Starting this month, we're trying something new - the AHCA/NCAL Regulatory Update is being published as a blog. Regulatory Update will continue to provide the same high quality of information, but the format has changed. The most recent posting will appear at the top of the page. To stories similar to the one you are reading, click on a "label" at the bottom of the story. These labels function as subject headings, that allow you to find stories by topic; a list of them can be found at http://www.ahca.org/members/regupdate/.
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Thursday, June 28, 2007
Sunday, June 24, 2007
OIG Posts Compendium of Unimplemented OIG Recommendations
On May 31, 2007, the U.S. Department of Health and Human Services, Office of Inspector General (OIG), posted the Compendium of Unimplemented Office of Inspector General Recommendations, which combines the annual Red Book (unimplemented monetary recommendations) and Orange Book (unimplemented nonmonetary recommendations) into one publication. The OIG believes that full implementation of the recommendations in this compendium could achieve substantial savings and increase the effectiveness of the Department’s programs.
Each narrative in the compendium contains a background summary, findings, recommendation(s), status, report number(s), and report issue date(s). In the case of monetary recommendations, there is also an estimate of the savings that may be achieved by implementing the recommendations. The estimated value of each monetary recommendation is based on the specifics of each review and not extrapolated beyond the scope of the original review. The actual savings to be achieved depends on the specific legislative, regulatory, or administrative actions. However, the estimates provide a general indication of the magnitude of savings possible. To obtain a complete copy of the new publication, go to http://www.oig.hhs.gov/publications/compendium.html.
Each narrative in the compendium contains a background summary, findings, recommendation(s), status, report number(s), and report issue date(s). In the case of monetary recommendations, there is also an estimate of the savings that may be achieved by implementing the recommendations. The estimated value of each monetary recommendation is based on the specifics of each review and not extrapolated beyond the scope of the original review. The actual savings to be achieved depends on the specific legislative, regulatory, or administrative actions. However, the estimates provide a general indication of the magnitude of savings possible. To obtain a complete copy of the new publication, go to http://www.oig.hhs.gov/publications/compendium.html.
CMS Releases NPPES Data Dissemination Notice
On May 30, 2007, the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), released a notice establishing the data that is available from the National Plan and Provider Enumeration System (NPPES), as well as addressing who may have access to the data, the processes for requesting and receiving the data and the conditions for data disclosure.
The Health Insurance Portability and Accountability Act (HIPAA), administrative simplification provisions, mandate the adoption of a standard unique identifier for health care providers to improve the efficiency and effectiveness of the electronic transmission of health information. In 2004, HHS published a final rule adopting the National Provider Identifier (NPI) as the standard unique identifier for health care providers. CMS developed the NPPES to assign these unique identifiers and established the following policy:
NPPES health care provider data (required to be disclosed under the Freedom of Information Act) will be made publicly available on June 28, 2007, 30 days after the publication of this notice. The data will be made available in a query-only database (so that providers can query by NPI or provider name) in an initial file downloadable from the Internet, with monthly update files. Health care providers who have NPIs should review their NPPES data at this time to make any necessary updates or corrections prior to the end of the 30-day period to ensure accuracy.
Health care providers who wish to delete any NPPES data that is not required may do so prior to the end of the 30-day period if they do not want that data disclosed.
To obtain a copy of the CMS notice, go to http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/DataDisseminationNPI.pdf.
The Health Insurance Portability and Accountability Act (HIPAA), administrative simplification provisions, mandate the adoption of a standard unique identifier for health care providers to improve the efficiency and effectiveness of the electronic transmission of health information. In 2004, HHS published a final rule adopting the National Provider Identifier (NPI) as the standard unique identifier for health care providers. CMS developed the NPPES to assign these unique identifiers and established the following policy:
NPPES health care provider data (required to be disclosed under the Freedom of Information Act) will be made publicly available on June 28, 2007, 30 days after the publication of this notice. The data will be made available in a query-only database (so that providers can query by NPI or provider name) in an initial file downloadable from the Internet, with monthly update files. Health care providers who have NPIs should review their NPPES data at this time to make any necessary updates or corrections prior to the end of the 30-day period to ensure accuracy.
Health care providers who wish to delete any NPPES data that is not required may do so prior to the end of the 30-day period if they do not want that data disclosed.
To obtain a copy of the CMS notice, go to http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/DataDisseminationNPI.pdf.
Friday, June 22, 2007
GAO Issues Report on Long-Term Care Partnership Programs
In May 2007, the U.S. Government Accountability Office (GAO) released a report, Long-Term Care Insurance: Partnership Programs Include Benefits That Protect Policyholders and Are Unlikely to Result in Medicaid Savings (GAO-07-231). According to the GAO, the Partnership programs are unlikely to result in savings for Medicaid, and actually may increase spending; however, any such increase is likely to be small. GAO reviewed current survey data on Partnership policyholders and found that about 80 percent would have purchased traditional long-term care insurance policies if Partnership policies were not available, which represented a potential cost to Medicaid. Additionally, about 20 percent of surveyed Partnership policyholders indicated they would have self-financed their care in the absence of the Partnership program, but data were not available to directly measure when or if any of these individuals would access Medicaid had they not purchased a Partnership policy. GAO also used illustrative financing scenarios that suggests an individual could self-finance care—delaying Medicaid eligibility—for about the same amount of time as he or she would have using a Partnership policy, although GAO identified some circumstances that also could accelerate Medicaid eligibility. The main conclusion from the GAO study is that while the majority of Partnership policyholders have the potential to increase spending, the impact on Medicaid is likely to be small because few policyholders are likely to exhaust their benefits and become eligible for Medicaid due to their wealth and having policies that will cover most of their long-term care needs.
The report is available on the internet at http://www.gao.gov/new.items/d07231.pdf.
For additional resources on LTC Partnership Programs, visit AHCA's website at http://www.ahca.org/brief/ltcpp/index.cfm.
The report is available on the internet at http://www.gao.gov/new.items/d07231.pdf.
For additional resources on LTC Partnership Programs, visit AHCA's website at http://www.ahca.org/brief/ltcpp/index.cfm.
Report Explores Experience of States Regulating Assisted Living Service Agencies, Not the Housing Component
A new AARP report scrutinizes a series of issues in the handful of states that regulate assisted living services agencies rather than licensing a single entity that provides both housing and services to residents, as most states do. The report concludes that this regulatory approach (not licensing the housing component of assisted living) has “several potential benefits and problems for consumers.”
According to the study, “potential benefits include improved access to assisted living for people with low incomes living in subsidized apartments, a home environment, a range of housing options, and, in some cases, the ability of residents to remain in assisted living when their needs increase. Challenges for states include ensuring that consumers are well informed; protecting residents' rights and ensuring quality of care, particularly regarding assessments, service terminations, and evictions; and providing adequate oversight and enforcement while maintaining the home environment that consumers prefer.”
In the regulatory model studied, while the building is required to comply with jurisdictions' relevant codes and requirements for multi-unit housing, it is not licensed, but instead arranges with licensed service agencies to provide services to residents. According to the author, this model “blurs the lines between assisted living, independent senior housing, and home care.” The report does not look at issues pertaining to facilities providing assisted living services in which neither agencies providing services nor the housing component is licensed.
Connecticut, Minnesota, New Jersey, and North Carolina were the states studied. In Connecticut, assisted living is provided in senior apartment buildings called managed residential communities that contract with assisted living services agencies (ALSAs) to provide services. The state also provides Medicaid funding for ALSA services in 16 state and three federally-subsidized senior housing communities.
In Minnesota, apartment buildings called housing with services establishments (HSEs) contract with home care agencies to provide services to residents. Assisted living services are also available to eligible residents in six low-income apartments and subsidized housing communities.
New Jersey originally had two types of licensed assisted living settings: assisted living residences and comprehensive personal care homes. In 1996, the state added a third category of assisted living, called assisted living programs, which are licensed agencies that bring assisted living services to older residents in subsidized housing.
