UPDATE Weekly

NCHCFA has been informed by a representative of NCTracks that nursing facilities will not receive Medicaid payments this week for their July claims. According to NCTracks, the Division of Medical Assistance (DMA) failed to send the July rates for nursing facilities for entry into the new claims processing system. NCTracks was aware of the missing rates, but did not ask DMA for guidance on how nursing facilities should be paid. Although both NCTracks and DMA were aware of this situation, neither gave any type of advance notice to the Association or impacted providers.

As we receive more information on the status of claims, we will pass it along to our member facilities.

If your facility continues to have issues with the new NCTracks system, attempt to resolve it with CSC, but we also ask that you also send Sam Clark, samc@nchcfa.org, a description of the issue(s) along with your contact information.

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The General Assembly has reached agreement on their long anticipated tax reform package. Final votes on the tax deal are expected in the House and Senate by Thursday. The bill then goes to Governor McCrory for his signature. In the meantime, House and Senate conferees began meeting last weekend to resolve differences in their spending bills. The matter of most concern to NCHCFA and other Medicaid providers is whether rates will be reduced for the fiscal year beginning on July 1st. The Senate proposes to cut (withhold) rates by 4%, while the House version calls for a 2% reduction. Any cuts in rates are of great concern to Medicaid providers. We are working tirelessly to convince legislators to find other ways to deal with Medicaid shortfalls. Rate reductions cannot continue to be the only option to control expenditures. If skilled nursing facility rates are reduced by either 2% or 4%, it would cause North Carolina to have the lowest Medicaid reimbursement rates in the Southeast. We urge you to keep making contact with you legislators with special emphasis on the members of the House and Senate Conference Committee. Your voices need to be heard TODAY! Members of the conference committee can be accessed at http://www.ncleg.net/gascripts/confcomm/confcommittee.pl?BillChamber=S&BillID=402&session=2013.

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Register today to attend the second annual NCHCFA Summer Symposium, August 6-8, 2013 at the Marriott Grande Dunes Resort, Myrtle Beach, SC for the most up-to-date information affecting long term care. You can register and pay on-line. Visit http://www.NursingHomesNC.com and click on Second Annual Summer Symposium Registration! Administrators and registered nurses will be able to earn up to 14.0 hours of continuing education. Early registration ends Friday, July 19th.

Don’t miss “Medicaid Managed Care – Will North Carolina Be Next?” on Wednesday, August 7th. Many states have placed portions of their Medicaid programs in the hands of Medicaid Managed Care Organizations (MCO’s). In April, Governor McCrory broadly outlined his plan to reform North Carolina’s Medicaid program. His initiative, “Partnership for a Healthy North Carolina” would create several Comprehensive Care Entities (CCE’s) that would “provide the framework to deliver high quality, patient-oriented care to Medicaid recipients.” Under the plan, CCE’s would be statewide in scope and manage all Medicaid services including skilled nursing care. There is much uncertainty surrounding the merits of turning the administration of the Medicaid program over to private managed companies. Providers are understandably nervous about managed care especially in light of the experiences from some states to date. This session will provide you with an overview of the Governor’s plan, what we have learned from other states, and the possible impact on skilled nursing services in North Carolina.

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It is time, once again, for the NCHCFA “Fabulous 50” awards! This time-honored event provides the opportunity to acknowledge front line, unlicensed personnel who have demonstrated outstanding achievements in the long term care profession. The Fabulous 50 awards program honors individuals who are the backbone in our facilities because of the support they provide to our residents. A panel of judges from the Education and Programs Committee will select ten nominees from each district. Each of the award recipients will be honored at a dinner and awards presentation in their district. The deadline to receive completed nominations is Tuesday, September 3rd. Please encourage your facility to participate in this special award program.

The dates for the 14th Annual Fabulous 50 Celebrations are:

District I – October 15, 2013, Grand Bohemian Hotel, Asheville
District II – October 21, 2013, Hilton Charlotte University Place, Charlotte
District III – October 24, 2013, Grandover Resort, Greensboro
District IV – October 29, 2013, Mad Boar Restaurant, Wallace
District V – November 4, 2013, Renaissance North Hills Hotel, Raleigh

To fill out nomination forms on-line, visit the Member Center of the Association Web site at http://www.NursingHomesNC.com. Click on “News & Updates”, select “2014 Fabulous 50 Nomination Packet” and choose “Survey Monkey”. If you have any questions about the Fabulous 50 awards, call the Association office at (919) 782-3827. Pictures for nominations submitted online may be e-mailed to kareno@nchcfa.org or mailed to the Association office.

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Before you break for summer vacation, don’t forget to register for the AHCA/NCAL 64th Annual Convention & Expo. Held October 6-9 in Phoenix, this is an event you don’t want to miss. The Convention & Expo brings together thousands of long term and post-acute care professionals from across the country and creates excellent opportunities for networking and learning.

Early bird registration ends July 19th so don’t wait any longer! When you register before the early bird deadline, you’ll save $100 off the Premium and Full meeting registration packages. Additional savings are offered on other registration packages as well.

For a complete list of education sessions, speakers, expo information, and event schedules, visit the Convention & Expo Website.

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Recently, a new requirement from CMS should have taken effect, the requirement that Medicare Advantage Organizations (MAOs) submit HIPPS codes on their SNF and home health claims by July 1st, 2013. After hearing concerns from the American Health Care Association (AHCA), CMS has decided to delay this requirement. Effective July 1st, MAOs will receive an “informational” edit for SNF and HH encounters submitted without HIPPS codes, but payment will not be denied. Effective December 1st, informational edits will change over to “Reject” edits, preventing the plans from submitting those encounters.

