CMS Revises Quality Indicator Survey

Published in September 17, 2015 Issue

On August 28, 2015 the Centers for Medicare and Medicaid Services (CMS) issued revised guidelines for trainers conducting Quality Indicator Surveys (QIS) surveys.  Click here to read the memo, S&C: 15-50-NH.

Deadline Nearing for Submitting Comments to CMS

Published in September 3, 2015 Issue

The Centers for Medicare and Medicaid Services (CMS), which revised regulations governing skilled nursing and long term care facilities, is accepting comments on the proposed changes through September 14 at 5:00 p.m.  CMS needs to hear directly from you since you're the expert in long term care.

CDC Report: Stop Spread of Antimicrobial Resistance

Published in September 3, 2015 Issue

With an increasing number of infections caused by multidrug-resistant organisms (MDROs) (such as carbapenem-resistant Enterobacteriaceae) and Clostridium difficile, it is crucial that healthcare facilities, including long term care facilities, implement effective antibiotic stewardship programs and infection prevention and control measures.

NOTICE Act Requires Medicare Beneficiaries to Be Informed of Hospital Status

Published in August 13, 2015 Issue

Congress has passed and President Barack Obama has signed the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act (H.R. 876). The new law, which will take effect next year, will require hospitals to notify Medicare beneficiaries of their outpatient status within 36 hours of service inception or at discharge (if sooner). Outpatient status affects a patient’s ability to receive Medicare coverage for post-acute care in a skilled nursing center.

VHCA Committees to Review Proposed Rule on Medicare Requirements of Participation

Published in August 6, 2015 Issue

The Virginia Health Care Association’s (VHCA) Regulatory and Quality of Care Committees are holding a joint meeting on August 20 to review the proposed changes to the Medicare and Medicaid participation requirements for nursing facilities. 

CMS to Host Call on Requirements of Participation Regulation Changes

Published in August 6, 2015 Issue

On August 11 from 2:30 p.m. – 4:00 p.m., the Centers for Medicare and Medicaid Services (CMS) is hosting a call for providers and stakeholders during which the agency will briefly walk through the many changes in the proposed rule for Medicare requirements of participation.  The agenda for the call is:

Overview of Proposed Rule to Overhaul Nursing Facility Requirements for Participation in Medicare and Medicaid

Published in July 30, 2015 Issue

On July 16, 2015, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) published a proposed rule to revise Medicare and Medicaid participation requirements for nursing facilities. The proposed regulations are the first comprehensive revisions to skilled nursing and long term care regulations since 1991 and include substantial changes and reorganization. Much of the 103 page proposed rule, if adopted, will codify existing facility and surveyor policies and practices.  However, there are a number of substantive changes among the many new rules. The Summer 2015 edition of the VHCA Legal Quarterly focuses on several key areas where proposed requirements are likely to change current facility practices significantly, including: 

CMS Proposes Mandatory Antibiotic Stewardship Program

Published in July 24, 2015 Issue

The Centers for Medicare & Medicaid Services (CMS) has proposed a rule requiring all long term care facilities to establish an antibiotic stewardship program, including antibiotic use protocols and antibiotic monitoring.  This initiative is a reflection of the federal government's escalated response in the battle against superbugs, malicious microbes that are resistant to these drugs.

Updated LEIE Database Now Available

Published in July 16, 2015 Issue

The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions through June 2015 and replaces the LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included. Healthcare providers are responsible for checking to ensure that excluded individuals are not working in their facilities, or they face significant fines. Instructional videos about how to use the online database and the downloadable files are available. Given the penalties and recent government warnings, long term care providers should check the LEIE on a regular basis.

New OSHA Enforcement Memo

Published in July 2, 2015 Issue

The Occupational Safety & Health Administration (OSHA) released an enforcement memo last week that provides guidance on inspections in hospitals and nursing and residential care facilities. The guidance is intended to replace the National Emphasis Program. Namely, OSHA indicates that all inspections, whether programmed or complaint-based, will cover on the five focus hazards:

Check Updated LEIE Database

Published in May 28, 2015 Issue

The US Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in April 2015. This new file is meant to replace the updated LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included in this file. The updated files are posted on OIG’s website, and health care providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines.

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Sustainable Growth Rate (SGR) - the “Doc Fix” - Passes Senate, Heads to President Obama

Published in April 16, 2015 Issue

As reported by AHCA 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. 

Doc Fix Update - Reminder

Published in April 9, 2015 Issue

As you know, the United States Senate recessed for two weeks without taking up the “Doc Fix” (Sustainable Growth Rate) legislation passed by the House of Representatives late last week.  The “Doc Fix” is a recurring policy issue where the annual formula for updating physician payment under Medicare results in a significant reduction relative to current physician payment.  In order to avoid the formula driven reduction, Congress typically passes legislation “fixing” the payment to maintain current payment levels.  In order to do so, Congress must come up with the required funding, which has often lead to reduction in other provider payment updates, including nursing facility payments under Medicare.

Update on Sustainable Growth Rate Legislation

Clifton J. Porter

Published in March 26, 2015 Issue

Today, the U.S. House of Representatives passed H.R. 2, permanently fixing the Sustainable Growth Rate (SGR) and getting us closer to the much-needed stability for the long term and post-acute care profession. The legislation passed by a vote of 392-37, with 212 Republicans and 180 Democrats supporting the measure.

National Healthcare Decisions Day (NHDD)

Published in March 20, 2015 Issue

Just one month to go.  National Healthcare Decisions Day (NHDD) 2015 will be April 16th, the day after “tax day.”

2013 NCAL VRT Report Now Available

Published in March 5, 2015 Issue

The Vacancy, Retention, and Turnover Survey (VRT) is a nationwide study to collect staffing rates among assisted living employees. This survey is supported by LeadingAge, the American Seniors Housing Association (ASHA), and the Assisted Living Federation of America (ALFA).

Check Updated LEIE Database

Published in March 5, 2015 Issue

The US Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in January 2015.

Webinar on VA Contracts and the Service Contract Act (SCA)

Published in March 5, 2015 Issue

It is long-standing policy that Medicare (Parts A and B) or Medicaid providers are not considered to be federal contractors. However, if a provider currently has VA patients, they are considered to be a federal contractor and subject to the Service Contract Act (SCA). On Wednesday, March 18, at 2:00 PM EST, get your pressing SCA related questions answered on issues impacting you as a VA contractor from officials from the U.S. Department of Labor (DOL) and U.S. Department of Veterans Affairs (VA). Click here for the registration link.

Update - Five Star Rating System Changes

Published in February 19, 2015 Issue

In October 2014, President Obama issued an executive action instructing the Centers for Medicare and Medicaid Services (CMS) to make changes to the Five Star rating system. CMS announced the first of these changes on February 12th.  Of the three parts of Five Star – survey, quality measures (QM), and staffing – CMS will make changes to the staffing component and to the quality measure component. The staffing component no longer allows centers with three or fewer stars on both RN and direct care staff to get a four star rating on the staffing component. The quality measure component adds two new quality measures (a long stay antipsychotic measure and a short stay antipsychotic measure) and rescales the cutpoints used to classify centers into the five QM Five Star ratings. These changes not only impact a center’s ratings on the staffing and QM components but will impact a center’s overall ratings as well (A link to AHCA’s PowerPoint is included for your reference).

Five Star Webinars Available This Week

Published in February 12, 2015 Issue

In October 2014, President Obama issued an executive action instructing the Centers for Medicare and Medicaid Services (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 2:00 pm 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.  The American Health Care Association (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.

