RIPPED FROM THE HEADLINES

DeSantis, Sprowls Announce Launch Of Data-Driven Health Care Cost Comparison Tool

Gov. Ron DeSantis joined speaker designate Rep. Chris Sprowls and Secretary of Health Administration Mary Mayhew Monday at a Walmart in Palm Harbor to announce the launch of Florida Health Finder, a new data-driven tool to provide Florida health care consumers with data comparing price and quality of common health care services at a granular level.

The roll-out is one piece of an extended effort by the Florida legislature to expand consumer health care protection and increase transparency. DeSantis explained how the Florida Health Price Finder might help a patient better examine the cost of a knee replacement compared to its quality, which according to the tool, could range from $33,000 to $54,000.

“That’s a difference in $21,000,” DeSantis explained. “In other areas of life you probably wouldn’t have that unless there’s some obvious benefit in quality, but it’s not clear that a patient would have an ability to discern that based on the old system.”

Sprowls pointed to the trend of health insurance and especially employer-paid plans toward high deductible options as a main reason to compare health care costs on the front end. “Cost matters more than it has ever,” said Sprowls. “Quality matters to our families.”

In addition, he said, “The price and the quality of a consumer product that is the delivery of healthcare should be something easily navigable. That’s why we went on this project three years ago, to make sure that we have billions of lines of health care data delivered directly to a consumer, regardless of where they are, about the price of and quality of your most common medical procedures at your facilities. Not just national averages but local, granular, in your own community so that you can begin to shop." Read More...

To read the press release issued by the Executive Office of the Governor, click here.

Source: Megan Holmes / St. Pete Catalyst

Ron DeSantis’ Health Care Agenda Focused On Implementation

Don’t expect much new in the way of a health care agenda from Gov. Ron DeSantis' administration for the coming 2020 session. That’s because he says he’s more focused on implementing what he already has accomplished.

DeSantis earlier this week boasted about his legislative health care accomplishments during his first year in office, and then segued into how he currently is focusing his efforts on putting into place one of the achievements: drug importation programs.

“We had a lot of good stuff on health care, as you know, from telehealth, CON reform, we did the patient savings where people can save if they choose cheaper options, then the big prescription drug thing,” DeSantis told a group of newspaper reporters and editors who gathered in Tallahassee for the annual Associated Press legislative planning session.

DeSantis said his administration was “actively working with HHS” on new proposed rules that would allow Florida to move ahead with its drug importation programs as outlined in HB 19, which he signed into law June 11.

“That is one thing the president, anytime we talk, will say, ‘You getting those drugs yet? Let me know if my guys aren’t going fast enough. We want to do it,’" DeSantis said. Read More...

Source: Christine Jordan Sexton / Florida Politics

ADVOCACY

LeadingAge Florida Members Participate in OIR Meetings on Proposed Continuing Care/Life Plan Community Rule

Over the past two weeks, the Office of Insurance Regulation (OIR) held two very productive meetings on revisions to the 14 forms included in the proposed continuing care/life plan community Rule 69O-013. Most of the discussion centered on recommendations submitted by LeadingAge Florida members and business affiliates during or after the October 15, 2019, rule workshop.

In addition, OIR used the first meeting as an opportunity to learn more about the concerns of investors in tax-exempt bonds related to withdrawals from the debt service reserve. Two bond attorneys participated in that discussion along with Rich Scanlon, Joel Anderson and Jon Corbin.

OIR is reviewing the comments submitted thus far and will consider them in revising the draft rules and forms.

We are grateful to OIR for holding these meetings and to the following members who participated: Joel Anderson (Village On The Isle), Scot Aurelius (Moore Stephens Lovelace, P.A.), Sue Bunevich (CliftonLarsonAllen LLP), Jon Corbin (Praxeis Senior Living Communities), Lynn Gordon (Erickson), Hank Keith and Garry Hennis (Westminster Communities of Florida), and Rich Scanlon (Ziegler).

This project is an excellent example of the importance of member collaboration with our public policy team on technical issues related to regulation. We are extremely fortunate to have members who generously share their time and talent assisting us with important projects such as this.

