UPDATE Weekly

Today, North Carolina received federal approval to implement the transition to Medicaid managed care and integrate physical health, behavioral health and pharmacy benefits. Receiving approval from the Centers for Medicare & Medicaid Services (CMS) of the amended 1115 Demonstration Waiver application submitted by the North Carolina Department of Health and Human Services in 2017 is a major milestone in implementing North Carolina’s Medicaid Transformation and in moving the state’s health care system toward further integration and coordination.

“Our highest priority is the health and well-being of the people we serve,” said DHHS Secretary Mandy Cohen, M.D. “Receiving this waiver approval from the federal government will help us continue to build an innovative and whole-person centered system that addresses both medical and non-medical drivers of health.”

The approved waiver gives North Carolina federal authority to implement through its managed care plans an innovative Healthy Opportunities pilot program to improve health and reduce health care costs. These pilots will identify the most cost-effective ways for managed care plans to deliver whole-person care and ensure that Medicaid dollars are purchasing value.

In 2015, the General Assembly directed the transition of Medicaid from a predominantly fee-for-service structure to managed care. Since then, DHHS has solicited extensive feedback from clinicians, beneficiaries, hospitals, counties, health plans, elected officials, advocates and other stakeholders in developing the components of the 1115 Waiver Demonstration. The approved waiver focuses only on the aspects of North Carolina’s Medicaid managed care transformation that require CMS approval.

Documents for the 1115 waiver, including a fact sheet of key components, the original and amended waiver applications, a copy of the approval letter from CMS and other related transformation information, may be found on the NC Medicaid transformation website at http://www.ncdhhs.gov/nc-medicaid-transformation.

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Representative Darren Jackson (District 39) toured BellaRose Nursing and Rehab on Thursday, October 19th, along with representatives of NCHCFA. The visit allowed Representative Jackson to see first-hand the care skilled nursing facilities provide to residents and to discuss issues facing the long-term care profession.

Robert Evans, President, and Justin Dixon, Administrator, spoke with Representative Jackson about staffing challenges facing North Carolina’s skilled nursing facilities as well as Fair Rental Value (FRV).

Congressional visits are an effective way to demonstrate the high quality, cost-effective and preferred care that North Carolina skilled nursing facilities provide. If you are interested in hosting a facility tour, please contact Adam Sholar, adams@nchcfa.org or Eric Kivisto, erick@nchcfa.org.

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The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) presented Linda Kluge, RD, LD, CPHQ, the 2018 Mary K. Ousley Champion of Quality Award on October 10th at AHCA/NCAL’s 69th Annual Convention & Expo in San Diego, California. Kluge, an Executive Director at Alliant Quality, a Quality Innovation Network – Quality Improvement Organization (QIN-QIO) for Georgia and North Carolina, was recognized for her contributions to quality in long term and post-acute care.

“Linda’s dedication and passion for improving quality have positively impacted thousands of lives,” said Mary Ousley, AHCA Quality Cabinet Co-Chair and namesake of the award. “She’s a role model and quality ambassador. I’m honored to recognize Linda with this award.”

For more than 40 years, Kluge has worked to advance quality performance in the profession. As part of a national effort to encourage patient-centered care, she co-founded the Culture Change Network of Georgia, a group focused on promoting and fostering culture change to improve the quality of life for older Georgians. Under her leadership, a Georgia coalition and advisory board were formed that played a role in the safe reduction of antipsychotic usage in skilled nursing centers throughout the state. She also championed the development of an educational toolkit used by nursing centers nationwide through the initiative Interventions to Reduce Acute Care Transfers (INTERACT®) to reduce unnecessary emergency room visits and hospital readmissions. Kluge received the Distinguished Service Award from Aging Services of Georgia in 2010, and was the recipient of the President’s Mentor Award from the Florida Dietetic Association.

AHCA/NCAL presents the Mary K. Ousley Champion of Quality Award to an individual that has made a significant national contribution to advancing quality performance in long term and post-acute care. Recipients display leadership in the development, promotion, and implementation of quality improvement initiatives that have resulted in measurable improvements in the quality of care and quality of life for individuals in long term care.

