HOPE is Moving

HOPE is moving its office location effective MARCH 1, 2016.  New address:

Hoosier Owners and Providers for the Elderly
101 West Ohio Street, Suite 2000
Indianapolis, IN 46204.
Our phone & fax numbers remain the same.

HFA/RCA Course

June 6, 2016 – July 18, 2016. With the exception of July 4th, the course will be 8 hours per day, Monday through Friday.
Location: 9480 Priority Way West Dr., Indianapolis, IN 46240
For the course registration form, please click here.  For the HFA application instructions, click here.

For more information, please contact Terry Miller 812-470-8256 or tmiller@hoosierownersandproviders.org.

Social Service Designee Course and Activity Director Course

Courtney and Associates is pleased to offer on-site Social Service Designee Course and on-site Activity Director Course.  Click here for more information.

Indiana General Assembly Underway
The Indiana General Assembly began their short session earlier this month.  This is a non-budget year.  The session is likely to be dominated by road funding, ISTEP testing, RFRA, and other issues unrelated to our members’ concerns.  There are two bills that we will be actively working – medical malpractice reform and property tax exemptions for affordable housing.  We will be following other bills and will be active as issues arise.  Click here for a listing of bills we are following. 

PAS/PASRR Redesign Trainings
Indiana has contracted with Ascend Management Innovations (Ascend) to assist with designing and executing the new PASRR process, which will be implemented on July 1, 2016. The Division on Aging is hosting several webinars to introduce the new PASRR system and provide an online demonstration.  The first one was on January 21 but the second will be on January 28. Additional sessions will follow in February and March.  Mandatory trainings will follow in May and June.  Click here to register. 

You can also sign up for the newsletters and updates from the Division of Aging and from Ascend as well as reviewing the PASRR webpage located on the Division’s websites.  Stay current on this project by visiting the PASRR Redesign page on the Division of Aging’s website where you can sign up to receive ongoing PASRR updates. Register for trainings and webinars through the Ascend website.

Karen Gilliland Appointed State Ombudsman
Karen Gilliland has been acting as the Interim State Ombudsman since Arlene Franklin’s retirement in August.  Recently, Yonda Snyder, Division on Aging Director, appointed her to this position permanently. Karen Gardner Gilliland, formerly the Deputy Director of Policy and Planning is now the Director of the State Office of the Long Term Care Ombudsman. 

Karen has been with the Division of Aging for eight years, most recently serving as Deputy Director for Policy and Planning. As a gerontologist, Karen has over forty years of experience in the world of service provision for older adults in both Indiana and Ohio. In May of this year, Karen was the recipient of the Indiana Association of Home and Hospice Care’s 2015 Advocate of the Year Award.

Sen. Pat Miller Announces Retirement Plans
Sen. Pat Miller (R-Indianapolis) has announced plans to retire at the end of 2016 and not run for another term.  She has served Senate District 32 since 1983.  Sen. Miller is the long serving, powerful Chair of the Senate Health and Provider Services Committee.  Virtually all health care related bills needed her support for passage.  Sen. Miller has been a supportive of LeadingAge Indiana issues and was critical in the passage of exemptions for continuing care retirement communities from the Quality Assessment and from moratorium legislation.  It is not known which senator will become the new Health and Provider Services Chair.

Nursing Home Satisfaction Survey Results to be Released in February
Site-specific data from the 2015 Press Ganey nursing facility satisfaction surveys will be distributed to the facilities, hopefully by late February. Yonda Snyder, Division on Aging Director, apologized for the delay to all facilities that have been anticipating this data. There will NOT be webinars about the data; facilities will just receive their data in the same report form that they have in previous years.  State-level data should be available on a similar timeline.  The Division on Aging has let the Press Ganey contract expire and will not be renewing it.

ISDH Provides Annual Informal Dispute Statistics
The Indiana State Department of Health has provided statistics on the number and results of informal dispute resolution requests for 2015 for both comprehensive and residential care facilities.

IDR requests: In 2015 there were IDR requests for 116 survey reports with 193 tags.

