UPDATE Weekly

Dr. Aldona Wos, the secretary of the state Department of Health and Human Services, is resigning from her position. Gov. Pat McCrory made the announcement at a Wednesday news conference. McCrory also announced Wos’ replacement, Richard Brajer, a CEO with a background in the health and hospital industries. Brajer, 54, has an MBA from Stanford and has been a CEO for Denver-based ProNerve and Raleigh-based LipoScience.

[Return to top]

“A NEW program Proposed Changes to the Requirements of Participation for Long-Term Care Facilities, will now be held on Friday, August 28th from 9:00 am – 11:00 am. CMS issued a proposed rule change for the SNF/NF Medicare and Medicaid Requirements for Participation on Monday July 13th 2015. The rule is very large in scope and contains both new requirements and some requirements already issued by CMS via Survey & Certification memoranda. During this session, Dr. Gifford will share important information about the Proposed Rule changes. Dr. David Gifford, Senior Vice President of Quality and Regulatory Affairs, American Health Care Association, will provide attendees with a robust explanation of the ramifications of the changes to the requirements of participation and other regulatory policies affecting SNFs including new payment models as well.”

Some of the proposed changes/requirements that stand out:

• Quality Assurance and Performance Improvement (QAPI) programs;
• Baseline care plan for each resident within 48 hours of admission;
• Compliance and ethics programs;
• Discharge planning;
• Facility assessment which aims to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies; and
• A more comprehensive Infection Prevention and Control Program including an Infection Prevention and Control Officer.
• Comments on the use of arbitration agreements.

David Gifford, MD, MPH serves as the American Health Care Association and National Center for Assisted Living’s (AHCA/NCAL) Senior Vice President of Quality and Regulatory Affairs. AHCA/NCAL represents more than 11,000 for- and not-for-profit nursing homes, assisted living residences, and facilities for the care of people with mental retardation and developmental disabilities. He oversees AHCA’s quality initiative and serves as co-chair of board for Advancing Excellence. Dr. Gifford previously served as the Director of the Rhode Island Department of Health, as well as the Chief Medical Officer for Quality Partners of Rhode Island where he directed CMS’s national nursing home-based quality improvement effort. He is a board certified Geriatrician and has worked as medical director in several nursing homes. He completed his primary care residency and geriatric fellowship at the University of California in Los Angeles (UCLA) after graduating from Case Western Reserve University School of Medicine. While a Robert Wood Johnson Clinical Scholar, Dr. Gifford received his Master’s in Public Health (MPH) in Epidemiology from UCLA.

[Return to top]

NCHCFA has made several important changes to the agenda for the upcoming 4th Annual Summer Symposium! Administrators will still be able to earn up to 12.5 hours of continuing education for all educational sessions. NEW programs include Effect of Palliative Care on Reducing Hospitalizations in the Long-Term Care Continuum on Wednesday, August 26th from 4:30 pm – 6:00 pm, and Proposed Changes to the Requirements of Participation for Long-Term Care Facilities on Friday, August 28th from 9:00 am – 11:00 am. Please visit the link below for the current 4th Annual Summer Symposium schedule of events:

Inventory of Class – http://nursinghnc.webfactional.com/files/2015/08/2015_ScheduleSummerSymposiumUpdated.pdf

[Return to top]

The North Carolina Health Care Facilities Association would like to thank our 2015 Summer Symposium Corporate Sponsors for supporting the upcoming Fourth Annual Summer Symposium in Myrtle Beach, SC: Healthcare Services Group, Medipack Pharmacy, QMX Mobile Health and Southern Pharmacy Services.

[Return to top]

Please plan to join your friends and colleagues in beautiful Pinehurst, North Carolina, on September 16th and 17th for the Fourth Annual Autumn Classic Golf Tournament. The event will begin Wednesday with golf, a reception, dinner and program held at the world famous Pine Needles Lodge 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! Click here for registration materials.

[Return to top]

This MLN Connects® National Provider Call provides an overview of the proposed rule to reform the requirements for long-term care facilities. These requirements are the federal health and safety standards that long-term care facilities must meet in order to participate in the Medicare or Medicaid programs. This presentation provides background for updating these requirements and briefly walks through many of the changes included in the proposal. A question and answer session follows the presentation.

