fbpx

*Updates are listed by date if applicable.

11/16/20: 2020 LeadingAge Award of Honor: Watch the video below to see Katie Smith-Sloan congratulating this year's Award of Honor recipients: EVERY MEMBER OF LeadingAge.  

Every year, we bestow this award on one member who has provided nationally significant, transformative leadership in aging services. This person shows vision, mission, compassion, and courage every day in their communities.

This year, in the face of great adversity and overwhelming tragedy, you have all risen to the occasion and demonstrated remarkable leadership and unbelievable courage in what will likely be remembered as the hardest year of your life.

Thank you for all you've done and that you continue to do. I am proud and honored to call you friends and colleagues.

--Katie Smith Sloan, president and CEO of LeadingAge

LeadingAge Nebraska members, you can save the image below to share on your website, with an email, or on social media. Thank you from the depths of our hearts for the amazing and hard work that you do every day. #courageous

4/2/20: Practical Ideas From LeadingAge Members: We're gathering examples of the innovative solutions members are deploying to better serve older people and support their staff. New stories are available now.

Nursing Home Rate Methodology Update - 2/21/20

If you were unable to join us for the Nursing Facility Rate Methodology hosted last week by DHHS, LeadingAge Nebraska, please see the information from the presentation included.  The Vimeo is a recording of the actual webinar presentation, the PowerPoint is the one used by Jeremy Brunssen for the webinar.  Also, included is a link to the DHHS Nursing Home Payment Project page where updates related to this process will continue to be posted as well.  You can subscribe to that site for updates.  The information on that site is historical information other than the post from February 2020.

Vimeo: https://vimeo.com/392953242

Link to PowerPoint Presentation

Link to the DHHS Medicaid and Long-Term Care Nursing Facility Payment Project: http://dhhs.ne.gov/Pages/Nursing-Home-Payment-Project.aspx

Please contact Jenifer at jenifer.acierno@leadingagene.org with any questions.

Thank you!

*********************************************************************************************

LeadingAge and NaCCRA joint letter to Senators regarding the MFAR proposed rule by CMS

(Posted 1/16/2020)

*********************************************************************************************

MAP OF STATE NURSING HOME/LIFE PLAN COMMUNITY PROVIDER TAX POLICIES

(Posted 1/9/2020)

Source: LeadingAge survey data, supplemented by AHCA and NCSL data

SUMMARY RELATED TO THE MEDICAID FISCAL ACCOUNTABILITY PROPOSED RULE

(Posted 1/9/2020)

Proposed Rule by the U.S. Centers for Medicare and Medicaid Services on

State Nursing Home Bed Taxes

BACKGROUND
The U.S. Centers for Medicare and Medicaid Services (CMS) has published a proposed rule that could significantly impact Nebraska's continuing care retirement communities also known as life plan communities.

The proposed rule as written would affect the Nebraska Legislature’s ability to oversee how it administers its current nursing home bed tax program.

Under current Nebraska law, skilled nursing home beds within a continuing care retirement community setting are exempt from Nebraska's nursing home bed tax.

About Life Plan Communities Nationally

  • Life plan communities/CCRCs are residential communities for older adults that provide independent living and nursing home services, and often provide assisted living and other types of services for older adults.
  • There are almost 2,000 life plan communities/CCRCs nationally.
  • CCRCs collectively serve almost 750,000 people, the vast majority of whom are older adults.
  • About 4 in 5 (79%) CCRCs are nonprofit organizations.
  • Most (65%) are faith/religiously-affiliated.
  • The average CCRC serves about 290 people and has an average annual budget of $12.2 million.
  • About 30% of life plan communities/CCRCs indicated in a 2019 survey that they were planning to reduce the size of their nursing homes- even before the proposed MFAR was announced.
  • Note: In addition to these national data, any information on the above at the state level would be useful to include.

 Changes to federal Medicaid financing policy disproportionately affect nursing homes

  • Medicaid pays for about 60% of nursing home care nationally.
  • Medicare pays for short-term/rehab stays only.
  • For hospitals, Medicaid pays for about 16% of care. Private insurance covers 40% and Medicare covers 25%. 3% of costs are out of pocket. For physician services, Medicaid pays for about 11% of care. Private insurance covers 43% and Medicare covers 23%. 8% of costs are out of pocket.
  • As a result, the MFAR proposal will have a more direct impact on nursing home than other types of providers, and the significant changes proposed could be disruptive to nursing home provider stability and beneficiary access.
  • LeadingAge recommendation: Given the critical role of Medicaid for nursing facility financing, CMS should consider exempting nursing facilities from this and other sections of the proposed rule, or delay doing so until it can assess the impact of the proposal on providers of other types of services that rely less significantly on Medicaid.

