FSSA/Medicaid to Hold Rebalancing Summit; Status of Rebalancing Plan Still Up in Air
HOPE has received notice of a rebalancing summit to be held December 16. Entitled Rebalancing for the Future, A Forum on Long Term Care in Indiana, the forum will be held at the University of Indianapolis. You can register to attend here. One session is about the state’s rebalancing plan but this plan has not been released yet. Given the speakers and titles of the sessions, we have concerns that this maybe a push for risk-based managed care for the dually eligible (Medicare/Medicaid). HOPE strongly opposes managed care for this population.

Transition from IndianaAIM to MMIS
On February 29, 2016, FSSA is expected to transition their claims processing system from IndianaAIM to CoreMMIS. Along with the processing system, FSSA will also transition filing claims from interChange to the Provider Healthcare Portal (Portal).

Press Ganey Survey Results to be Released Soon
Yonda Snyder, Director of the Division of Aging, has let HOPE know that the results of the Press Ganey surveys of residents, family and staff should be released soon. They will not be holding a webinar to go over the results this year, and the survey process will not be continued in 2016.

IHCP will Mass Adjust Nursing Facility Claims Denied Incorrectly
The Indiana Health Coverage Programs (IHCP) has identified an eligibility issue that affected certain claims billed for long-term care (LTC) facility residents whose level of care (LOC) status had not yet been entered into the claims processing system. LTC claims for affected members processed April 1, 2015-October 28, 2015 may have inappropriately denied with an explanation of benefits (EOB) 2042 – Member enrolled in HIP or Hoosier Care Connect.

ISDH Surveyors Receive Infection Prevention Guidance
In October, Indiana State Department of Health long term care surveyors attended an infection control and prevention update. Information on infection control and prevention from the Advanced Education Project Infection Prevention Course was provided. In addition, an update on hand hygiene, standard precautions, use of personal protective equipment (PPE) and environmental cleaning were included. Surveyors will be following guidance from:
How to Handwash?
How to Handrub?
5 Moments for Hand Hygiene
Sequence for Putting On / Removing PPE

Reporting of Medicaid Managed Care Days on the Nursing Facility Cost Reports
Medicaid recently informed HOPE that they will be instructing nursing facility providers to report their Medicaid Managed Care (HIP, HIP2, Hoosier Care Connect) days as Medicaid and make no coding distinctions between FFS and MMC on their MDS records. There will be no changes in the cost report forms at this time.

IU Nursing Professor Receives $2.2M Grant to Evaluate End-of-Life Planning Tool
The National Institute of Nursing Research has awarded $2.2 million to an IU School of Nursing professor at Indiana University-Purdue University Indianapolis to evaluate the use in Indiana nursing homes of a new advance-care planning tool created to help ensure that patients' end-of-life treatment preferences are honored. The research will provide information about how well the Physician Orders for Scope of Treatment (POST) tool reflects patients' treatment preferences and how well patients understand the orders they are choosing.

New Indiana POST Video
The Indiana Physician Orders for Scope of Treatment (POST) video is now available for your use at www.indianapost.org. This nine-minute video is appropriate for health care providers, as well as patients and families.

Division of Aging Sends PAS/PASRR Report to the General Assembly
Senate Enrolled Act 465 established a sunset date of June 30, 2016 for Indiana Preadmission Screening Program and required that the Division of Aging meet with stakeholders to create recommendations for a replacement approach and provide these recommendations to the Indiana General Assembly by November 1, 2015. The Division has released this report which can be found here.The report describes the new Level 1 system using the Ascend software platform which should significantly speed up these determinations and focus them only on Medicaid beneficiaries.

Washington Update
The following details outline the budget deal Congress recently passed as they relate to issues impacting members. This measure is mostly good news, as it averts a government shutdown by raising the debt limit until after next year’s election. Government shutdowns have not been good for our members who get paid under public programs.

Overtime Threshold Rule Coming in 2016
The U.S. Department of Labor’s final rule on overtime eligibility won’t go into effect until late 2016. As previously reported, this rule would increase the salary cap for who is eligible for overtime pay from $23,600 per year to $50,400 per year and automatically increase it every year to prevent the level from becoming outdated. The delay is due to the complexity of the change and the large volume of comments the proposal drew. Approximately 270,000 individuals and organizations submitted comments on the proposed change—more than three times the amount received when the rules were last modified in 2004.

CMS Recently Held Open Door Forum on IMPACT ACT
On October 21, 2015, CMS held an Open Door Forum (ODF) to discuss the IMPACT Act. The ODF provided a high level overview of the purpose of the IMPACT Act, such as escalating costs associated with PAC, lack of data standards/interoperability across PAC settings, and the goal of establishing payment rates according to the individual characteristics of the patient, not the care setting.

CMS Finalizes Hospital-Centric Bundled Payment Model for Hip, Knee Replacements
The Centers for Medicare & Medicaid Services (CMS) released its final bundled payment model for hip and knee replacement surgeries, which includes plans to waive the three-day stay rule for beneficiaries entering qualified skilled nursing facilities. This includes the metropolitan areas of Indianapolis, South Bend and Cincinnati impacting Indiana facilities. Although originally in the plan, the Evansville metropolitan area was removed.

Hospital Readmission Rates Falling for Older Adults Receiving Joint Replacements
The Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program is helping reduce the number of seniors readmitted to the hospital following joint replacement surgery, according to a new report from AARP.

CMS is Moving towards the Adoption of the 2012 Life Safety Code
The Centers for Medicare & Medicaid Services (CMS) is progressing toward final adoption of the 2012 National Fire Protection Association Life Safety Code (LSC) standards for care centers. CMS issued a proposed rule of adoption in the spring of 2014, and the agency has been expected to issue a final rule during 2015. HOPE learned CMS has forwarded its final rule to the White House Office of Management and Budget for review and approval.

Our national contacts are tracking the rule, and will alert us when they learn something definitive about when the final rule will be published. Frequently, but not always, federal rules are effective 60 days after publication. For a snapshot of the 2012 LSC provisions, see the LeadingAge analysis.

CMS Approves Advance Care Planning Codes in Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) issued a final rule last month updating payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule on or after Jan. 1, 2016.

2016 Medicare Parts A & B Premiums and Deductibles Announced
As the Social Security Administration previously announced, there will be no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be “held harmless” from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90.

A Guide for Families Demanding Hospitalization
There is a new guide now available for long-term care residents and their families explaining the risks and benefits of treatment in long-term care versus transfer to the hospital. The title is Go to the Hospital or Stay Here?

CMS Releases ICD-10 Contact List Guide
The Centers for Medicare & Medicaid Services (CMS) has released a guide providing specific CMS contacts for health care to which providers may direct any questions on the recent transition to ICD-10 coding. According to CMS, claims-related questions should be directed to the provider's Medicare Administrative Contractor or state Medicaid agency before the CMS ombudsman.

Get ICD-10 Answers in One Place
The ICD-10-CM/PCS Frequently Asked Questions web page has answers to your questions about claims processing and billing; coding; General Equivalence Mappings; National Coverage Determinations; and Local Coverage Determinations. Visit the ICD-10 Medicare Fee-For-Service Provider Resources web page for a complete list of Medicare Learning Network educational materials.

Managing Anticoagulants
Medication management is in the spotlight, for protocols for anticoagulant treatments. Anticoagulants are one of three most commonly implicated drug classes in adverse drug events. Anticoagulant-related adverse drug events (ADE) need to be reduced.