UPDATE Weekly

The Budget Control Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt action to address the current budget uncertainty and the economic hardships imposed by sequestration.

In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013. The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.

Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction. The Centers for Medicare & Medicaid Services encourages Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare’s reimbursement.

Questions about reimbursement should be directed to your Medicare claims administration contractor.

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Capitol Connection is published regularly by the American Health Care Association. Each issue contains information that will positively impact your facility. To access the latest issue, as well as past issues, click here.

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The Updated List of Excluded Individuals and Entities (LEIE) database file reflects all OIG exclusion and reinstatement actions up to, and including, those taken in February 2013. This new, “Updated LEIE” is a complete database file containing all exclusions currently in effect. Individuals and entities that have been reinstated to the Federal health care programs are not included in this file.

The new file is meant to REPLACE the “Updated LEIE” file made available for download last month. The new file is complete and need NOT be used in conjunction with the monthly exclusion and reinstatement supplements. Alternatively you may wish to download either the February Exclusions or Reinstatements databases only which are posted as the “Current Monthly Supplements.” All the updated files are posted at https://oig.hhs.gov/exclusions/exclusions_list.asp.

The full LEIE database — complete with all the monthly updates — is included in the OIG “Online Searchable Database” which may be accessed at http://exclusions.oig.hhs.gov.

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Certain nursing homes may be able to get a two-year extension on a requirement to install an automatic sprinkler system, under a rule proposed by the Centers for Medicare & Medicaid Services.

Nursing homes had until August 13, 2013 to install an automatic sprinkler system. The new rule would allow certain facilities to get an extension on the deadline if they meet certain stipulations such as undergoing a major renovation or in the process of constructing a new structure.

According to CMS, the new rule is intended to “reform Medicare regulations that CMS has identified as unnecessary, obsolete, or excessively burdensome on healthcare providers and suppliers.”

To read the proposed rule, click here.

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At the AHCA/NCAL Quality Symposium, it was announced that LTC Trend TrackerSM now has the MDS 3.0 rehospitalization measure – OnPoint-30® – available for skilled nursing facilities.

Provided by PointRight, this new report allows you to benchmark your hospital readmission rates against your peers (from your zip code to the national level). In addition, OnPoint-30 provides you with actual, expected and risk-adjusted rates, allowing you to furnish hospitals with information that may impact your referral patterns.

Get tracking today at http://www.ltctrendtracker.com!

OnPoint-30 will be a critical resource as AHCA members continue to strive to meet the Quality Initiative goal to reduce hospital readmissions within 30 days of SNF stay by 15% before March 2015. Learn more about what you can do to reduce your rehospitalization rates.

Please note that OnPoint-30 is only available on the report builder (AHCA Outcomes Report). AHCA is currently working on a dashboard widget for this report.

To learn more about OnPoint-30, please download AHCA’s help document.

Or you can sign-up for either of the two, upcoming OnPoint-30 Webinars:

• Thursday, March 14; 2:00 PM – 3:00 PM ET

Register online at https://cc.readytalk.com/cc/s/registrations/new?cid=89ox6svpc1rz

Register online at https://cc.readytalk.com/cc/s/registrations/new?cid=e08unum12kxe

If you have any questions in regards to OnPoint-30 or need your username, please contact customer.service@ltctrendtracker.com.

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The NC State Board of Examiners for Nursing Home Administrators will offer the 2013 Preceptor Seminars on April 22nd and 23rd, 2013 and April 23rd and 24th, 2013 at the Kingston Plantation, Myrtle Beach, SC. You will need to choose the first seminar dates for Renewal Preceptor certification and the second seminar dates for Initial Preceptor Certification and Continuing Education Only. The seminars will be open to all nursing home administrators seeking continuing education credits and/or preceptor certification. This is the only Preceptor Seminar being planned for 2013 by the NC State Board of Examiners for Nursing Home Administrators.

To register for your overnight rooms at Kingston Plantation, call 1-800-876-0010 or call (843)449-0006. The group’s special code is NBE. You can also book online at http://www.Hilton.com. Make sure that you are booking at the Embassy at Kingston Plantation. On the booking page, click on the box that says ADD SPECIAL CODE and then put NBE in the box marked “Group Code”. A block of rooms are reserved until March 23, 2013. Click Here to download more information along with the registration form.

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The national theme for the 2013 National Nursing Home Week (NNHW) is Team Care. NNHW will be observed in skilled nursing facilities throughout America, Beginning Mother’s Day, May 12th and continuing through May 18th, 2013.

NNHW’s theme recognizes residents and patients in long term and post-acute care settings, the dedicated staff who care for them, and the value of care planning where everyone “pitches in” for optimal outcomes. The observance is an opportunity to involve families, community members, youth, and others in a community-wide show of support and respect for these individuals and the staff who provide care or support services. Activities are designed to foster intergenerational contact, strengthen family relationships and to encourage volunteerism by individuals and local organizations.

Stay tuned for the planning guide, full of fun activity ideas to celebrate the week at your community. Themed products and merchandise developed by the American Health Care Association (AHCA) coming soon! For details visit http://www.nnhw.org and participate on Facebook. E-mail inquiries should be sent to nnhw@ahca.org. Please inform your staff of the date and theme!