 The proposed provider tax changes could increase state taxes for CCRC nursing home providers

  • Under current policy, state provider taxes for nursing homes in 19 states provide an exemption and/or discount for continuing care retirement communities.
  • The MFAR proposal would jeopardize these tax exemptions, because most CCRCs do not provide Medicaid services or have only a handful of Medicaid-funded nursing home beds.
  • As a result, the MFAR proposal would likely cause states to impose new taxes on these providers by ending the current exemptions and discounts.
  • Most CCRCs would not be able to absorb these new taxes without cutting services, passing the new costs along to their older adult residents or closing their nursing home operations entirely.
  • While CMS is right to make efforts toward ensuring Medicaid program integrity, doing so in a way that taxes nonprofit senior living communities is not the correct way to do so.

IMPACT OF PROPOSED RULE

The proposed rule by CMS, if it passes as written, would likely result in the Nebraska Legislature having to repeal the current exemption for continuing care retirement communities skilled nursing home beds.

There will be a significant financial impact to Nebraska's CCRC communities.

HOW YOU CAN HELP

The public has until February 1, 2020 to submit comment to the Centers for Medicare and Medicaid Services on this proposed rule.

You are encouraged to submit public comments. LeadingAge Nebraska and LeadingAge national will be doing the same.

Electronic comments are the fastest, easiest and recommended way to submit comments. Electronic comments can be submitted using the provided link:

https://www.regulations.gov/comment?D=CMS-2019-0169-0001

When submitting electronic or written (mail) comments reference this federal Docket #

CMS-2019-0169

You may also submit comments by mail to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2393-P, P.O. Box 8016, Baltimore, MD 21244-8016.

Please allow sufficient time for mailed comments to be received before the close of the February 1, 2020 comment period.

By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2393-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

*********************************************************************************************

MEMBERSHIP REVENUE REQUEST FORM

You can submit your revenue request form via email to julie.hulinsky@leadingagene.org OR via mail to LeadingAge Nebraska, 625 S. 14th St., Suite A, Lincoln, NE  68508. Thank you!

*********************************************************************************************

RoPs Phase 3 Upcoming Compliance & Ethics Toolkit (posted 10/31/19)

LeadingAge plans to release a compliance & ethics toolkit once the rule is finalized and guidance provided. They’re waiting because they don’t want to put anything out there that would lead members in the wrong direction.

The proposed rule really mucks things up, but here’s what we know providers will still need to comply with:

  • Must have in operation a compliance & ethics program to prevent and detect criminal, civil, and administrative violations and promote quality of care.
  • Must be overseen by designated, high-level personnel (meaning individuals who have substantial control over operating organization and substantial control over policy-making).
  • Must have written standards, policies, and procedures.
  • Must take reasonable steps to ensure compliance including but not limited to utilizing monitoring and auditing systems and disciplinary actions for violations.
  • Must have a method for reporting suspected violations without fear of retribution, including anonymous reporting.
  • Must have training / information dissemination for staff and volunteers about the C&E program.

The above information is based on a side-by-side comparison of the RoPs with the proposed rule.