North Carolina has two types of assisted living. Adult care homes are licensed assisted living settings, while multiunit assisted housing with services are not licensed but contract with home care agencies to provide services to residents.
In three states, this regulatory approach has helped make assisted living services available to people with low incomes, according to stakeholders interviewed. Although states did not license the assisted living housing component, they used a range of other means of assuring quality, including fire standards, a long term ombudsman program, food and kitchen standards, and contract requirements. People interviewed in all four states reported problems concerning consumer information, including lack of consumer awareness about their rights, discharge criteria, and where to take grievances.
For more information, see “Assisted Living in Unlicensed Housing: The Regulatory Experience of Four States,” Bernadette Wright, AARP Public Policy Institute, April 2007, which can be found at http://www.aarp.org/research/housing-mobility/assistedliving/2007_08_housing.html.
According to the study, “potential benefits include improved access to assisted living for people with low incomes living in subsidized apartments, a home environment, a range of housing options, and, in some cases, the ability of residents to remain in assisted living when their needs increase. Challenges for states include ensuring that consumers are well informed; protecting residents' rights and ensuring quality of care, particularly regarding assessments, service terminations, and evictions; and providing adequate oversight and enforcement while maintaining the home environment that consumers prefer.”
In the regulatory model studied, while the building is required to comply with jurisdictions' relevant codes and requirements for multi-unit housing, it is not licensed, but instead arranges with licensed service agencies to provide services to residents. According to the author, this model “blurs the lines between assisted living, independent senior housing, and home care.” The report does not look at issues pertaining to facilities providing assisted living services in which neither agencies providing services nor the housing component is licensed.
Connecticut, Minnesota, New Jersey, and North Carolina were the states studied. In Connecticut, assisted living is provided in senior apartment buildings called managed residential communities that contract with assisted living services agencies (ALSAs) to provide services. The state also provides Medicaid funding for ALSA services in 16 state and three federally-subsidized senior housing communities.
In Minnesota, apartment buildings called housing with services establishments (HSEs) contract with home care agencies to provide services to residents. Assisted living services are also available to eligible residents in six low-income apartments and subsidized housing communities.
New Jersey originally had two types of licensed assisted living settings: assisted living residences and comprehensive personal care homes. In 1996, the state added a third category of assisted living, called assisted living programs, which are licensed agencies that bring assisted living services to older residents in subsidized housing.
North Carolina has two types of assisted living. Adult care homes are licensed assisted living settings, while multiunit assisted housing with services are not licensed but contract with home care agencies to provide services to residents.
In three states, this regulatory approach has helped make assisted living services available to people with low incomes, according to stakeholders interviewed. Although states did not license the assisted living housing component, they used a range of other means of assuring quality, including fire standards, a long term ombudsman program, food and kitchen standards, and contract requirements. People interviewed in all four states reported problems concerning consumer information, including lack of consumer awareness about their rights, discharge criteria, and where to take grievances.
For more information, see “Assisted Living in Unlicensed Housing: The Regulatory Experience of Four States,” Bernadette Wright, AARP Public Policy Institute, April 2007, which can be found at http://www.aarp.org/research/housing-mobility/assistedliving/2007_08_housing.html.
NCAL Leads Coalition in Support of Medicare Part D Co-Payment Legislation
The National Center for Assisted Living (NCAL) and the American Health Care Association (AHCA) sent a letter on June 11 on behalf of more than 35 national organizations to Sen. Gordon Smith (R-Ore.) thanking him and his co-sponsors for introducing bipartisan legislation, the Home and Community Services Copayment Equity Act of 2007 (S. 1107).
The organizations represent a wide range of interests including consumers, long term care providers, health professionals, pharmacy groups, and state officials.
The legislation would eliminate Medicare Part D co-payments for dual eligible individuals—those covered by both Medicare and Medicaid—in assisted living and residential care facilities, group homes for people with mental retardation and developmental disabilities, psychiatric health facilities, and mental health rehabilitation centers. Dual eligible beneficiaries receiving services under home- and community-based waivers in home settings would also be relieved of Part D co-payments under the Senate bill, which has nine co-sponsors. NCAL and AHCA are working to introduce companion legislation in the House.
Under the Medicare Modernization Act, Congress exempted dual eligibles living in nursing facilities from any co-payments for their Part D prescription drugs. However, under current law dual eligibles in assisted living and residential care facilities must make co-payments of $1 to $5.35 per prescription for their Part D medications. About 15 percent of 1 million Americans residing in assisted living facilities are dual eligibles. Dual eligibles in assisted living are similar to those in nursing facilities. Both have limited incomes and use an average of eight to ten medications, according to recent studies.
The letter to Sen. Smith can be found at: http://www.ncal.org/news/letters/letterto_sen_smith_61107.pdf. Please contact Karl Polzer at 202-898-6320 or kpolzer@ncal.org with any questions.
The organizations represent a wide range of interests including consumers, long term care providers, health professionals, pharmacy groups, and state officials.
The legislation would eliminate Medicare Part D co-payments for dual eligible individuals—those covered by both Medicare and Medicaid—in assisted living and residential care facilities, group homes for people with mental retardation and developmental disabilities, psychiatric health facilities, and mental health rehabilitation centers. Dual eligible beneficiaries receiving services under home- and community-based waivers in home settings would also be relieved of Part D co-payments under the Senate bill, which has nine co-sponsors. NCAL and AHCA are working to introduce companion legislation in the House.
Under the Medicare Modernization Act, Congress exempted dual eligibles living in nursing facilities from any co-payments for their Part D prescription drugs. However, under current law dual eligibles in assisted living and residential care facilities must make co-payments of $1 to $5.35 per prescription for their Part D medications. About 15 percent of 1 million Americans residing in assisted living facilities are dual eligibles. Dual eligibles in assisted living are similar to those in nursing facilities. Both have limited incomes and use an average of eight to ten medications, according to recent studies.
The letter to Sen. Smith can be found at: http://www.ncal.org/news/letters/letterto_sen_smith_61107.pdf. Please contact Karl Polzer at 202-898-6320 or kpolzer@ncal.org with any questions.
VOR Conducts Annual Meeting
On June 9-11, 2007, the Voice of the Retarded (VOR) conducted its annual meeting in Washington, D.C. VOR is an organization, led by parents of individuals with developmental disabilities (DD), which advocates for a full range of DD residential options, including intermediate care facilities for mental retardation (ICFs/MR), group homes and home care.
Some highlights of the annual meeting included:
A session by Eileen Elias, Deputy Director of the Department of Health and Human Services (HHS) Office on Disability about the Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities/Access to Health Care. This document describes the challenges to health and wellness faced by individuals with physical, mental, psychological and chronic medical disorders, and sets goals as to how to rectify these issues. To view the report, go to http://www.surgeongeneral.gov/library/disabilities/calltoaction/calltoaction.pdf.
Greg Giordano, Chief Legislative Assistant to Florida State Senator Mike Fasano, briefed attendees about Florida S.B. 402 “An Act Relating to Developmental Disabilities Institutions.” This bill proposes setting limits on Protection and Advocacy (P&A) Agencies’ ability to close or reduce the resident population of DD institutions, such as ICFs/MR. This legislation went to the hearing stage in the Florida Senate, but did not make it to the floor for a vote. Per Greg Giordano, Senator Fasano will reintroduce this bill next year. To view the bill, go to http://www.ahca.org/members/operate/special/dd/florida_SB402.pdf.
Dr. Mary McTernan, VOR’s President, briefed participants on VOR’s legislative agenda. Similar to AHCA, VOR is closely monitoring reauthorization of the Developmental Disabilities Assistance and Bill of Rights Act of 2007 (DD Act). While the DD Act’s policy endorses residential choice for individuals with DD, state P&A’s (a DD Act program) often act, through class action litigation, to eliminate ICFs/MR. VOR and other DD stakeholder groups will call for reforms to address this situation when the legislation is introduced. For more information on VOR’s legislative positions, go to VOR’s web-site at http://www.vor.net/2007Leave-Behind.htm.
