|The Latest Wrinkle July 29, 2016|
Not-For-Profit Celebrates 50 Years
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What could be better than a sail on Grand Traverse Bay on a tall ship? How about sailing on Grand Traverse Bay while sampling some of Northern Michigan’s finest wines!
Across the Continuum
Hospitals See Stars!!
Following years of debate, hospitals this week joined other provider groups as individual facility star rankings were first published on the CMS Hospital Compare Website. Star rankings include up to 64 different quality measures including readmissions, condition – specific measures, and patient satisfaction.
Bundled Payment Program Extended
Three new bundled payment models were proposed this week by the Centers for Medicare and Medicaid as part of the goal to better manage care for Medicare A and B beneficiaries. Patients experiencing heart attack and/or cardiac artery bypass surgery will now be included in mandated programs within certain geographic areas. Additionally, the rule includes several proposed changes to the Comprehensive Care for Joint Replacement Model. All care within 90 days of hospital discharge will be included in the episode of care.
High-Alert Medications in Long-Term Care (LTC)
The Institute for Safe Medication recently released its list of High-Alert Medications in Long-Term Care (LTC) Settings. These are drugs that clinicians should recognize as producing a heightened risk for causing significant resident harm when used in error. Common high-alert medications listed include, digoxin, epinephrine, iron dextran, methotrexate, and morphine.
Preparing for 2016 – 2017 Flu Season
Members can remind residents that an annual flu vaccine is the best way to reduce the chances for seasonal influenza that can easily spread to others within a residential setting. The Centers for Disease Control and Prevention (CDC) provides free educational materials that help members limit the risk for becoming infected with the influenza virus including influenza vaccine information statements (VIS).
To prevent the risk of transmission of respiratory infections, infection control measures should be implemented at the first point of contact with a potentially infected person. These should be incorporated into infection control practices as one component of Standard Precautions: Facilities can
Post visual alerts at the entrance of facilities instructing residents/visitors to practice respiratory hygiene/cough etiquette.
Ensure the availability of materials for adhering to respiratory hygiene/cough etiquette including tissues, no-touch receptacles for used tissue disposal and conveniently located dispenser of alcohol-based hand rub where sinks aren’t available.
Offer masks to persons who may be coughing during periods of increased respiratory infection activity in the community. When space and chair availability permit, encourage coughing persons to sit at least three feet away from others in common waiting areas.
Advise healthcare personnel to observe Droplet Precautions (i.e., wearing a surgical or procedure mask for close contact) in addition to Standard Precautions when providing care to a resident who displays symptoms of a respiratory infection, particularly if fever is present. These precautions should be maintained until it is determined that the cause of symptoms is not an infectious agent.
FDA posted Warnings regarding Fluoroquinolone
On July 26, 2016, the U.S. Food and Drug Administration (FDA) issued a MedWatch safety alert regarding the use of Fluoroquinolone drugs for systemic use. This warning includes the following currently available fluoroquinolones:
Cipro extended-release (ciprofloxacin extended-release)
Ofloxacin (generic brand)
The FDA advises Health care professionals to avoid prescribing systemic fluoroquinolones to patients who have other treatment options for acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTI) because risks outweigh the benefits in these patients. Stop fluoroquinolone treatment immediately when a patient reports serious side effects and switch to a non-fluoroquinolone antibacterial drug to complete the patient’s treatment course.
Home Health and Hospice
2017 Home Health Proposed Rule
The 2017 Home Health (HH) Proposed Rule includes many changes to the HH Value-Based Purchasing (VBP) pilot that is in its first of 5 years of a five-year demonstration period.
The demonstration project includes nine states: Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington. The proposed rule includes the following changes:
CMS proposes to calculate the benchmarks and achievement thresholds at the state level rather than at the smaller- and larger-volume cohort level for all model years beginning with CY 2016. This change eliminates increased variation caused by small regional cohorts with few agencies but still allows for inter-state variation related to state regulatory differences.