Errata Document Issued for MDS 3.0 RAI Manual

Published in February 12, 2015 Issue

The Virginia Health Care Association recently received a communication from Cil Bullard, RN, CPC, Virginia RAI/OASIS Coordinator with the Office of Licensure and Certification in regards to an errata document on the Nursing Home Quality Initiatives:

Anthem Reports Data Breach

Published in February 5, 2015 Issue

Anthem Inc. has reported that hackers broke into a database containing names, social security numbers, addresses and other personal information for about 80 million customers and employees.  According to information from their website, Anthem will individually notify current and former members whose information has been accessed. Anthem is offering to provide credit monitoring and identity protection services free of charge to those who have been affected.  It is not yet clear whether Commonwealth Coordinated Care members are included in the breach.

2014 NCAL Performance Measure Survey Report Released

Published in February 5, 2015 Issue

The National Center for Assisted Living (NCAL) conducted its fifth annual Assisted Living Performance Measure Survey in 2014. Data collected includes domains associated with quality of care and strengthening the assisted living workforce. NCAL members were asked if they collect satisfaction data from residents, families, and employees; if they have resident and family councils, staff retention practices, and nurse availability, among other areas. 

President Releases his FY2016 Budget Proposal

Published in February 5, 2015 Issue

President Obama released his budget this week and it proposes significant cuts to Medicare by reducing the market basket, cutting bad debt reimbursement, etc.  AHCA/NCAL have already expressed their strong opposition to the cuts.  While it is not expected they will become law, VHCA wanted to provide you a  summary from AHCA/NCAL of the President’s budget provisions that would have a direct impact on the nursing and assisted living profession.

Pneumovax Coding

Published in February 5, 2015 Issue

The Virginia Health Care Association recently received a communication from Cil Bullard, RN, CPC, Virginia RAI/OASIS Coordinator with the Office of Licensure and Certification in regards to Pneumovax Coding:

Five Star: Changes in 2015

Published in February 5, 2015 Issue

The American Health Care Association recorded a 53 minute webinar on Tuesday, February 3, 2015 for members of the Association outlining proposed changes to the Five Star Rating System for Skilled Nursing Facilities.  Several quality measures will be added (such as antipsychotic usage), and MDS auditing will be expanded from five states to all states.  The presentation also focuses on the change in how staffing information will need to be supported by facilities.  The recording of the Five Star webinar can be accessed here.  To only view the slides, click here

Check Updated LEIE Database

Published in January 15, 2015 Issue

The US Department of Health and Human Services, Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in December 2014. This new file is meant to replace the updated LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

2015 Healthcare Observances Calendar Now Available

Published in January 8, 2014 Issue

A handy look at 2015 for all the monthly, weekly and daily healthcare observances has been posted to the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) website.  Members who are interested in finding out when certain celebrations or recognitions occur, this is the document to use for all your planning needs.

Webinar: Department of Labor & Department of Veterans Affairs-Wage Issue and VA Contracts

Published in January 8, 2014 Issue

On Thursday, January 15, from 2:00 - 3:30pm EST, providers will have the opportunity to get questions answered relating to the $10.10 wage issue and Veterans Affairs (VA) contracts with officials from the U.S. Department of Labor (DOL) and U.S. Department of Veterans Affairs (VA). As many may be aware from previous correspondences from AHCA, on February 12, 2014, President Obama signed Executive Order 13658, Establishing a Minimum Wage for Contractors.  The Executive Order raises the hourly minimum wage paid by contractors to workers performing on covered Federal contracts to: (i) $10.10 per hour, beginning January 1, 2015; and (ii) beginning January 1, 2016, and annually thereafter, an amount determined by the Secretary of DOL in accordance with the Order. On October 1, 2014, DOL published the final rule implementing the provisions of Executive Order 13658.

CMS Departures

Published in January 8, 2014 Issue

As some members may have heard, two key Centers for Medicare and Medicaid Services (CMS) deputy administrator positions are to be soon vacated.

Executive Order on $10.10 Hourly Federal Contractor Minimum Wage, VA Contracts, and VA Webinar

Published in December 18, 2014 Issue

On February 12, 2014, President Obama signed Executive Order 13658, Establishing a Minimum Wage for Contractors.  The Executive Order raises the hourly minimum wage paid by contractors to workers performing on covered Federal contracts to: (i) $10.10 per hour, beginning January 1, 2015; and (ii) beginning January 1, 2016, and annually thereafter, an amount determined by the Secretary of the Department of Labor (DOL) in accordance with the Order. On October 1, 2014, DOL published the final rule implementing the provisions of Executive Order 13658.

2015 Healthcare Observances Calendar Now Available

Published in December 18, 2014 Issue

A handy look at 2015 for all the monthly, weekly and daily healthcare observances has been posted to the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) website.  Members who are interested in finding out when certain celebrations or recognitions occur, this is the document to use for all your planning needs.

Emergency Preparedness: Active Shooter Information Available as Resource

Published in December 12, 2014 Issue

The American Health Care Association (AHCA) has recently shared a report posted to the Public Health Emergency website on “Emergency Preparedness: Active Shooter information”.  The report (Incorporating Active Shooter Planning into Health Care Facility Emergency Operations Plans) was developed with assistance from the Assistant Secretary for Preparedness and Response’s (ASPR) Divisions of Health System Policy and Tactical Programs, the Federal Emergency Management Agency, the Federal Bureau of Investigation, and the Healthcare and Public Health Sector Coordinating Council.  The document shows how government and private sector partners can work together to benefit healthcare and public health communities.  It is primarily designed to encourage facilities to consider how to better prepare for an active shooter incident and includes comprehensive guidance.

OIG Releases 2015 Work Plan

Published in November 20, 2014 Issue

The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) has reported that the US Department of Health and Human Services (HHS), Office of Inspector General (OIG), has released its 2015 Work Plan.

Updated VDH Guidance on Ebola for Health Care Providers

Published in October 30, 2014 Issue

In response to the continued concern about travelers bringing Ebola into the United States, the Centers for Disease Control and Prevention (CDC) and various states are issuing updated guidance for treating travelers coming into the country who have spent time in West Africa. 

Federal Minimum Wage for Federal Contractors and the Veterans Administration

Published in October 10, 2014 Issue

On February 12, 2014, President Obama signed Executive Order 13658, Establishing a Minimum Wage for Contractors. The Executive Order raises the hourly minimum wage paid by contractors to workers performing on covered Federal contracts to: (i) $10.10 per hour, beginning January 1, 2015; and (ii) beginning January 1, 2016, and annually thereafter, an amount determined by the Secretary of the Department of Labor (DoL) in accordance with the Order. On October 1, 2014, DOL published the final rule implementing the provisions of Executive Order 13658.

Revision to COT OMRA Completion Requirements

Published in October 2, 2014 Issue

The Centers for Medicare and Medicaid Services (CMS) released a memo regarding the revision to the Change of Therapy (COT) Other Medicare Required Assessment (OMRA) completion requirements. The memo states, “for the reasons specified in the FY 2015 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule (79 FR 45647 through 45649) and FY 2015 SNF PPS Proposed Rule (79 FR 25786 through 79 FR 25788), providers are permitted, in certain circumstances, to complete a COT OMRA for a resident who is not currently classified into a Resource Utilization Group, Version 4 (RUG-IV) therapy group, or receiving a level of therapy sufficient for classification into a RUG-IV therapy group.

