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Weekly Roundup …Reporting the state and national long-term care news

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Friday, October 18, 2019

ANHA NEWS Volunteer to Serve on ANHA’s Committees in 2020 Serving on a committee is one of the best ways to have an active role in your association and make a positive impact on the long-term care profession. We’re successful because people like you share ideas and experiences to help guide ANHA’s endeavors. ANHA needs your participation for the committees to be successful. Please review and complete the attached 2020 Committee Request Form and express your committee preferences. You are encouraged to add key members of your staff to serve on a committee. While completing the form; please indicate your preferences on a scale from 1 to 3 (1 being your first choice and 3 your third choice). Feel free to copy this form if you have more staff members interested in serving than there are spaces available. Please note that those committees marked with an asterisk meet on an as-need basis. Also, it may be necessary to limit the size of a committee to conduct business expediently. To allow time to prepare for the coming year, send your completed form to the Association office by Monday, December 15, 2019. You can fax the form to (334) 244-6509, e-mail it to [email protected] or mail it to ANHA, 4156 Carmichael Road, Montgomery, AL 36106. If you have any questions, or if you have items relating to a committee which you wish to discuss, please contact Kerri Parker at the Association office (334) 271-6214 or [email protected]. REGISTRATION NOW OPEN! “Regulatory Update 2019: Phase III – Are You Ready?” – November 11 Please mark your calendars for November 11, 2019, for the “Regulatory Update 2019: Phase III – Are You Ready?” seminar. This program will be held at the Hyatt Regency - Wynfrey Hotel in Birmingham. Please see the attached flyer for more details.

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Sponsor Alabama’s Best Practices The Alabama Nursing Home Association is seeking sponsors to help underwrite the cost of Alabama’s Best Practices. This is an excellent opportunity to show your company supports the great work taking place in Alabama’s nursing homes. Please see the attached flyer for more details.

Congratulations to the Facilities Chosen to Present at 2019 Alabama’s Best Practices 2019 These facilities were chosen to present at the 2019 Alabama Best Practices Program: • Aliceville Manor – Apple Tree Unwanted Behaviors • Arbor Springs Health & Rehabilitation Center –Spa-sation Restorative Program • Burns Nursing and Rehab – QAPI for Dummies • Cherokee County Health and Rehabilitation Center – LIVE Active Shooter Training • East Glen Center for Nursing and Rehabilitation – Residents in Action • Rehab Select of Albertville Welcome to our War Room • Talladega Health Care – Tag You Are It • Woodland Village Rehab & Health Care Center – Get Your Kicks on Route 66 Congratulations to these facilities as well as the 14 facilities that will be featured in our 2019 Alabama Best Practices Program Manual. As a reminder, the Alabama’s Best Practices Program is scheduled for Monday, December 9, 2019, at the Hyatt Regency – Wynfrey Hotel in Birmingham. Registration information will be released soon. Nursing Home Resident Christmas Ornaments for the Governor’s Mansion This Christmas the Alabama Governor’s Mansion will feature a tree decorated with ornaments made by nursing home residents. The Alabama Nursing Home Association is asking each nursing home to send at least one ornament made by a resident to the ANHA office by November 1. The ornaments will be displayed during the Christmas tours at the Governor’s Mansion. Please see the attached brochure for more information. List Your Jobs on ANHA’s Job Board The Alabama Nursing Home Association’s Job Board helps member nursing homes reach new employees. We encourage you to utilize this valuable tool in your workforce efforts. Follow these simple steps to get started: • Go to http://www.anha.org/jobs • Click the “Post A Job” link • Click “Register your account/create your profile” and create your account • You will receive an email from ANHA informing you that your account is approved • Follow the email’s instructions to begin posting jobs

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Registration Open: 2019 ANHA Owners’ Meeting & Educational Symposium Join ANHA for the 2019 Owners’ Meeting and Educational Symposium at the Ritz Carlton New Orleans in New Orleans, Louisiana. The event will begin Sunday, October 27 at 6:00 p.m., and conclude Wednesday, October 29. The ANHA board retreat and planning session and the owners’ meeting will be held October 28. The event has been approved for a total of three hours of continuing education credit for nursing home administrators. Please see the attached flyer for more details and registration information. Sponsored by: Associated LTC Insurance Co. Burr & Forman Carr Riggs & Ingram, CPAs Felder Services Gericare Medical Supply

