UPDATE Weekly

As you know, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule change for the SNF/NF Medicare and Medicaid Requirements for Participation on Monday July 13th 2015. The rule is extensive in scope and contains both new requirements and some that have already been issued by CMS via Survey & Certification memoranda. In fact, this proposal represents the first comprehensive change to the conditions of participation (CoPs) since 1991.

NCHCFA is initiating a campaign to impress upon CMS just how important these changes are to skilled nursing facilities in North Carolina. Polly Welsh and Eric Kivisto will oversee this effort. In order for this campaign to be effective, we will need you and as many individuals in your organization as possible to submit comments to CMS on these proposed changes. We are offering members a tool kit to make it easier to participate in this campaign.

Included are:

• Reed Smith’s, AHCA’s Legal Counsel, redline version of the proposed rule indexed according to the specific reference section of the proposed rule
• “Tips on Organizing Your Comments” handout
• Staff distribution chart (These are only our suggestions and these distributions may not be applicable in each facility)
• Response Template which indexes the specific reference section of the Proposed Rule
• Examples of public comments submitted to CMS

We are asking that every administrator, director of nursing, corporate officer, support staffer, everyone with a vested interest in the future of this profession carefully review these proposed changes. Your first assumption may be that the rule changes will only mean bigger challenges, but that may not be the case for all changes. A thoughtful and analytical assessment of the proposed regulations is necessary to assess both the costs and the benefits of the intended changes.

Members are asked to send their concerns and suggested changes to NCHCFA no later than September 2nd.

Filing comments is not as daunting as it may sound. A thoughtful letter will be very helpful. Your comment doesn’t even have to be that long. A meaningful paragraph about how the proposed rule will affect you and your patients and residents will have significant impact. And you can easily submit your comment electronically or by regular mail. We have seen the success of these efforts in other sectors. If done right, we can influence the final rule that CMS issues.

If you would like to receive an electronic copy of the Requirements of Participation (ROP) NCHCFA Tool Kit, please e-mail Eric Kivisto at Erick@nchcfa.org.

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There is still time to register for the fourth annual NCHCFA Summer Symposium, August 26-28, 2015 at the Embassy Suites Resort at Kingston Plantation, Myrtle Beach, SC for the most up to date information affecting long term care. You can register and pay on-line. Visit http://NursingHomesNC.com and click on Fourth Annual Summer Symposium Registration! Administrators and registered nurses will be able to earn up to 12.5 hours of continuing education.

Be sure to attend the NEW program Proposed Changes to the Requirements of Participation for Long-Term Care Facilities, on Friday, August 28th from 9:00 am – 11:00 am. CMS issued a proposed rule change for the SNF/NF Medicare and Medicaid Requirements for Participation on Monday July 13th 2015. The rule is very large in scope and contains both new requirements and some requirements already issued by CMS via Survey & Certification memoranda. During this session, Dr. David Gifford, Senior Vice President of Quality and Regulatory Affairs, American Health Care Association, will provide attendees with a robust explanation of the ramifications of the changes to the requirements of participation and other regulatory policies affecting SNFs including new payment models as well.

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Last week, the American Health Care Association (AHCA) shared a brief overview of the FY 2016 SNF PPS final rule released by CMS on July 30, 2015. They have since developed a more detailed summary, which highlights the following:

• Comments submitted to and responses received from CMS regarding payment provisions;
• SNF Value-Based Purchasing (VBP);
• SNF Quality Reporting Program (QRP);
• Changes to MDS 3.0 data collection; and
• Staffing data collection.

AHCA meets with CMS staff quarterly on the SNF PPS. During the fall meetings, AHCA will develop and present a proposal for a more refined approach to market basket updates, continue to apply pressure for a SNF-specific wage index, and work with the Center for Medicare and the Center for Clinical Standards and Quality on the still unfolding PAMA and IMPACT Act provisions.

If you have questions, suggestions or concerns, please contact Mike Cheek at mcheek@ahca.org or David Gifford at dgifford@ahca.org.

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Do not miss the NCHCFA Day at the Beach – Volleyball & Corn Hole Tournament on Thursday, August 27th. Join your colleagues on the beach for an afternoon of fun! Represent your district in the NCHCFA Volleyball Tournament. Challenge the NCHCFA staff and Board of Directors in the quest for the Chairman’s Cup. If you are not set on volleyball, get a team together for the Corn Hole Tournament or a friendly game of horseshoes. Sponsors will provide snacks, beverages and prizes throughout the day.

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McKnight’s Long-Term Care News reports that President Obama has signed into law the Notice of Observation, Treatment and Implication for Care Eligibility (NOTICE) Act, which “will require hospitals to tell Medicare beneficiaries of their outpatient status within 36 hours, or, if sooner, upon discharge.” Clifton J. Porter II, American Health Care Association senior vice president of government relations, hailed the law as “an important step forward.” In a statement, Porter wrote that enactment of the law “means millions of individuals who leave a hospital, preparing for a short stay in a skilled nursing center, will now know what their hospital status is, which could save them thousands of dollars in out-of-pocket costs.”

