Issue: May 15, 2014

Published on May 15, 2014

Articles in this issue:

CMS Finale Rule on HCBS Settings- Provider Assessment

Author: Hayden Parker

CMS has released a final rule on HCBS setting. 

View full document.

Download Your New PEPPER Report!

Author: Hayden Parker

Program for Evaluating Payment Patterns Electronic Report

Provide your feedback on PEPPER!

The Q4FY13 release of your new Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER), with statistics through September 2013, is now available for download through the Secure PEPPER Access page at PEPPERresources.org. To obtain your SNF's PEPPER, the Chief Executive Officer, President or Administrator of your SNF should: 

  1. Review the Secure PEPPER Access Guide.
  2. Visit the Secure PEPPER Access page at PEPPERresources.org.
  3. Review the instructions and obtain the information required to authenticate access.
  4. Click on the button to Access the Secure Portal.
  5. Complete all the fields.
  6. Download your PEPPER. 

The SNF PEPPER will be available to download as a Microsoft Excel file for approximately one year. The previous Q4FY12 SNF PEPPER, originally released in August 2013, will be made available via the Secure PEPPER Portal in the summer of 2014; an email notification will be sent when these PEPPERs are available.


New for this release in the SNF PEPPER: The "State" comparison group now includes all SNFs in a state. Previously, the "State" comparison group included all SNFs in a state that were in the same MAC jurisdiction. As a result, state percentiles will be available for most SNFs; state percentiles will differ from the previous PEPPER release.
 

For more information, visit the SNF Training and Resources section of PEPPERresources.org.

 

About PEPPER

PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. Visit PEPPERresources.org to access resources for using PEPPER, including recorded web-based training sessions, a sample SNF PEPPER and the current SNF PEPPER User's Guide, which are available on the SNF "Training and Resources" page. PEPPER is distributed by TMF® Health Quality Institute under contract with the Centers for Medicare & Medicaid Services.

 

Do you have questions or comments about PEPPER or need help obtaining your report? Visit our Help Desk to request assistance with PEPPER. Provide your feedback or suggestions regarding PEPPER through our feedback form

 

The PEPPER Team

Health Care Stabilization Fund Comments from Chip Wheelen

Author: Hayden Parker

Passage of House Bill 2516 amended several sections in the Health Care Provider Insurance Availability Act. Most of these amendments become law July 1, 2014. Among the amendments, the definition of “health care provider” is expanded to include five new categories, three types of facilities and two professions. In order to allow sufficient time for these new health care providers to transition from their current insurance arrangements to the insurance requirements stipulated in the Availability Act, the Legislature deliberately delayed the effective date of the new definitions until January 1, 2015. This will allow at least six months for nursing facilities, assisted living facilities, residential health care facilities, physician assistants, and nurse-midwives to learn about the Availability Act and inform their insurers of any changes that may be necessary. The phrase "health care provider" is defined in K.S.A. 40-3401 and includes the following:

 

 

*These categories of providers are carefully reviewed to assure they meet the strict statutory criteria for HCSF participation.

**These categories of health care providers are defined as such in K.S.A. 40-3401 effective January 1, 2015.

CMS Fines Andover Nursing Home After Allegations of Resident Abuse

Author: Hayden Parker

 

The recent news about abuse at Victoria Falls in Andover has left us shocked and dismayed. Our hearts go out to the residents and families who were harmed.

The center and the staff who have been accused are not associated with KHCA, so we cannot offer an opinion about their situation.

At Kansas Health Care Association, we feel that our seniors have created a lasting legacy for us as a society. We believe we have a sacred responsibility to give them our respect and the best possible care.

We will continue to do our utmost to serve Kansas senior citizens by providing ongoing training and support to our member skilled nursing and rehab centers. This helps promote a culture of quality, continuous improvement and dedication to the residents they serve. We are proud of our member organizations and the numerous quality awards they receive.