CMS is proposing to remove the following Quality Measures:
Care Management: Types and Sources of Assistance
Prior Functioning ADL/IADL
Influenza Vaccine Data Collection Period
Reason Pneumococcal Vaccine Not Received
Annual, rather than quarterly data reporting will be allowed for one of the three New Measures, Influenza Vaccination Coverage for Home Health Personnel. Agencies would report on this measure in October 2016 and January 2017 for Program Year 1. For Program Year 2, the first annual submission will be due in April 2017 (specifically, an annual submission in April for the prior 6-month reporting period of October 1-March 31 to coincide with the flu season is the proposed timeframe requirement) and annually in April thereafter. CMS believes that changing the reporting and submission periods for this measure from quarterly to annually would avoid the need for HHAs to have to report zeroes in multiple data fields for the two quarters (July through September, and April through June) that fall outside of the parameters of the denominator (October through March).
Also proposed is an increase in the timeframe for submitting the new measures data from seven calendar days to fifteen calendar days following the end of each reporting period to account for weekends and holidays.
CMS is also considering initiating public reporting for the HHVBP Model beginning no earlier than CY 2019, to allow analysis of at least eight quarters of performance data for the Model and the opportunity to compare how those results align with other publicly reported quality data.
New Hospice Report Available in CASPER Reporting Application
CMS recently announced a new Hospice Quality Reporting (QRP) report titled, “Hospice Timeliness Compliance Threshold Report” that is available to Hospice providers in the Hospice Provider report category in the CASPER Reporting application.
Reconsideration Period for Hospice Quality Reporting
As communicated in a recent Open Door Forum, the Centers for Medicare and Medicaid Services (CMS) mailed notifications to hospices that were determined to be out of compliance with Hospice Quality Reporting requirements for CY 2015 which will affect their FY 2017 Annual Payment Update. These letters were mailed on or before June 29, 2016. Hospices receiving a letter of non-compliance may submit a request for reconsideration to CMS within thirty (30) days after the date documented on the non-compliance notification letter. CMS will not accept any requests submitted after the thirty (30) day deadline. If you receive a notice of non-compliance and would like to request a reconsideration, should follow the instructions within the notification letter. Use this link to learn more about the reconsideration request process.
New Hospice Report Available in CASPER Reporting Application
CMS recently announced a new Hospice Quality Reporting (QRP) report titled, ‘Hospice Timeliness Compliance Threshold Report’. It is available to Hospice providers in the Hospice Provider report category in the CASPER Reporting application. This report displays provider level data regarding Hospice Item Set (HIS) records submitted successfully to CMS. The report displays the following information: Provider identification information, Provider CCN and FAC ID, number of HIS Records Submitted, number of HIS Records Submitted on Time and the percentage of HIS Records Submitted on Time. To learn more see the CMS website.
LARA’s LTC Quarterly Stakeholder Update
The volume of facility reported incidents (FRIs) in Michigan far exceeds the number reported for the other states in CMS Region V, according to Bureau of Health and Community Service Director Larry Horvath. The “algorithm” for what is considered ‘reportable’ developed years ago by the State Agency did not produce the clarity as hoped and providers who believed they were reporting as required often found themselves with citations for not reporting.
SNF Part B Rate Calculator Update
The July 15, 2016 Federal Register includes a rule that updates the Part B Rate Calculator effective 1/1/17 – 12/31/17. When the therapy calculator for the CY 2016 final rule was updated last November, the CY 2016 conversion factor was 35.8279. On 3/8/16, CMS issued a revision to the CY 2016 conversion factor, decreasing the factor from 35.8279 to 35.8043. This change in the conversion factor history has been noted at the bottom of this calculator (line 126). This number is therefore different from the number seen in last year’s calculator. This calculator is accessible via the LeadingAge website.
The new Quality Measures included in the 5-Star NH rating system
There are five new quality measures (QMs) that will be incorporated in the CMS 5-Star Nursing Home Rating System. These new QMs will be phased into the rating system between July 2016 and January 2017. Starting in July they will have 50% the weight of the current measures and in January 2017 they will have equal weight as the current measures. The new QMs are:
MDS Section GG
The revised DRAFT RAI Manual v1.14 was posted in May on the CMS website so users can preview significant changes before they become effective October 1, 2016. Included in this draft manual is a new Chapter 3, Section GG: Functional Abilities and Goals.
