ICD-10 Update: Rejected Codes and Formatting Errors

Published in October 8, 2015 Issue

The Virginia Department of Health has asked us to share information related to the October 1 transition to the ICD-10 coding regarding providers’ experience with rejected codes and formatting errors.

Comments Still Needed on the CMS Requirements of Participation Proposed Rule

Published in October 8, 2015 Issue

The comment period on the comprehensive overhaul of the skilled nursing facility regulations closes on October 14. If you've been putting it off submitting your input to the Centers for Medicare and Medicaid Services (CMS), now is the time to write and submit a comment to CMS. It will only take a few minutes of your time. Focus on a few items that will have the greatest impact on you, your staff, or your facility. 

Submit Your Comments to CMS by Monday, 9/14

Published in September 10, 2015 Issue

The Centers for Medicare and Medicaid Services (CMS), which is revising 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.

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.

New HIPAA Regulations Fact Sheet Available

Published in August 20, 2015 Issue

The Department of Health and Human Services (HHS) recently released an overview of the basics of the Health Insurance Portability and Accountability Act (HIPAA) regulations, and explains what covered entities (including skilled nursing facilities and assisted living facilities in some cases) must keep in mind as they work toward compliance. Specifically, the fact sheet explains that HIPAA plays “a vital role in protecting the privacy and security of patient information” and provides a “basic overview of the rules, the information protected by the rules, and who must comply with the rules.”

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: 

Requirement to Provide National Practitioner Data Bank (NPDB) Report for NF and ALF Administrator Licensure Effective July 16, 2015

Published in July 9, 2015 Issue

An amendment to the licensure regulations for nursing home administrators and also for assisted living facility administrators requiring submission of a current U.S. Department of Health and Human Services National Practitioner Data Bank (NPDB) report as part of the application package goes into effect on July 16, 2015.  According to the Board of Long-Term Care Administrators, this regulatory change “ensures that Virginia will not license a person who has had disciplinary action based on unprofessional conduct or a criminal conviction that would provide grounds for denial of licensure and avoids exposing Virginians to practice by a person who could present a risk to the public.”  The text of the amendment and discussion of the change can be accessed here.

 

CMS Issues Proposed Rule Related to Resident Rights

Published in December 18, 2014 Issue

On Friday, December 12, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule entitled: Medicare and Medicaid Program; Revisions to Certain Patient’s Rights Conditions of Participation and Conditions for Coverage.

GAO Reports NFs Compliance with Abuse/Neglect Regulations

Published in August 28, 2014 Issue

The US Department of Health and Human Services, Office of Inspector General (OIG) has released a report, Nursing Facilities’ Compliance with Federal Regulations for Reporting Allegations of Abuse and Neglect, which looks at nursing facility (NF) reporting practices for abuse and neglect. According to the report, of the nursing facilities (NFs) sampled, 85 percent of the facilities reported at least one allegation of abuse or neglect to OIG in 2012. These allegations included abuse, injuries of an unknown source, misappropriation of resident property, neglect or mistreatment. Overall, in 2012, NFs reported 149,313 allegations of abuse or neglect to OIG in 2012.

New July Edition of the AHCA LTC Survey: Includes Updates to 20 F-tags

Published in August 7, 2014 Issue

This week, the American Health Care Association (AHCA) will be releasing information to members regarding the NEW July 2014 edition of the Long Term Care Survey Manual. The new edition is the first major CMS (Centers for Medicare and Medicaid Services) update since March 2013 and includes revised guidance for 20 F-tags found in Appendix PP. The manual is at the printer now and will be available later this month.  AHCA is accepting pre-orders.

ICD-10 Delay

Published in May 8, 2014 Issue

According to the American Health Care Association, last week the US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) told participants at the American Health Information Management Association (AHIMA) ICD-10 Summit that Congress’ move to delay the ICD-10 transition until October 1, 2015 was a surprise to CMS, and that the delay had been difficult for the agency.  Prior to Congressional action when the short-term Sustainable Growth Rate patch passed with a provision delaying the implementation of ICD-10, CMS Administrator, Marilyn Tavenner, had gone on record stating that ICD-10 implementation would not be delayed beyond October 1, 2014.

Notice of Extended ICD-10 Implementation Date

Published in April 3, 2014 Issue

On Monday the U.S. Senate voted on a bill (HR 4302) that would implement a temporary fix for Medicare's sustainable growth rate formula but at the same time delayed the ICD-10 compliance deadline until 2015.  Because of the extended implementation for a year, VHCA has determined that it is in the best interest of our members to delay training on the ICD-10 as well.  Therefore, the April 9th and 10th training program, ICD-10-CM Coding: Countdown to October 1st will be rescheduled for a date closer to the new deadline.

CMS Proposes Emergency Preparedness Rules for LTC

Published in January 9, 2014 Issue

Based on the Centers for Medicare & Medicaid Services’ (CMS) proposal published in the Federal Register on December 27, 2013, long term care facilities would have to meet comprehensive emergency preparedness regulations.  The proposal would establish national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers to ensure that they adequately plan for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems.

Updated MDS 3.0 RAI Manual Available

Published in October 3, 2013 Issue

Cil Bullard, RN, CPC, Virginia RAI/OASIS Coordinator at the Office of Licensure and Certification, has notified providers that the updated RAI Manual is posted here.  The link contains the current MDS 3.0 RAI Manual v1.11, effective October 1, 2013, that incorporates clarifications to existing coding and transmission policy, integrates previously published Questions and Answers (Q & As) into the appropriate sections and addresses requested clarifications and scenarios concerning complex areas. Links at the bottom of the page give an option to either update the entire manual or just the updated pages.

Impact of Federal Shutdown on OLC Survey Activities

Published in October 3, 2013 Issue

On October 1st a Memorandum from the Centers for Medicare and Medicaid Services (CMS) to State Agency Directors (S&C 4-02-ALL) outlines contingency plans for State Survey & Certification activities in the event of a Federal Government Shutdown.  The Memo identifies functions that (a) are not affected by a shutdown, (b) essential functions that are to be continued in the event of a shutdown, and (c) other functions that are directly affected and should not be operational during a shutdown. 

CMS Provides Guidance on Implementing Transition to New MDS 3.0 Requirements Effective October 1st

Published in September 26, 2013 Issue

The Centers for Medicare & Medicaid Services (CMS) has released a new memorandum regarding policy changes affecting MDS 3.0 in the areas of swallowing and nutritional status as well as therapy services.  As a result of changes outlined in the SNF PPS FY2014 Final Rule, several new MDS 3.0 items capture distinct calendar days of therapy and co-treatment minutes, as well as the proportion of total calories a person receives through parenteral or tube feeding and daily fluid intake intravenously or through tube feeding.

New Privacy Practices in Effect September 23rd

Published in September 26, 2013 Issue

As of Monday, September 23rd, long term care facilities must be in compliance with recent amendments to HIPAA and the HITECH Act.  

As previously reported, in January of this year, the US Department of Health and Human Services (HHS), Office for Civil Rights (OCR) issued the long-awaited final privacy and security regulations (Omnibus Rule) under the Health Insurance Portability and Accountability Act (HIPAA) to implement the changes made in 2009 by the Health Information for Economic and Clinical Health Act (HITECH).  The Omnibus Rule was effective on March 26, 2013.  Covered entities (including long term care organizations) and business associates were required to comply by September 23, 2013.  All covered entities must have updated policies, procedures and notices of privacy practices. 

Empty Hospital Bed

Observation Stays Policy Update

Published in August 9, 2013 Issue

Last week, the Department of Health and Human Services’ Office of the Inspector General (OIG) released a memorandum report that focused on the Centers for Medicare and Medicaid Services’ (CMS) proposed rule regarding hospitals’ use of observation stays and short inpatient stays for Medicare beneficiaries. The report found that hospitals varied in patient admission placement, despite similar patient symptoms. The lack of clarity in the distinction between an inpatient and observation stay complicates issues for patients, and the report supported counting observation days towards the three-day inpatient stay minimum requirement.

Clarification on OLC Reporting Guidelines

Published in July 24, 2013 Issue

Carrie Eddy, Senior Policy Analyst with the Office of Licensure and Certification (OLC), has responded to a concern raised at the June NFAC (Nursing Facility Advisory Committee) meeting over the two OLC guidelines offering assistance to facilities for investigating and reporting misconduct towards individual residents.  The two Guidelines, “Facility Internal Investigations of Abuse, Neglect, and Misappropriation of Resident Personal Property,” Revised October 2006, and the Revised June 2008 guidance on “Reporting Abuse, Neglect or Misappropriation of Resident Personnel Property or Facility Reported Incidents (FRI)” do not currently appear on the OLC website.  According to OLC, the Guidelines are NOT a replacement for following state or federal law or regulations; they are supportive materials to assist facilities comply with laws and regulations.
 

