UPDATE Weekly

Below you will find CMS S&C Letters regarding MDS, Dementia, and Staffing focused surveys.

• National Rollout of Minimum Data Set (DS) 3.0 Focus/Staffing Surveys to begin this month in NC: Please read this Administrative Letter carefully as it is a comprehensive description of the rollout, surveyor training, survey process, survey materials, assessment of compliance, and enforcement. Admin Info. 15-24-NH can be accessed at: http://nursinghnc.webfactional.com/files/2015/04/CMS-MDS30_AdminInfo_15-24-NH.pdf

• Implementation of Section 6106 of the Affordable Care Act – Collection of Staffing Data for Long Term Care Facilities: Technical specifications and related information for the electronic submission of staffing information based on payroll data.

Information regarding the Payroll Based Journal (PBJ) is posted at:
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html

The S&C letter can be viewed at:
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-35.pdf

• 2014 Final Report & 2015 Expansion Project – Centers for Medicare & Medicaid Services (CMS) Focused Dementia Care Survey Pilot: “Final Report: Below is a final report that outlines the basis for the Focused Dementia Care Survey Pilot, the process utilized, conclusions gathered based upon post-pilot data analysis, as well as next steps for the future. CMS plans to expand upon the work of the focused survey pilot and has invited States to conduct such surveys in FY2015 on a voluntary basis. The expansion project will involve a more intensive, targeted effort to improve surveyor effectiveness in citing poor dementia care and the overutilization of antipsychotic medications, and broaden the opportunities for quality improvement among providers. Deficiency Implications: Deficient practices noted during the surveys will result in relevant citations. In the event that additional care concerns are identified during on-site reviews, those concerns will be investigated during the survey or will be referred to the SA as a complaint for further review.”

The S&C letter can be viewed at: Survey and Cert Letter 15-31 [PDF, 161KB]

[Return to top]

Mark your calendars for this seminar that will be held in Greensboro, NC on May 28th, 2015! Seating will be limited! Be on the look-out for brochures and registration forms being mailed next week! Included in this session, will be hot topics such as:

• Audits impacting nursing homes
• Who may audit you
• How to respond to audit requests
• Appealing audits
• The parts your employees play
• How to reduce/prevent audits

[Return to top]

Yesterday, the Senate sent a permanent Sustainable Growth Rate (SGR) solution to the President’s desk on a vote of 92 to 8. The bill, H.R. 2, will eliminate the perennial threat of providers paying for a “Doc Fix” and inject much-needed stability for the long term and post-acute care sector.

The annual routine of fixing the flawed SGR formula was always a billion-dollar risk for skilled nursing providers. Though the bill does contain a cut to our profession, it is a fraction of what we would have faced if we continued the risk of being a pay-for year after year. In addition, the law provides important therapy relief, which the American Health Care Association (AHCA) sought for many years.

What’s Included:

• Stability – A Permanent Fix to the Annual SGR Battle. The doc-fix limped along year-to-year for a total of 17 patches since 2003. We estimate that skilled nursing has been cut by more than $27 billion to pay for short-term SGR fixes.

• Therapy Reforms. The bill includes a 33-month extension of the therapy cap exceptions process (through December 31, 2017). This allows providers to continue delivering therapy above the current $1,940 threshold as long as supporting coding and documentation show the services were medically necessary.

o The legislation also mandates a proposed therapy review process to take the place of current manual medical review (MMR). The new structure will be in place within 90 days of enactment of the bill. It will target providers with high denial rates and outlier billing patterns as well as new providers, certain medical conditions and certain group practices. It also takes RACs out of the review process. The new system is limited to $10 million in funding across all provider settings for FY 2015-2016, which will substantially limit the regulatory burden on skilled nursing therapy services.

• One (1%) Percent Market Basket Update. Skilled nursing is part of the pay-for in this bill. AHCA staff worked closely with Congressional leadership to push the cut back to FY 2018 with the understanding that we can avoid the cut if we provide a better alternative in the interim. Under the proposal, skilled nursing providers will receive a 1 percent market basket increase, net of other adjustments, in FY 2018. This increase takes into account the productivity adjustment within the Affordable Care Act.

CMS will issue the annual payment rule in the coming weeks, and AHCA has been working with the agency to secure the best possible outcome for skilled nursing. Additionally, AHCA will continue to work with Congress to create alternatives to strict market basket cuts. Though the market basket adjustment contained in this legislation is preferable to the annual SGR fight, we are prepared to offer other options to Congress in order to advance quality care and preserve fair reimbursement for our members.

Claims Payment:

On April 1, 2015, the Medicare Physician Fee Schedule (MPFS) was updated using the Sustainable Growth Rate (SGR) methodology as required by current law. The SGR methodology required a 21% decrease in all MPFS payments beginning April 1, 2015. The Centers for Medicare & Medicaid Services (CMS) took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the MPFS with dates of service on and after April 1, 2015.

Beginning on April 15th, 2015, CMS will release held MPFS claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they are received. CMS will release one day’s worth of held claims, processing and paying at the rate that reflects the negative update. At the same time, CMS will hold the receipts for that day, thus, continuing to hold 10 days’ worth of claims in total. This is to provide continuing cash flow to providers, albeit at the rate that reflects the negative update. This “rolling hold” will help minimize the number of claims requiring reprocessing should the President sign the legislation changing the negative update.

