UPDATE Weekly

The current federal budget law (31 U.S.C. § 1105(a)) requires that the President submit the budget between the first Monday in January and the first Monday in February. The President’s budget is a blueprint which contains legislative proposals Congress may or may not take up as well as administrative proposals which government agencies, such as the U.S. Department of Health and Human Services, may implement without legislation using their administrative authority.

Below are key elements from the budget blueprint. For a detailed overview of the proposals excised from the proposal, click here. Please note the descriptions are directly from the budget proposal.

Medicare

• Address “Excessive Payment” for Post-Acute Care Providers by Establishing a Unified Payment System Based on Patients’ Clinical Needs Rather than Site of Care
• Reduce Medicare Coverage of Bad Debts
• Expand Basis for Beneficiary Assignment for Accountable Care Organizations
• Allow Accountable Care Organizations to Cover the Cost of Primary Care Visits to Encourage Use of the Accountable Care Organization Providers
• Repeal the Independent Payment Advisory Board
• Expand Prior Authorization to Additional Medicare Fee-for-Service Items at High Risk of Fraud, Waste, and Abuse
• Eliminate Excessive Payment in Medicare Advantage by Using Claims Data from Patient Encounters
• Implement a More Accurate Payment System for Home Health [Note: Due to the inclusion of home health payment reform the recently passed Continuing Resolution, it is unclear how this provision will be addressed.]

Medicaid

• Support for the Graham-Cassidy-Heller-Johnson legislation which would implement Medicaid per capita caps or block grants beginning in FY 2020
• Expanded State Section 1115 Medicaid Waiver authority which would foster state level Medicaid reform
• Streamlined and permanent Medicaid managed care authority for states
• Improve Data Collection on Medicaid Supplemental Payments
• Prohibit Medicaid Payments to Public Providers in Excess of Costs
• Reduce Medicaid eligibility by lowering allowing home equity

The proposal also includes an array of new program integrity provisions with provider implications. Of the proposals, the unified post-acute payment system and Medicaid reform are the most concerning. However, the Centers for Medicare and Medicaid Services would need legislative authority for both as well as the Medicare Bad Debt proposal.

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As you are probably aware by now, late last week, both houses of Congress passed a budget deal enacted by the President that provides short-term funding to keep the government open through March 23, 2018, and establishes a two-year budget framework. One very important provision in the deal that immediately impacts residents of nursing facilities is the permanent repeal of the Medicare Part B outpatient therapy caps. This article outlines the major provisions impacting Part B therapy contained in the new law.

First, this law permanently removes the risk of dramatically reduced revenues when the caps were enforced. Second, while we are disappointed that Congress again imposed a Part A market basket cut to help pay for the Part B therapy cap repeal provisions, this law permanently removes the recurring risk for future payment cuts to pay for 1-2-year extensions of the cap exceptions process that we have experienced over the past decade. Finally, and most importantly, this law now assures that nursing facility residents can receive necessary and uninterrupted physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services to improve or maintain their function and quality of life.

What’s in the New Law That You Need to Know and Share with Billing and Therapy Staff

• Therapy caps have been repealed – This means there are no longer any artificial annual limits.
• The repeal is retroactive to January 1, 2018 – This means that if you had any residents that had claims denied because they went over the $2,010 cap threshold in 2018 so far, you should be able to resubmit the claims for payment. This should also apply to Medicare Advantage denials as these plans must offer comparable coverage (we are awaiting specific CMS guidance for such situations).
• You will still need to submit a KX modifier on claims for any beneficiary services furnished over $2,010 annually for PT and SLP services combined, and over $2,010 annually for OT services separately – This modifier is being used as an attestation of medical necessity. Claims over $2,010 annual thresholds will be denied for noncompliance with this coding requirement.
• CMS will restore a targeted medical review program for a limited number of claims over a $3,000 annual threshold – Congress authorized a $5 million annual limit for CMS to conduct limited post-pay medical review, and only on claims that meet specific targeting criteria (such as a pattern of high costs within similar patient populations or similar types of providers).
• The calendar year (CY) 2019 Fee Schedule Update for part B therapy HCPCS billing codes will be 0.25% – In the prior 2014 MACRA “Doc Fix” legislation, Congress had locked in a fee schedule increase of 0.5% for CY 2019. This law has reduced that increase by 0.25%, which we estimate to average about a $350 impact on payments per SNF in 2019 (depending on Part B volume).
• Starting in CY 2022 the reimbursement for Part B therapy services furnished by PT assistants and OT assistants will be reduced by 15% – This law does not change reimbursement for Part A SNF PPS services furnished by PT or OT assistants – it only impacts Part B billing. SNFs with no therapy assistants will not be affected.

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The Centers for Medicare & Medicaid Services (CMS) has posted a revised SNF ABN form along with instructions at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/FFS-SNFABN-.html. The revised SNFABN has the requirements from the denial letters and looks very similar to the ABN with 3 different options. CMS will be discontinuing the 5 SNF Denial Letters and the Notice of Exclusion from Medicare Benefits – Skilled Nursing Facility (NEMB-SNF). Since the NEMB-SNF was used as a voluntary notice for care that is never covered by Medicare, CMS will continue to encourage SNFs to issue the revised SNFABN in this voluntary capacity. Chapter 30, Section 70 of the Medicare Claims Processing Manual revisions will be forthcoming. The revised SNFABN will be mandatory for use on May 7, 2018. During the interim, SNFs may continue to use the old version of the SNFABN, the Denial Letters or the NEMB-SNF, however, it is recommended that the revised SNFABN be used as soon as possible.