*********************************************************************************************

A NOTE FROM JUDY WILHIDE BRANDT: Posted 9/30/19 It's Sep 30th. Today is the last day for ARDs to pay for September. Take these steps: 1. For those in the window for a PPS 5 day, today is the last day to set it, no matter what day of the stay it is. You can combine the Admission with this 5 day (or any OBRA that is required), or put the Admission ARD in October, maybe on the same day as the Tranditioal IPA. 2. If day 15, 31, 61, 91 are on Sep 30 or later, you need an ARD, set no later than today, to pay for those days. These would be a PPS 14, 30, 60 or 90 day. 3. If you COT checkpoint is today or earlier than today, you need a COT with an ARD on the COT checkpoint. If today or earlier is not day 7 of the COT count, you will never need a COT on these. 4. If the 3rd missed day of therapy is today, set an EOT for today. Nursing Home Rate Methodology Update - 2/21/20 If you were unable to join us for the Nursing Facility Rate Methodology hosted last week by DHHS, LeadingAge Nebraska, please see the information from the presentation included.  The Vimeo is a recording of the actual webinar presentation, the PowerPoint is the one used by Jeremy Brunssen for the webinar.  Also, included is a link to the DHHS Nursing Home Payment Project page where updates related to this process will continue to be posted as well.  You can subscribe to that site for updates.  The information on that site is historical information other than the post from February 2020. Vimeo: https://vimeo.com/392953242 Link to PowerPoint Presentation Link to the DHHS Medicaid and Long-Term Care Nursing Facility Payment Project: http://dhhs.ne.gov/Pages/Nursing-Home-Payment-Project.aspx Please contact Jenifer at jenifer.acierno@leadingagene.org with any questions. Thank you! ********************************************************************************************* LeadingAge and NaCCRA joint letter to Senators regarding the MFAR proposed rule by CMS (Posted 1/16/2020) ********************************************************************************************* MAP OF STATE NURSING HOME/LIFE PLAN COMMUNITY PROVIDER TAX POLICIES (Posted 1/9/2020) Source: LeadingAge survey data, supplemented by AHCA and NCSL data SUMMARY RELATED TO THE MEDICAID FISCAL ACCOUNTABILITY PROPOSED RULE (Posted 1/9/2020) Proposed Rule by the U.S. Centers for Medicare and Medicaid Services on State Nursing Home Bed Taxes BACKGROUND
The U.S. Centers for Medicare and Medicaid Services (CMS) has published a proposed rule that could significantly impact Nebraska's continuing care retirement communities also known as life plan communities. The proposed rule as written would affect the Nebraska Legislature’s ability to oversee how it administers its current nursing home bed tax program. Under current Nebraska law, skilled nursing home beds within a continuing care retirement community setting are exempt from Nebraska's nursing home bed tax. About Life Plan Communities Nationally Life plan communities/CCRCs are residential communities for older adults that provide independent living and nursing home services, and often provide assisted living and other types of services for older adults. There are almost 2,000 life plan communities/CCRCs nationally. CCRCs collectively serve almost 750,000 people, the vast majority of whom are older adults. About 4 in 5 (79%) CCRCs are nonprofit organizations. Most (65%) are faith/religiously-affiliated. The average CCRC serves about 290 people and has an average annual budget of $12.2 million. About 30% of life plan communities/CCRCs indicated in a 2019 survey that they were planning to reduce the size of their nursing homes- even before the proposed MFAR was announced. Note: In addition to these national data, any information on the above at the state level would be useful to include.  Changes to federal Medicaid financing policy disproportionately affect nursing homes Medicaid pays for about 60% of nursing home care nationally. Medicare pays for short-term/rehab stays only. For hospitals, Medicaid pays for about 16% of care. Private insurance covers 40% and Medicare covers 25%. 3% of costs are out of pocket. For physician services, Medicaid pays for about 11% of care. Private insurance covers 43% and Medicare covers 23%. 8% of costs are out of pocket. As a result, the MFAR proposal will have a more direct impact on nursing home than other types of providers, and the significant changes proposed could be disruptive to nursing home provider stability and beneficiary access. LeadingAge recommendation: Given the critical role of Medicaid for nursing facility financing, CMS should consider exempting nursing facilities from this and other sections of the proposed rule, or delay doing so until it can assess the impact of the proposal on providers of other types of services that rely less significantly on Medicaid.  The proposed provider tax changes could increase state taxes for CCRC nursing home providers Under current policy, state provider taxes for nursing homes in 19 states provide an exemption and/or discount for continuing care retirement communities. The MFAR proposal would jeopardize these tax exemptions, because most CCRCs do not provide Medicaid services or have only a handful of Medicaid-funded nursing home beds. As a result, the MFAR proposal would likely cause states to impose new taxes on these providers by ending the current exemptions and discounts. Most CCRCs would not be able to absorb these new taxes without cutting services, passing the new costs along to their older adult residents or closing their nursing home operations entirely. While CMS is right to make efforts toward ensuring Medicaid program integrity, doing so in a way that taxes nonprofit senior living communities is not the correct way to do so. IMPACT OF PROPOSED RULE The proposed rule by CMS, if it passes as written, would likely result in the Nebraska Legislature having to repeal the current exemption for continuing care retirement communities skilled nursing home beds. There will be a significant financial impact to Nebraska's CCRC communities. HOW YOU CAN HELP The public has until February 1, 2020 to submit comment to the Centers for Medicare and Medicaid Services on this proposed rule. You are encouraged to submit public comments. LeadingAge Nebraska and LeadingAge national will be doing the same. Electronic comments are the fastest, easiest and recommended way to submit comments. Electronic comments can be submitted using the provided link: https://www.regulations.gov/comment?D=CMS-2019-0169-0001 When submitting electronic or written (mail) comments reference this federal Docket # CMS-2019-0169 You may also submit comments by mail to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2393-P, P.O. Box 8016, Baltimore, MD 21244-8016. Please allow sufficient time for mailed comments to be received before the close of the February 1, 2020 comment period. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2393-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. ********************************************************************************************* MEMBERSHIP REVENUE REQUEST FORM You can submit your revenue request form via email to julie.hulinsky@leadingagene.org OR via mail to LeadingAge Nebraska, 625 S. 14th St., Suite A, Lincoln, NE  68508. Thank you! ********************************************************************************************* RoPs Phase 3 Upcoming Compliance & Ethics Toolkit (posted 10/31/19) LeadingAge plans to release a compliance & ethics toolkit once the rule is finalized and guidance provided. They’re waiting because they don’t want to put anything out there that would lead members in the wrong direction. The proposed rule really mucks things up, but here’s what we know providers will still need to comply with: Must have in operation a compliance & ethics program to prevent and detect criminal, civil, and administrative violations and promote quality of care. Must be overseen by designated, high-level personnel (meaning individuals who have substantial control over operating organization and substantial control over policy-making). Must have written standards, policies, and procedures. Must take reasonable steps to ensure compliance including but not limited to utilizing monitoring and auditing systems and disciplinary actions for violations. Must have a method for reporting suspected violations without fear of retribution, including anonymous reporting. Must have training / information dissemination for staff and volunteers about the C&E program. The above information is based on a side-by-side comparison of the RoPs with the proposed rule. ********************************************************************************************* A NOTE FROM JUDY WILHIDE BRANDT: Posted 9/30/19 It's Sep 30th. Today is the last day for ARDs to pay for September. Take these steps: 1. For those in the window for a PPS 5 day, today is the last day to set it, no matter what day of the stay it is. You can combine the Admission with this 5 day (or any OBRA that is required), or put the Admission ARD in October, maybe on the same day as the Tranditioal IPA. 2. If day 15, 31, 61, 91 are on Sep 30 or later, you need an ARD, set no later than today, to pay for those days. These would be a PPS 14, 30, 60 or 90 day. 3. If you COT checkpoint is today or earlier than today, you need a COT with an ARD on the COT checkpoint. If today or earlier is not day 7 of the COT count, you will never need a COT on these. 4. If the 3rd missed day of therapy is today, set an EOT for today. Transition: 1. Set a Transitional IPA on Oct 1 - 7 for the entire Medicare A caseload that was skilled today and will be skilled tomorrow. The interim GG lookback is 3 days ending on the ARD. The interim GG is shorter, only the payment items. Don't waste time on the whole thing. 2. Medicare Managed Care: If your BO knows whether you get paid by levels, or RUG IV, or PDPM, follow whatever they say. a. If you need RUG IV, you can do the OSA. It doesn't matter that it's not a state required form. You aren't transmitting it. b. If they are going with PDPM, most are asking for a transitional IPA but not all. When in doubt, open one, just in case. ICD 10 coding: Use an ICD 10 coding book for FY 2020 starting tomorrow. This is non-negotiable. If your organization will not buy one for you, report it to your compliance committee. No free website can ensure accurate coding, therefore accurate payment. Not using an ICD 10 coding book can put you in "flagrant disregard" territory for false claims actions. Really. Turn off the damned internet/social media/Facebook pages for the next week. There's a lot of stupid, wrong stuff being spewed. The craziest I've seen: 1. We get no payment at all for the last 5 days of September (NOT TRUE) 2. All Sep ARDs must be locked by the end of today (NOT TRUE) 3. We can set COT checkpoints in October (NOT TRUE) 4. We don't have to have an Admission assessment for those who admitted the last week of September who are in the SNF through midnight of day 14 (NOT TRUE). Managers, check in on the MDS schedule. A few steps must be taken today, and the transitional IPAs needs to be set. Also, admissions starting tomorrow are no in the transition, so they will need a 5 day + any needed OBRA. I'm in the office this week for client questions, just ask me rather than get all spun up over false, ridiculous social media statements. Judy Wilhide Brandt, RN, BA, RAC-CTA, CPC, QCP, DNS-CT judy@judywilhide.com ********************************************************************************************* LIVANTA QIO PROVIDER BULLETIN Posted 9/20/2019 Below, please find a link to download the latest Provider Bulletin from Livanta. The topic of Provider Bulletin XV is an upcoming audit of Memoranda of Agreement (MOA) completion. If you have already completed and sent in your MOA, no further action is required from you at this time. If you have not already completed your MOA, please do so as soon as possible. Livanta will be conducting an audit in the coming weeks to identify providers who have not met this regulatory requirement. Download Provider Bulletin XV ************************************************************************************* NEW TOOL FOR NF PROVIDERS  Posted 9/16/2019 PDPM Implementation Almost Here, New Tools Available We are now less than one month from implementation of the new Patient-Driven Payment Model (PDPM) that will take effect on October 1.  LeadingAge Nebraska is fortunate to benefit from the work done by our national association and LeadingAge Wisconsin in developing new tools, including a rate calculator with casemix, which is posted in our Member Portal.  There are YouTube videos that accompany each tool as well.  You do have to enter your Nebraska-specific information into the spreadsheets in order to get your specific estimates. BUDGET TOOL Budget Tool video tutorial: https://www.youtube.com/watch?v=1n1jyg0Bp-c&t=107s GROUPER TOOL Grouper Tool video tutorial: https://www.youtube.com/watch?v=FYkhO1fVUh8&feature=youtu.be SPECIFIC STAY TOOL Specific Stay Tool video tutorial: https://www.youtube.com/watch?v=w0SYqf15MRE&feature=youtu.be%0d   Transition: 1. Set a Transitional IPA on Oct 1 - 7 for the entire Medicare A caseload that was skilled today and will be skilled tomorrow. The interim GG lookback is 3 days ending on the ARD. The interim GG is shorter, only the payment items. Don't waste time on the whole thing. 2. Medicare Managed Care: If your BO knows whether you get paid by levels, or RUG IV, or PDPM, follow whatever they say. a. If you need RUG IV, you can do the OSA. It doesn't matter that it's not a state required form. You aren't transmitting it. b. If they are going with PDPM, most are asking for a transitional IPA but not all. When in doubt, open one, just in case. ICD 10 coding: Use an ICD 10 coding book for FY 2020 starting tomorrow. This is non-negotiable. If your organization will not buy one for you, report it to your compliance committee. No free website can ensure accurate coding, therefore accurate payment. Not using an ICD 10 coding book can put you in "flagrant disregard" territory for false claims actions. Really. Turn off the damned internet/social media/Facebook pages for the next week. There's a lot of stupid, wrong stuff being spewed. The craziest I've seen: 1. We get no payment at all for the last 5 days of September (NOT TRUE) 2. All Sep ARDs must be locked by the end of today (NOT TRUE) 3. We can set COT checkpoints in October (NOT TRUE) 4. We don't have to have an Admission assessment for those who admitted the last week of September who are in the SNF through midnight of day 14 (NOT TRUE). Managers, check in on the MDS schedule. A few steps must be taken today, and the transitional IPAs needs to be set. Also, admissions starting tomorrow are no in the transition, so they will need a 5 day + any needed OBRA. I'm in the office this week for client questions, just ask me rather than get all spun up over false, ridiculous social media statements. Judy Wilhide Brandt, RN, BA, RAC-CTA, CPC, QCP, DNS-CT judy@judywilhide.com *********************************************************************************************