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The national prevalence of antipsychotic medication use in long-stay nursing home residents continues to decline, a report by the Centers for Medicare & Medicaid Services (CMS) shows. According to data compiled by the National Partnership to Improve Dementia Care in Nursing Homes – a public-private coalition under the direction of CMS – 18.7 percent of long-stay nursing home residents were receiving an antipsychotic medication in the first quarter of 2015 compared with 23.9 percent in the fourth quarter of 2011, representing a 21.7 percent decrease.

“This represents the progress we’ve made in bettering the lives of those we serve every day,” said Mark Parkinson, President and CEO of the American Health Care Association (AHCA). “Together with CMS and AHCA’s Quality Initiative, more than 35,000 nursing center residents living with dementia are no longer receiving antipsychotic medications. But we can’t stop there. We are working to safely reduce the use of the medication by a total of 30 percent over the next two years and are well on our way.”

As of the first quarter of 2015, AHCA members have achieved a 23 percent decrease in the reduction of antipsychotic use.

In May, AHCA announced the expansion of its nationwide, multi-year initiative to improve quality care in skilled nursing care centers. Building on the progress achieved by the profession, one of its goals is to safely reduce the off-label use of the medication by a total of 30 percent by the end of 2016.

“This new data demonstrates how a collaborative partnership between CMS, providers and consumers can be very successful,” said Dr. David Gifford, AHCA Senior Vice President of Quality and Regulatory Affairs and a board-certified geriatrician.

In 2012, AHCA launched its Quality Initiative and later joined CMS in supporting its National Partnership to Improve Dementia Care in Nursing Homes.

“However, despite the progress we’ve made, CMS is now proposing restrictive documentation regulations on how these medications can be prescribed,” said Gifford. “This proposed change will shift the focus away from providing better care for those with dementia. We will continue to work with CMS to recommend solutions to safely decrease the use of antipsychotics and promote more person-centered care.”

Highlights of the report by the Partnership are below. Data exclude residents diagnosed with schizophrenia, Huntington’s disease or Tourette’s Syndrome.

[Click For Larger View]

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The North Carolina Health Care Facilities Association would like to thank our 2015 Summer Symposium Corporate Sponsors for supporting the upcoming Fourth Annual Summer Symposium in Myrtle Beach, SC: Healthcare Services Group, Medipack Pharmacy, QMX Mobile Health and Southern Pharmacy Services.

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Please plan to join your friends and colleagues in beautiful Pinehurst, North Carolina, on September 16th and 17th for the Fourth Annual Autumn Classic Golf Tournament. The event will begin Wednesday with golf, a reception, dinner and program held at the world famous Pine Needles Lodge and Golf Club. The Pinehurst Autumn Classic is being sponsored by the NC Health Care Facilities Association to benefit our political action committee (PAC). You do not have to play golf to participate! Click here for registration materials.

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The “Updated LEIE” (List of Excluded Individuals and Entities) database file reflects all OIG exclusion and reinstatement actions up to, and including, those taken in July 2015. 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.

All updated files are posted at http://oig.hhs.gov/exclusions/exclusions_list.asp.

Instructional videos explaining how to use the on-line database and the downloadable files are available as follows:

• On-line Database Video: http://oig.hhs.gov/exclusions/online.asp.
• Downloadable Database Video: http://oig.hhs.gov/exclusions/download.asp.

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The Alliant Quality NH PIMS portal is ready to go, allowing you access to several items listed below. The Portal is a place where Providers and Nursing Homes are able to login to view reports for their entity and to submit information.

As your contact information is added to the system, you will receive an e-mail asking you to change your temporary password.

• A Temporary Password will be sent to your e-mail address.
• When you first login, you will be forced to change your temporary password and select your own password.

• If you would like additional staff to have access to the portal, please send Jovonn.Givens@alliantquality.org, the following:
o First Name
o Last Name
o Position or Title
o E-mail Address

1. Access the data including:
a. 30 Day Hospital Readmissions
b. Composite Score
c. Antipsychotic Rate
d. Restraint Rate
e. Pressure Ulcer Rate
f. Falls with Injury
g. ADL
h. Incontinence
 This data is updated on a monthly basis
 In the future, you will receive automated e-mails when the graphs have been refreshed
2. Upload QAPI Self-Assessment Tool through the portal (instead of e-mail or fax)
3. Upload completed PDSAs through the portal (instead of e-mail or fax)
https://pimsportal.alliantquality.org/login.aspx
You may access the portal using the link above ~ then, your user name and password.
Additionally, Alliant will be posting a short “How To” video on the Website ~ coming soon on the Resources Webpage under NH Portal.
Please contact JoVonn Givens at jovonn.givens@alliantquality.org with further questions.

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The North Carolina Directors of Nursing Administration Long Term Care, Inc. (NCDONA) are celebrating 20 years. The 20th Annual NCDONA Multistate Conference will be held at the Hilton Myrtle Beach Resort from September 23-26, 2015. There will be opportunities for multiple continuing education credits for Directors of Nursing as well as Administrators and for the first time, NCDONA will be offering the National Council of Certified Dementia Practitioner (CDP) Course. At the completion of this course, attendees will be eligible to apply for certification. Visit http://ncdonaltc.com/register to register today! Seating is limited so do not wait to reserve yours!