For more information about VOR’s meeting, go to the June 28 Washington Update article at http://www.ahca.org/members/operate/special/icfs-mr/VOR_mtg_062807_WUO.pdf.
OSHA Seeking Proposals for Safety and Health Training Grants
The Occupational Safety and Health Administration (OSHA) is accepting proposals for approximately $10.1 million in new grants to nonprofit organizations, including community and faith-based organizations, for employee safety and health training under the Susan Harwood Training Grants program. The grants are targeted to organizations proposing training for limited English proficiency employees and workers in high-hazard/high fatality rate industries. Long term care is considered a high hazard industry.
OSHA is also accepting new applications for Targeted Topic Training Grants, which support various topics including preparing workplaces for influenza pandemic [See OSHA Releases Pandemic Flu Guidance for Healthcare Workers article in this edition of Regulatory Update for more information.]
Details on eligibility and applications for the grants are available in the June 21, 2007 Federal Register at http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/pdf/07-3001.pdf.
OSHA is also accepting new applications for Targeted Topic Training Grants, which support various topics including preparing workplaces for influenza pandemic [See OSHA Releases Pandemic Flu Guidance for Healthcare Workers article in this edition of Regulatory Update for more information.]
Details on eligibility and applications for the grants are available in the June 21, 2007 Federal Register at http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/pdf/07-3001.pdf.
OIG FY 2007 Semiannual Report
On June 8, 2007, the U.S. Department of Health, Office of Inspector General (OIG) released its FY 2007 "Semiannual Report to Congress" for October through March. The OIG reports that during this period of time, it expects recoveries up to $2.9 billion in audit and investigative receivables. The OIG reports that 1,278 individuals and organizations were excluded from the Medicare or Medicaid programs for fraud and abuse against the government or beneficiaries. The OIG also reports 209 criminal actions against individuals or entities that engaged in crimes against federal health care programs and 123 civil actions. Further, the OIG engaged in oversight under its relatively new authority created by the Medicare Modernization Act and the Deficit Reduction Act - reviewing and evaluating: a) state's false claims laws; b) the compliance plans for prescription drug plan sponsors; c) reported deaths of patients in restraint or seclusion; and d) the responses of public health personnel to the emergencies created by Huricanes Katrina and Rita. To obtain a complete copy of the OIG report go to http://oig.hhs.gov/publications/docs/semiannual/2007/SemiannualFirstHalf07.pdf.
Regulatory/Life Safety
Sprinkler Recall Concluding. The six-year-old sprinkler recall is ending on August 31, 2007. In 2001, Central Sprinkler Company and the United States Consumer Product Safety Commission announced a voluntary replacement program for certain Central Sprinkler, Gem and Star O-ring sprinklers. AHCA members were advised of the recall in 2001 and 2002. In order to receive free replacement sprinkler heads and installation under the voluntary recall, a proof of claim form and waiver and release of claims must be submitted to Central Sprinkler Company postmarked by August 31, 2007. If there is any question that the sprinkler heads in a facility may need to be replaced, we recommend that the facility contact their sprinkler contractor for review. For more information, go to www.SprinklerReplacement.com, or call the Central Sprinkler voluntary replacement program hotline at 1-800-871-3492.
Thursday, June 21, 2007
Aging and Disability Resource Center Update
In fiscal year (FY) 2003, the Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS) formed a partership to launch Aging and Disability Resource Centers (ADRC) . AoA and CMS share a vision that these ADRCs will serve as highly visible and trusted places where people of all ages can turn for information on the full range of long term support options and a single point of entry to public long term support programs and benefits. ADRCs are a resource for both public and private pay individuals. They serve older adults, younger individuals with disabilities, family caregivers, as well as persons planning for future long term support needs.
Since FY 2003, 43 states have received 3-year grants from AoA and CMS to design and implement ADRC demonstrations serving the elderly and at least one other target population of adults with disabilities in at least one community. Currently, AoA and CMS are seeking proposals for competitive grants to assist those states that were funded to develop ADRCs in FY 2004 (Alaska, Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, New Mexico, North Carolina, Northern Mariana Islands and Wisconsin) to significantly expand their existing ADRC programs. Building on current efforts, ADRC programs funded under this new program announcement will be:
Since FY 2003, 43 states have received 3-year grants from AoA and CMS to design and implement ADRC demonstrations serving the elderly and at least one other target population of adults with disabilities in at least one community. Currently, AoA and CMS are seeking proposals for competitive grants to assist those states that were funded to develop ADRCs in FY 2004 (Alaska, Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, New Mexico, North Carolina, Northern Mariana Islands and Wisconsin) to significantly expand their existing ADRC programs. Building on current efforts, ADRC programs funded under this new program announcement will be:
- Expanded to provide services to additional communities, and/or
- Positioned to assume the role as the only entry point to publicly funded long term support systems, and/or;
- Enhanced to support states long term care rebalancng efforts either through nursing facility diversion or transition or participation in the re-direction of services dollars to consumer directed models including cash & counseling.
The total amount of Federal funds available for this grant program is $2.4 million. AoA anticipates funding up to 12 projects for a period of one year. Only states that received an AoA and CMS ADRC grant in FY 2004 are eligible to apply.
For a detailed description of this new grant program, go to www.aoa.gov/doingbus/fundopp/fundopp.asp.
NASUA Report on Long-Term Support Options Counseling in ADRCs
The National Association of State Units on Aging (NASUA) released, in January 2007, a report on options counseling in Aging & Disability Resource Centers (ADRC). ADRCs, funded jointly by the Administration on Aging (AOA) and the Centers for Medicare & Medicaid Services (CMS) have three major functions--awareness and information, assistance (including options counseling) and access. This report focuses on the importance of options counseling for ADRCs to successfully meet its goal of assistance.
The paper reports that options counseling is a pivotal function of ADRCs and that its essential elements are counseling and decision support. The paper notes that currently there is a diverse array of definitions of option counseling and this diversity runs the risk of diminishing its importance. Thus there is a need to develop a consistent definition of options counseling. NASUA suggests that options counseling is a unique service of the ADRC that distills the essential elements envisioned by AoA and CMS and reflects practices that currently are being developed by ADRCs across the country. It defines options counseling as follows:
Options Counseling-- an interactive decision-support process whereby consumers, family members and/or significant others are supported in their deliberations to determine appropriate long term-care choices in the context of the consumer's needs, preferences, values, and individual circumstances.
Options counselors, according to the report, must be knowledgeable about the long term care options available in the community, have an understanding of, and sensitivity to, the needs of people seeking help; and be trained as counselors. In addition, options counselors should be unbiased and able to support individuals who require extra help to access necessary services, as well as able to help families and individuals to identify options and next steps for meeting long term care needs.
To access the NASUA report, go to http://www.hcbs.org/moreInfo.php/doc/1929.
The paper reports that options counseling is a pivotal function of ADRCs and that its essential elements are counseling and decision support. The paper notes that currently there is a diverse array of definitions of option counseling and this diversity runs the risk of diminishing its importance. Thus there is a need to develop a consistent definition of options counseling. NASUA suggests that options counseling is a unique service of the ADRC that distills the essential elements envisioned by AoA and CMS and reflects practices that currently are being developed by ADRCs across the country. It defines options counseling as follows:
Options Counseling-- an interactive decision-support process whereby consumers, family members and/or significant others are supported in their deliberations to determine appropriate long term-care choices in the context of the consumer's needs, preferences, values, and individual circumstances.
Options counselors, according to the report, must be knowledgeable about the long term care options available in the community, have an understanding of, and sensitivity to, the needs of people seeking help; and be trained as counselors. In addition, options counselors should be unbiased and able to support individuals who require extra help to access necessary services, as well as able to help families and individuals to identify options and next steps for meeting long term care needs.
To access the NASUA report, go to http://www.hcbs.org/moreInfo.php/doc/1929.