LIVANTA QIO PROVIDER BULLETIN Posted 9/20/2019

Below, please find a link to download the latest Provider Bulletin from Livanta. The topic of Provider Bulletin XV is an upcoming audit of Memoranda of Agreement (MOA) completion. If you have already completed and sent in your MOA, no further action is required from you at this time. If you have not already completed your MOA, please do so as soon as possible. Livanta will be conducting an audit in the coming weeks to identify providers who have not met this regulatory requirement. Download Provider Bulletin XV

*************************************************************************************

NEW TOOL FOR NF PROVIDERS Posted 9/16/2019

PDPM Implementation Almost Here, New Tools Available

We are now less than one month from implementation of the new Patient-Driven Payment Model (PDPM) that will take effect on October 1.  LeadingAge Nebraska is fortunate to benefit from the work done by our national association and LeadingAge Wisconsin in developing new tools, including a rate calculator with casemix, which is posted in our Member Portal.  There are YouTube videos that accompany each tool as well.  You do have to enter your Nebraska-specific information into the spreadsheets in order to get your specific estimates.

BUDGET TOOL

Budget Tool video tutorial: https://www.youtube.com/watch?v=1n1jyg0Bp-c&t=107s

GROUPER TOOL

Grouper Tool video tutorial: https://www.youtube.com/watch?v=FYkhO1fVUh8&feature=youtu.be

SPECIFIC STAY TOOL

Specific Stay Tool video tutorial: