Issue: January 23, 2014

Published on January 23, 2014

Articles in this issue:

Remembrance of Charles W. Wurth

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The Kansas Health Care Association and The Kansas Center for Assisted Living would like to express it's deepest sympathies at the passing of Charles Wurth.  If you like to see the full obituary and leave a message for family, click here.

Cindy Luxem and AHCA PAC Host Benefit Breakfast for The National Republican Senatorial Committee

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On Tuesday, January 21, 2014, KHCA President and CEO, Cindy Luxem, and the AHCA PAC hosted a breakfast benefiting The National Republican Senatorial Committee (NRSC).  Special Guest NRSC Chairman Senator Jerry Moran was in attendance.  KHCA/KCAL would like to extend a special thank you to Harry Baum and Sharon Lane Health Services for hosting the event. 

Kansas Health Care Association Weekly Legislative Report

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KHCA/KCAL has released the first of its' weekly legislative bill tracker reports.  Please note that some of the bills are carryovers from last year. 

Download Bill Tracker Report

KHCA Legislative Conference- February 6, 2014

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Mark your calendars for February 6th 2014.  This is the day of the KHCA Legislative Conference at the Capitol.  Earn CEs and meet with your legislator.

Plus, Join us on the Virtual Dementia Tour

 

It’s hard to imagine what it’s like to have a mind robbing disease, but on February 6, you can - at least virtually. Sights and sounds will be altered to create confusion and distort reality. You can briefly feel what it’s like to walk in shoes of someone with dementia. The Virtual Dementia Tour® is a scientifically proven method of building a greater understanding of dementia through the use of patented sensory tools and instructions.

Download Brochure

2014 KHCA/KCAL Committees- Sign up

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We want you more involved with our association! Sign up for a committee today!

2014 Committee Sign up Form

KHCA/KCAL Distinguished Elder Recognition Program

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Distinguished Elder Recognition Program
The format of the program has changed for 2014!!
Join us in recognizing the Distinguished Elders in your homes.

The KHCA/KCAL Education Committee invites you to submit a nomination for the KHCA/KCAL Marty Hegarty Life Time Achievement/Distinguished Elder Recognition Program.  This program is designed to highlight and reflect the elders residing in nursing and assisted living homes who have spent much of their life making a difference in the lives of others. click here for the full application.  Please note the deadline for submission of March 1, 2014

Joint Provider Surveyor Training-QAPI and Root Cause Analysis

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The Joint Provider Surveyor Training is upon us again.  The topic for this year is QAPI and Root Cause Analysis. 

Our two speakers this year national trainers in the survey process.

Why You Should Attend:

Joint Training of Kansas providers and surveyors was created with the goal of bringing together Kansas long term care professionals and state surveyors in a way that promotes interaction, growth and understanding. Each Joint Training features a deficiency area with the goal of educating providers and surveyors on acceptable standards of practice. The Kansas Health Care Association has worked closely with LeadingAge Kansas, the Kansas Adult Care Executives, and the Kansas Department of Aging and Disability Services to present this Joint Training session. KHCA is pleased to offer these two one-day sessions to discuss the importance of QAPI and Root Cause Analysis in long term care.

Rick Harris is a retired United States Navy Service Member.  Rick Graduated from the University of New Hampshire Summa Cum Laude.  After that he graduated from The University of Pennsylvania Law School, obtaining a J.D. He began his career as a staff attorney with the Legal Services Corporation of Alabama.  He has worked a long and various career in the field of law.  He is an expert in many fields ranging from Leadership and Management, to general law council. 

Lisa Tripp is an Assistant Professor at Atlanta’s John Marshall Law School, Atlanta Georgia. She teaches Health Care Law, Torts and Remedies. Professor Tripp practiced health care law and commercial litigation prior to joining the faculty of Atlanta’s John Marshall Law School in 2006. As an attorney for the U.S. Department of Health and Human Services (HHS), Professor Tripp focused primarily on long term care enforcement. She litigated many cases involving physical and sexual abuse, elopements, falls, neglect and substandard quality of care. Professor Tripp currently serves as the Vice Chair of the Leadership Council of The National Consumer Voice for Quality Long-Term Care. She has served on health quality measurement committees and panels for the National Quality Forum and the Medicare Payment Advisory Commission (MedPAC). Professor Tripp received her law degree, with honors, from George Washington University Law School, in Washington, D.C.