 

Below are some talking points for you, KHCA/KCAL Members:

 

Dear KHCA Member,

This morning’s news has reported confirmed allegations of patient abuse at Victoria Falls, a non-KHCA member in Andover, Kansas. We are horrified by the stories and our hearts go out to the residents and families who were harmed.

We do not know the full situation, so we cannot point fingers or place blame.

KHCA is submitting letters to the editor to the statewide media today in response to the story. Copies of those letters are included in this email.

It’s possible that you may be contacted by the media for a comment. If you are contacted, below is a statement that you may wish to provide:

The recent news about abuse at Victoria Falls has left us shocked and dismayed. Our hearts go out to the residents and their families who were harmed.

The center and the staff that were charged are not associated with our facility or Kansas Health Care Association, so we cannot offer an opinion about the situation.

Our seniors have created a lasting legacy for us as a society. We believe we have a sacred responsibility to give them our respect and the best possible care.

We will continue to do our utmost to serve our senior citizens by providing ongoing training and support to our staff. This helps promote a culture of quality, continuous improvement and dedication to the residents we serve. We are proud of our colleagues across the state and the numerous quality awards we receive.

Talking points/answers to possible questions you may receive:

What do you think about (or can you comment on) the allegations in Andover?

This news has left us shocked and dismayed. Our hearts go out to the residents and their families.

The center and the staff in question are not associated with us, and we don’t know the full nature of the matter so we cannot offer an opinion on details about the matter.


Where can a person look up skilled nursing and rehab center ratings?

Information on the 5 star rating system and how skilled nursing and rehab centers compare can be found at Centers for Medicaid and Medicaid Services at www.cms.gov.


How can a family help ensure their senior is getting quality care?

It is always important for family members to ask lots of questions, do their research and stay in touch with providers to ensure quality care. For more information about evaluating skilled nursing and rehab centers and their ratings there are several reliable resources you can access for information:

 

Kansas Health Care Association: http://www.khca.org

Care Conversations: http://www.careconversations.org

Kansas Advocates for Better Care: http://www.kabc.org

Kansas Long-Term Care Ombudsman Office: kansasombudsmanksgov.com

KS Department for Aging and Disability Services (KDADS) Hotline: (800) 432-3535

 

What should a care center do to safeguard patients?

Quality care centers with Kansas Health Care Association or other associations provide ongoing education for staff at all levels, including clinical care, resident-centered services, correct policies and procedures and more. A constant focus on best practices and continuing education helps create a culture of quality that means residents are in the best environment possible.

 

Have you ever had any incidents in your facility?

We strive to hold ourselves to the highest standards. We are proud of our record, which is rated at  _____  stars and I’d encourage you to look at our reviews at Centers for Medicaid and Medicaid Services www.cms.gov.

 

Click here for the full article from Kansas Health Institute.

National Nursing Home Week!- Send Us Pictures of Your Celebrations!

Author:

KHCA/KCAL wants pictures of your National Nursing Home Week celebrations!

Send them to hparker@khca.org!

Mother’s Day Opens Week to Honor Residents & Workers
National Nursing Home Week® celebrated since 1967

Washington, D.C. – National Nursing Home Week® (NNHW), which began on Mother’s Day Sunday, May 11 and runs through Saturday, May 17, honors the residents and patients currently in skilled nursing and rehabilitation care centers across the nation with special activities and events.

Sponsored each year since 1967 by the American Health Care Association (AHCA), this year’s NNHW theme is “Living the Aloha Spirit.” In Hawaii, by “Living the Aloha Spirit,” a person shows love and respect to others and joyfully shares life to create a better world.

“Skilled nursing care centers strive daily to attain the ideal expressed in this year’s theme for all patients by focusing on person-centered care and continuous improvement,” said Mark Parkinson, President and CEO of AHCA. “This special week is also about honoring the staff in skilled nursing care centers. These dedicated individuals often form meaningful, enduring relationships with residents and families that are beneficial to everyone.”