FHCA Conducts Hurricane Summit for Gulf States
On May 21 - 22, 2007, the Florida Health Care Association (FHCA), with funding from the John A. Hartford Foundation, hosted a Nursing Home Hurricane Summit to focus on the needs of long term care facilities in seven southern coastal states (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina and Texas) during a major hurricane. Representatives from the local, state, and federal government, including the state emergency command centers, the Federal Emergency Management Agency, the Centers for Medicare and Medicaid Services , AARP, the motor coach industry, the American Health Care Association (AHCA) and its state affiliates, and nursing facility owners, administrators, physicians and clinicians, discussed their disaster planning and recovery experiences and goals for the future.
Summit participants agreed that transportation remains a major challenge and they discussed innovative solutions. Brian Scott, President of the United Motorcoach Association, urged facilities to develop relationships with transportation providers now and not wait until a disaster strikes to get to know them. Bob Watkins, Consolidated Safety Services, proposed using retired "metro buses." These buses have doublewide doors and are inexpensive. Watkins said the buses could be maintained and operated by a motorcoach company and accessed by facilities when needed. At the national level, AHCA and FHCA reported some progress utilizing a multi-disciplinary workgroup to highlight the impact of state-secured transportation contracts that remove buses from the national inventory and thus reduce transportation assets to nursing facilities.
Communication is another challenging area that was discussed in depth. Satellite phones were mentioned as a good alternative though it also was pointed out that they are not totally reliable. The difficult decision of evacating or sheltering in place received a lot of attention. The importance of maintaining staff during hurricanes, whether there is sheltering in place or evacuation, was stressed.
A new software decision-making template was showcased. The software, which is not yet finalized, to generate comprehensive emergency management plans for long term care facilities was developed by University of South Florida and FHCA with funding from the John A. Hartford Foundation. The software represents the first-ever electronic integration of federal and state requirements for nursing facility disaster plans and is also aligned with the latest recommendations from the U.S. Center for Disease Control and Prevention. Users will be able to generate a disaster plan and other reports and edit them with word processing software.
For more information on the Nursing Home Hurricane Summit, see the article entitled, "LTC Stakeholders Seek Inclusion in Emergency Preparedness Plans" in the July issue of Provider Magazine. Also, a report of the Hurricane Summit will be available soon and posted on the FHCA Web site at http://www.fhca.org/.
Summit participants agreed that transportation remains a major challenge and they discussed innovative solutions. Brian Scott, President of the United Motorcoach Association, urged facilities to develop relationships with transportation providers now and not wait until a disaster strikes to get to know them. Bob Watkins, Consolidated Safety Services, proposed using retired "metro buses." These buses have doublewide doors and are inexpensive. Watkins said the buses could be maintained and operated by a motorcoach company and accessed by facilities when needed. At the national level, AHCA and FHCA reported some progress utilizing a multi-disciplinary workgroup to highlight the impact of state-secured transportation contracts that remove buses from the national inventory and thus reduce transportation assets to nursing facilities.
Communication is another challenging area that was discussed in depth. Satellite phones were mentioned as a good alternative though it also was pointed out that they are not totally reliable. The difficult decision of evacating or sheltering in place received a lot of attention. The importance of maintaining staff during hurricanes, whether there is sheltering in place or evacuation, was stressed.
A new software decision-making template was showcased. The software, which is not yet finalized, to generate comprehensive emergency management plans for long term care facilities was developed by University of South Florida and FHCA with funding from the John A. Hartford Foundation. The software represents the first-ever electronic integration of federal and state requirements for nursing facility disaster plans and is also aligned with the latest recommendations from the U.S. Center for Disease Control and Prevention. Users will be able to generate a disaster plan and other reports and edit them with word processing software.
For more information on the Nursing Home Hurricane Summit, see the article entitled, "LTC Stakeholders Seek Inclusion in Emergency Preparedness Plans" in the July issue of Provider Magazine. Also, a report of the Hurricane Summit will be available soon and posted on the FHCA Web site at http://www.fhca.org/.
CMS Clarifies Special Transition Period for Retroactive Enrollment
The Centers for Medicare and Medicaid Services (CMS) issued guidance clarifying the 2007 policy outlined in section 50.10 of Chapter 14 of the Prescription Drug Benefit Manual on Coordination of Benefits entitled, “Special Transition for Retroactive Enrollment Situations.”
CMS learned that a number of Part D plan sponsors are incorrectly pointing to the March 31, 2007 coverage year deadline as a reason for non-payment of 2006 claims for covered Part D drugs associated with retroactive enrollment situations. This was an incorrect action and interpretation of the date of the deadline.
The March 31, 2007 date relates to the regulatory definition of a coverage year (see 42 CFR 423.308). This deadline is necessary in order for plans to prepare for payment reconciliation for which the plan’s prescription drug event data must be submitted to CMS by May 31st. This date is to be distinguished from cut-off dates for the submission of claims associated with payment reconciliation from the liability for payment of claims arising as a result of coordination of benefit situations.
In the case of retroactive enrollments, beneficiaries and other parties -- who made payment during a retroactive period eligible for reimbursement under a special transition period -- represent third party payers that are entitled to reimbursement by the plan under Part D coordination of benefit requirements regardless of CMS payment reconciliation timeframes. To ensure that these third party payers have opportunity to request reimbursement for claims incurred during the retroactive period, sponsors must use the date of the Medicaid notification to establish a new timely claims filing period.
In conclusion, a March 31st deadline cannot be used as a barrier to payer requests for reimbursement of claims incurred during periods covered by the retroactive enrollment. Rather, Part D plan sponsors must accommodate and facilitate requests for reimbursement of claims associated with retroactive enrollment coverage.
The issuance is available on the AHCA members only web site at http://www.ahca.org/members/finance/medicare/part_d/RetroactiveEnrollments052507.pdf. The issuance includes a chart that provides five scenarios and the action required of the Part D plan.
CMS learned that a number of Part D plan sponsors are incorrectly pointing to the March 31, 2007 coverage year deadline as a reason for non-payment of 2006 claims for covered Part D drugs associated with retroactive enrollment situations. This was an incorrect action and interpretation of the date of the deadline.
The March 31, 2007 date relates to the regulatory definition of a coverage year (see 42 CFR 423.308). This deadline is necessary in order for plans to prepare for payment reconciliation for which the plan’s prescription drug event data must be submitted to CMS by May 31st. This date is to be distinguished from cut-off dates for the submission of claims associated with payment reconciliation from the liability for payment of claims arising as a result of coordination of benefit situations.
In the case of retroactive enrollments, beneficiaries and other parties -- who made payment during a retroactive period eligible for reimbursement under a special transition period -- represent third party payers that are entitled to reimbursement by the plan under Part D coordination of benefit requirements regardless of CMS payment reconciliation timeframes. To ensure that these third party payers have opportunity to request reimbursement for claims incurred during the retroactive period, sponsors must use the date of the Medicaid notification to establish a new timely claims filing period.
In conclusion, a March 31st deadline cannot be used as a barrier to payer requests for reimbursement of claims incurred during periods covered by the retroactive enrollment. Rather, Part D plan sponsors must accommodate and facilitate requests for reimbursement of claims associated with retroactive enrollment coverage.
The issuance is available on the AHCA members only web site at http://www.ahca.org/members/finance/medicare/part_d/RetroactiveEnrollments052507.pdf. The issuance includes a chart that provides five scenarios and the action required of the Part D plan.
CMS Part D Plan Guidance Points Need Locator Code Use
AHCA continues to work with the Centers for Medicare & Medicaid Services (CMS) on Medicare Part D implementation issues. One of the ongoing problems facing Medicare beneficiaries in long term care settings is that many Part D Plans do not appropriately identify these beneficiaries, including dual eligibles, as residing in a skilled nursing facility (SNF).
This identification is essential for many reasons, such as the fact that co-payments for Part D drugs are waived for dual eligible beneficiaries in a SNF; certain Part B drugs are covered under Medicare Part D for all beneficiaries in SNFs, and special transition processes apply to beneficiaries in SNFs. AHCA has been urging CMS to require the plans to use standard National Council for Prescription Drug Programs (NCPDP) locator codes that identify beneficiaries as living in a long term care facility.
