UPDATE Weekly

UPDATE will not be published next week due to the Association’s Annual Convention and Exposition, but will resume publication on February 25, 2015.

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Time is running out, register today for the NCHCFA Annual Convention and Expo, February 15-18, 2015 at the Sheraton Greensboro Hotel at Four Seasons/Joseph S. Koury Convention Center, Greensboro, NC. Don’t miss the opportunity to earn up to 14.5 hours of educational credit for North Carolina Nursing Home Administrators, as well as up to 13.5 hours of Nursing CE credit! To obtain an additional brochure visit the Member Center of the Association’s Web site at http://www.NursingHomesNC.com.

If you have any questions or need additional details, please call the Association office at (919) 782-3827.

NCHCFA Convention registration will open Sunday, February 15th at 2:00 PM and remain open until 6:00 PM in the South Lobby of the Sheraton Greensboro Hotel at Four Seasons.

Call the Sheraton at (800) 242-6556 to make your room reservation. Identify that you are with “NC Health Care Facilities Association 2015 Convention” to receive the group discounted rate.

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Mark your calendar today for the North Carolina Health Care Facilities Association’s “Assessment of Wounds and Pain Management/Best Practices in Long-Term Care.”

The main topics are:

• Pain – The Fifth Vital Sign
• Assessment and Treatment of Vascular Disease and Ulceration
• Skin Care – A Guide for Wound Prevention and Long-Term Success

This program will be presented by Dr. Chuck Gokoo on March 26th, 2015 at the Embassy Suites Greensboro! Brochures will be mailed to all facilities soon and will also be available in the attendee notebooks at our 2015 Annual Convention and Expo!

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The North Carolina Health Care Facilities Association would like to thank our 2015 Gold Convention Hosts for supporting the upcoming Annual Convention & Expo – NCHCFA Diamond Jubilee Celebration. Be sure to visit them on Tuesday, February 17th during Expo 2015 – Voyage Through the Decades.

Blue Ridge Pharmacy – Booths 500 & 502
Healthcare Services Group – Booths 427 & 429
Legacy Consultant Pharmacy – Booth 516
Medipack Pharmacy – Booth 233
Neil Medical – Booths 301, 303, 400 & 402
NH Medical Services – Booths 229 &231
Poyner Spruill, LLP – Booth 302
PruittHealth – Booths 323, 325, 327, 329, 422, 424, 426 & 428
Southern Pharmacy Services – Booths 409 & 411

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Late last week, the Centers for Medicare and Medicare Services (CMS) sent a notice and a FAQ document to organizations representing providers that they were resuming the Medicare Part B therapy manual medical review (MMR) program immediately. As you may recall, the MMR program was implemented by CMS in October 2012 as part of a previous extension of the therapy caps exceptions process. Under MMR, Medicare recovery audit contractors (RACs) are to review Part B therapy claims over a $3,700 threshold per beneficiary per year. Due to problems in the MMR process and delays in issuing new RAC contracts, the therapy MMR program was put on a ‘pause’ at the end of February 2014.

Below is a summary of the key elements of the MMR resumption that AHCA members and their clinical and billing staff should be aware of and prepare for:

1. Starting immediately, RACs may resume part B therapy MMR for all MMR eligible claims over the $3700 threshold for claims paid between March 1, 2014 and December 31, 2014.
2. The reviews will be post-pay review only in all states for the 2014 claim reviews.
3. Claims will be reviewed in chronological order so that, for example, claims paid in March 2014 will be reviewed before claims paid in April 2014.
4. There will be 5 waves of reviews conducted to address all 2014 MMR reviews which AHCA estimates will be conducted from February through August 2015. Providers with therapy MMR eligible claims should expect to receive therapy MMR additional development requests (ADRs) approximately every 45 days as follows:
> 1. Phase 1 – One claim review request will be issued in the ADR.
> 2. Phase 2 – Up to 10 percent of the total MMR eligible claims for 3/14-12/14 will be included in the ADR.
> 3. Phase 3 – Up to 25 percent of the remaining MMR eligible claims for 3/14-12/14.
> 4. Phase 4 – Up to 50 percent of the remaining MMR eligible claims for 3/14-12/14.
> 5. Phase 5 – Up to 100 percent of the remaining MMR eligible claims for 3/14-12/14.

