CMS Rescinds Troubling SNF Benefit Policy Manual Language

As reported on AHCA/NCAL’s Long Term Care Leader Blog: On September 16, 2016, the Centers for Medicare and Medicaid Services (CMS) published Transmittal 227 which included updated language to Chapter 8 of the Medicare Benefit Policy Manual that describes Coverage of Extended Care (SNF) Services. The policy update is effective October 18. AHCA responded to CMS on September 26 and cited concerns that new policy language regarding the scope and purpose of Medicare’s post-hospital extended care benefit was confusing and appeared to conflict with existing Medicare law and regulations. The AHCA concerns centered on language pertaining to 1) the 3-day hospital stay requirement, 2) the definition of “skilled” services, 3) the 100-day stay benefit period, 4) the “intensity” of services, and 5) the absence of reference to the SNF as a “practical matter” requirement and “skilled maintenance” services. AHCA requested that the language be rescinded until the various concerns could be addressed. On October 13, CMS published Transmittal 228 that rescinded the language that was of concern to AHCA while maintaining other changes that were not controversial. Additionally, CMS published a revised MLN Matters article MM 9748 that summarizes the policy correction, which includes the following statement: “Language that was initially added by CR9748 in Transmittal R227BP to §20 of Chapter 8, regarding the scope [...]

October 27th, 2016|News, Newsfront, Quality Corner|

AHCA Seeks Injunction Barring CMS Implementation of Arbitration Rule

As reported by AHCA/NCAL: The American Health Care Association (AHCA) took another step this week in its legal challenge against the Department of Health and Human Services recently released Requirements of Participation regulation. The Association has filed both a request for preliminary injunction and a supporting memo. An injunction would bar the Centers for Medicare and Medicaid Services (CMS) from implementing the final rule that bans arbitration agreements in skilled and nursing care facilities. The rule is currently set to go into effect on November 28. The United States District Court for the Northern District of Mississippi will hear arguments related to the injunction on November 3 and a ruling is expected by November 7. “A preliminary injunction is both appropriate and necessary in this situation,” said Mark Parkinson, AHCA President and CEO. “Delaying the implementation of this provision of the rule will allow the court time to examine the legality of the issue.” Last week, AHCA and several skilled and nursing care centers filed a complaint for declaratory and injunctive relief asks that the court find the arbitration provision in the final Requirements of Participation rule unlawful. Plaintiffs include AHCA, the Mississippi Health Care Association, Great Oaks Rehabilitation and Healthcare Center, Heritage House Nursing Center and the Pavilion at Creekwood.

October 27th, 2016|News, Newsfront|

DCH: Suspension of Providers Who Have Not Revalidated Their Enrollment Effective November 1

Effective November 1, 2016, the Georgia Department of Community Health, Division of Medicaid will suspend those providers who were sent revalidation letters from Hewlett-Packard Enterprise (HPE) between June 1, 2016, and September 1, 2016, and have not submitted a revalidation application. As noted in the revalidation letter, DCH allowed providers a period of 60 days to revalidate. Those providers who have not revalidated their enrollment within the 60-day time period will be suspended from the Georgia Medicaid program. Click here to view the full notice from DCH.

October 25th, 2016|News, Newsfront, Reimbursement Corner|

NCAL Advocates on Concerns over HCBS Final Rule Implementation

As reported on AHCA/NCAL’s Long Term Care Leader blog: Last week the National Center for Assisted Living sent a letter to the Centers for Medicare and Medicaid Services (CMS) about concerns on the implementation of the home and community-based services (HCBS) waiver final rule. The rule, published in January 2014, presumes that certain settings are institutional and thus ineligible to provide Medicaid HCBS unless they overcome the presumption during a heightened scrutiny review from CMS. These settings include those in a publicly or privately owned facility that provides inpatient treatment, those located in a building on the grounds of or immediately adjacent to a public institution, or those that have the effect of isolating individuals receiving HCBS from the broader community. NCAL noted concern that the rule could ultimately exclude many AL communities from the Medicaid program. These exclusions would reduce access to this type of home and community-based setting and therefore significantly increase Medicaid expenditures because AL residents would be left with no options other than costlier intuitional settings. NCAL requested more guidance from CMS, specifically on: (1) operationalizing PCC for people with dementia; (2) criteria for AL communities to overcome a heightened scrutiny review for home and community-based settings that are co-located with or adjacent to an institutional setting; (3) CMS’ process for [...]

October 20th, 2016|News, Newsfront|

 NCAL Announces Addition of Assisted Living Measures in LTC Trend Tracker at Convention

As reported by AHCA/NCAL: At the AHCA/NCAL National Convention, the National Center for Assisted Living (NCAL) announced an expanded national effort to demonstrate the profession’s commitment to quality care through data. NCAL added four new assisted living measures to its online data collection tool LTC Trend Tracker: hospital admissions, hospital readmissions, the off-label use of antipsychotic medications, and occupancy rates. “We know our assisted living communities are providing high quality care, but in today’s health care environment, we need to be able to demonstrate it,” said NCAL Executive Director Scott Tittle. “NCAL is proud to grow our assisted living footprint in LTC Trend Tracker to help providers better understand how they’re doing, share that with other health care partners and consumers, and hopefully, get recognized for their amazing work.” The four additional measures bring the total to six for assisted living providers in LTC Trend Tracker. Reports currently exist regarding staffing (calculating turnover and retention) and customer satisfaction. Today’s announcement now gives NCAL member organizations the ability to track their progress on all of the NCAL Quality Initiative goals within one tool. “What sets LTC Trend Tracker apart from other data collection platforms is that our measures are clearly defined, so that everyone is comparing apples to apples,” said NCAL Senior Director of Workforce & [...]