Petition to Ban Adult Portable Bed Rails

Published in June 13, 2013 Issue

This week, McKnight’s Long Term News Daily Update alerted its readers to a notice that was in the Federal Register entitled: Petition Requesting a Ban or Standard on Adult Portable Bed RailsComments on the petition are due to the Consumer Product Safety Commission (CPSC) by August 5, 2013.

Life Safety Update on Possible Defective Fire Pull Stations

Published in May 9, 2013 Issue

We are repeating this notification due to the fact that the image we included in last week’s CareConnection was not an accurate representation of the defective pull stations.

Life Safety Update on Possible Defective Fire Pull Stations

Published in May 1, 2013 Issue

Honeywell recently announced a potential defect with its BG-10 series fire alarm pull stations. These pull stations were manufactured from 1992 through 2010 under multiple brands including ADT, Fire-Lite Alarms, Johnson  Control  Inc. and Notifier.  Over time, deterioration inside the devices can occur, preventing the pull stations from transmitting an alarm signal when activated.  Included in a recent update from the American Health Care Association & National Center for Assisted Living are links to the manufacturer’s website and original notice as well as recommendations about how to address the problem in your nursing or assisted living center.

CMS Releases Memo on Access to Statements of Deficiencies (2567’s)

Published in April 4, 2013 Issue

On March 22nd the Centers for Medicare & Medicaid Services (CMS) released a Memo to State Survey agencies (S&C: 13–21- ALL) announcing a change in the posting of facility survey results.  The Memo notes that in July 2012 CMS began posting nursing home statements of deficiencies based on the CMS-2567, Statement of Deficiencies, on Nursing Home Compare.  Since that release, visitors to the Nursing Home Compare site have been able to view electronic replicas of completed CMS-2567 reports for the most recent standard health survey and the most recent 15 months of complaint surveys.  CMS simultaneously began posting the same CMS-2567 deficiency data on the Five-Star Nursing Home Quality Rating System section of the Survey and Certification page of the cms.gov website.  Both websites are refreshed each month.

CMS Releases Clarification on ADL Coding

Published in March 28, 2013 Issue

The Centers for Medicare & Medicaid Services (CMS) has released a clarification to State RAI Coordinators on correct Activities of Daily Living (ADL) coding.  Since this clarification will change the way many providers in Virginia code their assessments, Cil Bullard, Virginia RAI/OASIS Coordinator is preparing a webinar to be available once CMS releases additional information.  The clarification will be included in the new RAI Manual expected to be released early May.  Because CMS considers this announcement as a clarification of current guidance, it is effective now.  The clarification has been released due to questions sent to CMS from providers and state coordinators due to inconsistencies and apparent conflicts in the RAI Manual, especially between the ADL graph and the text of Section G.

NCAL’s 2013 Regulatory Review Available

Published in March 28, 2013 Issue

The National Center for Assisted Living’s (NCAL) 2013 edition of Assisted Living State Regulatory Review has just been released.  The report notes that assisted living regulations, statutes, and policies in 18 states were changed during the past year.  Nine states made major changes to their assisted living regulations last year, with Colorado, Michigan and New Jersey making innovative changes to their survey processes.  More than one-third of states refined or developed assisted living regulations.  The annual report summarizes state assisted living regulations across 21 categories including life safety, physical plant requirements, medication management and move-in/move-out criteria.  The NCAL report is the only source that summarizes the assisted living regulations in 50 states and the District of Columbia that is published to inform the public.

New HIPAA Privacy Regulations Released by Department of Health and Human Services

Published in March 25, 2013 Issue

On January 25, 2013, the federal Department of Health and Human Services (HHS) issued significant changes to existing HIPAA privacy regulations that will require substantial changes for long term care facilities. The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL), in partnership with the health care law firm Rolf Goffman Martin Lang LLP, has developed an e-book to help providers understand everything needed to know to make sure they are compliant with these new rules. Compliance is required no later than September 23, 2013.

Pain Medication Reclassification Not Included in Final FDA Bill

Published in June 22, 2012 Issue

On Monday, lawmakers announced that an amendment to reclassify some pain medications to a more strict status will not to be included in the final FDA user fee agreement.  The American Health Care Association (AHCA) is supportive of this decision, as the amendment called for the reclassification of some Schedule III drugs that contain hydrocodone, including Vicodin, to Schedule II status.  While AHCA recognizes that some Members of Congress are trying to curb drug abuse in their communities, the long term care community sees the unintended effect for skilled nursing facility patients:  it will be more difficult for SNF residents to receive their medications in a timely manner. The restrictions around Schedule II medications make them more difficult to obtain than other scheduled drugs, which causes complications for those residents who require medications in off hours. AHCA staff met with the sponsors of the legislation and committee staff during this debate to convey concerns. The final bill language, announced Monday evening, did not include the amendment. Congress is scheduled to vote on the final package this week.  We will pass along updates as we receive additional information.