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It is time once again for the NCHCFA “Fabulous 50” awards! This time-honored event provides the opportunity to acknowledge front line, unlicensed personnel who have provided outstanding care. The Fabulous 50 awards program honors individuals who are the backbone in our facilities because of the support they provide to our residents. A panel of judges from the Education and Programs Committee will select ten nominees from each district. Each of the award recipients will be honored at a dinner and awards presentation in their district. The deadline to receive completed nominations is Tuesday, September 1st. Please encourage your facility to participate in this special award program.

The dates for the 16th Annual Fabulous 50 Celebrations are:

District I – October 20, 2015, Grand Bohemian Hotel, Asheville
District II – October 22, 2015, Hilton Charlotte University Place, Charlotte
District III – October 27, 2015, Grandover Resort, Greensboro
District IV – October 29, 2015, Mad Boar Restaurant, Wallace
District V – November 5, 2015 Sheraton Imperial Hotel, Durham

To fill out nomination forms on-line, visit the Member Center of the Association Web site at http://www.NursingHomesNC.com. Click on “News & Updates”, select “2016 Fabulous 50 Nomination Packet” and choose “Survey Monkey”. If you have any questions about the Fabulous 50 awards, call the Association office at (919) 782-3827. Pictures for nominations submitted online may be e-mailed to karenl@nchcfa.org or mailed to the Association office.

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When you have to replace an RN, the average cost is one hundred thousand dollars. By the time you find the right candidate, hire, train, and help them become productive, it could cost 150% of their base salary. It’s a lot less expensive to keep the employees you have, especially in a competitive market!

• Gero Nurse Prep prepares RNs for successful attainment of board certification as Gerontological Nurses, the gold standard of excellence.
• Employer support for continuing education and board certification can increase RN job satisfaction.
• Satisfied, well-trained, and committed RNs provide better quality care.
• RN satisfaction and a supportive workplace are linked to decreased turnover rates.

In addition to staff retention, your support of certification is an investment in your center’s performance, reputation, and residents. To learn more about these and other benefits of the course please go to http://www.geronurseprep.org.

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They say things in Texas are bigger and better. The AHCA/NCAL 66th Annual Convention & Expo is shaping up to be just that, all from historic and beautiful San Antonio. Experience the food, the landmarks, and the fun of this Texas-sized destination, while you network, learn, and enjoy yourself at this must-attend event. This is not just a networking and educational event: this helps AHCA/NCAL further their mission to deliver solutions for quality care. The 66th Annual AHCA/NCAL Convention & Expo is a chance to share your knowledge and learn from your peers, your contemporaries, and experts in long term and post-acute care. The fact that it takes place in San Antonio, one of the southwest’s most colorful and entertaining cities, just makes it even better!

Register now! Additional savings are available when multiple people register from the same facility. There is something for everyone at the 66th Annual AHCA/NCAL Convention & Expo.

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Mark your calendars for this wonderful opportunity to earn CEU’s while hearing from the best about this important topic! This seminar will be held in Greensboro, NC on September 30th, 2015. Brochures will be mailed soon.

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ICD-10 coding will be implemented in just months. Is your facility ready for the transition? Nationally recognized coding expert Karen Fabrizio, RHIA, CHTS-CP, CPRA, AHIMA, Approved ICD-10-CM/PCS Trainer, will help you train with her new, comprehensive ICD-10 coding training manual. Specific to long-term care, this manual gives detailed coding training and how-to guidance for the top diagnoses in the long-term care setting. ICD-10 is a complex new coding set, so it is crucial your facility is prepared.

This book provides:

• In-depth coding how-to for the most commonly documented diagnoses in the long-term care setting
• Guidance on how to properly document and code in ICD-10 to ensure appropriate coding on claims
• Quiz questions, examples, and sample scenarios to help train staff
• A detailed understanding of how long-term care providers in particular can best conquer ICD-10 complexities
• “How to” chapters that focus on each diagnostic area

To order, visit http://www.AHCApublications.org or call (800) 321-0343.

Product #8347
AHCA MEMBERS $149.00

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This DVD, Mobility and Safe Movement of the Elderly, Improving Your Skills to Prevent Injuries and Reduce Falls, by Teepa Snow, MS, OTR/L., FOTA, Dementia Care & Training Specialist, was developed in conjunction with Wake Allied Health Education Center, Durham Technical Community College and the University of North Carolina School of Medicine, Office of Information Systems. The content is formatted in separate segments in order to customize the delivery of content to your learning objective. Handouts developed by Teepa accompany each video and may be reproduced. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org. The price is $35.00 (tax and shipping included).

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Art Enriches Seniors’ Lives – Connecting When Words May No Longer Be Possible

http://www.providermagazine.com/archives/2015_Archives/Pages/0715/Art-Enriches-Seniors-Lives.aspx

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A flamingo can eat only when its head is upside down.

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