Price: $75 before February 4th

          $100 after February 4th

 

February 18, 2014- Topeka- Register Online

February 19, 2014- Wichita- Register Online

Download Brochure

Kansas Adult Care Executives Wants Your Input- Animals in the Dining Room?!

Author: Hayden Parker

Kansas Adult Care Executives need your input:

There was a question posted on our Member only Discussion board.

The question is:

We are having an issue with one of our residents family member who brings in their dog and allows the dog to wander all over during meal times begging for food from the residents.  The dog is not kept on a leash.  The other dog is kept on a leash at all times in the building, but is brought to the dining room. Any one have policies about this they would share or thoughts on this subject.   I plan to interview the residents to see if any are against having the dogs in the DR during meal times.  I will appreciate any and all comments.

Please reply back to Teresa and I will post any comments or please click on the following link: 

Member only Discussion - please sign-in to make comments online. 

Care Plans for Medications

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From the desk of Audry Sunderraj:

Medications in the comprehensive care plan.  What should it include? You may be a little confused as to what the comprehensive care plan should include.  Below is some guidance from an article published by KDADS in the January 2013 Sunflower Connection:

Incorporate into a comprehensive care plan that reflects appropriate medication related goals and parameters for monitoring the resident’s condition, including the likely medication effects and potential for adverse consequences. Examples of this information may include the FDA boxed warnings or adverse consequences that may be rare, but have sudden onset or that may be irreversible.

Monitoring parameters are based on the resident’s condition, the pharmacologic properties of the medication being used and its associated risks, individualized therapeutic goals, and the potential for clinically significant adverse consequences.


Download Full Article

CMS HCBS Waiver Webinar

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CMS has published the information for participating in the January 23, 2014 webinar on the final CMS rule on Medicaid waiver HCBS programs, including the new CMS definition of HCBS settings.  The webinar information is below.  Please note that the webinar will be repeated on January 30.  Both webinars are from 12:00 p.m. to 2:00pm CST.

Link to free webinar - Call:1-877-267-1577 PIN:993724826

Link to CMS page about the final rule

 

KanCare Welcomes New Ombudsmen

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The Topeka (KS) Capital-Journal reports that Kerrie Bacon has been appointed as the KanCare Ombudsmen replacing James Bart.  Bart will move into the position of "Director of Managed Care" formerly hekd by Kim Brown who has left state employment for the private sector.

View full Capital Journal article

Manual Updates to Clarify Coverage Pursuant to Jimmo vs Sebelius

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“Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius” has been released and is now available in downloadable format.  The article was prepared and is being distributed as a result of the settlement agreement in the case of Jimmo v. Sebelius. This article is designed to provide education on the updated portions of the “Medicare Benefit Policy Manual”. It includes clarification on the coverage requirements of skilled nursing and skilled therapy services to Medicare beneficiaries.


Download MLN Matters Article #MM8458

Surge of Medicaid Managed Care is Fraught with Probelms Unless Root Concerns are Addressed

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Surge of Medicaid Managed Care is Fraught with Problems Unless Root Concerns are Addressed

New Analysis Showing Potential Growth Reveals Potential Problems for Older Adults in Nursing Centers, says Parkinson

 

Washington, DCIn light of a new report issued this week forecasting the continued rise of Medicaid managed care plans, the American Health Care Association (AHCA) today called on state and federal agencies to carefully weigh and consider the needs of older adults as they implement new payment structures under Medicaid.  Specifically, the Association is concerned that long term services and supports (LTSS) will be managed by groups with little-to-no experience in the vastly complex needs of Medicaid’s older adult population in nursing centers.