Changes in tags resulting from IDR
66.84%  No change (last year 68%)
16.06%  Tags removed (last year 15%)
7.25%  Scope and severity (s/s) changes (last year 3%)
6.22%  Example removed (about the same as last year)
0.0%    Tag change (last year 1.25%)
6.22%   s/s change / example removed (last year .83%)

33.16% of requested reviews had some kind of change.

Type of review
57.76% were paper reviews (last year 61.29)
42.24% were face to face reviews (last year 38.71)

Scope and severity of requested reviews
s/s J-L— 3.36%  (last year 2.92%)
s/s G-I— 26.42 (last year 16.25%)
s/s D-F— 56.99%  (last year 69.58%)
s/s A-C— 6.74%  (last year 6.67%)
s/s G-L— 30.05% (last year 19.17%)

IIDR was not included in the above statistics.  Here is the information about the independent informal dispute resolution requests:

3 in 2012;
2 in 2013;
3 in 2014;
1 in 2015.

There have been no changes in any of the IIDRs. In 2014, the IIDR contractor recommended a change in one tag. The recommendation was rejected by CMS.

Indiana RUG-IV Transition
The Office of Medicaid Policy and Planning (OMPP) is transitioning Indiana's Medicaid nursing facilities
from a RUG-III 34-classification group to the RUG-IV 48-classification group based reimbursement system.

Please note the items below in regards to the transition:

1. All MDS assessments will be classified in the RUG-IV 48-group beginning January 1, 2016
2. MDS assessments with an Assessment Reference Date (ARD) on or after January 1, 2016 will be reviewed in accordance with the RUG-IV 48-group Supportive Documentation Requirements (SDR)
3. First quarter of 2016 CMI Resident Roster reports will reflect RUG-IV 48-group
4. Rate effective July 1, 2016 will reflect RUG-IV 48-group

The revised Time-Weighted CMI Resident Roster User Guide or the 48-Grouper is now available at in.mslc.com. Direct any questions to our Help Desk at 317-816-4122.

ISDH Announces New Division of Healthcare Education and Quality Director
The Indiana State Department of Health (ISDH), Health Care Quality and Regulatory Commission, is pleased to announce the selection of Janelyn Kulik, RN, as Director for the Division of Healthcare Education and Quality.  Ms. Kulik will begin her new responsibilities on January 11.

The Division of Healthcare Education and Quality is one of five divisions in the Healthcare Quality and Regulatory Commission. The Division Director is responsible for the surveyor training program and is the lead trainer for the long term care survey programs. The Division Director also has responsibility for the aide education and registry programs. 

Jan graduated from Purdue University in 1985 with a Bachelor Degree in Retail Management and then continued her education for a year at Texas Women’s University in Denton, Texas. Jan returned to school in 1992 at Bowling Green State University in Bowling Green, Ohio. Jan earned a Bachelor Degree in Nursing from Bowling Green in 1996 and is a Registered Nurse.

From September 2007 to September 2011, Jan worked at the Indiana State Department of Health as a Public Health Nurse Surveyor in the Division of Long Term Care. Since September 2011, Jan has served as a Public Health Nurse Surveyor Supervisor for Area 1 in Northwest Indiana. Jan previously worked in physician offices in pediatric, internal medicine, and orthopedic nursing.

Summary of Indiana Residential Survey Tag Report for December 2015

The most frequently cited residential tags for December 2015.

Definitions of Indiana Residential Tag classifications:
Offense:  Substantial probability that death or a life –threatening condition will result.  Requires immediate correction.
Deficiency:  Immediate or direct, serious adverse effect on the health, safety, security, rights, or welfare of a resident.
Noncompliance: In-direct threat on health, safety, security, or rights of a resident.

