UPDATE Weekly

Make plans today to join your colleagues for the fifth annual NCHCFA Summer Symposium. The three-day event will be August 9-11, 2016 at the Embassy Suites Resort at Kingston Plantation, Myrtle Beach, SC. Call the Embassy Suites Resort at (800) 876-0010 to reserve your overnight room. Use group code “HFA” to identify yourself as a NC Health Care Facilities Association Convention attendee! To make your reservation on-line, visit http://tinyurl.com/summersymposium2016. Brochures will be available in June!

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Last year, the Division of Medical Assistance (DMA) changed the policy on how they paid crossover claims for Qualified Medicare Beneficiaries (QMBs). A few months later, they retroactively changed the payment policy. Because of these changes, some providers received higher payments than the state intended on certain claims. The following is a message from NCTracks providing an update on the QMB claim situation.

Reprocessing of Crossover Claims for Services Rendered to Qualified Medicare Beneficiaries

Dear Provider,

In adherence to Centers for Medicare & Medicaid Services (CMS) Informational Bulletin, Payment of Medicare Cost Sharing for Qualified Medicare Beneficiaries (QMBs), dated June 7, 2013, Medicaid is legally obligated to reimburse providers for cost-sharing that is due for a Qualified Medicare Beneficiary (QMB) according to the state’s CMS-approved Medicare cost-sharing payment methodology.

Effective November 1, 2015, the “lesser of” logic is being applied to services covered by both Medicare and Medicaid that are rendered to QMBs. Specifically, claims for Medicare covered services that are also covered in the Medicaid State Plan are paid at the lesser of the:

• Medicare cost-share (which is the sum of co-insurance, deductible and co-pay), or,
• Difference between the amount paid by Medicare and the Medicaid State Plan rate (if any).

For services not covered under the N.C. Medicaid State Plan, the claims are paid the Medicare cost share amount. This rule applies to both crossovers and secondary filed claims for Q-class recipients. This methodology results in the provider receiving the Medicare or Medicaid allowable and the QMB recipient not being responsible for any additional monies for services covered by Medicaid and/or Medicare.

QMB claims last processed between March 1, 2015, and Oct. 31, 2015, will be reprocessed in batches over the course of this summer.

You are receiving this message because you have claims affected by this reprocessing. While some previously denied claims will now process for payment, the majority of claims will have a lower net reimbursement due to the CMS QMB rule. The final amount will be established when the actual claims are reprocessed.

If there are not sufficient funds from new claims paid in the checkwrite to cover the adjustment from reprocessing, an accounts receivable will be created. Funds from claims paid in subsequent checkwrites will be applied to the accounts receivable until the adjustment is fully recovered. To fully satisfy the recovery, NCTracks will look for available funds from any other NPI within the same corporate structure (shared Tax Identification Number). All amounts owed to the N.C. Division of Medical Assistance that are not satisfied within 30 days from the Systematic Payment Adjustment Begin date will incur penalty and interest.

The reprocessed claims will appear in a separate section of the paper Remittance Advice (RA) with a unique Explanation of Benefits (EOB) code. Depending on the date when the claim was originally processed, one of two EOB codes will be associated with the reprocessed claim: EOB 06000 – “Medicare QMB Reprocessing of Claims Processed Between July 1, 2013 and February 28, 2015” or EOB 06021 – “Medicare QMB Reprocessing of Claims Processed Between March 1, 2015 and October 31, 2015”. The 835 electronic transactions will include all of the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)

No action is required on the part of providers. If providers have any questions about the reprocessed Q-class claims, please contact the NCTracks Call Center at 1-800-688-6696 or NCTracksProvider@nctracks.com.

Thank you,
The NCTracks Team

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Occupational Safety and Health Administration (OSHA) recently issued a final rule to revise its Recording and Reporting Occupational Injuries and Illnesses regulation. According to OSHA, “The final rule requires employers in certain industries to electronically submit to OSHA injury and illness data that employers are already required to keep under existing OSHA regulations. The frequency and content of these establishment-specific submissions is set out in the final rule and is dependent on the size and industry of the employer. OSHA intends to post the data from these submissions on a publicly accessible Web site. OSHA does not intend to post any information on the Web site that could be used to identify individual employees.”

“The final rule also amends OSHA’s recordkeeping regulation to update requirements on how employers inform employees to report work-related injuries and illnesses to their employer. The final rule requires employers to inform employees of their right to report work-related injuries and illnesses free from retaliation; clarifies the existing implicit requirement that an employer’s procedure for reporting work-related injuries and illnesses must be reasonable and not deter or discourage employees from reporting; and incorporates the existing statutory prohibition on retaliating against employees for reporting work-related injuries or illnesses.”