“Too much is at stake here, with too many moving parts,” said Mark Parkinson, President and CEO of AHCA.  “Our members are concerned that Medicaid managed care adoption is occurring without placing the needs of the older adults in these programs at the forefront of this effort.  Managed care organizations have laudable goals of enhancing care coordination and saving state dollars, but the managed LTSS model as it stands today has unclear and mixed quality and cost savings outcomes for patients and states themselves. Any new programs must be implemented with consideration of what works best for those receiving care.”

Conducted by Avalere Health and released earlier this week, the comprehensive analysis projects a 20 percent increase in managed care enrollment in 2014.  The report credits this to states’ managed care expansion efforts and growth in new Medicaid beneficiaries through the Affordable Care Act (ACA). While most of the growth is attributed to enrollment of the ACA Medicaid expansion targeted to working age, childless adults, a notable number of older adults and persons with disabilities also will be enrolled as a dozen states move forward with expanding or implementing Medicaid managed LTSS.  The addition of 12 states to the ranks of Medicaid managed LTSS states will bring the total number of states using such approaches to 28 while evidence of savings and quality remains weak.

Late last year, AHCA issued 3 broad principles and a report of its own designed to help state policymakers review and better implement managed LTSS.  The principles focused primarily on ensuring patients’ access, improving care quality and enhancing patient choice in a managed care environment.

 

AHCA Update Regarding Office of Medicare Hearings and Appeals Public Meeting on February 12, 2014

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AHCA has provided a brief update regarding the US Department of Health (HHS), Office of Medicare Hearings and Appeals (OMHA), announcement that it will be holding a public meeting on Feb. 12, 2014, for those appealing Medicare claims to discuss various agency attempts to handle the lengthy appeals backlog.  AHCA will be attending the OMHA meeting and advocating on behalf of the Kansas Health Care Association.  Since the original announcement, OMHA has released additional information and materials on its website at http://www.hhs.gov/omha/omha_medicare_appellant_forum.html, which include:

·      Letter from the Chief Administrative Law Judge (ALJ) – OMHA has temporarily suspended the assignment of most new requests for an ALJ hearing to allow OMHA to “catch up.”  This temporary measure was necessitated by a dramatic increase in the number of decisions being appealed to OMHA , the 3rd level of appeal.  OMHA will continue to assign and process requests filed directly by Medicare beneficiaries, to ensure their health and safety.  Assignment of all other new requests for hearing will resume as ALJs are able to accommodate additional workload.  However, with the current backlog, OMHA does not expect general assignments to resume for at least 24 months. 

·      Event Information – OMHA will host a Medicare Appellant Forum Wednesday, February 12, 2014, from 10:00AM - 5:00PM, ET, in the Cohen Auditorium of the Wilbur J. Cohen Building located at 330 Independence Ave., SW, Washington, Dc, 20024.  The purpose of the meeting is for OMHA to provide updates, relay information on OMHA initiatives designed to mitigate a growing appeals backlog, and furnish information on measures that providers can take to make the administrative appeals process more efficient.

·      OMHA Medicare Appellant Forum Agenda – Agenda is posted at http://www.hhs.gov/omha/omha_medicare_appellant_forum.html and is an entire day of updates from the federal government.

·      Registration Form – The registration form is posted http://www.hhs.gov/omha/omha_medicare_appellant_forum.html.  Deadline to register is Tuesday, January 28, 2014.  OMHA is considering a phone line for the event depending on who many individuals are interested in attending.  For additional information, call Sylvia Baquero, (703) 235-0145, sylvia.baquero@hhs.gov, or Paula Taylor, (703) 235-0125, paula.taylor@hhs.gov.  Alternatively, you can request additional information via email to OSOMHAAppellantForum@hhs.gov.

·      Attendee Information –Directions to the OMHA Forum are posted on the OMHA website.

 

OMHA also has advised the public to periodically review the website, as more documents and materials may be added prior to the event.  To obtain a complete copy of the Federal Register with the original OMHA Medicare Appellant Forum announcement go to http://www.gpo.gov/fdsys/granule/FR-2014-01-03/2013-31461/content-detail.html.  We will continue to update you on this matter as it unfolds.