The call will take place on Tuesday, August 11, 2015 from 2:30 pm until 4:00 pm ET.

A link to the slide presentation will be posted here prior to the call. A link to the audio recording and written transcript of this call will also be posted approximately 2 weeks following the call.

To register for this and other MLN Connects Calls, click here. Additional details can be found by clicking here.

[Return to top]

The Alliant Quality NH PIMS portal is ready to go, allowing you access to several items listed below. The Portal is a place where Providers and Nursing Homes are able to login to view reports for their entity and to submit information.

As your contact information is added to the system, you will receive an e-mail asking you to change your temporary password.

• A Temporary Password will be sent to your e-mail address.
• When you first login, you will be forced to change your temporary password and select your own password.

• If you would like additional staff to have access to the portal, please send Jovonn.Givens@alliantquality.org, the following:
o First Name
o Last Name
o Position or Title
o E-mail Address

1. Access the data including:
a. 30 Day Hospital Readmissions
b. Composite Score
c. Antipsychotic Rate
d. Restraint Rate
e. Pressure Ulcer Rate
f. Falls with Injury
g. ADL
h. Incontinence
 This data is updated on a monthly basis
 In the future, you will receive automated emails when the graphs have been refreshed
2. Upload QAPI Self-Assessment Tool through the portal (instead of email or fax)
3. Upload completed PDSAs through the portal (instead of email or fax)

https://pimsportal.alliantquality.org/login.aspx

You may access the portal using the link above ~ then, your user name and password.

Additionally, Alliant will be posting a short “How To” video on the Website ~ coming soon on the Resources Webpage under NH Portal.

[Return to top]

When you have to replace an RN, the average cost is one hundred thousand dollars. By the time you find the right candidate, hire, train, and help them become productive, it could cost 150% of their base salary. It’s a lot less expensive to keep the employees you have, especially in a competitive market!

• Gero Nurse Prep prepares RNs for successful attainment of board certification as Gerontological Nurses, the gold standard of excellence.
• Employer support for continuing education and board certification can increase RN job satisfaction.
• Satisfied, well-trained, and committed RNs provide better quality care.
• RN satisfaction and a supportive workplace are linked to decreased turnover rates.

In addition to staff retention, your support of certification is an investment in your center’s performance, reputation, and residents. To learn more about these and other benefits of the course please go to http://www.geronurseprep.org.

[Return to top]

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) enacted in April contained provisions to replace the problematic Part B therapy Manual Medical Review (MMR) process which required 100 percent review of all claims above a $3700 annual per-beneficiary threshold with a targeted review program for claims over the $3700 threshold. The Centers for Medicare and Medicaid Services (CMS) was instructed to implement the targeted approach no later than 90 days of enactment, and that deadline has recently expired. CMS has not posted any substantive updates to date, and providers continue to receive therapy MMR ADRs.

Since the enactment of MACRA, AHCA and other and provider organizations have been in regular contact with CMS to clarify the intent of the legislation and provide recommendations regarding implementation. Part B therapy MMR is in a very fluid state currently, but is moving in a positive direction. This article provides an update as to the status of the CMS implementation of the new targeting requirements based upon these communications with CMS.

Currently, the only MMR taking place is for MMR-eligible claims paid in 2014.

• This is post-payment review only for facility-based providers such as SNF. Pre-payment review stopped in February 2014.
• Due to contracting issues, the Recovery Auditors (RACs) assigned the 2014 facility-based provider claims for review earlier this year will continue to conduct MMR on these claims.
• As of mid-July the RACs were instructed to stop 100 percent review, and instead conduct targeted review of the 2014 claims using their existing proprietary targeting processes. RACs are incentivized to identify improper payments, and the new targeting instructions should reduce review volume for providers with low MMR denial history.
• The RACs must still comply with Additional Documentation Request (ADR) limits so that providers are not overwhelmed with reviews.
• The RACs must still comply with the 5-phase therapy MMR cycle for eligible 2014 claims. This means that providers should not receive any more than five MMR ADR letters from RACs, and these letters cannot be sent earlier than 45 days from the prior MMR ADR letter.
• Providers continue to have 45 days to respond to the MMR ADR letter.
• The RACs continue to have 60 days to make a decision on these post-payment reviews.