Check Updated LEIE Database

Published in September 25, 2014 Issue

The US Department of Health and Human Services, Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in August 2014. This new file is meant to replace the updated LEIE database file available for download last month.  Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

RAI Manual Updates and CCC MDS Information

Published in September 25, 2014 Issue

The Virginia Health Care Association has received an update from Cil Bullard, RN, CPC, Virginia RAI/OASIS Coordinator, noting that the Centers for Medicare and Medicaid Services (CMS) has released the October 2014 RAI manual.  There are some identified issues with missing parts to the manual, as well as textual errors. CMS will be sending out an errata or updated manual which will be at the same site.  Ms. Bullard recommends if you print the manual that you wait until clarifications are released by CMS.  Among issues with the current release are missing item sets, incorrect or unclear text examples, and conflicting instructions. A webinar about the updates will be posted on the Virginia Department of Health website after the manual is finalized.

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DEA Final Rule Reclassifies Hydrocodone Combination Products to Schedule II

Published in September 11, 2014 Issue

The Drug Enforcement Administration (DEA) has issued a final rule imposing stricter regulatory controls and sanctions on people who handle or propose to handle hydrocodone combination products, drugs that contain hydrocodone and specified amounts of other substances. Effective October 6, 2014, the rule moves hydrocodone combination products from Schedule III to Schedule II.

Check Updated LEIE Database

Published in August 28, 2014 Issue

The US Department of Health, Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file,  which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in July 2014.

CMS SNF/LTC Open Door Forum Excerpt: COT OMRA & RAI Manual Update

Published in August 21, 2014 Issue

During the August 5, 2014 SNF/Long term Care Open Door Forum (ODF), the Centers for Medicare and Medicaid Services’ (CMS) officials addressed the Change of Therapy Other Medicare Required Assessment (COT OMRA) change associated with the FY 2015 SNF PPS Final Rule. During the ODF officials stressed that this change allows providers to use the COT OMRA “to reclassify a resident into a therapy RUG from a non-therapy RUG, but only in certain limited circumstances”. “More specifically, a COT OMRA may be completed when a resident is not currently classified into a RUG-IV therapy group but only if both of the following conditions are met: first, that the resident has been classified into a RUG-IV therapy group on a prior assessment during the resident’s current Medicare Part A stay, and second, that no discontinuation of therapy services, planned or unplanned, occurred between day 1 of the COT observation period for the COT OMRA that classified the resident into his or her current non-therapy RUG-IV group and the ARD [assessment reference date] of the COT OMRA that reclassified the resident into a RUG-IV therapy group.”

Beneficiary and Family-Centered Care Vendor for Virginia, KEPRO, Seeks Contact Information for Expedited Discharge Appeals

Published in August 21, 2014 Issue

he new Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) contract between CMS and KEPRO (for Virginia) remains a focus for VHCA and our members as implementation issues continue to be worked through (see last week’s CareConnection for additional background).  We have been made aware that residents/facilities have been:

New Treatment Options for Methicillin-Resistant Staphylococcus Aureus

Published in August 7, 2014 Issue

Since late May, the Food and Drug Administration (FDA) has approved two new drugs - Dalvance and Sivextro - to treat acute bacterial skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and certain other bacteria. These drugs were the first to be approved under a new Qualified Infectious Disease Product program that includes incentives to entice pharmaceutical companies to develop drugs to help fight antibiotic resistance. Dalvance is administered intravenously and Sivextro is available for intravenous and oral use. FDA news releases on these drugs are available at:

CMS Announces Revisions to the State Operations Manual (SOM)

Published in August 7, 2014 Issue

In a Survey & Certification memo (S&C: 14-37-NH) sent to State Survey Agency Directors, CMS (Centers for Medicare and Medicaid Services) announced revisions to the State Operations Manual (SOM), Appendix PP- (Guidance to Surveyors for Long-Term Care) and Chapter 4.  Updates apply to interpretive guidelines and, where appropriate, investigative protocols for F Tags that incorporate Survey & Certification (S&C) policy memos issued between October 2003 and May 2014.   While this is the first major CMS update of the SOM since March 2013, VHCA members have been routinely updated on the tag revisions as they were published by CMS.  The updated SOM includes revised guidance for the following F-tags in Appendix PP:

ICD-10 Compliance Deadline Formally Set for October 1, 2015

Published in August 7, 2014 Issue

Announced several weeks ago, the US Department of Health and Human Services has now formally set the new compliance date for health care providers, health plans and health care clearinghouses to transition from ICD-9 to ICD-10 through publication of the Final Rule.  According to the press release from CMS (Centers for Medicare and Medicaid Services), the new deadline “allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.”  CMS further expects the transition to ICD-10 “help to better coordinate a patient’s care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to greater accuracy of reimbursement for medical services.”  More information on ICD-10 can be found here

Recall of Emergency Light Fixture

Published in July 31, 2014 Issue

The Consumer Product Safety Commission (CPSC) has released an advisory announcing that Lithonia Lighting has recalled emergency lights due to a fire hazard.  These emergency light fixtures may be used in nursing centers and assisted living centers.  The recall information provides a photograph of the fixtures as well as a description of the potential danger and remedy.  The announcement notes that the circuit board can overheat and cause the fixture to melt, catch fire and ignite nearby items, posing fire and burn hazards to consumers.  According to the notice, this recall involves the Quantum® series ELM and ELM2 emergency light fixtures.  Consumers should contact Lithonia Lighting to receive detailed instructions on how to locate the circuit board and series name and to order a free repair kit, which includes a new circuit board. Lithonia Lighting can be contacted toll-free at (888) 615-4501 from 8 a.m. to 5 p.m. ET Monday through Friday or online at by clicking on “Quantum® ELM/ELM2 Recall Information”.

Federal Minimum Wage for Veterans Administration Contractors

Published in July 17, 2014 Issue

The American Health Care Association (AHCA) has responded to The Department of Labor’s notice of proposed rulemaking to establish a minimum wage of $10.10 per hour for all Veterans Administration (VA) contractors including long term care facilities who provide services to veterans.  AHCA requests an exemption from the proposed rule and states many facilities would be forced to cancel VA contracts if they are not exempted.  We have included a link to the AHCA response.

Check Updated LEIE Database

Published in July 17, 2014 Issue

The US Department of Health, Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in June 2014. This new file is meant to replace the updated LEIE database file available for download last month.

CMS Five-Star Rating System Five Year Report Available

Published in July 17, 2014 Issue

A report of the Five-Star Rating System , Nursing Home Compare Five-Star Quality Rating System: Year Five Report [Public Version],  was issued on June 16, 2014 summarizing the quality of nearly 16,000 nursing home nationwide since the rating system began in 2008. The report presents a brief overview on the construction of the Five-Star Ratings presented on Nursing Home Compare as well as corresponding descriptive information on the rating and their components.  The Rating System has brought increased attention to the data that are publicly reported on the Nursing Home Compare website.  The study, completed by Abt Associates Inc. for CMS, offers conclusions based on an analysis of data of the three domains of nursing home quality:  health inspections results, staffing, and quality measures (QMs).  Because of the design of the Five-Star Rating System, there is essentially no change in the distribution of Health Inspection ratings.  (By design, the distribution of Health Inspection Star ratings is fixed within each state so that 10 percent of nursing centers receive 5 stars, 20 percent receive 1 star, and 70 percent receive 2, 3, or 4 stars.)  Over the five years from 2009 through December 2013, the proportion of nursing homes receiving a one-star Quality Measure (QM) rating decreased from 20.0 percent to 3.2 percent.  The proportion receiving a four-or five-star rating increased from 34.1 percent to 71 percent. There have been large improvements in the reported QMs since July 2012 when the QM rating was substantially reviewed to incorporate the new MDS 3.0 QMs.  CMS is analyzing this in greater detail.  From January 2009 to December 2013, the proportion of nursing homes with a one-star Staffing rating decreased from 22.9 percent to 12.1 percent.  Although there was a modest increase in the proportion of nursing homes with a Five-Star Staffing Rating (7.2 percent to 10.5 percent), the proportion with a four-star Staffing Rating increased from 30.6 percent to 42.5 percent.