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The Centers for Medicare and Medicaid Services (CMS) released a fact sheet containing information about the inaugural release of the SNF QRP data on the Nursing Home Compare Website that occurred on October 24th, 2018. Click here to view.

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The nomination deadline for the NCHCFA Annual Awards Program is this Friday, October 26th. We are asking that you recognize and celebrate someone who makes a significant difference in the lives of your residents and their families. Click here to download and print the nomination forms. To complete nominations online click here. If you have any questions about the Annual Awards, call the Association office at (919) 782-3827.

The Nurse Aide of the Year will be chosen per District (there are five districts) and the J.R. Garrett, Jr. Direct Care Worker of the Year Award winner chosen out of these five. In addition, a sixth recipient in a non-nursing discipline will also be chosen to receive the Riley W. Clapp Outstanding Service Award. These six recipients will be honored during the Awards Gala at the Annual Convention and Expo in February of 2019. The Awards Gala has become the highlight of our convention and is a wonderful and moving way to honor these outstanding individuals, their families, and co-workers. Pictures for nominations submitted online may be mailed to the Association office or may be emailed to karenL@nchcfa.org. Only one nomination may be submitted for each discipline, but we welcome nominations from more than one department of your facility.

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The TRECS Institute, with support from the Leonard Davis Institute of Health Economics (LDI) is pleased to announce the launch of a national, grass roots initiative designed to identify and address “No Brainers” within our long term care system.

A “No Brainer” is any current practice that negatively effects the quality of care provided to the residents in our nation’s long term care facilities and results in unnecessary and wasteful spending. These practices are driven by historical practice patterns, reimbursement and/or operational regulations and have two undeniable outcomes:

1) The practice is not in the best interest of residents
2) The practice results in wasted and unnecessary spending for our health care system

The goal of this initiative is to identify “No Brainers”, confirm the negative quality implications they present and to estimate the overall negative economic impact they have on our healthcare system.

To find out more about this initiative or submit what you believe to be a “No Brainer” specific to the long term care system, please visit the TRECS Institute’s Web site and follow the prompts for the “No Brainer” Initiative.

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The NCHCFA Annual Convention and Trade Show will be held February 24-27, 2019 at the Sheraton Four Seasons Hotel/Koury Convention Center in Greensboro, NC. Brochures outlining specific program information will be available in December.

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NCHCFA presents MDS and QRP- Section GG and Section N with speakers from RTI International. RTI International is one of the world’s leading research institutes, dedicated to improving the human condition by turning knowledge into practice and recently presented a national train-the-trainer presentation concerning the MDS and QRP changes at the CMS Quality Conference in Baltimore, MD this year. This conference was highly attended and highly recommended.

Seminar Summary

Section N – Drug Regimen Review

Section N of the Minimum Data Set (MDS) has been updated to include items for the Drug Regimen Review Conducted with follow-up for identified issues quality measure and Data collection that began on October 1, 2018. Section N includes standardized patient assessment data elements and was implemented in response to the Improving Medicare Post-Acute Care Transformation (IMPACT Act).

Objectives:

• Describe the intent of the new Section N data elements
• Discuss the steps for assessment and coding the data elements
• Describe the Drug Regimen Review (DRR) Quality Measure (QM)
• Accurately code the Section N DRR scenarios

Section GG – Functional Abilities and Goals

Section GG of the Minimum Data Set (MDS) has been updated and data collection began on October 1st, 2018. Section GG includes standardized patient assessment data elements and was implemented in response to the IMPACT Act.

Objectives:

• Describe the intent of Section GG
• Define the assessment reference period for each data element
• Discuss the steps for assessment
• Accurately code Section GG scenarios

Click here to register online today!

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Cindy DePorter, MSSW, State Survey Agency Director, Division of Health Service Regulation, will be teaching a full day session (two locations) on the following topics:

• Upcoming changes/additions to the federal regulations for November of 2019
• Review of the changes to the state nursing home regulations
• Update on current CMS workgroups on area of transfer/discharge, Facility Reported Incidents
• Revisions to Immediate Jeopardy language

The sessions will be presented at the following two locations:
November 7th – Sheraton Imperial Hotel, Durham, NC
November 13th – Crowne Plaza Hotel, Asheville, NC

Click here to register online! Click here to download the brochure with registration form.