“The final rule also amends OSHA’s existing recordkeeping regulation to clarify the rights of employees and their representatives to access the injury and illness records.”

The full rule can be viewed here.

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The Department of Health and Human Services, Office for Civil Rights (OCR), issued on May 13, 2016, a final rule implementing §1557 of the Affordable Care Act (ACA), and prohibiting discrimination on the basis of race, color, national origin, sex, age or disability in certain health care programs (including the Medicare and Medicaid programs), effective July 18, 2016.

According to OCR, under the rule, “individuals are protected from discrimination in health care on the basis of race, color, national origin, age, disability and sex, including discrimination based on pregnancy, gender identity and sex stereotyping. In addition to implementing Section 1557’s prohibition on sex discrimination, the final rule also enhances language assistance for people with limited English proficiency and helps to ensure effective communication for individuals with disabilities.”

A summary of the rule is available here, and more information is available here.

AHCA provided the following key provisions of the new rule:

Assurance and Notice Requirements:

The rule requires covered entities to file an assurance of compliance form that guarantees that the entity’s health programs and activities are operated in compliance with §1557. The entity also must “take appropriate initial and continuing steps to notify beneficiaries, applicants, and members of the public” that it: 1) does not discriminate on the basis of race, color, national origin, sex, age or disability; 2) will provide appropriate aids and services without charge in a timely manner; 3) provide language assistance including translating documents and oral interpretation without charge and in a timely manner; and 4) will provide information to beneficiaries on how to obtain aids and services, contact the employee responsible for compliance, understand the grievance process and instruct how to file an OCR complaint. Information must be posted in conspicuous physical locations and in communications targeted at enrollees, applicants, and members of the public. OCR will provide the content of the notice in English and in the top 15 non-English languages of any state. Notices and communications provided by the covered entity also must have taglines in the top 15 non-English languages in the entity’s state. See Translations of a sample notice and taglines on the HHS Web Site.

General Discrimination Prohibition:

The rule is not a general prohibition against discrimination, but rather it prohibits discrimination in health care programs and activities. The rule’s discrimination prohibition does not apply to discrimination by a covered entity against its employees unless it applies to the employee’s health benefit program. It does not apply to age distinctions permitted or required by federal, state, or local statutes or ordinances. It also does not prohibit health status discrimination, which is prohibited by other federal and state laws.

Discrimination Against Persons With Limited English Proficiency:

The rule includes discrimination prohibitions against individuals with Limited English Proficiency (LEP). An individual with LEP is a person whose first language is not English, and who has limited ability to read, speak, write, or understand English. A covered entity who fails to take reasonable steps to provide meaningful access to language assistance services is a form of national origin discrimination. HHS has applied and will continue to apply a flexible standard in requiring language access in consideration of the particular facts of a specific situation. This standard is based on recognition that: 1) safety and quality in health care requires clear communication between patients and providers; and 2) the level, type, and manner of language assistance is dependent on the relevant facts, which may include the operations and capacity of a covered entity. Language assistance services must be provided in a “timely manner,” and a covered entity must use qualified translators and interpreters (e.g., cannot rely on staff or family members to interpret and/or translate except in emergencies).

Discrimination Against Persons With Disabilities:

The rule requires effective communication with individuals with disabilities, and in accordance with the US Department of Justice (DOJ) interpretation, mandates that a covered entity has to provide auxiliary aids and services to individuals with impaired sensory, manual, or speaking skill impairments. The rule requires a covered entity to conform with the 2010 Americans with Disabilities (ADA) accessible design standard if there is an alteration or new construction on or after July 18, 2016. A covered entity also must ensure that any of its health care program or activities communicated through electronic or information technology is accessible to individuals with disabilities unless it would impose undue financial or administrative burdens and would result in a fundamental alteration in the nature of the program or activity. If compliance with this rule would cause an undue burden or fundamental alteration, the covered entity must provide information in another format that will guarantee that individuals with disabilities have access to services or benefits.

Sex, Gender, And Sexual Orientation:

The final rule prohibits discrimination based on gender identity. Gender identity is defined to include identity as “male, female, neither, or a combination of male and female.” A covered entity is required to treat transgender individuals consistently with their own gender identity. An individual has a transgender identity if the individual’s identity is different from the sex assigned to the individual at birth.