AARP, The Commonwealth Fund and The Scan Foundation Release the 2014 LTSS State Scorecard: Virginia Ranks in Top Quartile for Affordability

Published in June 20, 2014 Issue

The American Association of Retired Persons (AARP), the Commonwealth Fund, and The SCAN Foundation recently released the second edition (2014) of:  Raising Expectations:  A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers.  This “scorecard” is purported to measure performance of the long-term services and supports (LTSS) system across five key areas:

Updated LEIE Database

Published in June 20, 2014 Issue

The US Department of Health, Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in May 2014.

CMS Revises F341 Guidance on Preparation of Eggs in NFs

Published in May 30, 2014 Issue

A May 20th S&C Memo to State Survey Agency Directors revises guidance and procedures for Sanitary Conditions (F371) clarifying the use and serving of soft-cooked, undercooked or sunny-side up eggs to nursing facility residents.  Facilities should use pasteurized shell eggs or liquid pasteurized eggs to eliminate the risk of residents contracting Salmonella Enteritidis (SE).  The use of pasteurized eggs allows for resident preference for soft-cooked, undercooked or sunny-side up eggs while maintaining food safety.  In accordance with the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) standards, skilled nursing and nursing facilities should not prepare nor serve soft-cooked, undercooked or sunny-side up eggs from unpasteurized eggs.

CMS RA Report to Congress

Published in May 15, 2014 Issue

Recovery Audit (RA) contractors returned $1.9 billion to the Medicare Trust Fund in FY 2012, according to a recently released Centers for Medicare & Medicaid (CMS) report, Recovery Auditing in Medicare and Medicaid for FY 2012.

OIG Releases List of Exclusions - Check Updated LEIE Database

Published in May 15, 2014 Issue

The US Department of Health, Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in April 2014.

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GAO Releases Medicare Fraud Report

Published in May 15, 2014 Issue

The US General Accounting Office (GAO) recently released a report, Medicare Fraud: Progress Made, but More Action Needed to Address Medicare Fraud, Waste and Abuse.  This report considers the progress that the Centers for Medicare & Medicaid (CMS) has made in implementing key strategies previously recommended to protect the Medicare program from fraud but also deterThe US General Accounting Office (GAO) recently released a report, Medicare Fraud: Progress Made, but More Action Needed to Address Medicare Fraud, Waste and Abuse.  This report considers the progress that the Centers for Medicare & Medicaid (CMS) has made in implementing key strategies previously recommended to protect the Medicare program from fraud but also determines what actions CMS must still take to make improvements.mines what actions CMS must still take to make improvements.

David Tucker Chosen as a Future Long Term and Post-Acute Care Leader

Published in May 15, 2014 Issue

VHCA is pleased to announce today that David Tucker, CEO of Commonwealth Care of Roanoke has been selected by the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) as a future leader in long term and post-acute care. Tucker will join the Association’s Future Leaders program, a year-long program that offers training and guidance for long term and post-acute care professionals.

Updated LEIE Database - March 2014

Published in April 25, 2014 Issue

The US Department of Health, Office of Inspector General (OIG) recently released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in March 2014.

Place NNHW Orders Today to Ensure Availability

Published in April 11, 2014 Issue

Don’t wait until the last minute.  The American Health Care Association’s National Nursing Home Week (NNHW) products are very popular and will sell out quickly.  Plan ahead and place orders early to ensure product availability, size and color selection and timely delivery.

National Nursing Home Week (NNHW) Scheduled for May 11 - 17

Published in April 3, 2014 Issue

The American Health Care Association (AHCA) has put together a group of products that reflects this year’s National Nursing Home Week (NNHW) theme, Living the Aloha Spirit.  Visit AHCA’s online store today to view products developed for this year’s theme.  Don’t wait until the last minute. NNHW products are very popular and will sell out QUICKLY.

Motion Picture Licensing Corporation Agreement

Published in March 28, 2014 Issue

The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) and LeadingAge continue to hold an agreement with the Motion Picture Licensing Corporation (MPLC) that exempts nursing and assisted living facilities from licensing fees for showing video performances in common areas.

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Latest on Part B Therapy MMR

Published in March 28, 2014 Issue

The American Health Care Association (AHCA) has discussed the status of the Medicare Part B therapy manual medical review (MMR) program with an official at the Centers for Medicare and Medicaid Services (CMS).  Based on this conversation, AHCA suggests that SNF operators and therapists consider how to manage and store the documentation associated with therapy MMR eligible claims being paid during the current RAC review ‘pause.’  For care centers, this advance work may ease the burden of having to locate and prepare therapy MMR “additional development request” (ADR) responses once the ‘pause’ ends and reviews resume.

Participate in AHCA's 2013 Staffing Survey

Published in March 21, 2014 Issue

The American Health Care Association (AHCA) is conducting its annual, nationwide staffing survey to examine retention and turnover rates for nursing facility employees.  The 2013 Staffing Survey is being sent to all nursing facilities in the United States.  All facility providers are asked to complete and return the survey by Thursday, May 1, 2014. Individual center responses to the survey will be kept confidential. Published results will appear in the aggregate form only.

National Healthcare Decisions Day

Published in March 21, 2014 Issue

April 16th, the 7th Annual National Healthcare Decisions Day, is less than a month away.   

President Obama Releases His FY2015 Proposed Budget

Published in March 6, 2014 Issue

Given its significance to our members, we are reproducing the content of a communication sent by American Health Care Association President Mark Parkinson on March 4th.

CMS Issues Survey and Certification Emergency Preparedness Initiative

Published in March 6, 2014 Issue

On February 28, the Centers for Medicare and Medicaid Services (CMS) issued a Survey and Certification emergency preparedness initiative communication: S&C Emergency Preparedness Checklist Revision to State Survey Agency Directors.  The revisions were made to the recommended CMS Emergency Checklist.  According to the Survey & Certification Memorandum, the information is current policy and is in effect for all health care facilities.  Highlights of the changes include:

CMS Extends Audit Moratorium to MMRs

Published in February 27, 2014 Issue

The Obama administration has extended its moratorium on health care audits to include the controversial manual audits, offering another olive branch to long term and post-acute care advocates.

OIG to Examine Hospice Services in Assisted Living

Published in February 12, 2014 Issue

The U.S. Department of Health and Human Services Office of Inspector General (OIG) will examine hospice services in assisted living in 2014.  According to the OIG, assisted living residents have the longest length of stays in hospice care.  Specifically, the OIG will review the extent to which hospices serve Medicare beneficiaries who reside in assisted living communities and determines the length of stay, levels of care received, and common terminal illnesses of assisted living residents who receive hospice care.

OIG Releases 2014 Work Plan

Published in February 6, 2014 Issue

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG) has just released its Work Plan for FY 2014, which summarizes new and ongoing OIG reviews and activities for 2014. Usually released each year in October, but delayed this year, the Work Plan helps LTC providers to focus on the issues most critical to the federal government. 