Healthcare Services Group McKesson Medline Pharmacy Care Associates Senior Dental Care of Alabama

Medicaid Cost Reports The Alabama Nursing Home Association is collecting Medicaid cost reports for analysis by its independent reimbursement consultant firm, Bishop & Company. As in the past, the reimbursement consultant will provide you a detailed analysis of your costs compared to the costs of other facilities of a similar size. ANHA cannot overstate the importance of sending in your cost report. In order to negotiate with Medicaid on various issues, we need to have accurate information concerning the profession. This information has proved very beneficial in the past. Please send a copy of your 7/1/2018 – 6/30/2019 Medicaid Cost Report to [email protected] or by mail to:

Alabama Nursing Home Association 4156 Carmichael Road Montgomery, Alabama, 36106 Attn: Katrina Magdon

Donate Used Wheelchair, Walkers and Rollators By: Lance Bolding If you’re like me, wheelchairs, walkers and rollators take up space in a room or storage building at your nursing home. This October, we have an opportunity to help the less fortunate in other countries while cleaning out unneeded items. The Alabama Nursing Home Association is once again partnering with the Ryan Prince Memorial Wheelchair Drive to collect used wheelchairs, walkers, rollators and parts – no power chairs please. Volunteers will pick up these items from your nursing home or you may drop them off at designated locations around the state. The items will be refurbished and given to the non-profit Joni and Friends which will distribute them overseas to individuals in need. The donation drive is October 1-31. To schedule a pickup: • Email [email protected]. Include your nursing home’s name, address and

phone number. Also include the appropriate contact person, their email address and a brief description of the items you want to donate.

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• Tax deduction receipts are available upon request for wheelchairs only. Please indicate in the email if you need a receipt.

• A volunteer from the Ryan Prince Memorial Wheelchair Drive will contact you to schedule a pickup or drop off.

Editor’s Note: Hatley Health Care Administrator Lance Bolding is project director for this campaign. Contact Lance at [email protected].

NATIONAL NEWS CMS Announces Changes to Nursing Home Compare The Centers for Medicare & Medicaid Services (CMS) announced this week that starting October 23, 2019, Nursing Home Compare (NHC) will flag skilled nursing centers that have been cited for abuse, neglect and exploitation. A nursing center will receive an alert icon on NHC if it falls under one of two categories: 1. If a nursing center has been cited for abuse that led to harm (G or above) in the last year for

one of three abuse F-tags; or 2. If a nursing center has been cited for abuse with the potential for harm (D and above) in each

of the last two years. The three abuse and neglect citations that will result in an icon are as follows: 1. F600: Free from abuse and neglect 2. F602: Free from misappropriation/exploitation 3. F603: Free from involuntary seclusion After a nursing center has been free from any of these three citations (at any level) for a full year or inspection cycle, the icon will be removed. The NHC website will be updated with new information on a monthly basis. A full copy of the CMS announcement can be found at https://www.cms.gov/newsroom/press-releases/trump-administration-empowers-nursing-home-patients-residents-families-and-caregivers-enhancing. CMS Changes Announced - 5-Star Rating System On October 23, the Centers for Medicare & Medicaid Services (CMS) will make several changes to the Nursing Home Compare website and the Five-Star Quality Rating System. These changes will affect the health inspection and quality measure (QM) domains for skilled nursing centers. The Centers for Medicare and Medicaid Services (CMS) has published updates to the Five-Star Technical Users' Guide stating that centers that receive the abuse icon will have their health inspection rating on Nursing Home Compare capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility flagged for abuse can have is four stars. In addition, CMS will be removing two quality measures from the Five-Star Quality Rating System. These measures are:


1. Percentage of short-stay residents who report moderate to severe pain. 2. Percentage of long-stay residents who report moderate to severe pain. As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QM ratings will change starting later this month. These changes will overall maintain the same distribution of short-stay and long-stay QM ratings that were posted on Nursing Home Compare in July 2019. The new cut-points are shown in the table below. Point Ranges for the QM Ratings (as of October 2019)

Update on MAC “Hold Claims” Message As you likely know, several Medicare Administrative Contractors (MACs) have been holding PDPM claims and issuing differing messages. This week, the American Health Care Association (AHCA) staff held a call with the CMS payment policy team, billing staff and MAC officers. The CMS staff indicated the Agency sends quarterly updates to MACs. The updates typically are sent by the 14th of the month. The October quarterly update needed to process claims is delayed due to software issues likely due to PDPM changes. CMS MAC staff indicated the following: • Corrected update will be sent to the MACs by October 17; and • Target date to begin processing claims is October 24. Additionally, MAC contracting staff are preparing a script for all MACs to use when providers contact MACs about claims. Their aim is to ensure more consistent messaging rather than the mixed messages members currently are receiving. On October 17, AHCA staff will contact CMS to ensure the update was released, and they also will contact CMS on October 24 for an update on the resumption of claims processing. In the coming week, we would encourage you to contact your MAC via phone and email AHCA staff with the MACs’ verbal responses. This also will help AHCA assess their progress towards the October 24 target date.


CMS Posts PDPM Claims Processing, Benefit Policy, and Entitlement Manual Updates Related to PDPM Implementation The Centers for Medicare and Medicaid Services (CMS) posted the long-awaited claims processing, benefit policy and entitlement manual updates for PDPM implementation. The updated chapters are listed below: • R261BP - Manual Updates for CR11152 Implementation of the Skilled Nursing Facility

(SNF) Patient Driven Payment Model (PDPM) https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019-Transmittals-Items/R261BP.html.

• R4409CP - Manual Updates for CR11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019-Transmittals-Items/R4409CP.html.

• R126GI - Manual Updates for CR11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019-Transmittals-Items/R126GI.html.

SNF PDPM Assessments and Grouper Update The Centers for Medicare and Medicaid Services (CMS) is aware of issues with the latest PDPM DLL Package (V1.0002 FINAL). CMS has targeted to release an updated version on Monday, October 7, 2019, which corrects the identified grouper discrepancies. SNF providers should continue to follow the Resident Assessment Instrument (RAI) requirements which include, but are not limited to, establishing assessment reference dates for OBRA or PPS assessments that are required/scheduled, including the PDPM Transitional Interim Payment Assessments, assessing residents, and coding the applicable MDS assessments. As per the RAI requirements, assessments should be completed within 14 days and recorded in Z0500. Late submission payment penalties do not apply under the SNF PPS. We will work with providers to ensure that timely payments are made. We will continue to share updates as they become available. In the meantime, providers should not hesitate to contact us. For questions regarding PDPM please send inquiries to [email protected] and or information technology questions please send emails to [email protected]. Please contact your state Medicaid agency for questions related to the Other State Assessment (OSA) and Medicaid payment. U.S. Department of Labor Approves New Respirator Fit Testing Protocols to Protect Workers from Airborne Contaminants The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has issued a final rule that provides employers with two new fit testing protocols for ensuring that employees’ respirators fit properly. The new protocols are the modified ambient aerosol condensation nuclei counter (CNC) quantitative fit testing protocol for full-facepiece and half-mask elastomeric respirators, and the modified ambient aerosol CNC quantitative fit testing protocol for filtering facepiece respirators. Both protocols are variations of the original OSHA-approved ambient aerosol CNC


protocol, but have fewer test exercises, shorter exercise duration, and a more streamlined sampling sequence. These two quantitative methods add to the four existing in Appendix A of OSHA’s Respiratory Protection Standard, which contains mandatory respirator fit-testing protocols that employers must choose from to protect employees from hazardous airborne contaminants. The rule does not require employers in general industries, shipyard employment, and construction to update or replace their current fit testing methods and does not impose additional costs. The rule became effective September 26, 2019. Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit www.osha.gov.