By late 2015, CMS intends to implement the new targeted MMR program per MACRA legislation requirements for remaining eligible claims paid through 2017.

• AHCA and other professional associations are communicating with CMS in writing and via meetings.
• No start date has been established by CMS so no MMR for 2015 claims is currently being conducted.
• CMS has not decided if the Medicare Administrative Contractors (MACs) or Supplemental Medical Review Contractor (SMRC) will conduct the new MMR, but it definitely will not be the RACs.
• CMS has not determined how the targeting of claims will be conducted, to comply with the MACRA legislative requirements, but only claims above the $3700 threshold will be subject to the targeting.
• CMS has not yet determined if the new targeted MMR reviews will be conducted on a pre-pay or post-pay basis.

The three prior iterations of the Part B therapy MMR program implementation/revisions were fraught with serious problems that directly impacted beneficiary access to care and provider cash-flow. AHCA is cautiously optimistic that this fourth iteration will be more reasonable as CMS is taking the prudent routes of: 1) applying a retroactive targeted approach to 2014 claims already in the RAC review pipeline to reduce burden, and 2) seeking stakeholder input before implementing the new MACRA required targeting methodology moving forward. We will continue to update you as soon as substantive information becomes available.

If you have any questions regarding the new targeted MMR process, or continue to have unresolved problems with the prior 100 percent review MMR process, please contact AHCA at dciolek@ahca.org or (302) 740-7888.

[Return to top]

The next CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum scheduled for Thursday, August 6th at 2:00 PM (ET).

The planned agenda:
I. Opening Remarks
II. Announcements & Updates
· SNF/LTC Final Rule
o Rate Update
o Policy and Quality Measures
o SNF Value Based Purchasing Program
o Electronic Staffing Data Submission PBJ Update
· Reminder for registration of voluntary submission period
· Overview of Coordinated Care for Joint Replacement Proposed Rule
· Quality Improvement Organizations (QIOs) – New regulation and Chapter 5 manual revisions
III. Open Q&A

To participate, call (800) 837-1935 and reference Conference ID 6583445.

Encore is an audio recording of this call that can be accessed by dialing (855) 859-2056 and entering the Conference ID beginning the following Monday. The recording expires after 3 business days.

[Return to top]

The Centers for Medicare & Medicaid Services (CMS) is implementing new time frames for all quality of care reviews. Once implemented, providers will have 14 days (currently 30 days) to send in the medical record, once a medical record request is received. Because of these tightened time frames, providers will be encouraged to fax medical records to KEPRO rather than sending them via mail. The quality of care department at KEPRO has its own dedicated fax number, which will be listed on the medical record request.

After the medical records are received, KEPRO has 30 days to complete the review. Providers that wish to provide a response when they receive an inquiry from KEPRO will also have a shortened time frame, which will be noted on the inquiry letter.

The official effective date is unknown at this time and will be provided by CMS in the future. Further information and education will be available at http://www.keproqio.com.

[Return to top]

Mark your calendars for this wonderful opportunity to earn CEU’s while hearing from the best about this important topic! This seminar will be held in Greensboro, NC on September 30th, 2015. Brochures will be mailed soon.

[Return to top]

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 provided outstanding care. 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 1st. Please encourage your facility to participate in this special award program.

The dates for the 16th Annual Fabulous 50 Celebrations are:

District I – October 20, 2015, Grand Bohemian Hotel, Asheville
District II – October 22, 2015, Hilton Charlotte University Place, Charlotte
District III – October 27, 2015, Grandover Resort, Greensboro
District IV – October 29, 2015, Mad Boar Restaurant, Wallace
District V – November 5, 2015 Sheraton Imperial Hotel, Durham

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 “2016 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 karenl@nchcfa.org or mailed to the Association office.