October 20th, 2016|Assisted Living, News, Newsfront|

AHCA/NCAL Elects New Board of Governors, Directors at Annual Convention in Nashville

As reported by AHCA/NCAL: This week, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) elected AHCA’s Board of Governors and NCAL’s Board of Directors for the 2016-2017 term. Tom Coble of Oklahoma was elected for a second term as AHCA Chair, and Christian (Chris) Mason of Oregon was re-elected as NCAL Chair. New to the AHCA Board of Governors were Not-For-Profit Representative Gary Kelso (Utah), Affiliated State Health Care Association Executives (ASHCAE) Representative Dirk Anjewierden (Utah), and At-Large Board Representative Janet Snipes (Colorado). New members to the NCAL Board of Directors include ASHCAE Vice President Veronica Sharpe (Washington, D.C.) and At-Large Representative Gail Sheridan (Minnesota). “We are proud to welcome this distinguished group of leaders to our respective Boards,” said AHCA/NCAL President and CEO Mark Parkinson. “We face many challenges and opportunities in the coming year, and I believe that we can continue to deliver solutions for quality care under Tom and Chris’ leadership.” Coble is CEO of Elmbrook Management Company in Oklahoma. He has been a board member of the Oklahoma Association of Healthcare Providers since 2000 and began serving on AHCA’s Board of Governors in 2011 in various roles. Coble spent over 15 years working in the oil and gas industry prior to entering the long term care profession [...]

October 20th, 2016|News, Newsfront|

American Health Care Association Files Court Challenge to Arbitration Rule

CMS Exceeds Statutory Authority by Banning Pre-Dispute Arbitration Agreements in Updated Requirements of Participation As reported by AHCA/NCAL: On Monday, the American Health Care Association (AHCA) filed a lawsuit against the Department of Health and Human Services challenging the legality of a provision of a recently released regulation. The Requirements of Participation final rule, issued by the Centers for Medicare and Medicaid Services (CMS) on September 29, will prohibit skilled and nursing care facilities from entering into pre-dispute arbitration agreements with residents at their centers, no matter how fair or beneficial those agreements may be to residents. By filing the suit, the named plaintiffs are seeking to enforce rights under federal law, including the Federal Arbitration Act (FAA), to enter into arbitration agreements. The FAA mandates that arbitration agreements can only be changed by Congress. Congress has repeatedly rejected attempts to regulate or prohibit the use of arbitration agreements between nursing care centers and their residents. “We are taking this step to stop what is a clear overreach by CMS. Federal law plainly prohibits CMS from issuing this arbitration regulation,” said Mark Parkinson, AHCA President and CEO. “The merits of allowing individuals in our centers and their families this legal remedy are clear: study after study shows that arbitration is fair and speeds judgments in [...]

October 20th, 2016|News, Newsfront|

Update Following Hurricane Matthew

Last week, Gov. Nathan Deal declared a state of emergency ahead of Hurricane Matthew. Thirty counties were included in the state of emergency and Gov. Deal ordered a mandatory evacuation for six of those counties. GHCA staff worked throughout the storm to ensure that members were prepared and safe. The State of Georgia activated the State Operations Center ahead of the storm and GHCA Emergency Preparedness Coordinator Alexandra Benoit was onsite to assist with the Emergency Support Function 8 (ESF 8). GHCA staff assisted the State Operations Center by calling centers in the six evacuating coastal counties to help coordinate their evacuation plans. Alexandra was on hand at the ESF 8 Transportation Desk to help manage evacuation transportation requests made through the Georgia Emergency Management and Homeland Security Agency (GEMHSA) LTCF Evacuation Transportation Board. Over 2,000 residents and caregivers were safely evacuated during Hurricane Matthew. Following the storm, Alexandra worked with GEMHSA and the Department of Public Health to assist in transportation efforts to return residents and staff back to their respective centers after the affected counties were cleared for reentry. As of October 13, 2016, all evacuated residents and caregivers have returned to their buildings with the exception of one facility that is in the process of repairing damage. GHCA’s Emergency Preparedness Council Coordinators were extremely [...]

October 14th, 2016|Emergency Preparedness, News, Newsfront|

October 13 DCH Board Meeting Recap

On October 13, the Department of Community Health (DCH) held its monthly Board meeting. There was no Commissioner report, as Commissioner Reese was not in attendance. After committee reports, the Board gave final approval to two public notices: Community Behavioral Health Rehabilitation Services State Plan Amendment to add new services for children, youth, and families and expand services New Options Waiver (NOW) Program Amendment to add new rates and services There was no new business for the Board.

October 13th, 2016|News, Newsfront, Reimbursement Corner|

CMS urges providers: Give feedback on functional outcome quality measures for SNFs

As reported on McKnight’s Long Term Care News: The Centers for Medicare & Medicaid Services is seeking providers' comments on recently drafted functional outcomes quality measures for skilled nursing facilities. The proposed measures, published in a report by CMS contractor RTI International late last month, focus on residents' self-care and mobility activities. The measures cover: Change in self-care score between admission and discharge for skilled nursing residents Change in mobility score between admission and discharge for skilled nursing residents Percentage of skilled nursing residents who meet or exceed an expected discharge self-care score Percentage of skilled nursing residents who  meet or exceed an expected discharge mobility score The measures are calculated based on assessment items from the Continuity Assessment Record and Evaluation Item Set, according to CMS. The public comment period on the draft measures began Friday and will remain open until October 28. Comments can be submitted at

October 13th, 2016|News, Newsfront, Quality Corner|