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On Tuesday, you should have received an email from NCHCFA containing the following information on three memoranda CMS released to the states revising previous versions of:

• Advance Directives (F155)
• Naso-Gastric Tubes (F322)
• Physician Delegation of Tasks in SNFs and NFs

In addition to the memoranda and guidance, the revisions to Advance Directives and Naso-Gastric Tubes are reflected in revised surveyor training materials. You may link to the attached documents for complete details.

• SC13-15. Physician Delegation Of Tasks In SNFs And NFs
• SC13-16.01. F155 Advance Directives – Revised Advance Copy
• SC13-16.02. IG F155 Revision Highlighted
• SC13-16.03. F155. Powerpoint Training Revision
• SC13-17.01. F322-Nasogastric Tubes Revised Advance Copy
• SC13-17.02. IG F322
• SC13-17.03. Interpretive Guidance Training F322 Feeding Tubes

F-Tag 155: Advance Directives (replaces previous version of S&C 12-47-NH dated September 27, 2012)

The revisions are highlighted in the Advance Copy Interpretive Guidelines and include:

• Removal of the term “right to accept” preceding language specific to medical and surgical treatment to correlate with the regulatory language at §483.10(b)(4).
• Language specific to experimental research has been added to the Interpretive Guidance (IG) and correlates with the Power Point training materials. A definition for investigational or experimental drugs has been added to the definitions sections of the IG.
• Clarification to specify that §483.10(b)(8) applies only to adult residents and not all residents regardless of age, as evidenced in the regulatory language.
• The Investigative Protocol has been updated to include guidelines specific to experimental research and record review considerations relative to a physician’s basis for conscientious objection and/or need for additional information related to a resident’s decisional capacity.
• The “Use” section of the Investigative Protocol has been revised secondary to burden reduction considerations. Surveyors will no longer use the protocol for all residents in the survey sample, only residents who meet the parameters listed in this section.
• Updated Power Point training slides to correlate with revisions made to the Surveyor Guidance at F tag 155. Revisions made to the training slides have a red font color.

F-Tag 322: Naso-Gastric Tubes (replaces previous version of S&C 12-46-NH, dated September 27, 2012)

The revisions are highlighted in the Advance Copy Interpretive Guidelines and include:

• Revision of the regulatory language to now resemble the formatting of §483.25(g) in the Code of Federal Regulations (CFR).
• Additional clarification related to the expanded definition of “Naso-Gastric tubes.”
• Updated Power Point Training slides to correlate with revisions made to the Surveyor Guidance at F tag 322. Revisions made to the training slides have a red font color.

Physician Delegation of Tasks in SNFs and NFs (replaces S&C-04-08, dated November 13, 2003)

CMS is clarifying the regulatory differences concerning physician delegation of tasks in SNFs and NFs. The distinction in policies between these two settings (SNFs and NFs) is based in statute and regulation. Improper application of these regulations may affect a facility’s compliance and may also affect payment to providers. The key to accurate application is to identify:

1. in which setting, SNF or NF, the physician services are being provided;
2. whether the task must be performed personally by the physician; and
3. whether or not the non-physician practitioner (NPP) is employed by the facility.

The “setting” is determined by whether the visit to a patient in a certified bed is to a resident whose care is paid for by Medicare Part A in a SNF or under Medicaid in a NF. The memorandum addresses the authority of NPPs (i.e., nurse practitioners, physician assistants, or clinical nurse specialists) to perform certain tasks, such as conducting physician visits and writing orders, and to sign certifications and re-certifications.

Summary of elements of the memo:

• Guidance revision: Clarification of Federal guidance related to physician delegation of certain tasks in SNFs and NFs to non-physician practitioners (NPPs; formerly “physician extenders”) such as nurse practitioners, physician assistants, or clinical nurse specialists.
• Implements Section 3108 of the Affordable Care Act (ACA): Implements section 3108 of the Affordable Care Act, which adds physician assistants to the list of practitioners that can perform Skilled Nursing Facility (SNF) level of care certifications and re-certifications.
• Co-signing of orders: Clarifies policy on co-signing orders in SNFs and NFs.

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This book will show you the true financial consequences of unchecked resident readmission and provide you with the tools to do something about it! It delivers several practical strategies your facility can employ, such as enhanced resident assessment and documentation policies, provider partnerships that improve transitions of care, staff education tools, and methods to achieve resident and staff involvement. You’ll learn how to ensure smooth care transitions through resident education and effective communication with staff and other care providers, reduce costs associated with re-hospitalizations, and maintain or improve the resident’s quality of life.

To order, visit http://www.AHCApublications.org or call (800) 321-0343.

Product #8238
AHCA MEMBERS $129.00

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Facebook’s oldest user is 105 years old.

http://abcnews.go.com/Health/facebooks-oldest-user-105/story?id=18422943

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An estimated 1.65 million pairs of eyeglasses have made their way to Disney World’s lost-and-found bins since 1971. Every year, the park finds an average of 6,000 cellphones, 3,500 digital cameras and 18,000 hats.

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