UPDATE Weekly

Make plans today to join your colleagues for the second annual NCHCFA Summer Symposium. The three-day event will be August 6-8, 2013 at the Marriott Grande Dunes Resort, Myrtle Beach, SC. Call the Marriott Resort at (800) 228-9290 to reserve your overnight room. Identify yourself as a NC Health Care Facilities Association Convention attendee! To make your reservation online, visit http://tinyurl.com/2013symposiumreserve. Please note that when our room block is full, rooms will be on a first come, first served basis at prevailing published rates.

Please call the Association office at (919) 782-3827 with any questions. Brochures will be mailed to members in May!

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Mark your calendar now and plan to attend four value-packed days of learning and networking in Phoenix, AZ, October 6-9, 2013! Choose from over 60 sessions in 11 education tracks ranging from advocacy to finance to person-centered care to quality improvement. Take advantage of terrific networking opportunities, outstanding educational programming, and fabulous entertainment, all in a beautiful location. Visit http://www.AHCAconvention.org for event details and registration information! Early bird discount ends July 19, 2013!

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As of April 1, 2013, Recovery Auditors (RAs) will be reviewing therapy claims that exceed $3,700. RA pre-payment reviews will occur in eleven states (including North Carolina) through the end of 2013. All other states will have post-payment review.

Called “manual medical review,” and required by Congress through the end of 2013, the Centers for Medicare & Medicaid Services (CMS) has said it wants to know about any glitches in the review process immediately. Thus, the American Health Care Association (AHCA) has taken steps to continuously channel providers’ problems with the process to CMS through the AHCA Manual Review Clearinghouse at manualreview@ahca.org. If a provider is facing a glitch or problem that it cannot get resolved, AHCA asks that the provider send the problem to the clearinghouse at manualreview@ahca.org.

On the positive side of the manual review process, CMS is requiring RAs to complete pre-payment reviews within ten days and AHCA especially wants to hold them to this timeframe.

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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 March 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 March 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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On January 24, 2013, the U. S. District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius, in which the plaintiffs alleged that Medicare contractors were inappropriately applying an “Improvement Standard” in making claims determinations for Medicare coverage involving skilled care (e.g., the skilled nursing facility (SNF), home health (HH), and outpatient therapy (OPT) benefits). CMS has just posted a Fact Sheet on the settlement agreement.

The Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet to address some of the issues with this case. Click here to read. CMS states that it will complete the manual revisions and educational campaign by January 23, 2014, which is within one year of the approval date of the settlement agreement.

As discussed during the NCHCFA Convention, AHCA recommends that providers resist pressure to “implement” Jimmo before CMS issues formal guidance. However, CMS explains in the Fact Sheet that skilled care may be provided in specific instances where no improvement is expected but skilled care is, nevertheless, required in order to prevent or slow deterioration and maintain a beneficiary at the maximum practicable level of function. A demonstration of the medical necessity and reasonableness of skilled services is always required, but it is believed that a decision, before formal CMS guidance is available, to provide skilled care where no improvement is expected, calls for very explicit and complete documentation of the medical necessity and reasonableness of the skilled services.

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Submit nomination forms today for the American Health Care Association (AHCA) 2013 Volunteer of the Year awards. Nominations for the Volunteer of the Year award must be submitted through the NCHCFA office — not directly from individual facilities. The deadline for nominations is Friday, May 17, 2013. Visit the News and Updates section of the Member Center on the Association’s Web site at http://www.NursingHomesNC.com to obtain nomination forms and to review all rules and criteria. Because the nomination forms are reproduced as is and submitted to judges in the long term care community, please make sure your forms are typed. Variations of AHCA’s nomination forms will not be accepted. Faxed nomination forms will not be accepted. The winners will be honored at AHCA’s 64th Annual Convention and Exposition, October 6-9, 2013 in Phoenix, AZ. If you have any questions or comments, please e-mail or call Ms. Claire Krawsczyn at ckrawsczyn@ahca.org or (410) 340-2210.

AHCA will also recognize an honoree of distinction from an ICF/IID facility or HCBS Waiver Home for their dedication to improving the quality of life of clients and advancing community understanding of individuals with intellectual or developmental disabilities. The same rules/regulations apply as above. (Intellectual Disabilities/Developmental Disabilities Hero of the Year Award- ID/DD Hero of the Year)

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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.

