Issue: December 12, 2013

Published on December 12, 2013

Articles in this issue:

KHCA Spring 2014 Education Events



Mark your 2014 calendars for these KHCA/KCAL education opportunities:

Spring 2014 Education Opportunities

KDHE KanCare Providers Survey- High Importance



Attention: KanCare Providers!

The Kansas Department of Health and Environment, Division of Health Care Finance, is launching the first in a planned series of provider experience surveys related to the KanCare program. The brief surveys will be electronically captured and cover a variety of provider experience issues designed to help ensure that we are as responsive and provider-friendly as possible with the KanCare program.

We are asking that provider agency leadership staff complete the survey, which is expected to take between 5 and 10 minutes to complete. This survey is intended for CEOs, COOs, CFOs or senior leadership staff at provider organizations so we’re able to receive a broad view of experiences reported. Your feedback is important to the program’s success.

Access the survey here: survey will be open until Friday, December 20, 2013. 

Only one submission is allowed per user. Any duplicate entries will be discarded.

Looking for a CDM?



Are you looking for a Certified Dietary Manager?  KHCA has a resume that we would be happy to share with you.

Contact Cindy if you are interested

Upcoming AHCA Webinars


Don't miss out on the upcoming AHCA/NCAL webinars:

December 19, 2013 at 1:00pm- Insights into Healthcare Ecosystem:  The National Research Report for Post-Acute Providers

January 21, 2014 at 1:00pm- Nutrition and MDS 3.0: Janine Lehman and Brenda Richardson

January 30, 2014 at 1:00pm- AHCA/NCAL Connect Training for the NFP Council and ID/DD Committee


CMS Update- Health Insurance Marketplace- "Shop for Health"



CMS has released an article about the Health Insurance Marketplace:

CMS Article

Jimmo Lawsuit Update



 On December 6, 2013, in accordance with the Jimmo v. Sebelius Settlement Agreement, the Centers for Medicare & Medicaid Services (CMS) has revised portions of the relevant chapters of the Medicare Benefit Policy program manual used by Medicare contractors to clarify that coverage of skilled nursing and skilled therapy services does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.  The changes will take effect on January 7, 2014.

The Jimmo v. Sebelius Settlement Agreement was approved on January 24, 2013 by the U.S. District Court for the District of Vermont.  In Jimmo, the Center for Medicare Advocacy (CMA) alleged that Medicare claims involving skilled care were being inappropriately denied by contractors based on a rule of thumb “improvement standard,” under which a claim would be summarily denied due to a beneficiary’s lack of restoration potential even though the beneficiary did in fact require a covered level of skilled care in order to prevent or slow deterioration in his or her clinical condition.  CMS last April posted a Fact Sheet on the settlement agreement.

As stated in the December 6, 2013 CMS Manual Update, the following are some significant aspects of the manual clarifications:

§  No “Improvement Standard” is to be applied in determining Medicare coverage for maintenance claims that require skilled care.  Medicare has long recognized that even in situations where no improvement is possible, skilled care may nevertheless be needed for maintenance purposes (i.e., to prevent or slow a decline in condition).  The Medicare statute and regulations have never supported the imposition of an “Improvement Standard” rule-of-thumb in determining whether skilled care is required to prevent or slow deterioration in a patient’s condition.  Thus, such coverage depends not on the beneficiary’s restoration potential, but on whether skilled care is required, along with the underlying reasonableness and necessity of the services themselves.  The manual revisions now being issued will serve to reflect and articulate this basic principle more clearly.

§  Enhanced guidance on appropriate documentation.  Portions of the revised manual provisions now include additional material on the role of appropriate documentation in facilitating accurate coverage determinations for claims involving skilled care.  While the presence of appropriate documentation is not, in and of itself, an element of the definition of a “skilled” service, such documentation serves as the means by which a provider would be able to establish and a Medicare contractor would be able to confirm that skilled care is, in fact, needed and received in a given case.  Thus, though the Jimmo settlement does not explicitly reference documentation requirements, CMS has nevertheless decided to use this opportunity to introduce additional guidance in this area, both generally and as it relates to particular clinical scenarios.  An example of this material appears in new section of the revised chapter 8, in the guidelines for SNF coverage under Part A.

The Settlement Agreement.  The Jimmo v. Sebelius settlement agreement itself includes language specifying that “Nothing in this Settlement Agreement modifies, contracts, or expands the existing eligibility requirements for receiving Medicare coverage.”  Rather, the intent is to clarify Medicare’s longstanding policy that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration.  By contrast, coverage in this context would not be available in a situation where the beneficiary’s maintenance care needs can be addressed safely and effectively through the use of nonskilled personnel.  As such, the revised manual material now being issued does not represent an expansion of coverage, but rather, provides clarifications that are intended to help ensure that claims are adjudicated accurately and appropriately in accordance with the existing policy.

Relias Learning- Cost Cutting Through Staff Training



A message from Relias Learning regarding staff training and your bottom line:


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Benefit from the cost-savings and know your staff is experiencing a better way to train. Contact us to schedule a demonstration today.