Labor Laws

Fact Sheets Available about Compliance with Labor Laws

Published in January 20,2012 Issue

The Fair Labor Standards Act (FLSA) governs workplace issues such as minimum wage, overtime, hours worked and child labor.  Compliance with these provisions can be challenging given the fast-paced, 24/7 nature of long term care settings.

HHS HIPAA Audits

Published in January 13,2012 Issue

The Department of Health & Human Services (HHS), Office for Civil Rights (OCR) has announced it is beginning Health Insurance Portability and Accountability Act (HIPAA) audits to assess covered entities’ (nursing and some assisted living facilities) compliance with the privacy, security and breach notification rules.  Under a $9 million contract announced this last summer, KPMG has developed protocols and begun auditing.  The audits are required by the American Recovery and Reinvestment Act of 2009 (ARRA).  There are not a lot of audit details to date, but we understand that the audits will include site visits, interviews with leadership, documentation, an examination of operations and an assessment of the facility’s consistency with its written policy.  Each audit will generate a report, which will at least address compliance efforts and what corrective actions if any have been taken by the facility.  Providers should note that this contract will increase both the frequency and depth of government audits for HIPAA and HITECH compliance over the upcoming year. To obtain more information go to the HIPPA website.

EMPLOYEES

NLRB Delays Employee Rights Notification Rule

Published in January 6,2012 Issue

The National Labor Relations Board (NLRB) has agreed to postpone the effective date of its employee rights notice-posting rule at the request of the federal court in Washington, DC hearing a legal challenge regarding the rule.  The Board’s ruling states that it has determined that postponing the effective date of the rule would facilitate the resolution of the legal challenges that have been filed with respect to the rule. The new implementation date is April 30, 2012.   Most private sector employers will be required to post the 11-by-17-inch notice on the new implementation date of April 30. The notice is available at no cost from the NLRB through its website which has additional information on posting requirements and NLRB jurisdiction.



CMS Releases Three Memoranda to State Agencies on Revisions and Guidance

Published in March 14, 2013 Issue

The Centers for Medicare & Medicaid Services (CMS) has released three memoranda to the states, each revising previous versions for the following:

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CMS Issues Revised Guidance on F Tag 441-Laundry and Infection Control

Published in January 31, 2013 Issue

In a January 25th Memo to State Survey Agencies (S&C: 13-09-NH), the Centers for Medicare & Medicaid Services (CMS) clarified and revised guidance to surveyors in Appendix PP of the SOM (State Operations Manual) regarding citations under F Tag 441, Infection Control.  The memo addresses laundry detergents with and without antimicrobial claims, use of chlorine bleach rinses, water temperatures during the process of washing laundry, maintenance of laundry equipment and laundry items, and ozone laundry cleaning systems.

REMINDER: OSHA Injury & Illness Forms Must be Posted by February 1st

Published in January 4, 2013 Issue

Long term care providers, including assisted living facilities, are required to post the Occupational Safety and Health Administration (OSHA) - OSHA Form 300A by February 1st.  The form should be posted in a public area where employees can view it. The report must remain posted through April 30, 2013.  To obtain instructions and forms, click here.

HUD Section 232 Final Rule on Partial Payment of Claims

Published in January 4, 2013 Issue

The Department of Housing and Urban Development (HUD) has issued a final rule, effective January 7, 2013, to establish the criteria and process by which the Federal Housing Administration (FHA) will accept and pay a partial payment of a claim under the FHA Section 232 mortgage insurance program, which insures mortgage loans to facilitate the construction, substantial rehabilitation, purchase, and refinancing of nursing homes, intermediate care facilities, board and care homes, and assisted-living facilities. Through acceptance and payment of a partial payment of claim, FHA pays the lender a portion of the unpaid principal balance and recasts a portion of the mortgage under terms and conditions determined by FHA, as an alternative to the lender assigning the entire mortgage to HUD. Partial payment of claim also allows FHA-insured healthcare projects to continue operating and providing services. To view the entire rule, go to the Federal Register website.