For the month of November 2015 the cited Offenses were:

 

Tag Cited	# of Facilities Cited	Category	Description
R0002	1	Scope of Residential Care- Offense	A residential care facility may not provide comprehensive nursing care except to the extent allowed under this rule.
R0241	2	Health Services- Offense	The administration of medications shall be ordered by the resident’s physician and shall be supervised by a licensed nurse on premises or on call.  Medication shall be administered by licensed nursing personnel or qualified medication aides

Frequently Cited Deficiencies in December 2015:

Tag Cited	# of Facilities Cited	Category	Description
R0053	2	Residents’ Rights -Deficiency	Residents have the right to be free from verbal abuse.
R0217	2	Evaluation-Deficiency	Completion of an evaluation, the facility using appropriately trained staff members, shall identify and document the services to be provided by the facility.
R0243	2	Health Services-Deficiency	The individual administering the medications shall document the administration in the individual’s medication and treatment records that indicate the: time, name of medication or treatment, dosage, and Name or initials of person administering the drug or treatment.
R0273	10	Food and Nutritional Services-Deficiency	All food preparation and serving areas are maintained in accordance with state and local sanitation ,including 410 IAC 7-24

The following tags were cited at least once at a deficiency level in the month of December 2015:  R0029, R0055, R0117, R0144, R0145, R0148, R0298, R0302, and R0414.
Number of Offense Tags cited:       3
Number of Deficiency Tags cited:   25
Number of Residential Tags cited:   28

IMPACT Act Connecting Post-Acute Care across the Care Continuum Call

CMS will be holding a call on Feb. 04, 2016 on the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 which requires the reporting of standardized patient assessment data by Post-Acute Care (PAC) providers, including skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals. It specifies that data elements must be standardized and interoperable to allow for the exchange and use of data among these PAC and other providers, including common standards and definitions to facilitate coordinated care and improved beneficiary outcomes.

During this call, CMS subject matter experts and the Office of the National Coordinator for Health IT discuss the implications of the IMPACT Act for health information exchange across the care continuum.
Agenda:

• Requirements to standardize and make interoperable post-acute care assessment data elements
• Using and exchanging clinically relevant assessment data for multiple purposes
• Health Information Technology Standards - A Primer
• CMS Data Element Library
• Electronic health information exchange

Target Audience: Providers across the care continuum, including long-term/post-acute care and home and community-based service providers, acute and primary care providers, integrated delivery systems and representatives from other payment models, health IT vendors, and other interested stakeholders.
Continuing education credit may be awarded for participation in certain MLN Connects Calls. Visit the  to register.

MedPAC Recommends Nursing Home Rate Freeze
The Medicare Payment Advisory Commission (MedPAC) voted to approve a series of recommendations to Congress that include freezing reimbursement rates for skilled nursing facilities. Other changes included in the recommendations were implementing Medicare’s first pay-for-performance policies, reducing reimbursements to hospitals, and freezing home care and hospice reimbursement rates.

In its draft recommendations in December, MedPAC demonstrated double-digit profit margins for home care agencies and skilled nursing facilities, as well as data which suggested there was sufficient access to care, volume of service, quality of care and other factors that imply current payment levels are adequate. MedPAC also reiterated its recommendation that the skilled nursing facility prospective payment system (PPS) be revised to eliminate inherent biases. To read more on the recommendations, click here

November OIG Exclusion List Available with New Format
The Office of the Inspector General (OIG) has released is November update to the List of Excluded Individuals/Entities (LEIE), which include newly excluded individuals and entities as well as reinstatements. Members who participate in Medicare or Medicaid programs are prohibited from employing or contracting with a person or vendor listed on the OIG exclusion list, and should take the time to review this list each month.

The November 2015 updates are posted to the OIG website.  An archive of updates from prior months is also available. With the November 2015 update, OIG announced it will begin a three-month transition toward offering this data in a new file format. The current downloadable files are offered in DBF format and contained within self-extracting/compressed files (EXE and ZIP). OIG will now offer raw data in comma-separated value (CSV) format, which is currently contained in a TXT file. All fields and data within the files remain the same. The new CSV format will be replacing the previous formats.

To ease the transition over the next three months, OIG will continue offering the previous file formats along with the new format. It will eliminate the DBF, EXE and ZIP files in February 2016. While the DBF files are still available, the agency strongly recommends downloading the CSV-formatted file and testing it in your software environment. OIG invites providers to report any issues to the following email address which has been set up specifically to receive feedback about your experience: leie.update@oig.hhs.gov.