CMS just issued additional guidance to the Part D Plans that indicates CMS is working to change the existing system and recommends that the Part D Plans obtain updated beneficiary information from pharmacies. According to CMS’ issuance, it is permissible under the Health Insurance Privacy and Portability Act (HIPPA) for a long term care pharmacy to disclose protected health information such as beneficiaries’ addresses to a Part D Plan. The guidance is available on the AHCA members only web site at http://www.ahca.org/members/finance/medicare/part_d/LTCConvenientAccess-final_060107.pdf
This identification is essential for many reasons, such as the fact that co-payments for Part D drugs are waived for dual eligible beneficiaries in a SNF; certain Part B drugs are covered under Medicare Part D for all beneficiaries in SNFs, and special transition processes apply to beneficiaries in SNFs. AHCA has been urging CMS to require the plans to use standard National Council for Prescription Drug Programs (NCPDP) locator codes that identify beneficiaries as living in a long term care facility.
CMS just issued additional guidance to the Part D Plans that indicates CMS is working to change the existing system and recommends that the Part D Plans obtain updated beneficiary information from pharmacies. According to CMS’ issuance, it is permissible under the Health Insurance Privacy and Portability Act (HIPPA) for a long term care pharmacy to disclose protected health information such as beneficiaries’ addresses to a Part D Plan. The guidance is available on the AHCA members only web site at http://www.ahca.org/members/finance/medicare/part_d/LTCConvenientAccess-final_060107.pdf
CMS IGT Final Rule
On Friday, May 22, 2007, the Centers for Medicare and Medicaid (CMS) issued the final rule with comment period regarding the Medicaid program and the use of intergovernmental transfers (IGT). The regulation was published in the Federal Register on May 29, 2007 "Medicaid Program; Cost Limit for Providers Operated by Units of Government and Provisions to Ensure The Integrity of Federal-State Financial Partnership", 72 Federal Register 29748. The comment period pertains solely to the definition of “unit of government.” The full text of the final rule is available at: http://www.ahca.org/members/finance/medicaid/cost_limit_final_rule_070529.pdf. AHCA has a summary, which is available at:
http://www.ahca.org/members/finance/medicaid/igt/wu070607.htm.
CMS cannot implement the final rule at this time due to the supplemental bill signed by the President into law. This bill includes a one year moratorium on the rule. Nevertheless, the rule indicates CMS’ thinking and the type of rule that they will issue in one year – barring any other developments that would again impede implementation.
The preamble text of the final rule is lengthy with CMS appearing to respond to the many comments received. However, the responses, especially to questions on the overall financial impact of the rule, are very repetitive and redundant and demonstrate that CMS is exceedingly dismissive of the many fiscal problems raised by the commenters.
CMS’ responses can be categorized as falling into two categories. The first category is an overarching policy message that the agency will not back down and that its policy of carefully defining a unit of government and limiting federal financial participation (FFP) reimbursement to these units to cost are driven by the imperative of fiscal responsibility and integrity. The agency does not acknowledge the breadth of potential harm in their responses to financial impact issues raised by the commenting public and concerns about payment methodology impact.
The second category is the set of responses to specific issues raised in particular by the governmentally-operated entities regarding the definitions, burdens and mechanics of the requirements mandated by the proposed rule. Here, again, CMS’ responses appear to indicate very little flexibility. AHCA addresses both categories in the summary memorandum. Key CMS policy positions articulated in the final rule include the following:
- The agency simply refused to acknowledge that there would be cuts to programs. It insisted that the cost limit provision should not force cuts to the Medicaid program, nor affect eligibility, benefits and services.
- As if to point out how fortunate governmentally-operated providers would be under the new rule, CMS not only insisted that they would be better off under the new rule (if they had not been receiving payment in excess of cost), but were indeed a lot better off than most private facilities. CMS made clear that the norm for private health care providers is NOT to receive more than cost. In fact, CMS observed in no less than three different parts of the preamble that, “While the provisions of the regulation do not impose a Medicaid cost limit on private health care providers, we have found during recent reviews of Medicaid reimbursement methodologies, States typically reimburse private health care providers at rates less than the cost of serving Medicaid eligible individuals.”
- CMS would not acknowledge any confusion regarding imposing cost limits on PPS type payment methodologies. CMS declared that the regulation does not preclude states from using the same payment methods for governmental and private providers, as long as governmental providers are not paid in excess of cost. CMS added that the provisions of the regulation do not force states to dismantle any of the existing Medicaid reimbursement rate methodologies they are currently utilizing to reimburse health care providers -- states may continue to use Medicaid reimbursement rate methodologies, but will need to compare such rates to the actual cost of providing services to Medicaid individuals and make reconciling adjustments in the event of overpayments to a particular governmentally-operated health care provider.
Tuesday, June 19, 2007
GAO Report – Other Countries: Policies and Practices that Help Women Enter and Remain in the Workforce
The Government Accountability Office (GAO), at the request of the Joint Economic Committee, examined the policy and practices in other developed countries that attract and retain individuals who otherwise might not be in the workforce or who drop in and out of the workforce. The purpose of the study and the Joint Economic Committee’s request was to examine the experience in other countries that may be useful to United States (US) policymakers. Examiners looked at policy and practices that helped women and low-wage skilled workers enter and remain in the workforce. Canada, United Kingdom (UK), the Netherlands, Demark, Belgium, France, Ireland, New Zealand and Sweden were targeted by the examiners. Policy and practices in each country were reviewed and government officials interviewed.
Most of the countries studied are members of the European Union (EU) and thus, EU laws were taken into account. The EU provides minimum standards or basic rights for individuals across the member states. For example, an EU directive in 1997 mandated that people holding less than full-time jobs be given pro rated pay without discrimination.
The GAO examiners found that governments and employers in other countries developed a variety of laws, government policies and formal and informal practices addressing period of leave, flexible work schedules, childcare, and training. Each country has some form of paid family leave (maternity, paternity, parental), subsidized or tax credit benefits for childcare and offers a range of training and apprenticeship program. A few countries offer flexible work opportunities, apart from leave, like the Netherlands where workers have the right to increase or decrease working hours no matter the reason for doing so and employers have the right to deny the request if the accommodation results in a serious obstacle.
In general, the GAO found that workplace policy and practices in the countries studied reflect cooperation among government, employer and employee organizations. Many of these policies and practices were found to help women and others to enter and remain in the workforce. The information learned from this examination lead the GAO to conclude that by potentially increasing the women’s labor force participation by further facilitation a balance of work and family and improving the skills of low-wage workers throughout their careers, may be important in helping the US maintain the size and productivity of it labor force.
The entire report, GAO-07-817, June 2007, Women and Low-Skilled Workers: Other Countries’ Policies and Practices That May Help These Workers Enter and Remain in the Labor Force can be found, at no charge, on http://www.gao.gov/.
Most of the countries studied are members of the European Union (EU) and thus, EU laws were taken into account. The EU provides minimum standards or basic rights for individuals across the member states. For example, an EU directive in 1997 mandated that people holding less than full-time jobs be given pro rated pay without discrimination.
The GAO examiners found that governments and employers in other countries developed a variety of laws, government policies and formal and informal practices addressing period of leave, flexible work schedules, childcare, and training. Each country has some form of paid family leave (maternity, paternity, parental), subsidized or tax credit benefits for childcare and offers a range of training and apprenticeship program. A few countries offer flexible work opportunities, apart from leave, like the Netherlands where workers have the right to increase or decrease working hours no matter the reason for doing so and employers have the right to deny the request if the accommodation results in a serious obstacle.
In general, the GAO found that workplace policy and practices in the countries studied reflect cooperation among government, employer and employee organizations. Many of these policies and practices were found to help women and others to enter and remain in the workforce. The information learned from this examination lead the GAO to conclude that by potentially increasing the women’s labor force participation by further facilitation a balance of work and family and improving the skills of low-wage workers throughout their careers, may be important in helping the US maintain the size and productivity of it labor force.