RAI Manual Update

Published in December 4, 2012 Issue

The MDS 3.0 RAI Manual has been updated to incorporate revisions found in the previously posted Errata documents. Also included in the updated manual are element clarifications based on issues and concerns raised by providers.  The new RAI Manual can be found here.  Please note that the MDS QM (Quality Measure) Technical Manual is posted as well.  AHCA Publications is in the process of reviewing these new changes to incorporate revisions to the AHCA RAI MDS 3.0 Manual that will be available later this year.

The Long Term Care Survey is Back

Published in December 4, 2012 Issue

The newly updated Long Term Care Survey manual is ready for distribution. This November 2012 edition contains all the most recent changes and additions from the Centers for Medicare & Medicaid Services (CMS) since October 2010.

Call today at 800.321.0343 to order your copy.

Softbound Edition

6775-1112

$59.95 member/$69.95 non-member

Binder/Notebook Edition

6775N-1112

$79.95 member/$89.95 non-member

The 2012 Survey Includes All CMS Updates:

  • Revisions to Appendix P of the SOM: use of new QM report
  • Changes to Appendix PP:
-F-tag 309 (Quality of Care at or near End of Life)
-F-tag 322 (Feeding Tube)
-F-tag 155 (Residents Rights to Establish Directives and Accept or Decline Treatments)
  • Revisions to Chapter 9 of the SOM: changes and deletions to Exhibits

All updates go into effect by December 1st.

OSHA Recordkeeping Guide for Nursing and Assisted Living Facilities

Published in November 20, 2012 Issue

One fundamental obligation of nursing facilities, assisted living facilities, and other long term care employers is to ensure that all work-related injuries and illnesses are properly recorded as required by the Occupational Safety & Health Administration’s (OSHA) recordkeeping rule.   Nursing facilities and assisted living facilities are among those included in an OSHA National Emphasis Program for programmed inspections which is in effect until April 2015.  The OSHA 300 Log is an essential document for every nursing facility and assisted living facility.  This Log is required by OSHA and will be reviewed at the start of any inspection.  Since completion of this log can often be confusing, AHCA’s OSHA consultant Jackson Lewis has prepared the OSHA Recordkeeping Made Easy to assist members comply with the OSHA requirements.  

HUD Rule Changes REAC Investigations for NFs

Published in October 24, 2012 Issue

The US Department of Housing and Urban Development (HUD), Federal Housing Administration (FHA), has released a final rule, effective October 9, 2012, Section 232 Healthcare Facility Insurance Program-Strengthening Accountability and Regulatory Revisions Update, that revises the regulations applicable to, and closing documents used in, FHA insurance of multifamily rental projects.

Report on Future Needs for Health IT Adoption in LTPAC

Published in August 22, 2012 Issue

Earlier this week, the Department of Health and Human Service’s Office of the National Coordinator for Health Information Technology (ONC) posted the Long-Term and Post-Acute Care (LTPAC) Roundtable Summary Report of Findings which reflects LTPAC stakeholder comments and recommendations from a day-long meeting held in May 2012. The roundtable was held to provide an opportunity for stakeholders to discuss the information needs of LTPAC providers and how these needs could be supported through electronic health record (EHR) adoption and health information exchange.

AHCA/NCAL and MPLC Agreement Exempts Nursing and Assisted Living Facilities from Licensing Fees

Published in August 15, 2012 Issue

Last year, AHCA/NCAL and LeadingAge negotiated 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.  This agreement is still in effect.

LEIE Database Updated with June 2012 Exclusions and Reinstatements

Published in July 25, 2012 Issue

The "Updated LEIE" database file reflects all OIG exclusion and reinstatement actions up to, and including, those taken in March 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.

US Supreme Court Upholds ACA

Published in June 29, 2012 Issue

As widely reported yesterday and summarized this morning by the American Health Care Association (AHCA), the U.S. Supreme Court ruled that the Affordable Care Act's (ACA) individual health insurance mandate does not violate the Constitution because it may be viewed as a permissible tax on individuals who do not obtain health insurance.  The only provision of the law that the Court invalidated is a Medicaid provision that threatened states with the loss of all existing Medicaid funding if they decline to comply with the ACA's Medicaid coverage extension.  By preserving the vast majority of the landmark health reform law, the Court avoided the policy chaos that would have resulted from striking down the ACA in its entirety.  There is now legal certainty for state and federal governments, health care providers and suppliers, drug and device manufacturers, employers and individuals.  Although the legal battle is over, the political battle will continue.  A copy of the US Supreme Court opinion can be found here.  A copy of AHCA/NCAL’s General Counsel, Reed Smith, analysis of the US Supreme Court litigation can be read on the Health Industry Washington Watch website.  Additionally, AHCA/NCAL's Labor Counsel, Jackson Lewis, has also provided its analysis of yesterday's decision.