Enforcement:

OCR will enforce section 1557 using the procedures applicable to the federal law. If a covered entity refuses to provide OCR with requested information in a timely manner, OCR will use appropriate enforcement procedures, including suspension or termination of funding.

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The US Department of Labor (DOL) announced today its new overtime rule. According to the DOL, the rule will:

• Raise the salary threshold indicating eligibility from $455/week to $913 ($47,476 per year).
• Automatically update the salary threshold every three years, based on wage growth over time.
• Strengthen overtime protections for salaried workers already entitled to overtime.
• Provide greater clarity for workers and employers.

The final rule will become effective on December 1, 2016, giving employers more than six months to prepare. The final rule does not make any changes to the duties test for executive, administrative and professional employees.

The DOL says this rule will impact more than 150,000 workers in North Carolina.

Additional information about the rule from the DOL can be found here.

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Mark your calendar today for the North Carolina Health Care Facilities Association’s session/seminar “The Changing Definition of Quality-A National Update.” Long term care leaders are equipping themselves for a new climate, a new day in healthcare. Many changes on a federal level include;

• Additions to Five Star
• New Quality Measures
• Progress on the Improving Post-Acute Care Transformation (IMPACT) Act
• Electronic staffing data collection
• Changes to the Requirements of Participation and a new survey process

These will allow us to reevaluate our systems and find new opportunities to drive quality, improving care for our residents. Discover how to navigate this new environment and become Quality Change Agents. Discover how a systems approach and AHCA’s tools and resources can provide solutions for your organization. Leave this session with tools, ideas and a fresh perspective on how to move forward in these changing times. Topics will include:

• Identify changes that will occur over the next three years and the impact they will have on your setting
• Actions and best practices that will help you and your organization be a top performer
• Recognizing the resources and support that AHCA/NCAL provides

This information will be presented by Lyn Bentley, MSW, VP of Quality and Regulatory Affairs and Marguerite McLaughlin, Sr. Director of Quality Improvement at American Health Care Association (AHCA). This seminar will be in Greensboro, NC on June 21st, 2016. Brochures will be mailed to all facilities Friday!

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AHCA/NCAL heads to Music City USA! Great entertainment, friendly people, and unforgettable experiences – all of this describes Nashville, Tennessee, known as Music City USA. But this also describes the AHCA/NCAL 67th Annual Convention & Expo, to be held in Nashville on October 16-19. This is the gathering place for long term and post-acute care professionals, where leaders in the field gather to share ideas, learn about new techniques and services, network, and have fun. Educational sessions are designed to help you provide for your residents in the most efficient and effective way; keynote talks will inspire you; visits to the Expo Hall will expose you to the very latest in products and services for your business; and networking events will help you make new friends. AHCA has it all this fall, and it’s all at the Annual Convention & Expo, in beautiful, friendly, musical Nashville. Make your plans now to attend! Click here to see more details and register today!

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This part of the Building Prevention Into Every Day Practice Series focuses on developing a Framework for Successful Clinical Outcomes.

Success in achieving positive resident/patient outcomes is more critical now than ever before. The link between quality and payment in long term and post-acute care is growing stronger, as evidenced by the SNF Value Based Purchasing Program (VBP), Improving Post-Acute Care Transformation (IMPACT) Act, SNF Quality Reporting Program (QRP) and more. In addition, regulatory activity is intensifying through focused surveys on adverse events, dementia care and MDS. The Five-Star Rating system and Nursing Home Compare have been revised and will add items in the future as it broadens public reporting and transparency. Most importantly, consumers expect and deserve high quality care.

The entire framework outlines key elements from both an organizational and clinical nature that are critical to successful clinical and organizational outcomes. Positively, these elements reflect common denominators that cross multiple care situations. Therefore, instead of being yet another initiative or single focused project to achieve just one outcome, it is a way of acting, thinking and being that will benefit multiple areas across an organization. Each element is addressed in detail throughout the framework.

This week we will feature the element of Organizational Foundation: Team-Based Care

Key Takeaways: Team-Based Care

 No one discipline or individual can deliver all the necessary care and support.
 Create and reinforce a culture of giving care in the proper context of the “big picture” and not in “silos.”
 All departments and disciplines contribute and receive relevant information to help identify issues and concerns before they lead to a more complicated situation.

Probing Questions for Team Reflection and Discussion:

1. How do we work together, versus in silos? How can we get better?
2. How do we build relationships between staff, residents, families and others?
3. How can we improve the collaboration and coordination across all staff to improve outcomes for residents?