CMS Updates

Published in February 6, 2014 Issue

Last week, the Centers for Medicare and Medicaid Services (CMS) provided the American Health Care Association (AHCA) with a series of updates on the following topics important to SNFs and NFs.

Minimum Wage Initiative Tied to Services Provided to VA Patients

Published in January 30, 2014 Issue

On Tuesday, President Obama issued an executive action regarding the minimum wage increase for new federal contract workers.  In advance of this week’s State of the Union address, the White House released some details about the executive action that would raise the minimum wage from $7.25 to $10.10 for new federal contract workers by 2015.  It is important to note that this executive action does not impact Medicare or Medicaid providers, as it is a long-standing policy that such providers are not "federal contractors."  It is also important to note that if long term care facilities serve VA patients, those facilities are considered to be federal contractors, and thus, this executive action may apply.

Posting of OSHA Illness and Injury Forms February 1 through April 30, 2014

Published in January 23, 2014 Issue

This is a reminder that employers must post the Summary of Occupational Safety & Health Administration Occupational Work-Related Injuries and Illnesses Summary Form 300A on February 1st and that it must remain posted until April 30, 2014. The injuries and illnesses being reported are for calendar year 2013. Work-related injuries and illnesses that must be reported are those that occur in a work environment and results in one of the following conditions: a loss of consciousness, sick days, medical treatment beyond first aid, restricted work activities, a job transfer, and death. Other conditions that must be recorded are needle stick injuries or cuts from sharp objects as well as sprain and strain injuries to muscles joints and connective tissue according to the OSHA Form 300. For a complete list of injuries and illnesses that need to be recorded, click here.  The website has forms available that can be completed by printing a blank form or can be completed online.

Updated LEIE Database

Published in January 15, 2014 Issue

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in December 2013. This new file is meant to replace the updated LEIE database file available for download last month.  Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

REMINDER ABOUT POSTING OSHA Illness and Injury Forms

Published in December 19, 2013 Issue

This is a reminder that February 1st is the deadline for employers to post the Summary of Occupational Safety & Health Administration Occupational Work-Related Injuries and Illnesses Summary Form 300A.  The form, reporting injuries and illnesses for calendar year 2013, must remain posted until April 30, 2014. Work-related injuries and illnesses that must be reported are those that occur in a work environment and result in one of the following conditions: a loss of consciousness, sick days, medical treatment beyond first aid, restricted work activities, a job transfer, and death. Other conditions that must be recorded are needle stick injuries or cuts from sharp objects as well as sprain and strain injuries to muscles joints and connective tissue according to the OSHA Form 300.  For a complete list of injuries and illnesses that need to be recorded, click here.  There are forms that can be completed by printing a blank form or forms can be filled out online. An employer must keep the OSHA’s log and summary for five years after the reported year. For example, 2012 must be retained through 2017.

Introduced: Protecting Health Care Providers from Increased Administrative Burdens Act

Published in December 12, 2013 Issue

A few of VHCA nursing facilities have received notice from the federal Office of Federal Contract Compliance Programs (OFCCP) indicating that the facility would be audited for compliance with certain federal regulations that only apply to federal contractors, such as requirements concerning compliance with affirmative action laws.  The OFCCP has taken the position that participation in TRICARE resulted in federal contractor status, thereby affecting health care providers, including nursing facilities.  In the past, health care providers have not been considered federal subcontractors simply because they provide health care services and receive payment under a federal health care program.

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Observation Stays Issue Update

Published in December 12, 2013 Issue

The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) continues its support and advocacy for legislation, The Improving Access to Medicare Coverage Act of 2013 (S. 569/H.R. 1179), introduced by Representatives Joe Courtney (D-CT) and Tom Latham (R-IA), along with Senator Sherrod Brown (D-OH), which seeks to count all hospital days spent in observation towards the three-day stay requirement.  The number of co-sponsors since the bills were introduced earlier this year have increased significantly.  Currently, S. 569 has 24 bipartisan co-sponsors, while H.R. 1179 has 125 bipartisan co-sponsors.  AHCA/NCAL also continues its work as part of the Observation Stays Coalition, which now consists of 19 organizations advocating for this important legislation.  Most recently, The Jewish Federations of North America (JFNA) joined the efforts.  In addition to AHCA/NCAL and JFNA, Coalition members include:  AARP, AMDA, American Case Management Association, American Medical Association, Alliance for Retired Americans, Center for Medicare Advocacy, Inc., Leadership Council of Aging Organizations, LeadingAge, Medicare Rights Center, National Academy of Elder Law Attorneys, National Association of Professional Geriatric Care Managers, National Association of State Long-Term Care Ombudsman Programs, National Committee to Preserve Social Security and Medicare, National Consumer Voice for Quality Long-Term Care, National Senior Citizens Law Center, and Society of Hospital Medicine.  The updated Coalition fact sheet can be found here.  For more information about observation stays, visit the AHCA/NCAL website.

Washington Update from AHCA’S Mark Parkinson

Published in December 12, 2013 Issue

We are passing along selected text from a communication from American Health Care Association President Mark Parkinson sent on December 11th to provide members with an update on year-end activities in Washington, DC.  It’s crunch time, with Congress working on the budget, the doc fix and therapy issues before Members head home for the year.  Although this is still a very fluid situation, this is where it stands as of Wednesday afternoon:

NCAL Launches National Patient Safety Organization for Assisted Living

Published in November 26, 2013 Issue

On November 21st, the National Center for Assisted Living (NCAL) announced forces with the New Jersey Hospital Association (NJHA) to form the National Patient Safety Organization (PSO) for Assisted Living.  The PSO will electronically collect data from NCAL’s participating assisted living members on a range of clinical performance outcomes and processes.  The effort is the first of the profession’s kind to be carried out at a national level and will develop insightful reports highlighting the causes of patient safety events in assisted living settings.

More on PEPPER Reports

Published in November 26, 2013 Issue

As the American Health Care Association (AHCA) has previously reported, the Centers for Medicare & Medicaid Services (CMS) recently distributed to each individual SNF facility, through its contractor (TMF Health Quality Institute), a Program for Evaluating Payment Patterns Electronic Report (PEPPER).  Although these reports have been distributed to other types of health care providers (e.g., hospitals, psychiatric facilities, hospice, etc.) in the past, this is the first time that the SNF profession has received PEPPERs.  AHCA has had a lot of contact with TMF Health Quality Institute contractor, Kimberly Hrehor, who also provided a two-part webinar series for the AHCA membership to help with reading and analyzing the information in the report accurately. To hear PEPPER Part I, click here. To hear PEPPER Part II, click here.

CMS Issues RAI Manual Corrections

Published in November 14, 2013 Issue

The Centers for Medicare & Medicaid Services (CMS) made several corrections to the October 1, 2013- RAI Manual, v. 1.11 related to therapy coding and the ADL function algorithm. Changes are found in the following sections:

CMS Issues Memo on CPR in Nursing Homes

Published in November 6, 2013 Issue

The Centers for Medicare and Medicaid Services (CMS) has issued an S&C Memo 14-01-NH, “Cardiopulmonary Resuscitation (CPR) in Nursing Homes,” which makes the following three key points:

CMS Issues Clarification to State Agency Questions Related to Federal Government Shutdown

Published in October 10, 2013 Issue

In last week’s CareConnection we included information described in a Memorandum to State Agency Directors (S&C 4-02-ALL) from the Centers for Medicare and Medicaid Services (CMS) outlining contingency plans for State Survey & Certification activities related to the Federal Government Shutdown.  The article identified functions that (a) are not affected by a shutdown, (b) are essential functions to be continued during the shutdown, and (c) other functions directly affected and not to be operational during a shutdown. 