[Return to top]

Back by popular demand, NC Health Care Facilities Association will present a repeat seminar on August 11th, 2015 in Greensboro, NC! If you missed this seminar in May, you will not want to miss it again! This program will provide strategies for managing the people, records, and processes for responding to an auditor’s request for records and appealing denials. The role each person plays during this process includes coordination, preparation, documentation, and tracking. Preventing denials in the first place is part of a comprehensive compliance program as an internal QA function.

Topics include, but not limited to the following:

• 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

Here are only a few comments some of our attendees had to say:

“One of the best presentations I have been to in a while!”

“Speaker was very knowledgeable and enthusiastic with significant experience. Would like further trainings to be provided by this speaker!”

“Excellent presentation- so informative and helpful!”

“The speaker was terrific! Her knowledge is so vast! This was one of the best seminars I have attended!”

The cost to attend this seminar is $185 for members and $370 for non-members. This fee includes handouts and breaks (morning & afternoon). YOU CAN REGISTER AND PAY ON-LINE! TO REGISTER, GO TO http://NursingHomesNC.com AND CLICK ON Audit Survival in Long Term Care. You may also download a Brochure here! Members may be invoiced. Non-members must submit payment online or mail with registration. Registration is open to anyone who would like to attend! REGISTER TODAY!

[Return to top]

They say things in Texas are bigger and better. The AHCA/NCAL 66th Annual Convention & Expo is shaping up to be just that, all from historic and beautiful San Antonio. Experience the food, the landmarks, and the fun of this Texas-sized destination, while you network, learn, and enjoy yourself at this must-attend event. This is not just a networking and educational event: this helps AHCA/NCAL further their mission to deliver solutions for quality care. The 66th Annual AHCA/NCAL Convention & Expo is a chance to share your knowledge and learn from your peers, your contemporaries, and experts in long term and post-acute care. The fact that it takes place in San Antonio, one of the southwest’s most colorful and entertaining cities, just makes it even better!

Register now! Additional savings are available when multiple people register from the same facility. There is something for everyone at the 66th Annual AHCA/NCAL Convention & Expo.

[Return to top]

KEPRO is the BFCC-QIO for over 30 states. Offering information and assistance to providers, patients, and families regarding beneficiary complaints, discharge appeals, and Immediate Advocacy. During the Webinar, KEPRO representatives will present an overview of the role of the BFCC-QIO and the services provided, including the upcoming time frame changes for quality of care reviews.

Event Name: The BFCC-QIO Program
Event Audience: Healthcare providers and stakeholders
Event Time: August 12, 2015, 2 pm-3:15 pm ET
Event Speakers: Shiva Mumtazi, Outreach Specialist, KEPRO; Lisa Stansbury, Outreach Specialist, KEPRO
Event Registration: To register for the Webinar, go to https://qualitynet.webex.com and look for KEPRO – the BFSS-QIO.

[Return to top]

The North Carolina Directors of Nursing Administration Long Term Care, Inc. (NCDONA) are celebrating 20 years. The 20th Annual NCDONA Multistate Conference will be held at the Hilton Myrtle Beach Resort from September 23-26, 2015. There will be opportunities for multiple continuing education credits for Directors of Nursing as well as Administrators and for the first time, NCDONA will be offering the National Council of Certified Dementia Practitioner (CDP) Course. At the completion of this course, attendees will be eligible to apply for certification. Visit http://ncdonaltc.com/register to register today! Seating is limited so do not wait to reserve yours!

[Return to top]

High-quality clinical care comes from high-quality education. Prove the value of your staff development program with help from author and staff development expert Adrianne E. Avillion, DEd, RN, in this new groundbreaking book. Avillion offers clear guidance to help you put your program’s worth into quantifiable terms and align staff development with your organization’s goals. Educators of all levels will be able to evaluate the effect of training on retention, staff competency, and patient outcomes.

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

Product # 8333
AHCA Members (on-line price) $99.00

[Return to top]

If you missed the Upcoming Hospice Regulations seminar, the notebook/presentation is now available for purchase. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org. The cost is $25.00 plus tax and shipping.

[Return to top]

Antipsychotic overuse not just a problem in nursing homes

http://www.modernhealthcare.com/article/20150304/NEWS/150309951

[Return to top]

A typical cloud weighs around 1.1 million pounds.

[Return to top]