An Additional Meeting and Second Rule Workshop Scheduled by OIR Related to CCRC Rule

A third meeting was scheduled by the Office of Insurance Regulation (OIR) for today, Friday, November 8th from 9:30 AM to 12:00 PM in Room 142 of the Larson Building in Tallahassee to discuss outstanding issues and questions related to the proposed continuing care/life plan community rule. In addition, at the request of LeadingAge Florida, OIR scheduled a second rule workshop for Tuesday, November 12 beginning at 9:30 AM in room 116 of the Larson Building in Tallahassee. Please call (850) 413-1558 and enter conference ID# 500816 to participate by phone.

Getting Cheap and Safe Canadian Drugs to Floridians is a Big Unknown

Florida regulators are proceeding with plans to import cheaper prescription drugs from Canada, but questions persist about when the drugs will begin flowing, whether the Canadian government will object, and whether officials can guarantee the safety of these drugs.

Canadian consular officials have expressed concern about the potential of sapping Canada’s prescription drug supply to feed Florida’s market, state officials acknowledged.

But if the plans work out, the cheap drugs initially would go to programs involving Florida’s most vulnerable – the poor, the disabled, the mentally ill and state prisoners.

The state also is designing a broader system intended to benefit private patients. Overall, state officials estimate savings to taxpayers as high as $150 million annually if the cheap drugs programs come to fruition. But that may take time.

During recent hearings before the Florida Senate Health Policy Committee, Mary Mayhew – secretary of the state Agency for Health Care Administration, or ACHA, which would administer part of the importation program – said officials were waiting for the U.S. Department of Health and Human Services to issue regulations. Read More...

Source: Michael Moline / Florida Phoenix

REGULATORY

Closing Out The Top Ten Deficiencies 

This week we published deficiencies from the last of the top 10 deficiencies cited in the state of Florida – F677 ADL Care Provided for Dependent Residents.

When I read these deficiencies, I saw that several of them had only one example where a resident was not provided appropriate grooming. I wondered why a facility was meeting grooming needs for all residents except for one. Was there a valid reason for the care not being provided? (i.e. resident refusing care, family had requested to provide care, etc.) If there was a valid reason it should have been on the care plan because it might have avoided the deficiency.

Another observation was that the surveyor checked the medical record to the see if there was documentation that a shower or nail care had been given. The surveyor concluded the lack of documentation meant the care wasn’t provided. There is no specific regulatory requirement to document all activities of daily living (ADL) care provided, but a surveyor will review the documentation if they observe residents who appear to have not been showered, nails trimmed, or if an oriented and alert resident reports not receiving care.

Remember a surveyor is looking to confirm that you assessed the resident’s inability to perform ADLs; that you developed and implemented interventions in accordance with the resident’s assessed needs, goals for care, preferences, and limitations in ability to perform ADLs; and that these care needs are planned.

Connie Cheren, RN, MSW, LeadingAge Florida's Clinical and Compliance Specialist, can be reached via email or phone at (678) 778-0561 to help answer questions before, during and after your surveys. As a value-added service provided by LeadingAge Florida, Connie can help nursing home and assisted living facility members improve regulatory compliance and clinical outcomes, in addition to offering suggestions about corrective plans of action to improve your surveys.

PDPM CLAIMS ISSUES

While we have not heard from many members with specific issues regarding SNF claims, CMS has noted that there have been bumps in the road in PDPM implementation. We wanted to share with you this notice that CMS just put out via the Medicare Learning Network. If you are experiencing issues, it is helpful to provide us with specific information that can be shared with CMS to identify the scope and magnitude of issues occurring with claims. Useful data points include:

• the number of October claims you submitted with percentage having multiple PDPM HIPPS codes;
• the total amount billed for using claims with multiple PDPM HIPPS codes; and
• the MAC's narrative claim status reason code if placed on hold, not paid accurately, or otherwise producing an unexpected result.

If you are experiencing issues please email me directly (tsununu@leadingageflorida.org) so that we can let CMS know how LeadingAge Florida members are experiencing the PDPM rollout.

Here is the text of CMS’ recent notice:

Skilled Nursing Facility Claims Hold
As CMS has undertaken the implementation of the Patient Driven Payment Model (PDPM), we are holding a limited number of Skilled Nursing Facility (SNF) claims while we make further refinements to our claims processing system.
PDPM is a historic reform of the SNF prospective payment system. PDPM focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment. PDPM was effective on October 1, 2019.