CDC Landmark Report on Antibiotic Resistance

Published in September 26, 2013 Issue

In an effort to raise awareness, the Centers for Disease Control and Prevention (CDC) released “Antibiotic Resistance Threats in the United States, 2013.”  the first report on antibiotic resistance and potential consequences of inaction. The threats are categorized as urgent, serious, and concerning. The report was written to be accessible to clinicians, consumers, and policymaker and includes technical information, references, and web links. This report covers bacteria causing severe human infections and the antibiotics used to treat those infections. Infections caused by the bacteria Clostridium difficile (C. difficile) are also included in this report; although C. difficile infections are not yet significantly resistant to the drugs used to treat them, most are directly related to antibiotic use and thousands of Americans are affected each year.

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Attention LTC Trend Tracker Users!

Published in September 6, 2013 Issue

Members are now able to login to view their First Quarter 2013 Rehospitalization rates. Users can compare and contrast their actual and risk-adjusted rates to their peers. This data comes from the MDS 3.0, so users do not have to input any data to see this information. Log on today to see your information.

CMS Issues S&C Memo: MDS 3.0 Discharge Assessments

Published in August 29, 2013 Issue

The Centers for Medicare and Medicaid Services (CMS) issued a Survey and Certification (S&C) memo to State Agency Directors on August 23, 2013 outlining steps nursing home providers must take to address any MDS 3.0 discharge assessments that have not been completed and/or submitted since the inception of MDS 3.0. These missed discharges have resulted in residents who are no longer active appearing on the facility’s current MDS 3.0 Roster report. The memo clarifies steps to take to address completion of discharge assessments for inactive residents by September 30, 2013 to ensure compliance with regulation. 

CMS Issues Memo on F-Tag Changes & Advance SOM Guidance

Published in August 15, 2013 Issue

On August 2, 2013, the Centers for Medicare & Medicaid Services (CMS) published a memorandum to State Survey Agency Directors (S&C:  13-50 –NH) defining Administrator requirements to provide written notification of an impending facility closure, including the plan for relocation of residents at least 60 days in advance of the closure.  The guidelines provide specific instructions related to administrator responsibilities and requirements for what must be contained in the notification and who must be notified in writing prior to the impending facility closure.

August LEIE Database

Published in August 15, 2013 Issue

The Updated LEIE (List of Excluded Individuals and Entities) database file reflects all Office of Inspector General (OIG) exclusion and reinstatement actions up to, and including, those taken in July 2013. This new "Updated LEIE" 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.  The new file is meant to replace the "Updated LEIE" file made available for download last month, is complete and need NOT be used in conjunction with the monthly exclusion and reinstatement supplements. Alternatively, you may download either the November Exclusions or Reinstatements databases which only are posted as the Current Monthly Supplements. All of these downloadable files are zipped, self-extracting .dbf files, meaning that they will not open automatically when you click on the links.  After you have downloaded the files to your computer and inflated them, the files must be opened into either a spreadsheet program such as Excel, or a database program such as Access.  Basic download instructions are provided at the bottom of the page where the updated files are posted. The full LEIE database -- complete with all the monthly updates -- is included in the OIG Online Searchable Database which is very user-friendly and may be accessed here.

New Nursing Home Salary and Benefit Survey Report Available

Published in August 9, 2013 Issue

The Hospital & Healthcare Compensation Service (HCS) 2013/2014 Nursing Home Salary and Benefit Survey Report is now available. The report, supported by the American Health Care Association (AHCA), covers information on salaries and wages for 42 management and 45 nursing, therapy, dietary, and clerical positions, as well as benefit information, for various geographic areas. AHCA members may purchase the report at the reduced rate of $250. See the HCS website for more information.

OIG Updates Self Disclosure Protocol

Published in August 1, 2013 Issue

Health and Human Services (HHS) Office of Inspector General (OIG) updated its Provider Self Disclosure Protocol (SDP).  The updated SDP replaces OIG’s original SDP, published in October 1998, and supersedes OIG’s related open letters from 2006, 2008 and 2009.  The original SDP was to “establish a process for health care providers to voluntarily identify, disclose, and resolve instances of potential fraud involving the Federal health care programs;” and to provide guidance on how to investigate this conduct, quantify damages and report the conduct to OIG to resolve the provider’s liability under OIG’s civil monetary penalty (CMP) authorities.  The updated SDP generally affirms OIG’s past positions regarding voluntary disclosure; but it also makes some important changes including:

OIG LEIE Database Updated

Published in July 24, 2013 Issue

With the July 2013 List of Excluded Individuals and Entities (LEIE) update, Office of Inspector General (OIG) continues the transition of files to the upgraded Online Exclusions Database and the LEIE Downloadable Databases.  In June 2013, OIG added new fields to the LEIE including the National Provider Identifier (NPI), a waiver and waiver state.  OIG also redesigned the online search of the LEIE.  Through August 2013, OIG will post both files with and without the new fields. This will allow users time to work with the new fields while still having access to the files in which they are accustomed.  In September 2013, only the file with the new fields will be available.  Click here to obtain the LEIE instructions. Click here to obtain more information about the LEIE files.

OIG Releases Exclusion Guidance

Published in July 24, 2013 Issue

Health & Human Services Office of Inspector General (OIG) recently released Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs, which is OIG’s first published guidance on “exclusions” since 1999.  By way of background, the effect of an OIG exclusion is that no federal health care program (e.g., Medicare or Medicaid) may pay for items or services 1) furnished by an excluded person, or 2) directed or prescribed by an excluded person. The new guidance emphasizes that the payment prohibition applies to all methods of federal health care program payment, whether from itemized claims, cost reports, fee schedules, capitated payments, a prospective payment system or other bundled payment, or other payment system and applies even if the payment is made to a state agency or a person that is not excluded.

Changes to the Nursing Home Compare Website Data Effective July 2013

Published in July 3, 2013 Issue

In a June 28, 2013 Memorandum to State Survey Agency Directors,  the Centers for Medicare & Medicaid Services (CMS) announced that starting in July 2013, CMS will direct users of the Nursing Home Compare website to the data.medicare.gov website to download or view nursing home data.  This is the main website for regulators, researchers, quality improvement leads, and other individuals who have a need to download nursing home data.  According to the Memo (S&C  13-43-NH), the re-directed website should provide better access and navigation for users as well as improve transparency and provide more information to the public about nursing homes.

Administration Delays Employer Coverage Mandate

Published in July 3, 2013 Issue

The Obama Administration on Tuesday announced a one-year delay in the health reform mandate that larger employers provide health care coverage for their workers or pay penalties. The decision postpones the effective date to 2015. 

AHCA, Alliance Unite to Form Strong Voice for Elderly & Long Term, Post-Acute Care Community

Published in May 30, 2013 Issue

The American Health Care Association (AHCA) and The Alliance for Quality Nursing Home Care (Alliance) announced this week they have reached an agreement to combine their operations into one organization. The full joining of operations is expected to be complete by July 1st. The new entity will retain the AHCA name.

New Staff Stability Toolkit to Help Achieve AHCA/NCAL Quality Initiative Goals

Published in May 30, 2013 Issue

One of the four major goals of the American Health Care Association’s (AHCA) Quality Initiative is to reduce nursing staff (RN, LPN/LVN, CNA) turnover by 15% before March 2015.  The Staff Stability Toolkit is an excellent resource to help your facility achieve this goal.

