This week, GHCA President and CEO Tony Marshall and GHCA VP for Government Affairs Russel Carlson joined GHCA Chairman Harve Bauguess in hosting House Majority Leader Jon Burns (R-Newborn) and Senator Jesse Stone (R-Waynesboro) at Syl-View Health Care Center, his facility in Sylvania, GA. During the visit, the legislators toured the facility and held a meet and greet with the families and residents. Rachel Eggleston, Administrator of the facility, conducted the tour.
As reported on AHCA/NCAL's Provider Daily newsletter: The Miami Herald (9/19, Veciana, 776K) reports that a Medicare rule which “allows private health insurance companies to enroll individuals who become eligible for Medicare into their Medicare Advantage coverage is costing surprised patients lots of money.” Under the rule, called a “seamless conversion,” Medicare Advantage plans can automatically enroll seniors who become eligible for coverage. Insurers are required to notify beneficiaries in writing, and give them the option to opt out within two months, but many seniors who are unaware of this option throw away the letters, and only find out when they receive bills from physicians or hospitals. CMS has yet to release a list of insurers which are approved to enroll seniors in this way, and in the meantime, “consumer advocates are demanding more transparency from CMS and the health insurance companies.”
GHCA Staff Meets with Gov. Deal Senior Staff Member On Monday, President & CEO Tony Marshall, VP for Government Relations Russel Carlson, and VP of Reimbursement Hope Hickman, met with Governor Nathan Deal’s Deputy Chief of Staff for Policy, Katie Childers. They discussed potential 2017 legislative issues primarily concerning funding. GHCA Staff Attends Fundraiser for House Rules Chairman On Monday afternoon, VP for Government Relations Russel Carlson represented GHCA at a fundraiser for House Rules Chairman John Meadows (R-Calhoun). Numerous House members were in attendance, including Speaker David Ralston (R-Blue Ridge). GHCA Staff Accompanies Legislators to Member Facilities in Southeast On Wednesday, President & CEO Tony Marshall and VP for Government Relations Russel Carlson spent the day in Southeast Georgia with Senate Appropriations Chairman Jack Hill (R-Reidsville) and House Health Appropriations Chairman Butch Parrish (R-Swainsboro). Chairman Hill and Chairman Parrish joined Russel and Tony on a visit to PruittHealth – Swainsboro. There they were joined by GHCA PAC Committee Chair Sarah Ralston. Chairman Hill went on to join Russel and Tony in Statesboro to visit Heritage Inn and Eagle Health and Rehab.
Summary of Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
AHCA has provided a summary of the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers rule that was released by CMS last week: Members Impacted These include Skilled Nursing Facilities (SNF), Nursing Facilities (NF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). This final rule is not applicable to Assisted Living Providers. The rule was released on Friday, September 16, 2016, and can be found here. Introduction The four main components of the requirements are consistent with the National Preparedness Cycle. The emergency plan, policies and procedures, communication plan and the training and testing program all must be reviewed and updated at least annually. Annual reviews will allow a center to identify gaps and areas for improvement to the center's emergency plan. Policies and procedures are to be based on the emergency plan, risk assessment, and the communication plan. The policies and procedures will operationalize a center's emergency plan. Components of the final requirements focus on an integrated response during a disaster or emergency situation. Surveyors will be provided training on the emergency preparedness requirements and interpretative guidance will be developed for each provider and supplier types. Below is an overview of the six main components of the rule with suggested next steps for providers to take to help prepare for [...]
This month, GHCA offered advanced MDS training. At the end of the course, participants had the opportunity to take a certification exam. Of the twenty-six attendees who took the exam, there was a 92% pass rate! We applaud these nurses' commitment to professional development and appreciate center leadership’s commitment to the development of those who are responsible for this critical area of clinical and performance excellence. Thank you to the team of subject matter experts, led by Andrea Jersey, RN NACC RAC- CT, who dedicated their time and expertise to support this certification training.
As reported on McKnight’s Long Term Care News: The average length of a skilled nursing facility stay dropped 1.3 days for patients who underwent orthopedic surgery through the Bundled Payments for Care Improvement initiative, according to a new federal report. The report, prepared for the Centers for Medicare & Medicaid Services by healthcare policy research firm the Lewin Group, is the second annual evaluation of the BCPI program's impact on care costs and quality. Click here to view the report. Click to read full article.
New palliative care research out of Brown University has determined that palliative care consultations in nursing homes lead to less burdensome care, fewer rehospitalizations, better pain management and do not cost the system more. The research findings were released this week in the Journal of the American Geriatrics Society. Click here to view. For more information, click here.
This week, the Department of Health and Human Services Office of Inspector General, in conjunction with CMS, published a proposed rule in the Federal Register that would update the Medicaid fraud program. This proposed rule would amend the regulation governing State Medicaid Fraud Control Units (MFCUs or Units). The proposed rule would incorporate statutory changes affecting the MFCUs as well as policy and practice changes that have occurred since the regulation was initially issued in 197. These changes include a codification of OIG’s delegated authority, MFCU authority, functions, and responsibilities; disallowances; and issues related to organization, prosecutorial authority, staffing, recertification, and the MFCUs’ relationship with Medicaid agencies. Click here to view the proposed rule.
The Centers for Medicare and Medicaid Services (CMS) has revised its quick reference chart designed to educate on short and long descriptors for each of the 42 non-payable functional G-codes. Click to view. The Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012 amended the Social Security Act to require a claims-based data collection system for Medicare Part B outpatient therapy services, including physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. The system collects data on beneficiary function during the course of therapy services to better understand beneficiary conditions, outcomes, and expenditures. Beneficiary function information is reported using 42 nonpayable functional G-codes and seven severity/complexity modifiers on Part B therapy claims for PT, OT, and SLP services. SNF billers and therapists are encouraged to review the revised reference chart.
As reported on AHCA/NCAL’s Long Term Care Leader Blog: The Centers for Medicare and Medicaid Services (CMS) Supplemental Medical Review Contractor (SMRC) recently announced that they have initiated a special medical review study of SNF Medicare Part A Therapy Services. Per the SMRC website, Project Y4P0432 – Skilled Nursing Facility (SNF) Therapy Services (08/11/16) was requested by CMS based upon the findings of a recent Office of Inspector General (OIG) report entitled Skilled Nursing Facility Billing for Changes in Therapy: Improvements are Needed, OEI-02-13-00611. In this study, the OIG evaluated how SNFs utilized three new Minimum Data Set (MDS) patient assessments that were implemented in FY 2011 and 2012 to better reflect the amount of therapy provided. The new assessments better capture when beneficiaries start therapy, end therapy, and decrease or increase therapy significantly enough to impact the Resource Utilization Group (RUG) payment case mix. In the report, published June 2015, the OIG suggested that some SNFs may be using the new assessments incorrectly, which could result in improper payments. Per the SMRC website, as directed by CMS, Strategic Health Solutions will conduct post payment medical review of the SNF Therapy services. The details of how many SNF providers will be reviewed was not provided. However, the SMRC did provide a link to an example [...]