Specifically, CMS is holding claims with:

• Dates of service October 1, 2019 or later and
• Type of Bill (TOB) inpatient services (21X) and swing bed services (18X) subject to SNF Patient Driven Payment Model (PDPM) and
• Multiple line items, Health Insurance Prospective Payment System (HIPPS) codes, with different rate codes (revenue code 0022).

Typically, SNFs bill these claims on monthly cycles. Claims with single HIPPS codes were previously being held but are now being released for processing. We anticipate releasing the remaining held claims in late November, once CMS completes systems testing to ensure accurate and timely payment. As of November 1, less than 50 claims are being held.

In addition, we underpaid some SNF inpatient services (21X) and swing bed services (18X) claims for dates of service in October 2019 with a single line item, single HIPPS code. We are automatically reprocessing those claims; no provider action is needed.

CMS will continue to provide updates as further information develops.

If you have any questions, please contact Tyler Sununu, Director of Nursing Home Public Policy, at (850) 702-0315 or via email.

MEMBER SPOTLIGHT

Jefferson Center in Sarasota Celebrates 50th Anniversary and Rededication

This Wednesday more than 100 residents and guests of Jefferson Center gathered to celebrate the 50th anniversary of the community’s founding with a rededication ceremony and special recognitions.

The community, an affordable senior living community on Sarasota’s bayfront, was established in 1969 by the Unitarian Universalists of Sarasota. Today it serves more than 200 older adults and is managed by Westminster Communities of Florida. “Jefferson Center has provided more than 3,000 residents with a comfortable, safe and affordable place to live over the last 50 years,” said Dawn Lucido, administrator of Jefferson Center. “Thank you to everyone who has made this a friendly place to live!”

Sarasota City Commissioner Willie Charles Shaw, one of the speakers, celebrated the community’s mission of service and Sarasota’s support of its older adults. He presented Jefferson Center with a proclamation on behalf of the Sarasota City Commission, mayor and vice mayor (see picture). For more information visit the Westminster Communities of Florida website.

Indian River Estates Hosts Legislators During FLiCRA Town Hall Event

Indian River Estates hosted Senator Debbie Mayfield and Representative Erin Grall during a FLiCRA (Florida Life Care Residents Association) town hall event on Friday, November 1st to discuss critical issues facing Florida's seniors today. Topics included workforce shortage, keeping physicians in Florida, the rising cost of prescription drugs, and numerous other topics brought forth by the over 100 residents in attendance. Both legislators also shared information that came out of the 2019 session and the committees on which they serve.

"A long term-term approach to government affairs requires relationship building, visibility, awareness and vigilance," said Indian River Estates Executive Director Scott Cairns. "It is therefore essential we build relationships with our legislators to effectively have our voices heard. The best way to do that is having legislators visit with our residents to explain why certain issues are important and how it will affect them. I am thankful to Senator Mayfield and Representative Grall for participating in a successful event and taking time to speak with our residents."

HOUSING

Clearwater To State Lawmakers: Stop Raiding The Affordable Housing Trust Funds

Should most of the money in the state’s affordable housing trust funds go to affordable housing?

For 12 years in a row, the Florida Legislature has said no. Clearwater officials want their answer to change this year.

That’s according to the city’s legislative priorities for the upcoming legislative session, which begins in January. The first bullet point of a drafted document laying out the city’s stances says the state should fully fund the William E. Sadowski Affordable Housing Trust Funds and make sure the money in them goes exclusively to housing.

It’s no wonder why Clearwater would prioritize the issue. Chuck Lane, the city’s assistant director for economic development, said the Tampa Bay area’s third-largest city has been hit particularly hard by the affordable housing crunch that afflicts cities all over the state.

Clearwater, with its world-renowned beach, is a tourism town, and tourism is an industry largely staffed by the working class. Those people need affordable places to live, and they’re having difficulty finding them in the city, Lane said.

The Sadowski funds, which come from a small tax on real estate transactions, will have an estimated $350 million available this fiscal year. According to the state formula that assigns the funds to municipalities, Clearwater is looking at around $1 million in affordable housing money from those funds if they stay intact, Lane said. Read More...

Source: Kirby Wilson / Tampa Bay Times

HEALTH NEWS

Health Insurer To Offer Lyft Rides

Florida Blue announced that Affordable Care Act customers will have access to Lyft rides as part of the benefits package in individual health-insurance policies, beginning Feb. 1.