Rehospitalization Information in Seconds

Published in May 30, 2013 Issue

Now you can use LTC Trend Trackersm to download detailed facility level (name of facility) information for rehospitalization, antipsychotics and turn over. With a few clicks of the mouse you can have this data delivered in an excel format for every facility in your organization. The user can use this feature to benchmark certain facility’s performance at the state and national level. In addition, the tool provides the user with their baseline rate, which allows for a quick assessment on progress towards goals. Users of LTC Trend Tracker can use this report for QA/PI goal setting, marketing with hospitals, conversations with ACOs and for corporate reporting.

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AHCA/NCAL National Quality Award Program Bronze Recipients Announced

Published in May 30, 2013 Issue

The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) is pleased to announce that 361 facilities are recipients of the 2013 Bronze – Commitment to Quality Award. This is the first step in the AHCA/NCAL National Quality Award journey and recognizes that a provider has developed a foundation to begin a journey of continuous quality improvement.

Consumer Information on Five Star Rating and Nursing Home Compare

Published in May 30, 2013 Issue

In response to members’ questions about how to describe the limitations of the Five Star Rating System to families and consumers, Lyn Bentley, Senior Director of Regulatory Services at the American Health Care Association (AHCA), has prepared a document on The CMS Five Star Rating System and Nursing Home Compare:  Tools to Help the Consumer Make a Choice and Their Limitations.  In this document she describes the purpose of the Five Star Rating System for nursing facilities and Nursing Home Compare’s limitations, highlighting the representation of therapy staffing published on the Nursing Home Compare website  which may be misleading.  She notes that no rating system can address all of the important considerations that go into a decision about choosing a home for a particular person.  Members may find the paper helpful to educate consumers with questions about the Five Star Rating System or Nursing Home Compare staffing for Therapy.

NCAL Unveils Website

Published in May 22, 2013 Issue

The National Center for Assisted Living (NCAL) has unveiled their newly re-designed website that features a refreshed look to support their new branding colors and logo.  The website is interactive, featuring content for a diversity of constituency groups including State Affiliates, member communities, residents, family members, policymakers, the media and vendors.  Providing the latest in technological advancements for members and the public is a focus of NCAL.

AHCA/NCAL‘s Quality Initiative Website has Been Redesigned

Published in May 22, 2013 Issue

The American Health Care Association & the National Center for Assisted Living (AHCA/NCAL) has launched a redesigned website for the Quality Initiative.

Court Strikes Down NLRB Union Posting Requirement

Published in May 22, 2013 Issue

The United States Court of Appeals for the D.C. Circuit has issued a ruling striking down the National Labor Relations Board’s (NLRB) notice of employee rights posting requirement. The federal rule would have required businesses to put up posters informing workers of their right to form a union.  The ruling found that the NLRB violated employers' free speech rights in trying to force them to display the posters or face charges of committing an unfair labor practice.  In addition, two judges of the three judge panel believed the rule, requiring the Notice posting, exceeded the NLRB’s rule making authority under the National Labor Relations Act (NLRA). 

Administrators, Have You Completed the Staffing Survey?

Published in May 22, 2013 Issue

You still have time!  The American Health Care Association (AHCA) is conducting its annual nationwide nursing facility survey to examine retention, turnover, and vacancy rates for nursing facility employees. We need your help to make this survey a success! The 2012 Staffing Survey has been sent to all nursing facilities in the United States. The survey questionnaire can be downloaded from the AHCA website.

Former Virginia HHR Secretary Confirmed to Lead CMS

Published in May 22, 2013 Issue

On Wednesday, May 15, 2013, Marilyn Tavenner was confirmed by the United States Senate on a vote of 91-7 to serve as administrator of the Centers for Medicare and Medicaid Services (CMS).  Ms. Tavenner was originally nominated in December 2011 to replace Don Berwick, the former administrator of the Centers for Medicare & Medicaid Services (CMS).  Ms. Tavenner is the first confirmed CMS administrator since 2006.  She will be responsible for running the Medicare and Medicaid programs and for implementing numerous provisions of the Affordable Care Act.

Observation Status Coalition Heads to Capitol Hill

Published in May 22, 2013 Issue

The American Health Care Association (AHCA) and the Observation Status Coalition recently headed to Capitol Hill as a group to meet with members of Congress and its staff to raise the issue of Medicare beneficiaries’ access to skilled nursing facility (SNF) care being constrained by the increased use of extended hospital stays in observation status.  Specifically, the group is advocating for the Improving Access to Medicare Coverage Act of 2013 (S. 569/H.R. 1179), which aims to ease access to skilled nursing care for Medicare beneficiaries following a hospital stay.  The coalition brought with it a fact sheet signed by a dozen organizations including AHCA/NCAL.  AHCA staff has been hitting the Hill since the bill was introduced in March and welcomes the opportunity to work in a coalition with others interested in advancing the legislation. The coalition will continue to meet with key Congressional offices to garner support for the Improving Access to Medicare Coverage Act.

MDS Open Door Forum Updates

Published in May 15, 2013 Issue

The Centers for Medicare & Medicaid Services (CMS) has released the following Open Door Forum Update announcements:

CMS Issues FAQ Related to ABNs for Therapy Services

Published in May 15, 2013 Issue

On May 1, the Centers for Medicare and Medicaid Services (CMS) released a new Frequently Asked Questions (FAQ) document on Advance Beneficiary Notice of Noncoverage.  All facility members are encouraged to review the new FAQ document.

Update of CMS Nursing Home Quality Measures Report

Published in May 9, 2013 Issue

The American Health Care Association (AHCA) has announced the posting of the Nursing Home Quality Measures (QM) Report statistical data reports.  These reports, updated quarterly and using data publicly reported on the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare website provide information on the average score for each QM by state and overall. To access these reports, select Research and Data and scroll down to the Quality section to access current and previous reports. Please direct any questions or comments about these reports to research@ahca.org.

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Call for Stories – Observation Stays Issue

Published in April 25, 2013 Issue

The American Health Care Association & the National Center for Assisted Living (AHCA/NCAL) has made the issue of Observation Stays one of its top advocacy and outreach priorities.  Efforts include supporting the Improving Access to Medicare Coverage Act of 2013, which ensures observation stays count toward the Medicare-required three-day hospital stay, and connecting with key members of Congress to support this legislation.  To boost AHCA/NCAL’s efforts, help is needed in collecting stories and/or names of those beneficiaries who have been impacted financially and emotionally by this observation stays issue.

DEA Sponsoring Drug Collection Day Scheduled for April 27th

Published in April 17, 2013 Issue

The Drug Enforcement Administration (DEA) is sponsoring drug collectons all over the United States on April 27, 2013 from 10:00 am – 2:00 pm staffed by local law enforcement.  Prescription drugs, OTC (Over the Counter) drugs, veterinary drugs, and nutritional supplements that are no longer wanted or needed are being collected.  Locations can be found here.  Click on the “Got Drugs?” logo on the right side of the page, and then go to “Locate Collection Site Near You” to see collection sites or call 800.882.9539 for more information.

AHCA/NCAL Submit Statement of Support for Tavenner Confirmation

Published in April 10, 2013 Issue

On Tuesday, the American Health Care Association & the National Center for Assisted Living (AHCA/NCAL) submitted a statement for the record to the Senate Committee on Finance on the nomination of Marilyn Tavenner to Acting Administrator of the Centers for Medicare and Medicaid Services (CMS). Tavenner has been serving as Acting Administrator of CMS since November 2011. AHCA/NCAL have been vocal supporters of Ms. Tavenner's confirmation and reiterated that support in the following statement:

National Healthcare Decisions Day Set for April 16, 2013

Published in April 10, 2013 Issue

Join Americans across the country in making their future healthcare decisions known to family, friends, and healthcare providers.   Share your wishes and complete your advance directive, because…YOUR DECISIONS MATTER.  Learn more about National Healthcare Decisions Day and get free information at www.nhdd.org.