The revised SNFABN and the form instructions may be located at http://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html.

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Last week, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) launched a new Website to help long term and post-acute care providers administer CoreQ.

The Website includes new resources such as a CoreQ Technical Manual as well as a list of customer satisfaction vendors that have adopted CoreQ and can upload member CoreQ data to LTC Trend Tracker.

As LTC Trend Tracker Users, AHCA/NCAL has the following updates and reminders for you as you upload your CoreQ data:

• For the Assisted Living Measures upload file and all CoreQ upload files (Assisted Living, Long-Stay Skilled, and Short-Stay), they have updated the year column to reflect 2018. Please make sure to download the updated version from LTC Trend Tracker and that you are using the correct file.
• If you are uploading your CoreQ data, make sure to ask your vendor if they will upload it on your behalf.
• Remember to visit the LTC Trend Tracker Resource Center here to access how-to videos and documents to help you upload your data.

If you have any questions or concerns regarding LTC Trend Tracker, please let AHCA know at help@ltctrendtracker.com.

For additional assistance regarding CoreQ, e-mail coreQ@ahca.org.

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NCHCFA is adding a new benefit of membership in 2018—a monthly Lunch and Learn Webinar Series. NCHCFA will offer a one-hour Webinar on a timely and relevant topic to its members for no additional charge. There will be no CEUs offered for these Webinars. Information on topics for the year will be available in the coming weeks.

The next Webinar in the series is scheduled for February 15, 2018, from 12 noon-1:00 PM. Mark your calendar today! Webinar details are below:

Title: Using the Composite Measures to YOUR Advantage
Presenter: Alliant Quality (QIN-QIO for Georgia and North Carolina)

This Webinar will focus on utilizing composite measures as an important tool to monitor quality improvements and outcomes in nursing homes. The calculator can help nursing homes identify specific areas for improvement among 13 long-stay quality measures that comprise the composite score. Alliant Quality will focus on opportunities for improvement with the various quality measures and discuss best practices for successful outcomes.

Make sure that you are on a sound-enabled computer with speakers. Please register for the event prior by clicking here! You will use this same link to join at Noon tomorrow.

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American Health Care Association (AHCA) LTC Trend Tracker (LTCTT) users should be on the lookout for “Your Top-Line” quarterly report, which will be sent from AHCA on February 21st. Find out more here about this resource.

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Since January 1, 2018, NCHCFA has allowed Assisted Living Facilities (ALFs) in North Carolina to join the National Center for Assisted Living (NCAL) through NCHCFA’s affiliation with AHCA/NCAL. Any ALF that elects to join NCAL will be a member facility of NCAL but will not be a member of NCHCFA.

If an ALF wishes to join NCAL, please e-mail Karen Lennon for membership dues information at KarenL@nchcfa.org or phone at (919) 782-3827.

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To be as successful as possible, Not for Profit organizations, especially trade associations, rely heavily on the volunteer time of its membership. One important way to make a difference is by serving on one of NCHCFA’s committees. Members have until February 15, 2018 to volunteer to serve on one of NCHCFA’s committees.

All committee assignments are for a two year term beginning at the time of appointment and ending February 29, 2020. Appointments are made by the Chair of NCHCFA’s Board of Directors. Except for the Associate Advisory Committee, only representatives from operators of member facilities in good standing are eligible to serve. Committees generally conduct two in-person meetings per year and others as needed by conference call. When submitting your request please choose more than one committee and make selections in order of preference. Please see below.

Individuals who serve on NCHCFA committees are leaders in the Association and are asked to lead by example. This includes committing to participate in committee activities and joining the NCHCFA Political Action Committee (PAC). All committee Chairs do strive, however, to be respectful of committee members’ time and busy schedules. Members currently on committees will need to go through the sign-up process again.

You have several options for turning in your committee sign-up form:

1. Submit on-line at https://www.surveymonkey.com/r/NCHCFACommittees
2. E-mail your form to Karen Lennon at the Association office at KarenL@nchcfa.org
3. Fax to (919) 787-8418

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This book offers Certified Nursing Assistants (CNA) the support of trained and experienced mentors to guide their way as they develop into quality health care professionals. Implementing this program can help you reduce your facility’s CNA turnover rate, save money and build a more competent staff. You’ll have happier residents and a higher quality facility as a result!

To order, visit http://www.AHCApublications.org or call (800) 321-0343. Fax orders may also be placed at (800) 869-5605.

Product #6706
AHCA MEMBERS $59.95

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If you were unable to attend one of our sessions on the Requirements of Participation Phase 2 and the New Survey Process, the notebook used in the training is now available for purchase. Email Donna Snyder to order a notebook for your facility at donnas@nchcfa.org. The cost is $25.00 plus tax and shipping.

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My Grandmother Found The Love Of Her Life At Ninety

Huffington Post Article

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Some farmers routinely feed red Skittles to their cattle, because it’s a cheap alternative to corn.

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