UPDATE Weekly

Last week, the District I Fabulous Fifty celebration was held October 18th at The Grand Bohemian Hotel in Asheville, NC. Dr. Carl Mumpower hosted the event.

Recipients of the 2013 District I Fabulous Fifty honor are:

• Earl Buckner – Universal Health Care/Fletcher, Fletcher, NC
• Nicole Galladay – Autumn Care of Saluda, Saluda, NC
• Jamie Green – Elderberry Health Care, Marshall, NC
• Paula Henderson – Smoky Mountain Health and Rehab, Waynesville, NC
• Judy Hughes – Pisgah Manor, Candler, NC
• Rosemary Lopez – Autumn Care of Saluda, Saluda, NC
• Daniel Marr – Skyland Care Center, Sylva, NC
• Teresa Orr – Graham Healthcare and Rehab, Robbinsville, NC
• Shirley Owens – Carolina Village, Hendersonville, NC
• Kathey Phillips – Autumn Care of Waynesville, Waynesville, NC

Last night, the Association was proud to honor the Fabulous Fifty winners in District II at the Hilton Charlotte University Place, Charlotte, NC. Senator Bob Rucho hosted the event.

Recipients of the 2013 District II Fabulous Fifty honor are:

• Veronica Adams – Carrington Place, Matthews, NC
• Olivia Bright – Huntersville Oaks, Huntersville, NC
• Monica Coleman – The Oaks at Town Center, Harrisburg, NC
• Sherneter Collins – Jesse Helms Nursing Center, Monroe, NC
• Sheila Dalton – Sardis Oaks, Charlotte, NC
• Rebecca Evans – Lutheran Home/Hickory West, Hickory, NC
• Autumn Kiser – Autumn Care of Statesville, Statesville, NC
• Glenda Miller – Wilkes Senior Village, North Wilkesboro, NC
• Sherry Welborn – Westwood Hills Nursing and Rehab, Wilkesboro, NC
• Betty Williams – Alleghany Care and Rehab, Sparta, NC

The next Fabulous Fifty celebration will be held on October 25th at the Sheraton Greensboro Hotel at Four Seasons, Greensboro, NC.

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The NCHCFA Annual Convention and Trade Show will be held February 10-13, 2013 at the Sheraton Greensboro Hotel at Four Seasons/Joseph S. Koury Convention Center in Greensboro, NC! Call the Sheraton at (800) 242-6556 to make your room reservation. Identify you are with “NC Health Care Facilities Association 2013” to receive the group discounted rate. Brochures outlining specific program information will be mailed in December.

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Recently, the Division of Medical Assistance announced a series of trainings for providers in the Medicaid Personal Care Services (PCS) program. These trainings will cover the most up-to-date information available concerning the changes being made to the PCS program. For more information on these changes, go to http://www.ncdhhs.gov/dma/pcs/pas.html.

Register at http://www.thecarolinascenter.org/default.aspx?pageid=194.

REMAINING SESSIONS:

• Friday, October 26, 2012 – Greenville, NC
• Thursday, November 1, 2012 – Charlotte, NC
• Friday, November 2, 2012 – Asheville, NC

TOPICS:

• PCS Policy 3L
• Transition assessments: Eligibility determinations, beneficiary notices, and appeal rights
• Reporting and request processes for new admissions, provider changes, and status changes
• Requirements for plan of care development and aide documentation
• Billing: Program billing codes and modifiers, and the CMS-1500

Information is also available online in the following locations:

What’s New – http://www.ncdhhs.gov/dma/index.htm

What’s New Information – http://www.ncdhhs.gov/dma/pcs/pas.html

Seminars and Trainings – http://www.ncdhhs.gov/dma/provider/seminars.htm

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Palmetto GBA is introducing to their J11 Part A providers quarterly Webinars which are intended to offer additional educational opportunities for providers to stay up-to-date on Medicare policy and procedures.