The entire report, GAO-07-817, June 2007, Women and Low-Skilled Workers: Other Countries’ Policies and Practices That May Help These Workers Enter and Remain in the Labor Force can be found, at no charge, on http://www.gao.gov/.
HRSA Updates Income Level Requirements for Nurse Education Loans
The Health Resources and Services Administration (HRSA) is updating income levels used to identify low income families for the purpose of determining eligibility for health professions training programs, like nursing, for individuals with disadvantaged backgrounds. Income levels identify individuals who are disadvantaged, those from disadvantaged backgrounds or from low-income families.
The various HRSA health professions and nursing grants programs use the income levels to determine the individual’s eligibility status and funding awards to accredited schools of medicine, osteopathic medicine, public health, dentistry, nursing, public health, pharmacy, optometry, chiropractic, podiatry, and veterinary medicine. Public or private nonprofit schools school that offer programs in mental and behavioral health are also eligible for program grants. Some of the HRSA programs provide repayment of health professions and nursing education loans.
A “low income family” is a group of two or more individuals related by birth, marriage or adoption who live together or an individual who is not living with any relatives. Most HRSA programs use the income of the student’s parents along as he/she is not listed as a dependent on the parent’s tax form. Some grant programs consider the age and circumstances of the individual as well. Other programs consider the student’s family rather than his/her parent’s family.
Every year, the income levels are adjusted and are based on poverty thresholds published by the U.S. Bureau of Census adjusted for changes in the Consumer Price index. The income levels using the student’s parent’s family size and income level includes:
Size of Parents’ Family Income Level
1 $20,420
2 $27,380
3 $34,340
4 $41,300
5 $48,250
6 $55,220
7 $62,180
8 $69,140
The Secretary of the Health and Services Administration (HHS) annually adjusts the income levels and makes them available to HRSA for various grant program administered under Titles III, VII and VIII of the Public Service Act.
The various HRSA health professions and nursing grants programs use the income levels to determine the individual’s eligibility status and funding awards to accredited schools of medicine, osteopathic medicine, public health, dentistry, nursing, public health, pharmacy, optometry, chiropractic, podiatry, and veterinary medicine. Public or private nonprofit schools school that offer programs in mental and behavioral health are also eligible for program grants. Some of the HRSA programs provide repayment of health professions and nursing education loans.
A “low income family” is a group of two or more individuals related by birth, marriage or adoption who live together or an individual who is not living with any relatives. Most HRSA programs use the income of the student’s parents along as he/she is not listed as a dependent on the parent’s tax form. Some grant programs consider the age and circumstances of the individual as well. Other programs consider the student’s family rather than his/her parent’s family.
Every year, the income levels are adjusted and are based on poverty thresholds published by the U.S. Bureau of Census adjusted for changes in the Consumer Price index. The income levels using the student’s parent’s family size and income level includes:
Size of Parents’ Family Income Level
1 $20,420
2 $27,380
3 $34,340
4 $41,300
5 $48,250
6 $55,220
7 $62,180
8 $69,140
The Secretary of the Health and Services Administration (HHS) annually adjusts the income levels and makes them available to HRSA for various grant program administered under Titles III, VII and VIII of the Public Service Act.
Friday, June 15, 2007
Financing Long Term Care
Financing Long Term Care
June 11, 2007
Georgetown University Long Term Care Financing Project sponsored a forum held on Monday, June 11, 2007 at the Kaiser Family Foundation in Washington, DC. To receive a copy of the forum’s documentation click on the link
http://ltc.georgetown.edu/forum.html
Some of the attendees consisted of representatives from the GAO, CMS, HHS/ASPE, OPM, Senate Special Committee on Aging, SSA, The Lewin Group, Paralyzed Veterans of America, AARP, and John Hancock Life Insurance just to mention a few. Sixteen presenters discussed their proposals which attempted to offer some solutions of how Long Term Care should be financed to meet the growing baby boomer population that will need LTC starting in 2011. The following is a brief summary of the proposals which is available in the Financing Long Term Care binder.
The need for LTC for the nation’s baby boomer is expected to double or triple and will level-off in 2050. From 1950 – 2000 there was a 2.2% increase in LTC growth. By 2020 there will be a 5% growth in the LTC population.
Today there are 5 million people with Alzheimer's disease and the population will triple with the aging baby boomers. Alzheimer will burden families financially and physically. Money that could be spent on their own LTC will be spent on aging family members.
It is expected that there will be a workforce shortage in LTC until 2050.
Most proposals indicated that there should be a balance between public (Medicare/Medicaid) and private LTC insurance.
Currently, more than 50% of Americans LTC is financed by Medicaid. If this trend continues it will put a strain on the US economy.
i) One suggestion is that we should purchase LTC insurance in our 20’s to avoid being caught in the 25% rejection rate. However, there is some risk of being denied benefits after paying the LTC insurance along with paying higher premiums in retirement.
ii) Another recommendation was to purchase annuities with tax incentives. The problem is that most LTC insurance companies offer very little asset protection and LTC insurance coverage.
At this time there are only 24 states that offer tax incentives for buying LTC insurance. In addiction, there is no LTC insurance for individuals with disabilities nor did any of the 16 presenters offer a solution for this population.
Some others proposed a mandate for everyone to purchase LTC insurance, create another tax bucket for LTC, and create a cash benefit for everyone to choose their LTC.
CDC FoodNet Releases Report on Foodborne Illnesses
In a recent news release from the Centers for Disease Control and Prevention (CDC), www.cdc.gov/od/oc/media/pressrel/2007/r070412.htm, some foodborne infection cases have leveled after a period of decline. For other infections, incidents seem to be returning to previous levels. According to the CDC ‘s FoodNet data, a foodborne disease surveillance network, there continues to be little change in the incidence of Salmonella cases and efforts made in reducing the cases of E. coli O157 infections have been lost.
The CDC states the reasons for the lack of decrease in the incidents of infections caused by E. coli O157 and Salmonella are not fully understood. When CDC’s FoodNet started monitoring boodborne disease outbreaks, spinach and peanut butter were found to be the primary sources of contamination.
According to Dr. Robert Tauxe, Deputy Director of CDC’s Division of Foodborne, Bacterial and Mycotic Diseases, these infectious agents are now appearing in foods that were not previously associated with the diseases. The recent foodborne outbreaks in the United States involve tomatoes, lettuce and spinach. Dr. Julie Gerberding, CDC Director states these findings underscore to the need to more effectively prevent contamination of produce.
To reduce the risk of foodborne illnesses, the CDC recommends following safe food-handling practices by avoiding consumption of unpasteurized milk and raw or undercooked oysters, eggs, beef and poultry. The risk of foodborne illness is also reduced by choosing in-shell pasteurized eggs, irradiated ground beef and high pressure-treated oysters.
To view the full CDC report, “Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food – 10 States, United States, 2006” go to http://www.cdc.gov/mmwr and type in the report title in the search bar. The report also appeared in the April 13, 2007 Morbidity and Morality Weekly Report.
The CDC states the reasons for the lack of decrease in the incidents of infections caused by E. coli O157 and Salmonella are not fully understood. When CDC’s FoodNet started monitoring boodborne disease outbreaks, spinach and peanut butter were found to be the primary sources of contamination.
According to Dr. Robert Tauxe, Deputy Director of CDC’s Division of Foodborne, Bacterial and Mycotic Diseases, these infectious agents are now appearing in foods that were not previously associated with the diseases. The recent foodborne outbreaks in the United States involve tomatoes, lettuce and spinach. Dr. Julie Gerberding, CDC Director states these findings underscore to the need to more effectively prevent contamination of produce.
To reduce the risk of foodborne illnesses, the CDC recommends following safe food-handling practices by avoiding consumption of unpasteurized milk and raw or undercooked oysters, eggs, beef and poultry. The risk of foodborne illness is also reduced by choosing in-shell pasteurized eggs, irradiated ground beef and high pressure-treated oysters.
To view the full CDC report, “Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food – 10 States, United States, 2006” go to http://www.cdc.gov/mmwr and type in the report title in the search bar. The report also appeared in the April 13, 2007 Morbidity and Morality Weekly Report.