Visit the AHCA Clinical Practice Website to learn more about the element of “Organizational Foundation: Team-Based Care” and answers to these key questions:

What does this mean? Why is this important? What are some examples? What is my part (as an individual employee, manager or practitioner)? What can my organization do?

Start somewhere, pick one element and work through it with your team.

Enjoy the journey through the framework!

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On April 3, NCHCFA sent a letter from NC SPICE to each facility describing this initiative. This is an opportunity for expert assessment and consultation regarding your infection control systems. This initiative is not affiliated with CMS and all data will be submitted to the CDC in aggregated and anonymous formats. Infections are, and will grow rapidly as, one of the major challenges of the health care system.

Staff from the DPH Communicable Disease Branch, along with SPICE, will oversee the implementation of two activities: 1) an infection control assessment program and 2) targeted healthcare infection prevention programs. The primary focus of this project will be to address the lack of comprehensive infection control training and oversight in hospital and non-hospital healthcare facilities across the state and to enhance the ability of public health to work with all facilities to prepare for and mitigate existing or emerging infectious disease threats. NC DPH Communicable Disease Branch is contracting SPICE to:

1. Develop a comprehensive database of all NC healthcare facilities including self-assessment of infection control practices, training, and outbreak assessment. Self-assessment will incorporate checklists developed by the CDC for various healthcare facilities: acute care, nursing home, ambulatory care, and dialysis. The goal is for 50% of each type of healthcare facility to complete the self-assessment. Acute care facilities (acute care hospitals, critical access hospitals, Long-Term Acute Care (LTAC), and Inpatient Rehabilitation Facilities (IRFs) and NC licensed nursing homes will initially complete the self-assessment, followed by ambulatory care facilities in the following year.

2. Conduct facility site visits/consultation (randomly selected from database) for in depth discussion and review of infection control practices and outbreak assessment (detect, report, respond). The goal is to visit 30 hospitals, 80 nursing homes, and 100 ambulatory care facilities.

3. Develop targeted infection control training and education based on identified gaps. SPICE has hired three nurse consultants to implement the site visit/consultation part of the project. In April 2016, they will begin contacting hospitals and nursing homes to schedule site visits/consultations.

One of the two first participants sent NCHCFA this feedback upon receiving our letter. “We completed this last week, and it was great! They provided so much good information for us to work on.”

You may also sign up for a visit and/or learn more about this program, by clicking on the following link: http://spice.unc.edu/icar

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Alliant Quality wants to encourage SNFs to keep signing up for the National Collaborative – or SPACE. Alliant recommends having as much time as possible to get started on Quality Assurance Performance Improvement (QAPI) improvement work and improving facility quality measures in a systems approach to improve their five star and composite scores.

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.

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 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.

When ready to register, click here for the Participation Agreement and fax or e-mail it back to Lisa Klemis. For more details, e-mail Jennifer Brock at Jennifer.Brock@area-F.hcqis.org or call (678) 527-3417.

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Alliant Quality will offer two Webinars on Tuesday, May 24, 2016, first at 10:00 AM and again at 2:00 PM aimed at reducing the unnecessary use of antipsychotics in nursing home residents with dementia. Dr. Adrienne Mims, Vice President, Chief Medical Officer for Alliant Quality, and Mike Crooks, Alliant Pharmacy Lead, will be reviewing the Resident Prioritization Tool – to guide centers in prioritizing residents appropriate for reduction.

Register now by clicking https://qualitynet.webex.com.

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Restorative nursing is an essential part of reimbursement, compliance, and the quality of life of your residents. Improper care planning or unclear documentation can negatively impact resident care and your bottom line. The Long-Term Care Restorative Nursing Desk Reference is a new all-inclusive desk reference that describes the clinical aspects of restorative nursing in detail and provides a much-needed guide for nurses in a long term care facility. This resource makes it easy to find instant answers to questions you may have about maintaining or developing your restorative program. The Long-Term Care Restorative Nursing Desk Reference offers the help you need to create or sustain an effective restorative care program that puts your resident’s needs first. This text also comes with a CD-ROM.

To order, visit http://www.AHCApublications.org or call (800) 321-0343. Fax orders may also be placed at (800) 869-5605.

Product #8241
AHCA MEMBERS $149.00

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This DVD, 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, 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 and may be reproduced. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org. The price is $35.00 (tax and shipping included).

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Building a culture of engagement: A transformational approach

http://www.providermagazine.com/reports/Documents/2016/Align_web.pdf

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All porcupines float in water.

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