The goal is to ensure policyholders can access needed health-care services, such as doctor's visits, or trips to the pharmacy. The policyholders will have $100 in transportation benefits from Lyft, a ride-sharing service.

Jacksonville-based Florida Blue, which offers Affordable Care Act policies in 67 counties, has sold individual policies to more than 1 million people in 2019 under the Affordable Care Act, commonly known as Obamacare. That is out of more than 1.6 million people in Florida who have purchased individual policies on the Obamacare exchange this year.

In a news release announcing the ride-sharing benefit, Florida Blue noted that people without reliable transportation can miss appointments. That can lead to "disruptions in care, and in turn, increased costly hospital and emergency room visits."

Open enrollment under Obamacare for 2020 health-insurance coverage began Friday and runs through Dec. 15.

Source: News Service of Florida

LEADINGAGE ZIEGLER 200

Ziegler and LeadingAge released the 16th Annual LeadingAge Ziegler 200 report revealing the largest not-for-profit senior living providers across the country based on unit count. The report also provides an update on relevant business trends in the industry. Read more.

NEW BUSINESS MEMBER

Please join us in welcoming our new business member Live Oak Contracting and be sure to visit their website to learn more about the services they offer to senior living providers.

• Live Oak Contracting - is a full-service General Contracting firm that specializes in multifamily and commercial construction, including development, design build, renovation, rehab, and tenant improvement projects. We have long-standing relationships with the top multifamily and commercial subcontractors, in addition to a team of experienced in-house professionals. Together, our handpicked team covers the full spectrum of skills needed to provide the highest quality projects for our clients.

The goal at LeadingAge Florida is to deliver the highest quality of service to our members. We strive to increase the value of, and return on, investment of your community's membership. As such, LeadingAge Florida works to connect our business members with your communities and facilities to help you secure the best possible services for your residents and benefits for your staffs.

If you have any questions or if you know of a business that we should contact, please let Business Development Manager Julie Copeland know by calling her at (850) 702-0317.

VALUE FIRST

On behalf of Value First we want to thank you, the members that make up LeadingAge Florida, for stopping by the Value First booth at the LeadingAge Convention in San Diego. It's great to see our members outside of your amazing communities! Thank you for your support of, and loyalty to, Value First. We made many new friends and discussed even more opportunities to save you money. Our booth was once again spectacular and had a beach theme. Check out the picture below.

As we close out the year, because of your loyalty and commitment to Value First, we will once again show higher usage than ever before -- specifically in the Food and MRO sector. For this we sincerely appreciate your vote of confidence and will continue to strive and work hard to present you with quality products and services at great prices.

Sherwin Williams has a new group buy for the months of November and December. Click here for more information.

Each LeadingLink newsletter has the latest Value First/Vizient-Provista Vendor Catalog. Check it out and get started with savings today. If you have any questions please email or give me a call.

Thank you again. All the best and see you on the road!

Robert "Bobby" Bernal, Value First Regional Southeast Manager

C: (850) 509-8112 | Email

COMING ATTRACTIONS

NOVEMBER

Focus on Fall Investigation & Interventions Webinar
11/21/2019 @ 10:30 AM EST
This webinar will Identify the prevalence of falls in long term care facilities; the importance of implementing appropriate interventions in preventing falls and repeated falls; and, defining the fall risk assessment and investigation process through the use of root cause analysis.

DECEMBER

MDS Coding Precision & PDPM Audit Processes Webinar
12/4/2019 @ 2:00 PM EST
This webinar will focus on MDS coding accuracy and review processes to ensure appropriate reporting of information and supportive documentation under the new Medicare payment model- PDPM. The webinar will include review of steps for assessment and coding tips for certain MDS items with an emphasis on supporting coding decisions through documentation and auditing data prior to assessment submission.

Legal Issues in Nursing Webinar
12/5/2019 @ 2:00 PM EST
This webinar will share the purpose of the state nursing laws and rules; where they are located and definitions of nursing liability and professional negligence. Types of torts related to nursing care; identifying and reporting misconduct and the disciplinary process; and rules and responsibility of delegation will also be reviewed.

JANUARY

Legislative Days: Advocacy in Action
January 28 - 30, 2020
Doubletree by Hilton | Tallahassee, FL
Registration is open, click here to register today.