IRS Gives Employers More Time For ACA Reporting
John Barlament and Sarah Fowles, Quarles and Brady
On December 28, 2015, the IRS issued guidance extending the deadline for providing new Affordable Care Act tax forms to employees and to the IRS. This guidance provides a bit of breathing room to employers with 50. However, it does not remove the reporting obligations; large employers still need to focus quickly on these new rules. To learn more, go to http://www.quarles.com/publications/happy-new-year-irs-gives-employers-more-time-for-aca-reporting/

Employer’s Requirement that Employees Submit to Wellness Program or Lose Health Insurance Does Not Violate ADA
A federal district court in Wisconsin has dealt a blow to the Equal Employment Opportunity Commission (EEOC) and the future of its proposed wellness program regulations. The court held that that the employer did not violate the Americans with Disabilities Act (ADA) by requiring its employees to participate in a wellness program, including undergoing health risk assessments and biometric screenings, as a precondition of participating in the employer’s health insurance plan. (Sesco Management Consultants)

CMS Call on the IMPACT Act
On Thursday, February 4 from 1:30 to 3 pm ET, CMS will host a call on the standardized assessment required in the IMPACT Act. The Improving Medicare Post-Acute Care Transformation (IMPACT Act of 2014) requires the reporting of standardized patient assessment data by Post-Acute Care (PAC) providers, including skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals.  To register for this call, visit MLN Connects Event Registration.  Space may be limited, register early.

New MedPac Recommendations
The Medicare Payment Advisory Commission (MedPAC) met on January 14 and 15. Of particular interest to LeadingAge members were votes on recommendations for updating payments, along with discussions of the Medicare Advantage program and developing a unified payment system for post-acute care. All of the presentations are available. To learn more, click here.

CMS Infection Control Pilot
A new pilot program launched by the Centers for Medicare & Medicaid Services will place more emphasis on infection control in nursing homes starting in fiscal year 2016. The three-year infection control pilot program seeks to improve infection control and prevention assessments for nursing homes, hospitals and care transitions between the two. The program will begin with 10 pilot surveys conducted in nursing homes with an expansion in FY 2017 and FY 2018 impacting both nursing homes and hospitals.
Read the CMS memo here.

CMS Announces Infection Control Pilot Project
The Centers for Medicare & Medicaid Services (CMS) has announced a three-year pilot project to improve assessment of infection control and prevention regulation in nursing facilities. 

The initial phase of the pilot will extend from early next year through Sept. 30. During that time a total of 10 educational pilot surveys will be conducted in nursing homes throughout the United States. From Oct. 1, 2016 through Sept. 30, 2018, an unspecified number of additional surveys will occur in nursing homes and hospitals.

CMS describes the scope of work as follows: “CMS will use a national contractor to perform educational pilot surveys. While no citations will be issued, if an Immediate Jeopardy deficiency is noted, a referral to the CMS Regional Office will be made. The surveys will provide nursing homes and hospitals with guidance on improving infection prevention within their catchment area. … After the survey findings are determined, a team of infection control professionals will use those survey findings to develop an action plan for improvement and to organize on-site technical assistance.”

Estimating that one to three million serious infections occur every year in care centers, CMS notes a “clear need to assess the continuum of infection prevention efforts between hospitals and nursing homes in order to prevent transmission of infections in both settings.”

CMS Issues Final Rule on Adequacy of Medicaid Payments to Providers
The Centers for Medicare & Medicaid Services released a final rule that provides guidance for states about creating a clear and evidence-based process to ensure Medicaid payments are adequate to attract enough providers to assure access to services for beneficiaries. To learn more, go here.
 

5 Wound Care Myths that need to go away:
The field of wound care has come a long way.  Unfortunately, there are still some wound care myths out there that just refuse to die.  Click here for five of the most frequent incorrect statements we still hear about out in the field.
 

Skin Tears:  Prevention and Management
Skin tears are a common occurrence with institutionalized adults, and often lead to the further complications.  A reported 1.5 million skin tears occur in this population each year, and that doesn’t include unreported incidents occurring at home.

Prevention is a critical element with skin tears, and education is a key component in a successful preventative or treatment program.  For more information on skin tears, click here.