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.

Team Care should be on display at your facility by using special themed products that are available from the AHCA Bookstore. Order soon as quantities are limited. More information is available at the dedicated Web site http://www.nnhw.org and 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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The American Health Care Association (AHCA) has previously reported on items related to payments made by CMS to Medicare Advantage (MA) plans. Additional information is being provided in response to questions from members.

First, April 1st marked the effective date of the two percent across-the-board cuts to all Medicare payments, known as the “sequester.” MA, or Medicare Part C, is subject to the sequester cuts just as Medicare Parts A and B are. For MA plans, the sequester cuts will be reflected in their first monthly capitated payment from CMS on or after April 1st. The implication to post-acute and long term care (PAC/LTC) providers depends on the language in the provider’s individual contracts with MA plans.

AHCA strongly recommends that providers review the provisions in their MA contracts to determine whether or not the plans are able to pass those cuts down to providers rates, and to seek legal counsel if they have concerns or questions about their options.

Second, on Monday CMS published their final announcement that the MA growth rate percentage for plan payments beginning on October 1st, 2013 (FY 2014) is 3.3 percent. This is the funding that the MA plans receive from the government. Whether or not the MA plan will pass on the increase to the provider again depends on the contract between the provider and the MA plan. This increase was a significant difference from the 2.2 percent cut they originally proposed in a 45-day advance call letter.

Even though CMS projects a growth rate increase in MA payments, in reality MA plan payments are likely to decrease in 2014, not increase. There are a number of reasons for this, including the sequester cuts which are described above. But more importantly, a number of provisions that were included in the Affordable Care Act (ACA) work to decrease payments to MA plans over time, and many of these will be implemented in 2014. Due to the fact that MA plans are likely to see their payments decrease, they may wish to enter into discussions with providers to renegotiate rates for 2014. AHCA and NCHCFA continue to remain engaged in this issue and will provide resources to members.

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The North Carolina Culture Change Coalition will be offering a free workshop at three different locations throughout the state. Each location will offer a 9 AM – 12 Noon session or 1 – 4 PM session.

• May 22, 2013 at Wake County Commons Building (Raleigh) | 4011 Cary Drive, Raleigh, NC 27610
• August 6, 2013 at WillowBrooke Court at Plantation Estates | 701 Plantation Estates Drive, Matthews, NC 28105
• October 9, 2013 at Davis Health Care Center | 1011 Porters Neck Road, Wilmington, NC 28411

Administrator CEUs, drinks and snacks will be provided. To register, contact Patsy Rudolph at patsy.rudolph@kindred.com. Comments and questions can be directed to Becky Wertz, becky.wertz@dhhs.nc.gov or by visiting the NC Culture Change Coalition’s Web site at http://www.ltcenhance.com.

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The AHCA 2012 Nursing Facility staffing survey is underway. The survey collects information on vacancy, turnover and retention for all staff categories. The information collected can be made available in LTC Trend Tracker to help you track and benchmark staff stability in your market, and will help AHCA and other stakeholders in policy development and advocating on workforce issues on your behalf.

The survey questionnaire can be downloaded from the AHCA Web site. All facilities are asked to complete and return the survey by Wednesday April 24, 2013. For more information, please e-mail research@ahca.org.

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This three-part DVD training series includes must-have background information for feeding assistants (Getting Started, 20 minutes), specific job responsibilities and procedures (Proper Feeding Techniques, 18 minutes), and helps prepare employees in case problems or emergencies arise (Problem Behavior and Emergencies, 14 minutes).

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

Product # 6790D
AHCA Members (online price) $99.00

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The notebook used in the training seminar is available for purchase. Contact Jan Williams at janw@nchcfa.org to order a notebook for your facility. The cost is $25 plus tax and postage.

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Medical students at Duke University are using a new virtual game-based tool to learn from their mistakes without a life depending on it.

http://www.wral.com/computer-simulations-allow-doctors-to-learn-skills-with-less-risk/12284450/

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On January 22, 1943, in Rapid City, SD, the temperature plummeted 47°F in 5 minutes from 60°F to 13°F, the fastest drop in temperature ever recorded.

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