National Nursing Home Week can be a time to reflect on the many challenges that society faces in ensuring access to the quality services available in a skilled nursing care center. Some of the national issues that potentially threaten such access include: federal reductions in Medicare payments; limitations on therapy services, such as physical therapy; and government Medicaid payments that are $7.7 billion below the cost of providing care nationwide.

Most importantly, NNHW week is a great time to visit a loved one, friend, acquaintance, or veteran in a skilled nursing care center or other setting. This special attention will help someone catch that “Aloha Spirit.”

Nurse Advisory Committee/ Facility Standards Call- Friday, May 16, 10am

Author: Hayden Parker


Calling all KHCA/KCAL Nurses!

If you received this, and are not a nurse, please forward on to KHCA/KCAL member nurses.
 
Don't forget to join us May 16, 2014 at 10:30am for the monthly NAC phone call. 

Dial in at 1-888-450-5996  Passcode 946659# 
 
Nursing Advisory Committee Call:
 
May 16, 2014
10:30am - 11:00am
 
Facility Standards Call with Linda Farrar:
 
May 16, 2014
11:00am
 
Be sure to stay on the call at 11:00 when Linda Farrar joins us for our monthly review of recent 2567's and survey trends.
*Please review these documents prior to the Facility Standards call*
 
April_Survey_Review.docx

April_Findings.docx

Health Care Stabilization Fund News- Upcoming Webinar- June 18th

Author:

Did you know providers will be considered “health care providers” after January 1, 2015?  You as providers will benefit from this designation in several ways.  KHCA, Leading Age, and Chip Wheelen with the Health Care Stabilization Fund will be offering a provider webinar on June 18th.  Look out for the announcement from the Associations. 

Please read the following news article to familiarize yourself with the Kansas Health Care Stabilization Fund written by Chip Wheelen.

Health Care Stabilization Fund Article

Message From KDADS About Timely Filling Of Claims

Author: Hayden Parker

Message from KDADS about timely filing of claims:

Because of timely filing requirement issues, the MCO’s are willing to work with individual providers to resolve billing problems. Whether it be provider-related or insurance company issue- they are willing to waive the requirement.  If you have requests please let me (Cindy cluxem@khca.org ) know and I will contact the CEO’s for help.

Basic Disaster Supplies Kit- Do you have one?

Author: Hayden Parker

Basic Disaster Supplies Kit

A basic emergency supply kit could include the following recommended items:

 

Click here for a full list of emergency supplies, and many tips and tools from ready.gov

CMS Issues Revised Surveyor Guidance at F441

Author: Hayden Parker

CMS has issued revised surveyor guidance at F441. It is posted on the CMS website at:  http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-25.html

 

According to the S&C Memo Summary:

 

Advance Copy: The guidance under Tag F441, Infection Control, Preventing Spread of Infection/Indirect Transmission has been revised.

Single-Use Device Guidance: Nursing homes may purchase reprocessed single-use devices when these devices are reprocessed by an entity or a third party reprocessor that is registered with the Food and Drug Administration.

Single-Use Device (SUD): A SUD is a device that is intended for one use on a single patient during a single procedure.

Reprocessed SUD: A reprocessed SUD is an original device that has previously been used on a patient and has been subjected to additional processing and manufacturing for the purpose of an additional single use on a patient.

 

Per the memorandum this guidance is “advance” guidance and is effective immediately. 

CMS Propose Rule for SNF Prospective Payment System

Author:

CMS released the proposed rule for the SNF Prospective Payment System, indicating our Medicare rates for the coming fiscal year. CMS is proposing a 2.0% increase, estimated to be $750 million for the profession. There are several aspects to this proposed rule that look positive. (Find the fact sheet on CMS' website.)

This reflects the third year in a row of market basket increases, and an increase from last year's 1.3% market basket update. I believe this is a direct result of the proactive approach we have implemented over the past few years to work with CMS before the rule is ever written.

Below is a short summary of the key provisions in the SNF PPS proposed rule that could have a direct impact on the long term and post-acute care profession.