Providers should remember that claims for services furnished on or before March 31, 2015 are not affected by the payment cut and will be processed and paid under normal time frames. The MACs will automatically reprocess the claims paid at the reduced rate if Presidential action is taken to avert the negative update. No action is necessary from providers who have already submitted claims for the impacted dates of service.

[Return to top]

Registration for the May 2015 Personal Care Services (PCS) Provider Trainings is now open. Please visit Liberty’s Website at http://www.nc-pcs.com/training-announcement to view the agenda for the training and register.

[Return to top]

NCTracks has been certified by the Centers for Medicare & Medicaid Services to meet their requirements for accurate and timely payment of claims. Click here for more information.

[Return to top]

Join the North Carolina Culture Change Coalition for a symposium that features an Interactive Theater performance on unnecessary wheelchair use in nursing homes. This event is open to medical directors, administrators, nursing, therapy, restorative aides, nurse aides, state surveyors and Ombudsmen.

This symposium is funded through CMP funds and FREE to four members of your certified nursing home to register. At least one of the attendees must be a certified nursing assistant. CEU credits may be provided for Administrators and nurses. Any additional registrants will be considered based on availability.

• May 8th – Crowne Plaza Asheville
• May 21st – Sheraton Imperial Hotel
• May 28th – Embassy Suites Charlotte/Concord
• June 4th – Double Tree by Hilton New Bern-Riverfront

To secure a spot for this career-enhancing workshop, click here.

[Return to top]

We are excited about the number of nursing homes that have decided to participate in the Alliant Quality National Nursing Home Quality Care Collaborative (NNHQCC). Alliant Quality would like to invite each of you to attend a brief (30-minute) informational session in April. If you have not already completed a participation agreement and do not want to be left out, please complete the agreement and return to nancy.fendler@alliantquality.org.

WEBINAR TOPICS:

• Overview of the SPACE Collaborative
• Performance Improvement Project Goal Selection
• Upcoming SPACE Educational Topics
• QAPI Self-Assessment Tool

Thank you for your commitment to improving healthcare quality and the lives of residents in nursing homes in North Carolina.

There are four Opportunities, please click on the dates below to register.

Tuesday, April 14, 2015

• 10:30 am – 11:00 am
• 2:00 pm – 2:30 pm

Thursday, April 16, 2015

• 10:30 am – 11:00 am
• 2:00 pm – 2:30 pm

ABOUT ALLIANT QUALITY
Alliant Quality is the Medicare Quality Innovation Network (QIN)-Quality Improvement Organization (QIO) for North Carolina. Under contract with the Centers for Medicare & Medicaid Services (CMS), Alliant Quality invites your nursing home to participate in a collaborative designed to ensure that every nursing home resident receives the highest quality of care. Specifically, the Nursing Home Quality Care Collaborative (NNHQCC) will strive to instill quality and performance improvement practices, eliminate healthcare acquired conditions, and dramatically improve resident satisfaction.

The Collaborative offers an exciting opportunity to learn from high performing nursing homes regarding their processes as they pertain to consistent/permanent staff assignment, teamwork and communications, leadership, regulatory compliance, clinical models, and quality of life indicators. The Collaborative aligns national nursing home quality initiatives and partnerships such as the Advancing Excellence in America’s Nursing Homes Campaign, The Partnership to Improve Dementia Care, and Quality Assurance Performance Improvement (QAPI). Targeted focus areas will include increasing mobility, decreasing unnecessary use of antipsychotics in residents with dementia, decreasing potentially avoidable hospitalizations and decreasing healthcare acquired infections and conditions.

WHO SHOULD ATTEND
Participants in the Alliant Quality National Nursing Home Quality Care Collaborative (NNHQCC) ~ Southern Partners Action Collaborative for Excellence (SPACE)

If you are ready to register, click here for the Participation Agreement and fax or e-mail it back to Nancy Fendler. For more details, e-mail Nancy at nancy.fendler@alliantquality.org or reach her at (678) 527-3679.

[Return to top]

“Bring on the Fiesta!” is this year’s theme for National Nursing Home Week! Speak the language of Familia, Vida and Amor during National Nursing Home Week 2015! Imagine an event that brings the long-term care (LTC) community of residents, rehab patients, families and care center staff together for a weeklong festival in 2015. Think of all the fun your LTC community can have, which is precisely why the American Health Care Association (AHCA) will designate National Nursing Home Week (NNHW) as “Bring on the Fiesta!” week. National Nursing Home Week products are selling out! Hurry and place your orders today and “Bring on the Fiesta!” Visit AHCA’s on-line store to place your order before it’s too late! National Nursing Home Week is May 10-17, 2015!

[Return to top]

This book covers 28 challenging cases that cover pivotal issues that most health care administrators and managers are likely to encounter at some point in their work – quality improvement, strategic planning, ethical dilemmas, organizational dynamics, cost-benefit analyses, resource utilization, and more. Providing an exceptional framework for decision-making and debate, Cases in Health Services Management is an outstanding casebook that provokes thought and discussion.

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

Product # 8248
AHCA Members (on-line price) $64.95

[Return to top]

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

[Return to top]

100 year-old shares secrets to long life

http://www.cnn.com/videos/health/2015/04/08/exp-human-factor-dr-ellsworth-wareham.cnn

[Return to top]

Most trees release their pollen in the early spring, whereas grasses release pollen in the late spring and early summer. Weeds, like ragweed, release pollen in the late summer and early fall.

[Return to top]