The first quarterly Webinar session will be held on Thursday, December 13, 2012, from 10:00 AM to 11:00 AM ET.

These Webinars are designed to provide pertinent updates, changes, and reminders to assist the provider community in staying compliant with Medicare rules and regulations and will include:

• Top Comprehensive Error Rate Testing (CERT) errors
• New and updated Change Requests (CRs) and Medical Learning Network Matters (MLN) articles
• Changes to current billing requirements
• Hot topics that impact provider billing
• Top denials and rejections

For information on accessing the Webinar, click here.

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By now, many people have probably heard of the settlement in the case of Jimmo v. Sebelius which asked the question of whether or not the Medicare “Improvement Standard,” which has operated as a rule of thumb to terminate or deny Medicare coverage to beneficiaries who are not improving, violates substantive and procedural requirements of the Medicare statue, the Administrative procedure Act, the Freedom of Information Act and the Due Process Clause of the 5th Amendment. The decision pertains to SNFs, home health (HH), and outpatient therapy (OPT) where Part A and Part B coverage has been tied to the necessity for improvement.

Originally, the federal government filed a motion to dismiss; but the Court determined that the case could proceed, but the Federal government asked for settlement discussions, which have been on-going throughout 2012 while the proceedings were stayed. On July 20, 2012, the parties informed the court that they had an agreement in principle, and they submitted that proposed written settlement agreement to the Court on Oct. 1, 2012.

The Court is now considering the proposed settlement provisions for fairness and reasonableness; but it is expected to be finalized in 2013. When the settlement is finalized, we expect that CMS will clarify the coverage standards for benefits when a patient has no restoration or improvement potential but still needs SNF, HH and out OPT services (e.g. “maintenance coverage standards”) by revising the Medicare Benefit Policy Manual as follows:

• SNF, HH and OPT coverage of therapy to perform a maintenance program does not turn on the presence or absence of a beneficiary’s potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care.
• SNF and HH coverage of nursing care to perform a maintenance program does not turn on the presence or absence of a beneficiary’s potential for improvement from the nursing care, but rather on the beneficiary’s need for skilled care.
• These revisions will not apply to therapy services provided in an inpatient rehabilitation facility (IRF). Again, upon approval of the Court, we expect that CMS will clarify that an IRF claim cannot be denied because a patient cannot be expected to: a) achieve complete independence in the domain of self-care; or b) return to his/her prior level of functioning.

There are likely other matters which will have to be clarified before we can speak knowledgably to the overall impact of the settlement; but we thought it was important to get this information out quickly.

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Through self-assessment tools, individual and small-group exercises and review questions, and case studies, supervisors can improve their own leadership skills. The keys to managerial leadership are operational, relational, and analytic skills. These are further broken down into 12 chapters. Each chapter describes the skill, suggests exercises for learning the skill, illustrates the skill with case studies, gives a set of review questions and related activities to assess learning outcomes, and closes with a self-assessment exercise to identify the reader’s current skill level.

Product #6860

AHCA MEMBERS $34.95

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

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Does your facility need an extra copy of the Membership Directory around the office? This informative guide lists the NCHCFA Board of Directors, member facilities (by facility, administrator and district), staff contacts, and the NCHCFA trade members. Contact Jan Williams at janw@nchcfa.org to order brochures for your facility.

NCHCFA Members Only: $35.00 plus tax and shipping

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The National Institute on Aging estimates around 7 million Americans are long-distance caregivers. Aside from economic factors that often drive people far from their hometowns, shifting demographics in the country could exacerbate the issue: Over the next four decades, the share of people 65 and older is expected to rapidly expand while the number of people under 20 will roughly hold steady.

http://www.msnbc.msn.com/id/46150872/ns/health-aging/#.UIgiC4ZP58E

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During Prohibition, some stores sold grape concentrate with warning labels that listed the steps that should be avoided to prevent the juice from fermenting into wine.

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