Market Basket Update

Other Key Provisions

AHCA will conduct a more detailed review and analysis of the SNF PPS NPRM in the coming days and provide a thorough summary next week.

Comments are due to CMS by June 30, 2014. AHCA will be submitting comments.  If members wish to provide comments to AHCA, we ask that they be provided by COB on June 1, 2014. Comments can be emailed to Elise Smith ( esmith@ahca.org), AHCA's Senior Fellow of Health Policy & Post-Acute Care.

2014 SNF PEPPER Reports Available in May Via Electronic Portal

Author:

2014 SNF PEPPERs Available in May Via Electronic Portal

TMF Health Quality Institute, the Centers for Medicare & Medicaid Services (CMS) contractor responsible to produce and distribute the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for various professional groups, including skilled nursing facilities (SNFs), has just announced a WebEX entitled The SNF Program for Evaluating Payment Patterns Electronic Report (PEPPER) on May 8, 2014, at 2:00PM, Central Daylight Time.  The WebEX will focus on:  1) Updates for the new SNF PEPPER, summarizing statistics for FYs 2011-2013; and 2)  the new method for accessing the 2014 SNF PEPPER via the Secure PEPPER Access portal on http://PEPPERresources.com.  Registration is not required to join the event.  Simply click on https://tmfpepper.webex.com/tmfpepper/onstage/g.php?d=924457628&t=a about 15 minutes prior to the start time of the WebEX. The event number is: 924 457 628 and the event password is: flower.  AHCA has advocated strongly for this process and is pleased that CMS is making this change.

Currently, the SNF PEPPERs are scheduled for release on May 5, 2014; however, TMF will send an email to announce the formal release when the SNF PEPPERs are available to access. To receive this email, join the email list at http://PEPPERresources.org.  SNFs do not have to register to receive a PEPPER report; however, TMF has asked us to share the following specific information:

Note: If providers use only letters in both of these fields they must contact TMF to request assistance. Patient names cannot be entered due to patient privacy laws.

If you have individual or specific questions regarding the 2014 PEPPER reports, please visit PEPPERresources.org to submit questions.

Sunflower HCBS POC Monthly Calculations

Author: Hayden Parker

SUNFLOWER’S HCBS POC MONTHLY CALCULATIONS

This announcement does not apply to I/DD HCBS

Beginning June 1, 2014, Sunflower Health Plan will use a more accurate calculation for monthly Plans of Care (POC) in Home and Community Based Services. The new calculation will use 4.5 weeks in each month instead of 5 weeks per month. The change does not apply to I/DD HCBS.

This scheduled change does not impact the member’s weekly service units. The new equation will contain a more accurate number for averaging the weeks in a month.

For example: John Smith will continue to receive 10 units of personal care weekly as noted on his Needs Assessment. The new calculation for the monthly personal care units will be: 10 units per week x 4.5 weeks = 45 units per month. In comparison, this has previously been calculated as: 10 units per week X 5 weeks = 50 units per month.

The State’s fee-for-service system previously used 5 weeks for every month of the year. The new 4.5 weeks per month will give us a number closer to the intended amount based on the weekly allocation. Please note that a 31-day month is still only 4.3 weeks (less than the 4.5 weeks we will be calculating).

The new Sunflower HCBS POC multiplier is consistent with the calculation used by one other KanCare health plan (Amerigroup).

Providers in Sunflower will use the new 4.5-week multiplier in non-I/DD HCBS needs assessments beginning June 1, 2014.

This change is not an appealable event as a POC or service reduction, as it is only a change in the method to more accurately calculate weekly units of service into a monthly total allocation.

For more information, call the Sunflower Provider Service Center at 1-877-644-4623

 

Joint Provider Fire Marshal Training

Author: Hayden Parker

The Joint Provider Fire Marshal training is on June 3,4 and 5 in three locations. 

June 3- Wichita

June 4- Salina

June 5- Topeka

Contact KACE with any questions.

Download brochure and registration form