Two Michigan PACE programs are celebrating major milestones in their organizations. PACE of Southeast Michigan, which is the first PACE program to open in Michigan (1995), recently surpassed 500 participants. They currently utilize a day center in Detroit and are excited to begin serving participants at their newest center in Southfield. In addition, they have an alternative care setting which serves older adults in Warren.
Unlicensed Assisted Living workgroup
In the interest of keeping members up to date on a fluid process, LeadingAge staff have been participating in a workgroup organized by the Bureau of HealthCare and Community Services (BHCS) with representatives from the other associations to discuss licensure requirements for Adult Foster Care (AFC) providers. Their (BHCS) stated goal was to understand the challenges that providers would experience should new criteria for AFC licensure be adopted as their (BHCS) interpretation of the licensure rules for AFC had veered from previous interpretations. Specifically, the relevance of ‘common ownership’ or ‘relatedness’ of the entities who provide any of the five elements (supervision, personal care, protection, room and board) has been patiently discussed. This workgroup met again on July 26 to receive an update from Director Horvath regarding the Bureau’s position on unlicensed entities who provide the five elements and do not hold a license to operate as an AFC or HFA. The Bureau is exploring various mechanisms that might provide relief for those providers who may face obstacles in complying with the current AFC or HFA requirements such as the Life Safety Codes. The workgroup asked for additional time to review the ‘Resident Board and Care Facilities’ LSCs and will reconvene in two weeks to share thoughts and/or considerations with Director Horvath. If you operate a unlicensed assisted living entity and would like further information about the workgroup activities and/or the life safety code rule set please contact LeadingAge Michigan at firstname.lastname@example.org.
Senate Passed Housing Opportunity Through Modernization Act
As reported by LeadingAge, the Senate passed the Housing Opportunity through Modernization Act (HR3700/S 3083). This is a significant victory for housing advocates and for housing providers as it includes several important reforms such as simplifying deductions for the elderly and people with disabilities, reducing the frequency of interim income reviews, basing rents on a tenant’s actual income in the previous year. The legislation will streamline tenant income determinations and rent setting. The bill will now be sent to the President for his signature.
Section 202 Supportive Service Demonstration Status Update
The U.S Department of Housing and Urban Development (HUD) just announced that a total of 756 applications were received in response to the Notice of Funding Availability (NOFA) for the Section 202 Supportive Service Demonstration for Elderly Households in HUD-Assisted Multifamily Housing that became available in late winter.
Due to the overwhelming response to this NOFA, the application screening stage was lengthened. The application screening stage includes a review of all applications to determine duplication, eligibility and/or completeness. Once the screenings are complete, applicants will be notified in writing should additional information be required or if the application has been found to be technically deficient. If additional information is requested or if members wish to appeal a decision, follow the guidance in the written correspondence, paying particular attention to how the requested information is to be submitted.
In accordance with the HUD Reform Act (24 C.F.R. Part 4, Subpart B), the Department is limited as to the information that may be shared prior to the official award announcement.
HUD has made significant progress in the selection of the contractor that will support the implementation of the Supportive Services Demonstration, and an award of this contract is expected in a few weeks. HUD plans to solicit proposals for the evaluation of the Supportive Services Demonstration in the fall.
Control Costs in the Summer Heat - Two Members Saw How
With the high heat this summer and excessive utility usage, we have published several articles on ways to save on utility costs. This week we want to showcase two members that recently underwent analysis by Academy Utility Consultants for their utilities and relay their savings experience.
Standish Named Executive Director at Friendship Village Senior Living Community in Kalamazoo
Presbyterian Villages of Michigan and McFarlan Announce Management Agreement and Executive Director Selection
UMRC Foundation Receives $2.5 Million Naming Gift for New Wellness and Aquatic Center
The United Methodist Retirement Communities (UMRC) Foundation received a pledge for a naming gift of $2.5 million in support of UMRC’s state-of-the-art health and wellness initiatives for residents from Tom and Debby McMullen of Ann Arbor.