CMS notes that this current resumption only applies to facility-based providers, including skilled nursing facilities. In addition, CMS has not identified a process yet for how they intend to conduct reviews for 2015 MMR eligible claims.

AHCA has been, and continues to be very concerned with the serious flaws in the arbitrary $3,700 therapy MMR threshold that Congress established, and how CMS has interpreted to mean that 100 percent of claims above this threshold must receive burdensome complex review, regardless of beneficiary condition, or provider history of compliance with Medicare policy.

AHCA is actively engaged with Congress in advocating for therapy reforms like the therapy cap repeal provisions reported out by the Senate Finance Committee in the 113th Congress. However, since that may take some time, we are also seeking immediate reforms to the therapy MMR program as a bridge to the larger reforms, and are asking Congress to require CMS to target MMR reviews and education efforts to providers with a history of improper payments rather than the cumbersome 100 percent review process described above.

If you have questions please contact Daniel Ciolok at dciolek@ahca.org or (302)740-7888.

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In October 2014, the President issued an executive action instructing CMS to make changes to the Five Star rating system. CMS will be announcing the first of these changes at its Open Door Forum on Thursday, February 12 at 2:00pm Eastern time. These changes have to do with how the staffing and quality measure ratings are calculated as well as the addition of two new measures to the quality measures component: (1) use of antipsychotics among short stay residents and (2) use of antipsychotics among long stay residents. These changes will likely cause some members to lose star ratings. AHCA CEO Mark Parkinson will host a call to brief members on the CMS announcements on Friday, February 13 at 1:30pm Eastern time. Below please find call in details for both the CMS Open Door Forum and the AHCA Member Webinar.

Five Star CMS Open Door Forum Call
Thursday, February 12, 2015 at 2:00pm Eastern
Dial: 1-800-837-1935
Conference ID: 12529597

CMS will be announcing the first of its changes to the Five Star rating system on this call.

AHCA Member Webinar on Five Star
Friday, February 13, 2015 at 1:30pm Eastern
Registration Link: http://webinars.ahcancal.org/session.php?id=15440
*If you are unable to join this Webinar live, the event will be recorded and a link to the recording will be made available.

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Recruitment continues through March 31, 2015 for the upcoming Southern Partners Action Collaborative for Excellence facilitated by Alliant Quality. Goals will include:

• Continued use of QAPI tools and resources
• Continued reduction of Off-Label Use of Antipsychotics
• Improvement in Mobility for Long-Stay Residents
• Improvement of Composite Score to 6 or better

To learn more about the CMS National Nursing Home Quality Care Collaborative, click here.

To learn more about the SPACE Nursing Home Quality Care Collaborative – Southern Partners Action Collaborative for Excellence Benefits, Expectations, and Commitments, click here.

Many members have submitted their participation agreement and we ask those facilities to please share with corporate level executives, consultants and sister facilities and encourage them to submit the completed participation agreement via e-mail or fax.

If you are ready to register, click here for the Participation Agreement and fax or e-mail back to Nancy Fendler as indicated. For more details, e-mail Nancy at nancy.fendler@alliantquality.org.

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Alliant Quality (GMCF) is excited to provide all of recruited homes with an update on the Southern Partners Action Collaborative for Excellence (SPACE) that will Kick-Off officially in April of this year. Alliant Quality (GMCF) will have a booth at the NCHCFA Annual Convention & Expo in February and will be providing each participating facility with a packet of data specific to that nursing home.