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The Situational Leadership workshop is an interactive and dynamic developmental session where attendees will discuss how best to apply the effective principles and approaches of The Situational Leadership Model popularized by renowned leadership and management experts Ken Blanchard and Paul Hersey.

Our high demand and ever-changing work environment requires that leadership interactions with staff be as effective and efficient as possible. Additionally, the diverse experiences, skills, and needs of our employees must impact, more than ever, how we manage, lead and inspire our workforce. The Situational Leadership Model suggests that there is no “one size fits all” approach to leadership.

The four different styles of situational leadership to be discussed are:

1. Delegating
2. Coaching
3. Directing
4. Supporting

This workshop will be held at the NCHCFA office in Raleigh, NC. It will be facilitated by Mark Gogal, a Human Resources Leader with over 25 years of progressive, global, and diverse human resources experience, practical business partnering expertise, strong organizational and analytical skills, and proven strategic management experience. He has a multi-faceted background in developing and implementing core HR policies/practices to meet the changing business, legal, and labor compliance environment. He has worked in a variety of industries in the public and private sectors including healthcare.

For the brochure and registration information, click here!

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NCHCFA has scheduled the AHCA/NCAL Bronze and Silver Quality Award Workshops. The AHCA/NCAL National Quality Award Program provides a pathway for providers of long term care services to journey towards performance excellence. The program is based on the core values and criteria of the Baldrige Performance Excellence Program. The Quality Award program has three progressive step levels.

The first level is Bronze, Commitment to Quality. Last year, 8 of out 10 facilities that attended the Bronze Quality Award workshop received the Bronze Quality Award! Bronze Award applicants begin their quality journey by developing an organizational profile including vision and mission statements, an awareness of their environment and customers’ expectations, and a demonstration of their ability to improve a process. This session includes a full day of training and consultation on how to complete the AHCA/NCAL Bronze Quality Award application. This training will decipher the criteria, answer questions, clarify concepts, and guide participants through the process of writing an organizational quality award application. Using interactive technology, participants will leave the workshop with their applications complete or with few areas to fill in. This workshop is being offered in two locations:

November 15th – Silver Bluff Village, 100 Silver Bluff Drive, Canton, NC 28716
December 6th – NCHCFA, 5109 Bur Oak Circle, Raleigh, NC 27612

Click here to download the brochure and registration form for the Bronze Quality Award Workshop.

The second level is Silver, Achievement in Quality. A requirement of the program is to receive a Bronze – Commitment to Quality Award before applying at the Silver level. At this level applicants continue to learn and develop effective approaches that help improve performance and health care outcomes. In addition to the Organizational Profile, applicants provide a thorough assessment of their systematic approaches and the deployment of these approaches. At the end of this workshop, participants will have the framework for the Silver AHCA/NCAL Quality Award application.

November 28th – 29th – NCHCFA, 5109 Bur Oak Circle, Raleigh, NC 27612

Click here to download the brochure and registration form for the Silver Quality Award Workshop.

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The AHCA third quarter Top-Line Publication for skilled nursing centers is now available. This valuable resource is a brief report that is customized with the latest Nursing Home Compare data. Additionally, assisted living centers can now access the AL Top-Line publication in LTC Trend Tracker℠, which gives AL’s the ability to view important assisted living data, their progress on the NCAL Quality Initiative, their status and eligibility to apply for the AHCA/NCAL Quality Awards Program, and more.

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NCHCFA members can register for a new education program designed by AHCA to help skilled nursing facilities succeed under the new CMS value based purchasing payment program (SNF VBP) that took effect Monday, October 1, 2018. The course (Understanding SNF VBP in Detail) contains six modules that provide an in-depth description of each feature of the SNF VBP program along with helpful tools, documents, and primary source references to the program.

Follow this link for more information and to register today for Understanding SNF VBP in Detail or go to https://educate.ahcancal.org/p/snfvbp.

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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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Choosing New Strategies to Meet the Occupancy Challenge

Provider Magazine Article

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Every day, one oyster filters 50 gallons of water and a healthy one-acre reef around 24 million gallons—enough to fill 36 Olympic swimming pools.

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