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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NCHCFA just learned some breaking news about the Independent Payment Advisory Board (IPAB). The board’s Medicare spending triggers officially won’t be met this year and are not expected to be activated for several more years. In a letter to Marilyn Tavenner, the CMS acting chief actuary explains that the projected 5-year average growth in Medicare per capita spending is 1.15 percent, and the 5-year average growth target is 3.03 percent. Because the projected 5-year Medicare per capita growth rate does not exceed the Medicare per capita target growth rate, there is no applicable savings target for implementation year 2015.

Click here to read the letter to Marilyn Tavenner referenced above.

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Honeywell recently announced a potential defect with their BG-10 series pull stations. These pull stations were manufactured from 1992 through 2010 under multiple brands including ADT, Fire-Lite Alarms, Johnson Control Inc. and Notifier. Over time, deterioration inside the devices can occur, preventing the pull stations from transmitting an alarm signal when activated.

For important information on this potentially dangerous situation, go to http://www.pullstationsafety.com.

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You never know when you will need to respond to a crisis. You need to be ready to respond! With the recent explosion at the West Fertilizer Company in Texas where more than 100 residents from West Rest Haven Home had to be evacuated and other unfortunate public tragedies – 2013 is proving to be a challenging year. Adding to this already perilous environment, hurricane season is four weeks away and forecasters agree that the 2013 season will be very active with above average numbers of named storms and hurricanes in the Atlantic.

Register TODAY for NCHCFA’s seminar: ALL HAZARDS EMERGENCY MANAGEMENT FOR LONG TERM CARE. This seminar will be held at The Sheraton Hotel in Chapel Hill on May 16th, 2013.

WHO SHOULD ATTEND?

Our recommendation is that you consider who the team is that is going to manage an isolated or catastrophic event and bring them to this program. This would include Owners or Regional VPs, Administrators, Directors, Directors of Nursing, Assistant Directors of Nursing, Maintenance Directors and Staff Development. This is a team effort and everyone involved in your disaster plan should be considered.

Click here to register on-line now!

Click here to download and print the seminar brochure and registration form!

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Health care providers whose claims are still pending when NCTracks goes live July 1, 2013, must resubmit those claims in the new system. That and other key cutoff dates for the transition to NCTracks are available in a SPECIAL BULLETIN.

NCTracks will go live July 1, replacing the Medicaid Management Information System (MMIS) and other legacy claims processing systems used by DHHS. The State and its new fiscal agent, CSC, have endeavored to make the transition as smooth as possible. The Special Bulletin outlines dates on which specific operations will cease in the legacy claims systems before resuming in NCTracks. Health care providers are advised to review the cutoff dates and plan accordingly. For example, claims and adjustments pending in legacy systems after the final checkwrite cycle will be denied. Providers will receive an explanation of benefits (EOB) stating that adjudication was not completed, and advising providers to resubmit the denied claims in NCTracks on or after July 1. Providers should also make sure they have taken all steps necessary to make sure claims are processed and paid. A complete checklist is available at http://ncmmis.ncdhhs.gov.

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The next CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum scheduled for Thursday, May 2, 2013 beginning at 2:00 PM ET. This call will include announcement and updates, as well as time for an open question and answer session. To participate, dial (800) 837-1935 and reference Conference ID 78862506.

Encore is an audio recording of this call that can be accessed by dialing (855) 859-2056 and entering the Conference ID. Encores for ODFs held on Thursdays can be accessed the following Monday. The recording is available for 3 business days.

For Open Door Forum schedule updates and E-Mailing List registration, visit http://www.cms.gov/OpenDoorForums.

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Recently, several nursing home providers have been approached by hospitals offering to pay the co-pay for a potential nursing home resident. Because of the potential problems that this may cause, Reed Smith, in cooperation with the American Health Care Association (AHCA) is providing the following information to clarify this situation.

QUESTION: Can a hospital supplement a patient’s co-pays to a SNF for a traditional Medicare patient?
ANSWER: No.

QUESTION: Is the answer the same for a Medicare Advantage patient?
ANSWER: Yes. The statutory Medicare anti-supplementation provision, 42 U.S.C. § 1395cc(a)(1)(A)(i), states that providers agree, pursuant to a Medicare provider agreement, “not to charge, except as provided in paragraph (2), any individual or any other person for items or services for which such individual is entitled to have payment made under this subchapter . . .” The subchapter referred to in the anti-supplementation provision quoted above is the Medicare statute, including the statutory provisions related to Medicare Advantage, 42 U.S.C. §§ 1395w21–1395w29. Thus, a Medicare provider may not charge a Medicare Advantage beneficiary or any other person, including a referring hospital, any amount for items or services that are covered under the Medicare program.

QUESTION: Is the answer the same for a private pay patient?
ANSWER: The answer would depend on the specific facts and circumstances of the arrangement. For example, if the SNF referred patients to the hospital, an all-payor anti-kickback law, such as Tex. Occ. § 102.001, may be implicated by a hospital providing payments to the SNF. However, an arrangement involving a private pay patient would be unlikely to implicate the Medicare or Medicaid anti-supplementation rules or the federal anti-kickback statute.

QUESTION: Do the state “Department of Insurance” agencies affect the answer to any of the above questions?
ANSWER: States’ laws and regulations regarding state Medicaid programs, the licensure of health care facilities, and insurance, may be implicated by any supplementation payments made by a hospital to a SNF. We have found that while some of these laws closely mirror the federal statutes and regulations, some of which are referenced above, many contain numerous variations which must be considered prior to implementing a proposed supplementation arrangement.

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There are several resources available to the provider community that are updated on a monthly basis.

MEDICARE ADVISORY: To view the current and archived issues of the Medicare Advisory, click here. The Medicare Advisory includes information provided by the Centers for Medicare & Medicaid Services (CMS) and is current at the time of publication. The May 2013 issue contains several articles that should be of interest to the SNF provider community.

MEDICAID BULLETIN: Published by the Division of Medical Assistance, the Medicaid Bulletin is only available in-line. The May issue contains articles on the new Medicaid claims processing system, the new checkwrite schedule, changes to the personal care services program and many others. To view both the current and past issues, click here.

LEIE DATABASE: The List of Excluded Individuals and Entities (LEIE) database file reflects all OIG exclusion and reinstatement actions up to the most recent update. Each month, this new “Updated LEIE” is a complete database file containing all exclusions currently in effect. 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.

CAPITOL CONNECTION: Capitol Connection is published several times each month by the American Health Care Association. Each issue contains information that may positively impact your facility. To access the latest issue, as well as past issues, click here.

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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 9:00 AM – 12:00 Noon session or 1:00 – 4:00 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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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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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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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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World War II vet who provided flag at Iwo Jima dead at 90.

http://usnews.nbcnews.com/_news/2013/04/28/17957227-world-war-ii-vet-who-provided-flag-at-iwo-jima-dead-at-90?lite

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Since 1928, May Day in Hawaii has been known as Lei Day, a spring celebration that embraces Hawaiian culture and in particular, the lei.

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