The packet will contain data related to the following:

• Readmissions
• Pressure Ulcers
• Restraints
• Falls
• Antipsychotics
• ADLs
• Composite Score

Please plan to have at least one of your staff members who will be involved in the collaborative come by and meet our Quality Advisors! We will review upcoming collaborative information during the Regulatory Update on Sunday, February 15 from 3:30 pm – 5:30 pm, as well.

Alliant Quality (GMCF) looks forward to seeing all of you at the NCHCFA Annual Convention & Expo.

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The Centers for Medicare & Medicaid Services (CMS) is required to collect staffing data using payroll information, including information related to contract staff. CMS has asked for assistance in identifying individuals who could serve on a group that will help guide CMS in development of the system to be used in obtaining the staffing data they need.

According to CMS: “This process should be full of two-way communication…With CMS informing/questioning the group on different facets of the program, and the group asking/informing CMS of their questions, concerns, or advice. Members of the group should plan on participating on one hour conference calls every couple of weeks. We don’t anticipate much more of a time commitment.”

NOTE: participation in this group would not require providing CMS with any center-specific data.

The American Health Care Association (AHCA) would appreciate if you would complete the survey below related to the type of payroll system you utilize and whether or not you would like to participate in the CMS group. Please provide your responses no later than Feb. 16, 2015.

Survey Monkey: https://www.surveymonkey.com/s/6YBKMY7

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The “Updated LEIE” database file reflects all OIG exclusion and reinstatement actions up to, and including, those taken in January 2014. This new, “Updated LEIE” (List of Excluded Individuals and Entities) 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.

All the updated files are posted at http://oig.hhs.gov/exclusions/exclusions_list.asp.

Instructional videos explaining how to use the on-line database and the downloadable files are available:

• On-line Database Video: http://oig.hhs.gov/exclusions/online.asp.
• Downloadable Database Video: http://oig.hhs.gov/exclusions/download.asp.

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The definitive resource for helping companies achieve world-class results, Baldrige Award Winning Quality – 18th Edition: How to Interpret the Baldrige Criteria for Performance Excellence is the only book on the Baldrige criteria to detail, in simple and straightforward language, every category, examination item, and area to address. From understanding the scoring system to preparing for a site visit, it guides you through all stages in the process. Reflecting the new criteria (2013-2014) that address education and healthcare, this edition outlines a comprehensive plan that is suitable for any company in any industry.

Offering detailed explanations of each of the 17 “Examination Items” and the 36 “Areas to Address” that compose the seven major categories, the book reveals exactly what examiners look for in each area and suggests what you need to include. It also discusses:

• Criteria of leadership and the role of senior management in the award process
• Importance of a long- and short-term strategic plan
• Where and how to satisfy the requirements for demonstrating effective “process” and “results”
• Lists of state award programs based on the Baldrige criteria
• Core values and themes that underlie the award
• How to weigh the importance of the 36 “Areas to Address”
• The significance of the Baldrige scoring scale, and its role in achieving performance excellence

The book devotes a chapter to supplying a clear and concise explanation on how to prepare for a site visit from the board of examiners. It details each facet of the site visit, including its purpose, what a Baldrige examiner looks for, and the questions typically asked during the visit. Complete with rules for preparing graphics and charts, the book includes helpful tips to help you avoid common mistakes when completing the application.

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

Product #6913
AHCA MEMBERS $59.95

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If you missed Upcoming Hospice Regulations seminar, the notebook/presentation is now available for purchase. To order, e-mail your request to Jan Williams at janw@nchcfa.org. The cost is $25 plus tax and shipping.

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Providers Ahead Of Antipsychotic Curve, Government Data Show

http://www.providermagazine.com/news/Pages/2015/0215/Providers-Ahead-Of-Antipsychotic-Curve,-Government-Data-Show.aspx

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In 1969, there were 105 Nursing Homes across the state of North Carolina. Sixty-Three of these Nursing Homes were members of NCHCFA.

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