Expect Updates to Nursing Home Compare & Five Star This Summer

Published in May 24, 2012 Issue

On May 16, the American Health Care Association (AHCA) and other stakeholders received a briefing from the Centers for Medicare & Medicaid Services (CMS) and agency contractors, Abt Associates, regarding the upcoming changes to Nursing Home Compare and the Five Star Rating System.  AHCA Quality Cabinet Chair Mary Ousley, Survey/Regulatory Committee Chair Steve Biondi, and AHCA staff Dr. David Gifford, Peter Gruhn and Ruta Kadonoff participated in the meeting with CMS.

CMS Issues Update on the Use of Physician Assistants to Perform SNF Level of Care Certifications and Recertifications

Published in May 11, 2012 Issue

Change Request (CR) 7701 implements Section 3108 of the Affordable Care Act. This section adds physician assistants to the list of practitioners who can perform SNF level of care certifications and recertifications. Performing this function is a requirement for Medicare coverage of Skilled Nursing Facilities (SNF) services under Part A.

CDC Position Statement on Single-dose/Single-use Vials

Published in May 11, 2012 Issue

The Virginia Department of Health’s (VDH) Healthcare-Associated Infections Program has notified us of a recently issued position statement from the Centers for Disease Control and Prevention (CDC) regarding the importance of protecting patients against preventable harm from the improper use of single-dose/single-use vials. This statement was created in response to ongoing questions and misinformation about CDC’s injection safety guidance.  A recent document circulated by the American Society of Interventional Pain Physicians may be causing confusion among clinicians.

LEIE Database Updated with April 2012 Exclusions and Reinstatements

Published in May 11, 2012 Issue

The "Updated LEIE" database file reflects all OIG exclusion and reinstatement actions. 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.

Posting of MDS 3 QMs Delayed

Published in April 26, 2012 Issue

The Centers for Medicare & Medicaid Services (CMS) has notified the American Health Care Association that the MDS 3.0 Quality Measures (QMs) will not be posted on Nursing Home Compare this month as originally expected.  According to the CMS office of Clinical Standards and Quality, CMS will provide the new MDS QMs to individual nursing facilities but they are not yet ready for public posting.  CMS is still reviewing the data but has not made a final decision on when the Quality Measures will become public.  CMS is targeting July for the posting of the QMs.

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OSHA Announces National Emphasis Program

Published in April 26, 2012 Issue

The Occupational Safety and Health Administration (OSHA) has announced a National Emphasis Program (NEP) to encourage compliance with safety and health standards at nursing centers through programmed inspections.  The NEP directs OSHA compliance officers to focus their inspections on (1) ergonomic stressors associated with lifting patients; (2) slips, trips, and falls; (3) bloodborne pathogens; (4) exposure to tuberculosis; and (5) workplace violence.  The NEP took effect on April 5, 2012 and remains in place for three years.  Nursing centers with a DART (days away, restricted work activity; and job transfer) rate of over 10.0 may be targeted under the NEP.  The special summary, developed by AHCA’s consultant Brad Hammock with the law firm of Jackson Lewis, is designed for AHCA and NCAL members and provides additional details to assist in preparing for the NEP.

New NLRB Posting Requirement for Employers Delayed

Published in April 20, 2012 Issue

This week the D.C. Circuit Court enjoined the National Labor Relations Board (NLRB) from enforcing the new posting requirements for most employers that was set to take effect on April 30.  The Court’s action likely means that no decision on the appeal will be made before this Fall, so employers are under no obligation to post the new notice at this time.  The American Health Care Association and the National Center for Assisted Living will keep members apprised of any developments related to the appeal and any posting requirements.

New NLRB Posting Requirements for Employers Effective April 30, 2012

Published in April 13, 2012 Issue

Previous CareConnection’s articles have reported on new posting requirements from the National Labor Relations Board (NLRB) informing employees of their rights under the National Labor Relations Act (such as the right to form a union, etc.).  While the effective date for private sector employers to post 11x17 posters was delayed by NLRB in the past, it now appears that this new posting requirement will be effective April 30, 2012.  The posting requirement applies to virtually all private sector, for-profit and not-for-profit nursing facilities and assisted living communities.