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DEA Sponsoring Drug Collection Day Scheduled for April 27th

Published in April 10, 2013 Issue

The Drug Enforcement Administration (DEA) is sponsoring Drug Collections all over the United States on April 27, 2013 from 10:00 am – 2:00 pm staffed by local law enforcement.  Prescription drugs, OTC (Over the Counter) drugs, veterinary drugs, and nutritional supplements that are no longer wanted or needed are being collected.  Locations can be found at www.dea.gov.  Click on the “Got Drugs?” logo on the right side of the page, and then go to “Locate Collection Site Near You” to see collection sites or call 800.882.9539 for more information.

Tools for Compliance with the Fair Labor Standards Act

Published in April 4, 2013 Issue

The Fair Labor Standards Act (FLSA) sets forth numerous federal workplace requirements related to child labor, hours worked, wages, recordkeeping and overtime pay. The U.S. Department of Labor has several fact sheets that were written to help assisted living and nursing facility providers comply with the FLSA. The fact sheets are important resources and training tools for LTC managers and supervisors.

National Healthcare Decisions Day - April 16th

Published in March 28, 2013 Issue

The 6th Annual National Healthcare Decisions Day will be April 16, 2013.  This nationwide event exists to encourage all people to engage in thoughtful advance health care planning, and to encourage health care providers to honor those decisions.

AHCA/NCAL and the Advisory Board Company Partner in ACO Webinar Series

Published in March 14, 2013 Issue

The American Health Care Association & the National Center for Assisted Living (AHCA/NCAL) has partnered with the Advisory Board Company to provide members with two new webinars focused on Accountable Care Organizations (ACOs). The Advisory Board is an industry leader in health care best practice research and consulting, and is one of the leading authorities on payment reform and the accountable care movement. These webinars will provide members with information on national ACO market trends, as well as tools and tactics for members to use to develop their own accountable care strategy. These are open to any and all interested AHCA/NCAL members. The first webinar, titled Preparing Post-Acute Providers for Accountable Payment, will take place on Wednesday, March 20th, at 1:00 pm ET.  Members can register for that webinar by clicking here.  The second webinar will take place on Wednesday, May 8th, at 1:00 pm ET; more information will follow at a later date.  For any questions, please contact James Michel at jmichel@ahca.org or 202.898.2809.

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CDC Issues Report On Deadly Bacteria

Published in March 7, 2013 Issue

The Centers for Disease Control & Prevention (CDC) issued a press release on March 5 calling attention to a highly dangerous family of bacteria, Carbapanem-Resistant Enterobacteriaceae – CRE, which kills up to half of patients who get bloodstream infections from them.  During the first half of 2012 approximately 18 percent of LTC facilities treated a patient with a CRE infection during that time.  The bacteria are noted to be increasingly resistant to antibiotics and can be spread easily, including from the hands of health care personnel. A CRE prevention toolkit, complete with in-depth recommendations for long term and post-acute care facilities, is available on the CDC website. The full press release, CDC: Action needed now to halt spread of deadly bacteria, includes additional information.

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Free Influenza Vaccine for Participation in Study of Vaccine Effectiveness

Published in March 7, 2013 Issue

A team of nationally recognized long term care researchers from Brown University is conducting a national study to evaluate the effectiveness of the annual influenza vaccine choice on long term care facility residents’ hospitalization risk for this fall’s (2013-2014) influenza season.  Nursing facilities that participate in the study will be allocated to receive free, either the standard dose annual trivalent influenza vaccine or the high dose trivalent influenza vaccine.  Both of these vaccines are recommended by the Centers for Disease Control & Prevention (CDC) for annual protection against influenza infection in adults.   Facilities will receive a free supply of vaccine for all their residents for the 2013-2014 annual vaccination and financial compensation for data entry.

If providers want to participate or want more information, please contact the study coordinating center, Insight Therapeutics, as soon as possible by calling 757.625.6040, or emailing H. Edward Davidson, PharmD, MPH, at edavidson@inther.com.

AHCA/NCAL Submits Comments to DEA on Disposal of Controlled Substances

Published in February 20, 2013 Issue

In the January 31st CareConnection we published the Drug Enforcement Administration (DEA) notice of proposed rulemaking on the disposal of controlled substances.  The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) has now submitted comments to the DEA on the proposed rule.  The rule, if implemented, will require long term care (LTC) providers to partner with a pharmacy that agrees to place and manage a controlled substance disposal receptacle in the facility.  Providers will also have the option of returning unused controlled substances to the resident or give person’s lawfully entitled to dispose of a decedent’s property the drugs for them to deliver to law enforcement agencies through take-back events and mail-back programs.

AHCA/NCAL Supports Nomination of Marilyn Tavenner as CMS Administrator

Published in February 14, 2013 Issue

The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) issued the following statement from CEO and President Mark Parkinson last week, after learning of the White House's renomination of Marilyn Tavenner as the Administrator of the Centers for Medicare and Medicaid Services (CMS):

National Assisted Living Week Theme Selected

Published in February 14, 2013 Issue

The National Center for Assisting Living (NCAL) is pleased to announce that Homemade Happiness is the theme selected for the 2013 National Assisted Living Week (NALW), which will be celebrated during the week of September 8 – 14, 2013. 

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National Partnership to Improve Dementia Care in Nursing Homes

Published in February 7, 2013 Issue

On the January 31st National Partnership call, the Centers for Medicare & Medicaid Services (CMS) provided an overview of their efforts related to decreasing the use of antipsychotic medications and improving care to individuals with dementia. The slides are available online.

Extend Therapy Caps Exception Process - Contact Congress Today

Published in December 18, 2012 Issue

Unless Congress passes legislation this year to stop arbitrary Medicare financial limits or "therapy caps," nursing home patients needing care above the therapy cap to will be forced to postpone or forgo care, or face paying 100 percent of the cost of additional treatment out-of-pocket when coverage expires.  Patients could reach the current caps within a matter of weeks.  

We must ensure that patients continue to receive medically necessary, Medicare Part B therapy services by extending the therapy caps exceptions process beyond December 31, 2012.  Contact Congress today and tell them to prevent thousands of Medicare beneficiaries from exceeding arbitrary limitations on outpatient physical therapy, occupational therapy, and speech-language pathology services (also known as the therapy caps).

November LEIE Database

Published in December 18, 2012 Issue

The "Updated LEIE" database file reflects all OIG (Office of Inspector General) exclusion and reinstatement actions up to, and including, those taken in November 2012. 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.  The new file is meant to replace the "Updated LEIE" file made available for download last month.  The new file is complete and need NOT be used in conjunction with the monthly exclusion and reinstatement supplements.

National Health Care Decisions Day – April 16, 2013

Published in November 20, 2012 Issue

The Virginia Health Care Association (VHCA) wants to remind members about an opportunity to promote advance care planning with residents, families, and staff.  April 16, 2013 has been designated National Healthcare Decisions Day (NHDD).  The NHDD Initiative, now in its sixth year, is a collaborative effort of national, state, and community organizations committed to ensuring that all adults with decision-making capacity in the United States have the information and opportunity to communicate and document their health care decisions.  For more information, click here.