requests through the  Quality Communications Support Page and group practices participating under the group practice reporting option (GPRO) must submit hardship exemption requests via a letter to CMS.  Additional information and resources are available at http://www.cms.gov/erxincentive

For the fourth year, the National Council of Certified Dementia Practitioners is offering The National Council of Certified Dementia Practitioners Alzheimer’s and Dementia Staff Education Week February 14th to the 21st Tool Kit. The Tool Kit is free and available at www.nccdp.org. The tool kit includes many free Power Point in-services for download beginning November 15th 2011 to March 1st 2012. Each in-service is designed to be taught in 30 minutes to health care professionals and front line staff.

The Tool Kit and the declaration by the NCCDP Alzheimer's and Dementia Education Week February 14th to the 21st was developed to bring national and international awareness to the importance of providing comprehensive dementia education by means of face to face interactive classroom environment to all healthcare professionals and line staff and to go above and beyond the minimum state requirements regarding dementia education.

Currently there are no national standards for dementia education. The regulations are different from state to state. The NCCDP recommends at minimum an initial 8 hours of dementia education to all staff. Throughout the year, additional dementia education should be provided that incorporates new advances, culture change and innovative ideas.

In addition to facilitating the Train the Trainer programs, The NCCDP promotes dementia education and certification of all staff who qualify as Certified Dementia Practitioners (CDP®). The NCCDP recommends that at minimum there should be one Certified Dementia Practitioner® per shift. The NCCDP recommends a trained and certified Alzheimer’s and dementia instructor by the NCCDP to utilize up to date NCCDP training materials.

The NCCDP recognizes the importance of educated and certified dementia unit managers and certifying the Dementia Unit Manager as Certified Dementia Care Manager (CDCM®). Dementia Unit Managers report that they have received little training as a Dementia Unit Manager.

Front Line First Responders and Law Enforcement need comprehensive Dementia training and the NCCDP provides Alzheimer’s and Dementia training to First Responder and Law Enforcement educators and certification as Certified First Responder Dementia Trainer®.

The free tool kit includes:
Free Power Point In-services (Many topics) for Health Care Staff which includes pre test, post tests, handouts, answers, in-service evaluation and in-service certificates.
Nurse Educator of the Year Nomination Forms 
Nomination Forms for NCCDP Alzheimer’s and Dementia Staff Education Week Contest 
Proclamations for Senators and Mayor 
Letters to the Editors Promoting Your Program 
97 Ways to Promote Alzheimer’s and Dementia Staff Education Week 2011 
Resources and Important Web Sites

The National Council of Certified Dementia Practitioners®, LLC was formed in 2001 by a group of professionals with varying work and personal experiences in the field of dementia care. The Council was formed to promote standards of excellence in dementia and Alzheimer's education to professionals and other caregivers who provide services to dementia clients. As the number of dementia cases continues to increase nationally and worldwide, there is a great necessity to insure that care givers are well trained to provide appropriate, competent, and sensitive direct care and support for the dementia patient. The goal of the Council is to develop and encourage comprehensive standards of excellence in the health care profession and delivery of dementia care.

On Friday September 23, 2011 the Treasury Department published a final rule in the Federal Register allowing the delivery of federal payments to resident trust or patient fund accounts held by nursing homes.  76 Federal Register 59024, Sept. 23, 2011.  (attached)  In the final rule, Treasury confirmed the position it had already taken in the proposed rule (also attached) after extensive and lengthy advocacy with respect to both the Social Security Administration and Treasury undertaken by AHCA.
 
After extensive AHCA advocacy with respect to both the Treasury Department and the Social Security Administration,  Treasury had provided the AHCA requested exception to the Treasury’s “in the name of the recipient requirement” in its proposed rule.  In the final rule, Treasury finalized the nursing facility exception confirming its position and restated many of the protections afforded such accounts in statute, regulation and guidance stating that:
 
In light of the extensive protections  provided to residents of nursing facilities whose funds are maintained in resident trust or patient fund accounts, we proposed to establish an exception to the ‘‘in the name of the recipient’’ requirement in order to permit payments to be deposited into resident trust or patient fund accounts established by nursing facilities.  76  Federal Register at 59026, September 23, 2011.  
 
Treasury made one change in the final rule to assuage concerns of some financial institutions that expressed concern that they could be held liable if funds are misapplied and suggested that the final rule either: (1) Specify that the payment be deposited into an account that is designated as a resident trust or patient fund account; or (2) allow the payment to be deposited into a deposit account established by the nursing facility. 
 
Treasury revised the wording of the exception to provide that where a Federal payment is disbursed to a resident of a nursing facility, as defined in 42 U.S.C. 1396r, the payment may be deposited into a resident trust or patient fund account established by the nursing facility ``pursuant to requirements under Federal law relating to the protection of such funds.''   31 CFR 210.5.  Treasury explained that “this wording addresses commenters' concerns by making clear that an eligible account is restricted to ``a resident trust or patient fund account’’ established by ``a nursing facility as defined in 42 U.S.C.  1396r'' and that the account is subject to all of the requirements governing the protection of funds held in resident trust or patient fund accounts.”  76 Federal Register at 59028-59029.
 
Treasury’s addition quoted above is in accord with AHCA’s position that there is extensive federal law in the form of statute, regulation and guidance that governs resident trust funds and with which, therefore,  nursing facilities must comply.
 
If you have any questions, please contact Elise Smith at mailto:esmith@ahca.org.