LEIE Database Updated with March 2012 Exclusions and Reinstatements

Published in April 13, 2012 Issue

The "Updated LEIE" (List of Excluded Individuals and Entities) database file reflects all the Office of Inspector General’s (OIG) exclusion and reinstatement actions up to, and including, those taken in March 2012.  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. The new file is complete and need NOT be used in conjunction with the monthly exclusion and reinstatement supplements.

MDS 3.0 Program Scheduled May 1st

Published in March 30, 2012 Issue

The Virginia Health Care Association has scheduled a program, MDS 3.0: April 2012 Changes & Challenges, for May 1st at the Holiday Inn Koger Conference Center in Richmond.

Medicare Recovery Auditor Webinars Beginning Next Week

Published in March 30, 2012 Issue

The American Health Care Association (AHCA), along with the Centers for Medicare & Medicaid Services (CMS) and Recovery Auditors (RA) (previously known as Recovery Auditor Contractors [RACs]), are hosting four separate webinars, entitled “Medicare Recovery Auditor (RA)/SNF Update,” to provide relevant information on the Medicare RA program.  As you know, the Medicare RA program was made permanent under the Tax Relief and Health Care Act of 2006, and required all 50 states to implement the program no later than December 31, 2010.  Under the RA program, each RA is responsible for one fourth of the US and is accountable for identifying both Medicare overpayments and underpayments for the federal government. RAs are paid on a contingency basis depending upon how many overpayments they identify. We hope these RA webinars help providers to better understand, prepare and avoid program audits.

OIG Releases Additional Videos on Health Care Boards and Compliance

Published in March 30, 2012 Issue

The Office of Inspector General (OIG) continues to release videos and podcasts on its website of interest to LTC providers.  Most recently, the agency released a video and audio podcast that provides a “toolkit” of tips to help healthcare board members to create a corporate culture focused on two primary goals:  promoting quality of care and embracing compliance with the law. View the video here. Further, in light of the upcoming Affordable Care Act (ACA) requirement that nursing facilities must have a corporate compliance program in place by March 23, 2012; OIG has developed free resources to help health care providers, practitioners, and suppliers understand the health care fraud and abuse laws and the consequences of violating them. These compliance education materials also provide ideas for ways to cultivate a culture of compliance within a health care organization.  To view the video, visit the OIG website.  

 



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CMS Memo Permits LSC Waivers to Aid with Culture Change in Facilities

Published in March 16, 2012 Issue

The American Health Care Association (AHCA) has notified us, following numerous discussions, that the Life Safety Committee and AHCA’s Life Safety Consultant, Tom Jaeger had with the Centers for Medicare & Medicaid Services (CMS), a Survey & Certification memorandum that permits waivers for certain changes in the 2012 edition of the Life Safety Code has been issued. This is a positive change that will help remove obstacles to facilities seeking to create a change of culture in their facilities.  The CMS memo addresses updates to policy regarding Capacity of the Means of Egress, Cooking Facilities, Heating, Ventilating, and Air Conditioning, and Furnishings, Mattresses, and Decorations.

Arbitration Update

Published in March 16, 2012 Issue

Last month the U.S. Supreme Court decision affirmed the use of pre-dispute arbitration agreements in nursing facilities.  The Virginia Health Care Association (VHCA) and the American Health Care Association (AHCA) have several documents relating to arbitration agreements and this court decision that you might find useful.  The documents are (1) AHCA’s press release announcing the US Supreme Court action, (2) a 2011 VHCA Legal Quarterly article addressing arbitration in Virginia’s nursing homes, (3) a 2004 article outlining the Federal Arbitration Act, and (4) a model arbitration agreement developed by AHCA.  To review these documents, go to the legal section for nursing facilities on the VHCA website. 

Pre-Order Your RAI/MDS 3.0 Update

Published in March 16, 2012 Issue

The American Health Care Association (AHCA) is now taking pre-orders for the April 2012 edition of the RAI/MDS 3.0 Manual. This edition is the latest since October 2011 and includes the most recent updates released by the Centers for Medicare & Medicaid Services (CMS) in January and February 2012 with changes to Chapters 1 through 6 and Appendix A, C, D, E, and G.  These changes go into effect April 1st. 