This does not mean that SNF claims submitted to MAOs will be automatically denied payment. Providers should be communicating with the MAOs with whom they have contracts to determine the appropriate steps necessary to avoid potential delays in payment. Over the next several months, CMS will be working with MAOs to implement this requirement. AHCA will stay engaged with CMS, and will continue to voice their members’ questions and concerns. In the meantime, should you or your members have any questions about this requirement, please feel free to contact James Michele at jmichel@AHCA.org.

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Please plan to join your friends and colleagues in beautiful Pinehurst, North Carolina, on September 11th and 12th for the Second Annual Autumn Classic Golf Tournament. The event will begin on Wednesday evening with a reception, dinner and program held at the world famous Mid Pines Inn and Golf Club. The Pinehurst Autumn Classic is being sponsored by the NC Health Care Facilities Association to benefit our political action committee (PAC). You do not have to play golf to participate! Registration details will be available later this month.

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Last week, AHCA staff received a call from a CMS contractor, the TMF Health Quality Institute (HQI). She informed AHCA that HQI had sent out, via regular mail, notification postcards to all 15,000+ SNFs. The postcard indicates to the SNF provider that it will soon receive a report called the Program for Evaluating Payment Patterns Electronic Report (PEPPER). This report provides Medicare claims data in specific targeted areas comparing the SNF to other SNFs throughout the US. The Report will be mailed to SNFs via regular mail on August 30th (see draft correspondence below) in an envelope with red print on the outside. It was requested that SNF companies be allowed to receive all of their facility information via electronic format, but CMS has determined this is not possible.

The Pepper program was initiated in 2003, but since 2003 has focused on other types of providers over the years. It is now adding SNFs. PEPPER gives provider-specific Medicare data statistics for services vulnerable to improper payments, according to the federal government, and allows providers to see how their facility compares to all other SNFs across the state, nation or MAC jurisdiction. For SNFs, the targeted areas were determined by recent OIG reports in 2010 and 2012 and conversations with CMS staff, and include:

• Therapy RUGs with High ADLs;
• Nontherapy RUGs with High ADLs; and
• Change of Therapy Assessment.

PEPPER data is shared with both the MACs and the Medicare Recovery Auditors (RAs); but not the Zone Program Integrity Contractors (ZPICs). HQI did acknowledge, however, that CMS contractors have much more sophisticated databases and systems for looking at SNF Medicare claims data.

For more information on SNF PEPPER, go to http://www.pepperresources.org. If you have any additional questions or concerns, please don’t hesitate to contact Dianne De La Mare at (202) 898-2830 or ddmare@AHCA.org.

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The Centers for Medicare & Medicaid Services (CMS) wants to let you about some changes happening in July to the Nursing Home Compare (NHC) downloadable data.

• Starting on or about July 18, 2013, CMS will direct users interested in accessing the NHC downloadable databases to the newly redesigned Data.Medicare.gov. The Nursing Home Compare Web site will still be available for those who want to find and compare and nursing homes.
• Data.Medicare.gov will now include some additional data about nursing homes not currently available on NHC, although some of these data are currently available on cms.gov. Here are some examples of the additional data we will begin posting on Data.Medicare.gov for download in July:
  • Expected and adjusted nursing home staffing data – the expected staffing data are based on the MDS-derived nursing home case mix
  • More detailed health inspection data – the number of revisits required to determine compliance, counts of substandard quality of care deficiencies, and health inspections points calculated by the Five-Star Quality Rating System
  • National and state averages – the number of health deficiencies, number and amount of civil money penalties, and quality measures.

Visit the newly redesigned Data.Medicare.gov Website and view the training video. The training includes:

• A message from CMS on how Data.Medicare.gov is meeting the goals of the Digital Government Strategy and the Open Data Policy
• A walk-through of Data.Medicare.gov
• Instructions on downloading data in a variety of formats
• Demonstrations on exploring the data and creating visualizations like charts, graphs, and maps
• A basic look at APIs

The purpose of Data.Medicare.gov is to make the Medicare.gov Compare Websites and Directory data readily available in open, accessible, and machine-readable formats. In addition to viewing the data in your browser, you can download the data in a variety of formats. You can also access the data through an Application Programming Interface, or API, which lets developers connect other applications to the Compare data in real time.

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This book describes how to change the culture of a long term care facility, and at the same time refine your leadership skills. The goal of this book is to make long term care more compassionate, effective, and successful through the leadership of the administrator. S.E.R.V.I.C.E. refers to service, education, respect, vision, inclusion, communication and enrichment – each with its own chapter and examples.

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

Product #6982
AHCA MEMBERS $23.95

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NCHCFA’s most popular educational tool is still available, Mobility and Safe Movement of the Elderly, Improving Your Skills to Prevent Injuries and Reduce Falls, by Teepa Snow, MS, OTR/L, FOTA, Dementia Care & Training Specialist. This DVD was developed in conjunction with Wake Allied Health Education Center, Durham Technical Community College and the University of North Carolina School of Medicine, Office of Information Systems. The content is formatted in separate segments in order to customize the delivery of content to your learning objective. Handouts developed by Teepa accompany each video. To order, contact Jan Williams at janw@nchcfa.org or (919) 782-3827. The price is $35.00 (tax and shipping included).

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‘Dementia Village’ inspires new care.

http://www.cnn.com/2013/07/11/world/europe/wus-holland-dementia-village/index.html?hpt=hp_c3

Older prisoners cost taxpayers $16 billion a year. The biggest segment of the incarcerated population is over 55, and a big chunk of that bill goes for medical care.

http://money.msn.com/now/post–older-prisoners-cost-taxpayers-dollar16-billion-a-year

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Eighteen of the top twenty-five largest hotels in the world are located in Las Vegas. Fifteen of the top twenty are located within the same 2 mile radius.

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