The Tom and Debby McMullen Wellness and Aquatic Center is a major component of UMRC’s Master Plan for growth at Chelsea Retirement Community, its flagship campus, and will feature an all-accessible swimming pool, warm water therapeutic pool, fitness area with specially designed cardio and weight training equipment, walking track, and more. Professionally trained clinical staff and therapists will create individually tailored fitness plans and activities to build and maintain strength and vitality in older adults.
A former swimmer himself, Tom McMullen and his wife are committed to health and fitness. However, they said it is UMRC’s faith-based mission that led them to make this gift to the UMRC Foundation.
Annual Leadership Institute
August 24-26 ~ Grand Traverse Resort, Acme, Mich.
The LeadingAge Michigan 2016 Annual Leadership Institute will once again provide the environment for strategic thinking, reflection, and networking as Michigan’s aging services leaders convene at the Grand Traverse Resort. The educational form includes both the topics and the speakers that will be engaging and thought provoking. We especially look forward to national and state leaders join us for an update on the ever-evolving state of health care and post-acute/long term supports and services.
Enjoy overnight accommodations in the 17-story glass tower guest rooms for panoramic views of Lake Michigan and all three championship golf courses. This event is an exceptional combination of cutting edge education addressing many of today’s current issues, in an environment for the enjoyment and relaxation for you and your entire family. The conference is designed for health care professionals at all levels, finance officers, reimbursement staff, and future leaders.
Click Here for more information and to register.
Become the Medicare leader in your facility with this comprehensive three-day workshop. This in-depth program will help you manage the reimbursement system, navigate audits, avoid risky practices, and stop drowning in confusing and ever-changing regulations.
Modular Education Program for Activity Professionals (MEPAP)
Students are being accepted for fall classes.
For more information and to register, please contact us at email@example.com.
SNF Regulatory Day
During this full-day program, we’ve assembled a faculty of Michigan experts who will guide you through the maze of new and revised rules, policies and procedures. Meet the recently designated State of Michigan Division Directors; Michelle Roepke, Director for the Federal Survey and Certification Division and Teri Dyke, Director for the Health Facility Licensing, Permits & Support Division who will share bureau updates including Facility Reported Incidences and Licensure and Recertification surveys. Teri Dyke and Thomas Bissonnette, State of Michigan Nurse Consultant and Trainer, will discuss recent changes recommended by LARA for TB screening and steps for conducting a TB risk assessment. Tom Katofiasc, Clinical Manager with Omnicare/CVS will present on the components of the new federal requirement to operationalize an Antibiotic Stewardship Program and the proposed Drug Regimen Review quality measure aimed at identifying issues to reduce unplanned hospital readmissions. Laura Funsch, Director of Regulatory Strategy for LeadingAge Michigan will review what surveyors look for when investigating an allegation of abuse or neglect. Amanda Daggett, Director of Nursing for Beacon Hill of East Gate will review a newly created tool that was jointly developed with the Bureau to assist with meeting requirements for conducting a thorough investigation when there is an allegation of abuse or neglect. Margaret Chamberlain, Attorney with Kitch, will review the S & C memos and provide OIG updates.
Nurse Aide Train-the-Trainer Workshops
This program is for licensed registered nurses who are interested in becoming qualified instructors of the Nurse Aide Training Program.
MDS RAC-CT AANAC Certification Workshop
Did you know...you can become RAC Certified in just three days?
The academy is designed to equip new and emerging leaders with the essential insights, knowledge, and skills to directly improve leadership effectiveness.
The academy integrates adaptive and technical learning for a comprehensive training experience. We will focus on what it takes to be a successful and effective leader in today's workplace; specifically within the aging services industry. Each class will provide unique, thought-provoking, opportunities for dialogue with aging services coaches, mentors, and executives. The academy will cultivate your leadership excellence, develop your leadership potential, and assist you in making a positive impact within your organization.
Mark Your Calendars and Plan to Join Us for …
Life Safety Code Training
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