HHS Announces Grants for Gulf Coast Region
On May 24, 2007, the Department of Health and Human Services announced $195 million in grants to improve health care in areas affected by Hurricane Katrina. $60 million will be divided between Alabama, Louisiana and Mississippi for skilled nursing facilities, acute care hospitals, inpatient psychiatric facilities and community mental health centers. Specifically, this money is to help providers that face financial pressures as a result of changing wage rates that have not yet been reflected or adjusted for in Medicare payment methodologies. Based on each eligible organization's share of total Medicare payments under a prospective payment system for inpatient care, the Centers for Medicare & Medicaid Services will allocate funds as follows: 44 percent, just over $26 million, for Louisiana; 39 percent, approximately $23 million for Mississippi; and 17 percent, $10.5 million for Alabama. Funding is available to care providers in counties/parishes designated by the Federal Emergency Management Agency to receive both individual and public assistance. As part of the grant process, the three states must submit applications to CMS. Providers would apply to their respective states to become a recipient of these funds. This is the second release of grants for provider stabilization; CMS allocated $160 million last year for the three states.
$100 million will be allocated to Louisiana clinics that provide primary care to low-income and uninsured residents in the Greater New Orleans area. The remaining $35 million will go to recruiting and retaining health care workers in the Greater New Orleans area, including physicians, dentists, psychiatrists, registered nurses, clinical faculty, and licensed professional health care staff. Louisiana has flexibility in determining the type and scope of recruitment activities, but efforts can include income guarantees, annual medical malpractice payment relief, loan repayments and incentive payments, such as relocation expenses and sign-on bonuses. This is the second release of grants for recruitment and retention; CMS awarded Louisiana $15 million grant this past January.
$100 million will be allocated to Louisiana clinics that provide primary care to low-income and uninsured residents in the Greater New Orleans area. The remaining $35 million will go to recruiting and retaining health care workers in the Greater New Orleans area, including physicians, dentists, psychiatrists, registered nurses, clinical faculty, and licensed professional health care staff. Louisiana has flexibility in determining the type and scope of recruitment activities, but efforts can include income guarantees, annual medical malpractice payment relief, loan repayments and incentive payments, such as relocation expenses and sign-on bonuses. This is the second release of grants for recruitment and retention; CMS awarded Louisiana $15 million grant this past January.
Alabama State Plan Amendment to Allow Self-Directed Personal Assistance Services
On May 24, 2007, the U.S. Department of Health and Human Services announced that Alabama is the first state to receive federal approval to allow self-directed personal assistance services (PAS) as a feature of its Medicaid plan, thus eliminating the need for a waiver. Under section 6087 of the Deficit Reduction Act of 2005 (DRA), states may offer Medicaid beneficiaries the opportunity to direct their own personal care services under a state plan amendment.
States still must seek federal approval to offer this state plan option, but once a state plan amendment has been approved by HHS, no further permission for this added benefit is required. States must provide necessary safeguards to protect the health and welfare of participants who choose to direct their own care. States must ensure that participants have the necessary information, counseling, training and assistance to enable them to successfully manage their own care.
Alabama's new benefit permits participants to direct their personal care, homemaker, unskilled respite and companion services and to hire legally liable relatives to provide their care. In addition, participants may use their service budgets to pay for items that increase their independence or substitute for human assistance. The state will also permit participants to receive some cash so that goods and services can be purchased directly.
States still must seek federal approval to offer this state plan option, but once a state plan amendment has been approved by HHS, no further permission for this added benefit is required. States must provide necessary safeguards to protect the health and welfare of participants who choose to direct their own care. States must ensure that participants have the necessary information, counseling, training and assistance to enable them to successfully manage their own care.
Alabama's new benefit permits participants to direct their personal care, homemaker, unskilled respite and companion services and to hire legally liable relatives to provide their care. In addition, participants may use their service budgets to pay for items that increase their independence or substitute for human assistance. The state will also permit participants to receive some cash so that goods and services can be purchased directly.
Emergency Respiratory Care Training Resource
On May 1, 2007, the U. S. Department of Health and Human Services Agency for Healthcare Research and Quality released a DVD titled “Cross Training Respiratory Extenders for Medical Emergencies (Project XTREME)” to train health care professionals who are not respiratory care specialists to provide basic respiratory care and ventilator management to adult patients in any mass casualty event. Among the possible emergencies when such auxiliary clinical help may be necessary are an influenza pandemic, a bioterrorist attack involving anthrax or other agents, or an outbreak of severe acute respiratory illnesses. Principal target groups for the training are physicians, physician assistants, and nurses. The DVD includes six training modules with interactive quizzes to test viewers’ knowledge. The modules cover infection control, respiratory care terms and definitions, manual ventilation (using hand-held bags), mechanical ventilation (using the two types of ventilators included in the Federal government’s Strategic National Stockpile of medicines and medical supplies for emergencies), airway maintenance, and airway suctioning. A related report also funded by AHRQ, “Project XTREME: Model for Health Professionals’ Cross-Training for Mass Casualty Respiratory Needs,” provides further information on the training model as well as the research and methodologies used in developing it. A free, single copy of the DVD and a CD-ROM with the report may be ordered by calling 1-800-358-9295 or by sending an e-mail to ahrqpubs@ahrq.gov. More information can be found online at http://www.ahrq.gov/prep/.
Fifth Year Report on Real Choice Systems Change Grants
In May 2007, the Centers for Medicare & Medicaid Services (CMS) released Real Choice Systems Change Grant Program Fifth Year Report: Progress and Challenges of the FY 2004 Grantees (October 1, 2005 - September 30, 2006). Grants under the Real Choice Systems Change Grant Program are intended to help states build an infrastrcture that enable individuals with disabilities or who are aged to 1) live in the most integrated community setting suited to their needs, 2) have meaningful choices about their living arrangements, and 3) exercise more control over their services. Grants were funded each fiscal year from FY 2001 to FY 2007. This report describes the FY 2004 grantees' accomplishments and progress in three long term care (LTC) systems areas as follows:
- Access to LTC services and supports: Increasing consumers' knowledge of available services, e.g., providing outreach and education was a primary method of improving access.
- Services, supports and housing: Initiatives included personal assistance services and supports, nursing facility transition and diversion, housing, mental health services and other efforts. Although transition and diversion was not a promary focus of the 2004 grants, some states were involved in activities such as downsizing facilities, developing strategies to support transition and diversion and the transition of 848 individuals to the community. Since affordable and accessible housing is a major barrier to community living, in FY 2004, CMS awarded 8 grants specific to this issue.
- Administrative and monitoring infrastructure: Most initiatives were designed to improve quality monitoring and management systems. States developed integrated quality assurance/quality improvement systems, added consumer-focused components to quality monitoring processes and developed or improving remediation systems.
Challenges for the grantees included difficulty in involving consumers and stakeholders in initiatives, staffing challenges, provider shortages and policy and administrative issues.
To read the report, go to http://www.hcbs.org/moreInfo.php/nb/doc/1935.
Influenza Pandemic Vaccine Manufacturing to Expand
On June 14, 2007, the U. S. Department of Health and Human Services (HHS) announced the award of two contracts to expand domestic influenza vaccine manufacturing capacity for use in a pandemic. Sanofi pasteur and MedImmune will receive $132.5 million to retrofit existing facilities and to provide warm-base operations. (In warm-base operations, the contractor does not shut down the facility.) Upon completion of the projects, these companies will expand domestic pandemic vaccine manufacturing capacit by 16% and will afford year-round production of pre-pandemic influenza vaccines for the national stockpile, which is limited currently to three months each year.
Thursday, June 14, 2007
DD Digest and Convention Discounts Are Now Available!
The sixth edition of DD Digest, a quarterly update for providers serving individuals with developmental disabilities (DD) is now available at http://www.ahca.org/members/operate/special/dd/200705.pdf. This edition contains information on CMS surveys of ICFs/MR, pending legislation that would affect DD providers, emergency preparedness, Medicaid restructuring, and much more!