AHCA/NCAL Quality Award Deadline

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We are only nine days from the Bronze and Gold Quality Award Deadline.  Application for these two award levels must be submitted to the AHCA/NCAL Quality Award portal by 8pm EST on January 30, 2014. Silver Quality Awards are due February 27, 2014.

KHCA/KCAL firmly believes in the benefit of the Quality Awards, and encourages you to begin or pursue the next level in the National Quality Award program.  Begin the never ending journey of improving your quality today. 

To support our members, AHCA/NCAL has provided sample applications, video series addressing each level's criteria, and sample worksheets.  All of these materials are available on the Applicant Resources website.

Any questions regarding the program can be directed to quality-award@ahca.org

AHCA/NCAL Conferences

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AHCA/NCAL is having a big first quarter with high quality education events!


2014 AHCA/NCAL Quality Symposium- February 10-12, New Orleans, Louisiana

Enjoy engaging speakers, lively discussions, and an inspiring atmosphere at one of the most important long term and post-acute care events of the year. The Quality Symposium features:

 

 

New this year!

 

 

Earn CEUs while networking and learning how to better achieve your Quality Initiative and National Quality Award goals.

 

 REGISTER TODAY

2014 NCAL Spring Conference- March 10-12, Las Vegas, Nevada

Position your company ahead of the curve by registering for this must attend event for assisted living organizations. Featuring dynamic keynote speakers, the latest in educational programing, and excellent networking experiences, this in-depth learning environment will help you and your team to succeed in the senior care marketplace.

Earn up to 10.25 CEUs through premier educational sessions including: 
  • Two hands-on tracks for Executive Directors/Community Leaders and Owner/Operators. 
  • Interactive sessions regarding ACOs, resident acuity, and the National PSO for Assisted Living and the role of REITs. 
  • Valuable resources for developing your social media presence, handling resident bullies, preparing for emergency events and addressing workplace violence.
 
Lean how to analyze your environment and implement the processes that will exceed expectations, improve your reputation, and increase revenues.
 
Early Bird Registration extended to January 17, 2014. 
Register Today!


2014 Independent Owner Leadership Conference- March 12-14, Las Vegas Nevada


Join your senior level colleagues in the uniquely exciting atmosphere of Las Vegas to meet and discuss the latest issues that matter to you. This year’s conference focuses on Thriving in a Changing World. You’ll learn innovative strategies and ideas to help you with the challenges of managing staff and patients, and explore different approaches for dealing with new laws and regulations. Discover the best practices in change management and get inspired to raise the quality of care you provide.

The Independent Owner Leadership Conference offers you:

  • Various education sessions with engaging speakers
  • The enormously popular Town Hall Meeting
  • An opportunity to earn up to 10.5 CEUs
  • Numerous networking and social opportunities including a reception on Wednesday, and a networking lunch, spectacular dinner, and special PAC event on Thursday 

 

 

The early registration deadline is February 11, 2014.

Early registration saves $75 off the standard member rate.

 

 

Learn more, Register Online, or download a registration form​.

Amerigroup Kansas Provider Representative Territory Coverage Map

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Amerigroup would like to remind KHCA/KCAL members of their provider representative territory coverage.

Download Provider Coverage Map and Representative List

Sunflower State Health Plan Update- Timely Filling

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Sunflower State Health Plan would like to update you on timely fillings:

 

Timely Filing

·         Providers are not subject to timely filing for Sunflower State Health Plan claim reprocessing projects.

·         Sunflower State Health Plan has processes in place to waive timely filing for claim adjustments that are related to processing errors. This includes corrected claims, reconsideration to an original claim and claim disputes received from a provider. If a claim is submitted to Sunflower State Health Plan as a first time submission, the timely filing edit is automatically applied by the claims system. It is important to refer to the original claim number when submitting a corrected claim or requesting an adjustment for a claims processing error.