Court Upholds Most of the NLRB’s Union Rights Poster Rule

Published in March 9, 2012 Issue

Troutman Sanders LLP law firm reports that last week a federal judge rejected a challenge to the controversial rule issued last year by the National Labor Relations Board (“NLRB” or “Board”) that will require employers to display posters informing workers about their rights to form or join a union.  (You can find our past analysis of this rule here.)  The National Association of Manufacturers and other business interests filed a lawsuit challenging the rule as beyond the Board’s authority under the National Labor Relations Act (“NLRA”).  The Board’s rule was originally scheduled to take effect on January 31, 2012, but after the lawsuit was filed, the effective date was pushed back to April 30, 2012.  In addressing the challenge to the rule, the Court upheld the posting requirement, finding that the Board was authorized to issue the rule under the Board’s rule-making authority to effectuate the purposes of the NLRA.  According to the Court, the NLRB is authorized to issue the posting requirement rule unless some provision of the NLRA limits the Board’s authority, and those challenging the rule failed to identify any sufficiently limiting provision.

GAO Issues Study on Implementation of the Quality Indicator Survey (QIS)

Published in March 9, 2012 Issue

This week the US Government Accountability Office (GAO) issued a study: Nursing Home Quality: CMS Should Improve Efforts to Monitor Implementation of the Quality Indicator Survey.  The study asserts that the Centers for Medicare & Medicaid Services (CMS) has not done an adequate job of monitoring the implementation of the QIS.   While CMS has taken some steps to monitor implementation progress of the QIS, the monitoring has not been systematic nor is it consistent with federal internal control standards.  (Virginia’s State Survey Agency (OLC) has not yet implemented the QIS survey process and has not indicated at what point Virginia will implement the QIS.)



2012 Edition of Assisted Living State Regulatory Review Available

Published in March 9, 2012 Issue

The National Center for Assisted Living (NCAL) has just released the 2012 edition of “Assisted Living State Regulatory Review  revealing that 16 states made changes to assisted living regulations, statutes, and policies during 2011. According to Karl Polzer, NCAL’s senior policy director and the report’s author, four states—Georgia, Nevada, North Carolina, and South Dakota—made major changes last year. A number of states are considering major changes for 2012 while 30% of states actively changed Assisted Living Regulations in 2011.

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Supreme Court Unanimously Upholds Validity of Nursing Home Pre-Dispute Arbitration Model

Published in February 24, 2012 Issue

The US Supreme Court has released a unanimous opinion affirming the use of pre-dispute arbitration agreements in nursing facilities; maintaining the Court’s long-standing position that the Federal Arbitration Act (FAA) has a strong public policy favoring arbitration.

OIG Advisory Opinion on e-Referral Vendor Contracts

Published in February 17, 2012 Issue

On July 7 and September 29, 2011, AHCA’s Legal Committee provided guidance for providers who had e-referral vendor contracts with companies that provide electronic discharge referral services.  The guidance was believed necessary in light of the 2011 OIG Advisory Opinion (No. 11-06) indicating that certain types of contracts for hospital patient referrals through soft-ware internet access arrangements to post-acute care providers’ data bases may violate the Federal Anti-Kickback law.  In July, AHCA encouraged providers to review their current contracts and ask for an affirmative representation or warranty in the contract from the e-referral companies that their arrangement did not violate the Anti-Kickback law and an indemnification (e.g., protection) for damages in the event the provider suffered some loss as a result.  AHCA also provided a form letter (from MO Health Care Association) to help members articulate their concerns and begin a discussion with the vendors regarding some assurances to this effect.  Some vendor companies have issued explanations about their business models, and why their model is different from the model addressed in OIG’s advisory opinion.  Unfortunately, the legal opinions and assurances from the vendors have not been forthcoming. 

LEIE Database Updated

Published in February 17, 2012 Issue

The "Updated LEIE" database file reflects all Office of the Inspector General (OIG) exclusion and reinstatement actions. 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.

MDS 3.0 Quality Measure Update

Published in January 27, 2012 Issue

The Centers for Medicare & Medicaid Services (CMS) recently held an Open Door Forum and offered an update on the MDS 3.0 Quality Measures (QMs).  CMS plans to use only the term “Quality Measures” going forward and will discontinue the reference and use of “Quality Measures/Quality Indicators.”  CMS plans to release the QMs on April 19, 2012.  Nursing facilities will get an opportunity to preview their QM performance via the Casper system by the end of January.

Dialysis Services Provided in SNFs

Published in January 27, 2012 Issue

Over the last month, the American Health Care Association’s (AHCA) Legal Committee and the Long Term Care Consortium (LTCC) Compliance Work Group have discussed the current position of the Centers for Medicare and Medicaid Services (CMS) concerning dialysis in skilled nursing facilities (SNFs).  SNFs must be End Stage Renal Disease (ESRD) certified providers to furnish and bill for both hemodialysis and peritoneal dialysis for residents in their facilities.  The governing guidance is found in S&C-04-24 and S&C-04:37.