In addition, for staff of intermediate care facilities for mental retardation (ICFs/MR) and group homes for DD, AHCA is offering discounts on full registration fees for the October annual meeting in Boston. The meeting includes five DD specific sessions, the first of which starts earlier than in previous years, on Sunday, October 7 at 2 pm, and focuses on sensory and visual strategies for adults with multiple disabilities. This session will take place immediately before the DD Town Hall meeting, so it’s a great way to learn about this important topic and start getting to know NEW friends and colleagues.
For more information on DD Digest, other DD track sessions for the annual meeting, and registration discounts, contact Melissa Temkin at mtemkin@ahca.org or 202-898-2822.
In addition, for staff of intermediate care facilities for mental retardation (ICFs/MR) and group homes for DD, AHCA is offering discounts on full registration fees for the October annual meeting in Boston. The meeting includes five DD specific sessions, the first of which starts earlier than in previous years, on Sunday, October 7 at 2 pm, and focuses on sensory and visual strategies for adults with multiple disabilities. This session will take place immediately before the DD Town Hall meeting, so it’s a great way to learn about this important topic and start getting to know NEW friends and colleagues.
For more information on DD Digest, other DD track sessions for the annual meeting, and registration discounts, contact Melissa Temkin at mtemkin@ahca.org or 202-898-2822.
OSHA Releases Guidance on Pandemic Flu for Healthcare Workers
The Occupational Safety and Health Administration (OSHA) recently released the Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers, which includes technical information on infection control, stockpiling checklists, sample pandemic plans, and other tools designed to reduce the risk of influenza (flu) infection in healthcare settings. OSHA states that the document is “completely consistent” with the Department of Health and Human Services’ (HHS) interim guidance on the use of surgical masks and respirators in healthcare settings. A summary and link to the HHS interim guidance is available on AHCA’s members only web-site at http://www.ahca.org/members/flu/wu061102-3.htm. To view the OSHA pandemic flu guidance, go to http://www.osha.gov/Publications/OSHA_pandemic_health.pdf.
OSHA Selects High Hazard Sites for Inspection, Adds Residential Facility Protocols
The Occupational Safety and Health Administration (OSHA) recently announced that it is targeting approximately 4,150 high hazard work sites for unannounced inspections under its site specific targeting (SST) plan for 2007. These work sites reported 11 or more injuries or illnesses resulting in days away from work, restricted work activity or job transfer (DART) for every 100 full-time workers or 9 or more cases that involve days away from work due to injuries or illnesses (DAFWII) for every 100 full-time workers per 2005 injury and illness data. As in previous years, OSHA will target for inspection and place on the primary inspection list only the highest 50% rated long term care facilities (standard industrial classification codes 8051, 8052, and 8059) with the above mentioned DART and DAFWII case rates.
Unlike previous years, SST-07 clarifies inspection scope protocols for residential care facilities, such as intermediate care facilities for mental retardation (ICFs/MR), group homes and assisted living facilities. These include requiring OSHA inspection of greenhouses, classrooms, work shops, etc. that are on-site at facilities, but not inspecting group home clients’ living quarters or the separate, individual homes of clients who receive in-home services from group home staff.
For a more in-depth summary and a link to the OSHA directive, go to http://www.ahca.org/members/operate/labor/osha/wu070524-1.htm.
Unlike previous years, SST-07 clarifies inspection scope protocols for residential care facilities, such as intermediate care facilities for mental retardation (ICFs/MR), group homes and assisted living facilities. These include requiring OSHA inspection of greenhouses, classrooms, work shops, etc. that are on-site at facilities, but not inspecting group home clients’ living quarters or the separate, individual homes of clients who receive in-home services from group home staff.
For a more in-depth summary and a link to the OSHA directive, go to http://www.ahca.org/members/operate/labor/osha/wu070524-1.htm.
VA’s “Aid and Attendance” Benefit Available for LTC Residents
AHCA/NCAL recently met with the Veterans Benefits Administration regarding a little known supplemental benefit called Aid and Attendance (A&A) that could help qualifying veterans and their surviving spouses (in some cases, children also qualify) receive extra monies for nursing facility (NF) and assisted living facility (ALF) care. A&A is paid in addition to VA standard monthly pension (for the veteran) or standard death pension (for the surviving spouse) that these individuals are already receiving.
NF and ALF providers can help eligible residents apply for this benefit, and free application assistance is available through VA county, state and regional offices. For more information on patient eligibility, suggested steps for applications, etc., go to the June 12 Washington Update article on AHCA’s members only web site at http://www.ahca.org/members/operate/special/veterans/wu070613.htm.
For general information on the Veterans Pension Program go to http://www.vba.va.gov/bln/21/pension/vetpen.htm.
For general information on Death Pension Benefits (VA Death Pension for Widows/Widowers and Dependent Children) go to http://www.vba.va.gov/bln/21/pension/spousepen.htm.
NF and ALF providers can help eligible residents apply for this benefit, and free application assistance is available through VA county, state and regional offices. For more information on patient eligibility, suggested steps for applications, etc., go to the June 12 Washington Update article on AHCA’s members only web site at http://www.ahca.org/members/operate/special/veterans/wu070613.htm.
For general information on the Veterans Pension Program go to http://www.vba.va.gov/bln/21/pension/vetpen.htm.
For general information on Death Pension Benefits (VA Death Pension for Widows/Widowers and Dependent Children) go to http://www.vba.va.gov/bln/21/pension/spousepen.htm.
NC Assesses Emergency Relocation Abilities
On June 12, 2007, the NC Office of Emergency Medical Services, with the assistance of the NC Health Care Facilities Association (NCHCFA) and local emergency medical services personnel, conducted an evacuation exercise at Britthaven nursing facility in Onslow County. The purpose of the exercise was to demonstrate and evaluate the state's ability to conduct a large-scale evacuation of special medical needs patients from a disaster zone. The exercise continued on June 14 at Surry County Community College where a medical evacuation center for patients with special needs was set up. The exercise provided an opportunity, not only to assess the nuts and bolts functioning of systems that would be used to transport medical patients from danger zones to safe havens, but also for nursing facility staff and emergency medical staff and state agency staff to learn about each other.
In addition, NCHCFA and the NC Office of Emergency Services have been working with consultants, LTC Alliance and LLC and Fire Safety, Inc., to develop an All Hazards Planning and Resource Guide and a template for long term care facilities that will be made available to every nursing facility in the state. NCHCFA also has planned five training sessions in July to assist facilities in their all hazards planning. NCHCFA received a $200,000 grant from the NC Department of Health and Human Services, Division of Facility Services, Office of Emergency Medical Services to develop this program. Once established, this program can be used to develop similar planning tools for Adult Care Homes, ICF/MRs, etc. However, this will be done outside of this grant.For more information on the guide or training for nursing facilities, contact Amy Bender, LTC Alliance, LLC at 704-799-1990 or ambconsult4u@aol.com. For information on the training exercise that was coordinated by the Department of Facility Services, Office of Emergency Services, contact Mark Chambers at 919-855-3958 or mark.chambers@ncmail.net.
In addition, NCHCFA and the NC Office of Emergency Services have been working with consultants, LTC Alliance and LLC and Fire Safety, Inc., to develop an All Hazards Planning and Resource Guide and a template for long term care facilities that will be made available to every nursing facility in the state. NCHCFA also has planned five training sessions in July to assist facilities in their all hazards planning. NCHCFA received a $200,000 grant from the NC Department of Health and Human Services, Division of Facility Services, Office of Emergency Medical Services to develop this program. Once established, this program can be used to develop similar planning tools for Adult Care Homes, ICF/MRs, etc. However, this will be done outside of this grant.For more information on the guide or training for nursing facilities, contact Amy Bender, LTC Alliance, LLC at 704-799-1990 or ambconsult4u@aol.com. For information on the training exercise that was coordinated by the Department of Facility Services, Office of Emergency Services, contact Mark Chambers at 919-855-3958 or mark.chambers@ncmail.net.
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