OTHER NEWS AHCA Posts New Tools Earlier this week, the American Health Care Association (AHCA) on ahcancalED published two new tools and a resource list developed by our Survey/Regulatory workgroup to support nursing centers and assisted living communities in preventing and addressing reported incidents of resident-to-resident mistreatment. This workgroup was led by Sarah Schumann and included Stephen Harris, Karen McDonald, Melissa Sorensen, and Kay Turner. The new member tools include a post-incident checklist and a provider self-assessment, as well as a compiled list of AHCA/NCAL resources. While mistreatment may or may not meet the definition of abuse, it would include negative and aggressive physical, sexual, or verbal interactions between long-term care residents that is unwelcome and has high potential to cause physical or psychological distress in the recipient. We encourage members to use and adapt these tools in a way that aligns with their unique culture, systems, and needs. Help Us Understand How Implementation Is Going and Your Needs Each week, the American Health Care Association will collect feedback on PDPM implementation. Please help provide valuable, real-time information by completing this survey each week. This will help us address your needs through member education, resources, and advocacy with CMS on regional and national issues. AHCA Member Support AHCA has worked closely with members over the past year to provide resources to ensure you are prepared for success under the new payment model. These efforts will continue into post-implementation.

PDPM Resource Navigators AHCA PDPM Resource Navigators are trained to help you find existing AHCA and CMS resources and guidance. They can be reached by email at [email protected] or by calling (202)-842-4444 and asking to speak with an AHCA PDPM Resource Navigator. If you have


technical questions, PDPM Resource Navigators will record your information and question(s) and submit them to in-house PDPM technical experts. Members will receive a same day response to questions and requests. You will be notified if additional technical research or clarification from CMS is required and a projected response date will be provided. Available Resources AHCA PDPM Resource Navigators can also help you find existing AHCA resources, such as those offered on ahcancalED. While many of the AHCA PDPM resources are available to all members, some are available only to participants of the PDPM Academy. The PDPM Resource Center for all members is available here, while resources for AHCA PDPM Academy registrants are available here . CMS also offers numerous resources in which the AHCA PDPM Resource Navigators can assist, such as the ICD-10 Mappings crosswalk for Primary SNF diagnosis and SLP and NTA comorbidities and a video on PDPM and the Agency's priorities. Recently Updated AHCA PDPM Resources • PDPM Status Webinars

1. Oct. 11 from 3-4 pm ET 2. Oct. 24 from 3-4 pm ET 3. Oct. 24 from 3-4 pm ET 4. Oct. 31 from 3-4 pm ET 5. Nov. 7 from 3-4 pm ET 6. Nov. 14 from 3-4 pm ET 7. Nov. 21 from 3-4 pm ET 8. Dec. 5 from 3-4 pm ET 9. Dec. 19 from 3-4 pm ET

• LTC Trend Tracker - PDPM Top Line Reports (NEW) • Veterans Administration (VA) SNF Payment Policies Impacted by PDPM (NEW) • PDPM and Medicare Advantage Toolkit (Recently Updated) If you need intensive, hands-on assistance, such as claims submissions, AHCA can refer you to a vetted consultant. Applications for 2020 AHCA/NCAL National Quality Award Now Available The 2020 AHCA/NCAL National Quality Award Program cycle is underway! Application packets are available online. Based on the Baldrige Performance Excellence Framework, the AHCA/NCAL National Quality Award recognizes long-term and post-acute care members for quality care. Participating in the Quality Award Program has many benefits, including: • It provides a proven framework that organizations can use to make improvements in any

clinical, quality or other operational issue (i.e. staff engagement, customer satisfaction, hospital readmissions).

• It prepares organizations to meet regulatory requirements and navigate a changing market. • It serves as a team building activity to engage staff across all levels of the organization. • Organizations gain national recognition and external validation for their care and services.


• It serves as a marketing resource for consumers, referral sources and other key stakeholders. • Participants receive customized feedback with their top strengths and improvement areas.

Visit the Bronze, Silver or Gold application pages to download your respective award level application materials to learn how your center should begin preparing. If you’re interested in other ways to get involved, consider becoming an Examiner for the 2020 program cycle. Examiners play a significant role in reviewing Quality Award applications and impacting quality improvement in organizations across the country. Get started today by visiting ahcancal.org/qualityaward! For questions, email [email protected].