·         Claims must be submitted within 180 days of the date of service. When Sunflower State Health Plan is the secondary payer, the claim must be submitted within 365 days of the date of the primary carrier denial. The primary carrier remittance advice must be submitted with the claim.

·         If a provider is submitting a first time claim outside of the 180 day timely filing period, proof of the reason to waive timely filing must be submitted with the claim.

 

We have identified that many of the claims denied for timely filing are corrected claims being submitted without information for us to tie it to the original claim.  We have included information about submitted corrected claims to try to assist with this.

Sunflower State Health Plan- Update and Email Alert Signup

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Sunflower State Health Plan would like update all providers with Long term Care/ Nursing Facility entities with the following:

On behalf of Sunflower State Health Plan, thank you for providing services to our members to
help keep them happy and healthy. This bulletin is to inform our nursing facility and long- term
care providers that we have completed system updates and are reprocessing claims to address the
following scenarios:

•    Client Obligation and Patient Liability – claims that did not have the appropriate Client
Obligation or Patient Liability withheld. Providers may experience an adjustment on their
remittance advice showing no change in payment if the original claim withheld Client Obligation or
Patient Liability appropriately.

•    Nursing Facility Rate Changes – all claims paid at the incorrect rate will be reprocessed with
the new rate changes beginning with dates of service January 2013 through December 2013

•    Retro Eligibility – claims identified for members with retro eligibility updates for the time
period Jan 1 through Nov 30 will be reprocessed if an authorization is on file for the date of
service.

•    Medicare Primary – claims that denied for a primary carrier EOB when Medicare is primary for
dates of service January 2013 through December 2013.

The system updates will be implemented on January 17, and the reprocessing of claims will be
completed over the next few weeks.

The 2014 Provider Manual is now available on our website at www.sunflowerstatehealth.com
under Provider Resources.

EMAIL ALERTS ARE NOW AVAILABLE!
Visit our website at www.sunflowerstatehealth.com to sign up for Sunflower’s email
alerts.

Sunflower State Health Plan Update on NCCI Edits for Modifiers 25 and 59

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Sunflower State Health Plan’s clinical editing team will review claims submitted with Modifiers 25 and 59. The team will determine if the claim provides enough information to warrant the use of these modifiers. If a claim has denied and you believe the modifiers were billed appropriately for services provided, please follow the processes for Corrected Claims, Requests for Reconsideration or Claim Disputes as outlined in the Sunflower State Health Plan Provider Manual. You must submit supporting medical documentation with your Request for Reconsideration or Claim Dispute.

The 2014 Provider Manual is now available on our website at www.sunflowerstatehealth.com under Provider Resources.


Significant, Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure

Modifier “-25” (Significant, separately identifiable Evaluation/Management (E/M) service by the same physician on the same day of the procedure), indicates that the patient’s condition required a significant, separately identifiable E/M service beyond the usual pre-operative and post-operative care associated with the procedure or service.

Providers must document both the medically necessary E/M service and the procedure must be appropriately and sufficiently documented by the physician or qualified non-physician practitioner in the patient’s medical record to support the claim for these services. This documentation should be submitted for reconsideration of a denied claim.


Procedure or Service was Distinct or Independent from Other Services Performed on the Same Day

Modifier -59
: "Distinct Procedural Service: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries)not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used."

More information and examples about the use of Modifier 59 can be found at

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html?redirect=/NationalCorrectCodInitEd/NCCIEP/list.asp

Dietitians in Healthcare Communities- 5 Star Gracious Dining Award

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Each year the Dietitian's in Healthcare Communities Practice Group sponsors the 5 Star Gracious Dining Award, given to the long term care community that provides outstanding dining and nutritional services to their elders.  Do you think you have the best dining services in the field?  Apply today. Applications are due by March1, 2014.  The winner will be recognized at the KDA Spring Conference Luncheon on April 25th at the Four Points by Sheraton Hotel in Manhattan, KS.

Click here for program details, how to apply, and application form