F E B R U A R Y / M A R C H 2 0 0 9

A G E N C Y F O R H E A L T H C A R E A D M I N I S T R A T I O N

Nursing Home Joint Training

Nursing Home Guides & Information

Federal Nursing Home Compare – 5 Star Ranking

Florida Nursing Home Guide

Comparison Chart (Handout) Time Frame

Violations Considered (Deficiencies)

Weight of Violations (Algorithms)

Star Rankings

Frequency of Updates

Inspection Reports Posted on the AHCA Web Site: ahca.myflorida.com/Consumer_Resources/index.shtml

Florida Nursing Home Quality Assessment

Authorized During January 2009 Special Session

Allows Florida Medicaid to Draw Federal Funds to Offset Cuts in Medicaid Budget

All Nursing Homes Pay Assessment Except:

Nursing Homes on the Campus of a Continuing Care Retirement Community (CCRC)

Hospital Based Skilled Nursing Units (SNUs)

Nursing Homes with 45 Beds or Less

Assessments Effective April 1, 2009

First Report Period May 1, 2009 – Deadline May 15th

Nursing Home Quality Assessment Rates

Per Day Assessment Rates Will Be Once Each Year

Rates will Differ for Large Versus Small Medicaid Providers

Large is 52,000 Annual Medicaid Days

Rates May Not Exceed 5.5% of Total Aggregate Net Patient Revenue

Report Monthly the Number of Non-Medicare Part A Days

Monthly Assessment = Number of Non-Medicare Days X Rate

Federal Approval Required from the Center for Medicare and Medicaid Services (CMS)

Modifications Must Be Made if Required by CMS

Nursing Home Quality Assessment Rates

Assessment Must Be Paid by the 15th of the Following Month

AHCA May Deduct from Medicaid Funds Owed or Fine $1,000 Per Day Late

Assessment Can Be Claimed in Medicaid Cost Reports with a Pass Through Reimbursement (full repayment)

Assessment Fee Amounts Cannot Be Passed on to Private Pay Residents

AHCA Developing the Method of Collecting Monthly Data and Fees

Emergency Status System Update

Provider, Affiliate, and Partner Accounts Available Nursing Home Enrollment 94%

Verify Your ESS Users & Access the System Update ESS Information:

Contacts, Numbers and Emails Utilities and Generator

ESS Activation: Email Users with Instructions Census and Bed Availability Impact if Affected

ESS Transportation Tab

Select the Add tab

Transportation Type

Select the Transport Type

Transportation Details

Transportation Updated

Emergency Status System Assistance

AHCA Emergency Resources: ahca.myflorida.com/MCHQ/Emergency_Activities/index.shtml

Emergency Status System Web Site: ess.myflorida.com

AHCA Long Term Care Unit: (850) 488-5861

AHCA Celerate

AHCA’s Version of “Accelerate Florida”

Focus on Opportunities to Simplify Processes & Information

Applications and Forms

Recognize Regulatory Requirements

Eliminate Duplication

Feedback Requested: ltcs@ahca.myflorida.com

New AHCA Web Site

Preview AHCA Web Site

Health Inspection Results: Florida Nursing Home Guide versus CMS Nursing Home Compare

Both web sites contain helpful information about nursing homes and can be used together with other information (such as a visit to the nursing home and information from your health care provider) to make informed choices when seeking nursing home care. The primary differences between the Health Inspection Stars

on the two web sites are described below:

Florida Nursing Home Guide Federal Nursing Home Compare Star Rankings Stars are based upon violations identified

during an inspection. “Health Inspections” Stars based upon certain violations identified during an inspection, staffing information, and quality measure information.

Time Frame Last 30 months of violations for all recertification and complaints inspections

Last 3 recertification surveys (which occur every 6-15 months) Last 3 years of complaints

Violations Considered

All federal nursing home deficiencies: “F” tags - Health and Services and “K” tags - Fire/Life Safety Non-certified nursing homes (5): “N” tags - State Licensure “K” tags - Fire/Life Safety

Certain federal nursing home deficiencies: “F” tags - Health and Services (“K” tags - Fire/Life Safety are excluded)

Weight of Violations

Violations are given points based on severity and scope (see chart) Certain critical violations receive additional points, See attached state algorithm All inspections are equal weight

Violations are given points based on severity and scope (see chart) “Substandard quality of care” violations additional points, See attached federal algorithm Most recent recertification inspections carry heavier weight: Most recent - 1/2 weight (50%) Second most recent - 1/3 weight (33.3%) Third most recent - 1/6 weight (16.7%)

Star Assignment Stars are allocated based upon a comparison with other nursing homes in the inspection region (11 geographic areas in Florida). Ranking across 100%: 5 Stars: Top 20% 4 Stars: 21% - 40% 3 Stars: 41% - 60% 2 Stars: 61% - 80% 1 Stars: Bottom 20%

Health Inspections Stars are allocated based upon a comparison with other nursing homes in the state. Ranking across 100%: 5 Stars: Top 10% 4 to 2 Stars: Middle 70% spread among 2 to 4 stars in 23.33% segments 1 Stars: Bottom 20%

Web Site Updates Quarterly Monthly

Florida’s Algorithm

Scoring and Ranking Algorithm

Severity

Immediate Jeopardy to Resident Health or Safety J=32 K=45 L=60

Actual Harm that is not Immediate Jeopardy G=16 H=22 I=28

No Actual Harm with Potential for more than

Minimal Harm D=5 E=8 F=11

No Actual Harm with Potential for Minimal Harm A=0 B=1 C=3

Isolated Pattern Widespread Scope

CMS Algorithm

Survey Deficiency Score: Weights for Different Types of Deficiencies

Severity Scope

Isolated Pattern Widespread

Immediate jeopardy to resident health or safety

J 50 points (75 points)

K 100 points (125 points)

L 150 points (175 points)

Actual harm that is not immediate jeopardy

G 20 points

H 35 points (40 points)

I 45 points (50 points)

No actual harm with potential for more than min. harm that is not IJ

D 4 points

E 8 points

F 16 points (20 points)

No actual harm with potential for min. harm

A 0 point

B 0 points

C 0 points