Auburn University at Montgomery Seeks Facilities to Provide Bingocize® Visit any nursing facility and you are likely to hear a resident enthusiastically shouting, “Bingo!” Unfortunately, playing bingo requires little physical movement and there is often little social interaction between the residents. Capitalizing on the popularity of bingo, Western Kentucky University (WKU) Associate Professor Dr. Jason Crandall created Bingocize® to address these problems. Residents play Bingocize® twice per week for about an hour each session. Led by trained staff members and university students, residents perform gentle strength, range of motion and balance exercises interspersed with bingo calls. This pattern is continued until a participant wins the game and is awarded a small prize. Previous research has shown that participation in the program can increase social engagement, improve functional/gait performance and improve aspects of executive function (Shake & Crandall, 2018; Falls et al., 2018, Crandall & Shake, 2016; Stevens et al., 2018; Crandall et al., 2015). Bingocize® has attracted national attention and funding as part of an effort to shift the culture of nursing homes by improving functional health and quality of life for residents. In 2017, Dr. Crandall was awarded a three-year Kentucky Civil Monetary Penalty (CMP) grant of more than $800,000. Since, the WKU team, in partnership with nine other Kentucky universities, have launched Bingocize® in 28 Kentucky nursing homes. Recently in 2019, Dr. Crandall and the WKU Center for Applied Science in Health and Aging, (CASHA) were awarded $500,000 in CMP reinvestment funds by the Tennessee Department of Health and the Centers for Medicare and Medicaid Services to launch Bingocize® in 40 Tennessee CNFs. Now, Auburn University at Montgomery (AUM) Assistant Professor Dr. Brett Davis is excited to bring Bingocize® to CNF residents in Alabama! The AUM team is looking for facilities interested in providing this unique activity program to residents. Here are some benefits of implementing Bingocize® for your facility: • No cost to your facility – Participating facilities will receive a free bingo game and exercise

materials, as well as, free prizes and t-shirts for residents. • Intergenerational approach providing a unique and fun experience for your residents. • A great tool to bridge interdisciplinary teams – Your CNF can use activities, restorative care

and physical therapy in conjunction with Bingocize®.


• Build new and sustainable partnership with local universities. • Provide students an opportunity to gain the tools needed to positively impact the lives of

older adults in long-term care. Have we piqued your interest! If so, please contact Dr. Brett Davis to learn more about providing Bingocize to your residents. Contact Information

Brett Davis, PhD, ACSM EPC, FMS-L1 Assistant Professor Department of Kinesiology Auburn University Montgomery Email: [email protected] Tel: (334) 394-5029 Fax: (334) 244-3198

CALENDAR OF EVENTS Date Event Location Time October ANHA Region 7 Meeting Felix’s Fish Camp 12:00 p.m. 25 RSVP by October 23 Mobile Mark Manning, (251) 363-6800, [email protected] Guest Speaker on Fall Prevention October ANHA Board Meeting & Retreat The Ritz-Carlton 9:00 a.m. 28 New Orleans November ANHA Region 3 Meeting Arlington Rehab & HealthCare 12:00 p.m. 5 Speaker: John Matson from ANHA Birmingham RSVP: Kevin Ball (205) 919-5058, [email protected] November ANHA Seminar: Regulatory Update – Hyatt Wynfrey 8:30 a.m. 11 Preparing for Phase III Birmingham December Alabama’s Best Practices Hyatt Wynfrey 9 Birmingham

Alabama Nursing Home Association 4156 Carmichael Road uMontgomery, AL 36106uPH: (334) 271-6214uFAX: (334) 244-6509

Links: Alabama Nursing Home Association http://www.anha.org

AL Board of Examiners of Nursing Home Administrators http://www.alboenha.alabama.gov AL Dept. of Public Health http://www.alabamapublichealth.gov

CMS http://cms.gov

weekly roundup - anha · weekly roundup …reporting the ... donate used wheelchair, walkers and...

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