UPDATE Weekly

On May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1446-P] outlining proposed Fiscal Year (FY) 2014 Medicare payment rates for skilled nursing facilities (SNFs). NCHCFA has prepared an Excel spreadsheet to assist you in comparing the proposed rates to the rates currently being paid. You can access this file by clicking here. At this point, the proposed rule is open for public comment. The rates in the Excel file are not necessarily the final rates that will be used effective October 1, 2013.

One of the changes contained in the proposed rule is the addition of an item to the Minimum Data Set (MDS) to record the number of distinct calendar days of therapy provided by all the rehabilitation disciplines to a beneficiary over the seven-day look-back period. Furthermore, CMS is clarifying that the qualifying condition for the Medium Rehab (RM) Category requires 5 distinct calendar days of therapy. Similarly, CMS is clarifying that the qualifying condition for the Low Rehab (RL) Category would be clarified to require 3 distinct calendar days. Currently, the number of days for each therapy disciplines reported on the MDS is summed without regard to the number of separate and unique days per week on which the patient receives therapy services across all rehabilitation disciplines. This results in some patients receiving higher SNF payments for an RM or RL Resource Utilization Group (RUG) when the patient actually does not meet the qualifying conditions for that RUG. According to CMS, the proposed addition to the MDS ensures SNFs are paid accurately for their patients.

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NCTracks is the Medicaid Management Information System (MMIS) that will replace the current HP system on July 1, 2013. NCTracks was developed under a contract with Computer Sciences Corporation (CSC). CSC will serve as the Fiscal Agent for DHHS and its divisions, providing operational support to manage provider and recipient call centers, prior authorization reviews, claims processing, pharmacy operations, medical policy reviews, and other administrative activities. As part of the transition process, CSC has held trainings, published newsletters and made information available via the internet.

Providers should prepare for the transition by reviewing the provider checklist to ensure that they have done everything required of them. In addition, there are numerous “tool kits” available for providers to use and informative newsletters dating back to May 2012.

The resources can be accessed at http://ncmmis.ncdhhs.gov/communication.asp.

In addition, as part of the transition, the NC Department of Health and Human Services (DHHS) has published a Medicaid Special Bulletin with the cutoff dates from the legacy claims system to NCTracks. Click here to view the special bulletin.

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Beginning in 2014, the Affordable Care Act (ACA) requires employers with 50 or more full-time employee equivalents either to offer health insurance coverage to their full-time employees or face potential financial penalties.

To help its members in planning their employee health coverage, the American Health Care Association (AHCA) has developed a calculator designed to provide a rough estimate of potential ACA penalties based on a company’s size. The calculator is located on AHCA’s Affordable Care Act Web site. Look for the calculator icon on the left hand side of the page.

Estimating potential penalties is just one of many elements in developing a strategy to respond to the new requirements. In making health coverage decisions, employers should consult with experts including, but not limited to, their attorneys, accountants, and benefits advisors.

If you have additional questions, please e-mail the AHCA ACA team at insurancecoverage@ahca.org.

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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 April 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 April 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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Currently enrolled health care providers who did not receive a registration letter by May 1, 2013, should immediately call (866) 844-1113, or e-mail NCMedicaid@csc.com.

Registration in NCTracks is the method for Currently Enrolled Providers (CEP) to provide essential information that will not automatically transfer from the legacy claims systems:

• bank account numbers for electronic payment
• trading partners or clearinghouse billing agents, if applicable
• a valid e-mail address
• designation of an Office Administrator for security, contact and other purposes
• and other data.

Providers who fail to complete their CEP registration in a timely manner risk not having their claims processed and paid when NCTracks goes live July 1. Processing of CEP registrations ends June 24. Providers are encouraged to submit CEP registrations well in advance of that cutoff date, as response times could be lengthened by a high volume of last-minute submissions.

CSC, the new fiscal agent for DHHS, mailed CEP registration letters—one letter per National Provider Identifier (NPI) number—to all providers enrolled in legacy claims systems. The letters with special red markings on the envelopes were mailed in batches from February through April. Providers who did not receive a CEP letter or who need assistance from CSC to complete the process can phone the CSC Call Center at (866) 844-1113 or e-mail NCMedicaid@csc.com.

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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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This course is designed to create a better understanding of the MOST form and how it ties into advance care planning.

Objectives: At the conclusion of this educational activity, participants will be able to:

• Distinguish between traditional advance directive and medical orders.
• Explain how the MOST form provides increased specificity, portability, and translation of patient preferences into clinical practice.
• Explain when to use the MOST form.
• Use components of the MOST form during advance care planning discussions.
• Complete and use each section of the MOST form.
• Explain when the MOST form should be reviewed.
• Explain the guidelines for using copies and multiple versions of a MOST form.
• Place the MOST form in the proper location.

While this course is named “part 2”, it may be taken independently of “part 1”. “Part 1” is still in development. To participate in the online course, participants must register at https://www.wakeahec.org/CourseCatalog/CASCE_courseinfo.asp?cr=40327.

Completion of this online course will take approximately 30-45 minutes and you may reenter the course at any time to complete it. To receive credit, the participant must pass the knowledge assessment at 80%. After satisfactorily completing the assessment, the participant will be directed to the evaluation and directions for downloading the certificate of credit. The first 250 participants are free. Afterwards, the registration fee will be $5/person.

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The American Health Care Association (AHCA) is conducting their annual nationwide nursing facility survey to examine retention, turnover, and vacancy rates for nursing facility employees. Currently, they have a response rate of 30 percent. Your help is still needed to increase the survey response.

The 2012 Staffing Survey is being sent to all nursing facilities in the United States. Nursing facilities can also participate in this survey by downloading the survey questionnaire on-line. You can also find the 2011 survey report at the same place.

In an effort to generate more responses, the submission deadline has been extended to Friday, May 31, 2013. For more information, please e-mail research@ahca.org or call Jeffrey Liu (202-898-2818) or Lisa Matthews-Martin (202-898-2824).

Thank you in advance for your participation.

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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 later this month!

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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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Written by a team of experts in management and in long term care, this easy-to-read handbook supplies nurse managers with practical, easy-to-grasp management skills. The new 3rd Edition delivers the essentials of management and leadership, such as team building, communication, staff development, performance issues, and organization, all with a specific, long term care focus. New discussions on effectively managing conflict, diffusing tension with humor, and achieving work/life balance make this always-popular book even more useful for nursing professionals everywhere.

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

Product # 6816
AHCA Members $34.50

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The notebook used in the October 2012 training is available for purchase. Contact Jan Williams at janw@nchcfa.org or (919) 782-3827 to order one for your facility. The cost is $25 plus tax and shipping.

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Relationships Matter…Part 2 – The practice of relational coordination can boost continuous improvement in long term care settings.

http://www.providermagazine.com/archives/2013_Archives/Pages/0513/Relationships-Matter.aspx

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Armed Forces Day is celebrated the third Saturday of May. The United States honors the men and women of the military services. The Armed Forces Day Celebration combined the Army, Navy, and the Air Force in 1950. Prior to that year, they had been held at separate times.

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