RIPPED FROM THE HEADLINES

Hearing Starts on Nursing Home Generator Rules

Long-term care providers squared off Thursday against Gov. Rick Scott's administration in a legal challenge to emergency rules that require nursing homes and assisted living facilities to have generators that can power air-conditioning systems for as long as four days.

Gov. Scott Directs AHCA, DOEA to Begin Permanent Rulemaking to Require Generators at Nursing Homes, ALFs

Governor Rick Scott directed the Agency for Health Care Administration (AHCA) and the Department of Elder Affairs (DOEA) to immediately begin the formal rulemaking process to permanently enact a rule requiring emergency generators at assisted living facilities (ALFs) and nursing homes. The emergency rule adopted September 16th requires all assisted living facilities (ALFs) and nursing homes to obtain ample resources, including a generator and the appropriate amount of fuel, to sustain operations and maintain comfortable temperatures for at least 96-hours following a power outage. The formal rulemaking process will permanently codify these life-saving measures and allow for extensive public comment through workshops and public meetings.

Governor Scott said, “After the heartbreaking tragedy at the Rehabilitation Center of Hollywood Hills following Hurricane Irma, I implemented emergency rules to ensure nursing homes and assisted living facilities across the state would take immediate action to keep their patients safe. Today, I am directing the state to begin the formal rulemaking process to make these protections permanent. Families rely on assisted living facilities and nursing homes to be fully prepared to care for their loved ones, and it is the responsibility of these facilities to provide a safe environment for their elderly and vulnerable residents. I will also be working closely with the Legislature to put this into law and I asked the Constitution Revision Commission (CRC) to consider proposals that would also help protect the residents of these facilities. We will continue to explore every possible avenue in our fight to keep all residents safe.”

To view the AHCA Notice of Rule Development, click HERE.

To view the DOEA Notice of Rule Development, click HERE.

 EXPERT OPINION

If You Don’t Monitor Your Internal Controls, Fraud Can Find Its Way In
By Dennis Maschke, Manager, CliftonLarsonAllen

The most effective way to mitigate the risk of fraud in your business or organization is by designing and implementing strong internal controls. But even the best laid plans are susceptible to fraud if no one is monitoring those systems.

Fraud is perpetrated in large companies, small family-run businesses, nonprofits, and governmental entities all the time — and the victims are always incredulous. Time and again, I hear them say, “I just didn’t think it could happen here.” As auditors, we see clients develop strong control environments with effective control activities, but all too often they miss the opportunity to ensure those controls are working effectively and efficiently as changes occur in their organizations.

ADVOCACY UPDATE

Rule Information-Updated Questions and Answers Regarding the Nursing Home (59AER17-1) and Assisted Living Facility (58AER17-1) Emergency Rules

This notice provides a link to an updated Q&A document with answers to questions received and a Frequently Asked Questions document regarding requests for a waiver or variance of portions of the rule.

Links to the licensure web pages where these documents are maintained are also provided below. As responses are finalized to the questions and comments received they will be added to the web pages. Please review the pages frequently for updated information.

Questions and Answers
The answers to the following questions were revised on 10/10/2017:

Question 4: Will a mobile generator meet the requirements of the rule?

Answer: The rule does not restrict the type of generator required, but it must be installed and maintained at the facility. If the emergency generator used to meet the temperature requirements in the rule also supplies power for life safety and critical equipment, a level 1 generator must be used and the fuel supply and distribution equipment must be protected from debris impact as required by the Florida Building Code.

Question 5: Can natural gas be used as a fuel source?

Answer: Yes. Piped natural gas is an allowable fuel source under the rule. The plan submitted for review should include fuel information.

Rule Waiver/Variance FAQs

County EM Q&As Document added 10/10/2017

Nursing Home Emergency Rule (59AER17-1)
Statutes and rules related to nursing homes can be found on our Long-Term Care Unit webpage.

Nursing home emergency power plans must be submitted to the local emergency management agency and the Agency for Health Care Administration at: NH_Emergencyrule@ahca.myflorida.com


Assisted Living Facility Emergency Rule (58AER17-1)
Statutes and rules related to assisted living facilities can be found on our Assisted Living Facility webpage.

Assisted living facility emergency power plans must be submitted to the local emergency management agency and the Department of Elder Affairs at: ALFEMP@elderaffairs.org

You may submit additional questions or comments regarding the emergency rules to: BHFR@ahca.myflorida.com

Thank you for your concern for the residents of Florida’s nursing homes and assisted living facilities and how the emergency rules affect those facilities.

AHCA Announces Additional Information About Emergency Power Plan Rule

“The Agency for Health Care Administration (AHCA) provided additional information about the Emergency Power Plan Rule. This does not repeal or modify the requirements of the Emergency Power Plan Rule. Nursing homes and assisted living facilities are still required within 60 days of the rule being published to have working generators and 96 hours of fuel to keep patients safe and comfortable.

“This information outlines the rule variance process where under extreme circumstances beyond a facility’s control, a facility can request more time to comply with this life-saving rule per Florida law. Each variance request must contain: steps the nursing home has taken to implement the rule, specific circumstances beyond the facilities control that have prevented full implementation, what arrangements have been made to fully implement the rule, a plan to inform residents and their families of the variance request, and an estimated time of full compliance with the rule. Each request will be thoroughly reviewed for consideration by AHCA.

Click here to review the notice of emergency rule.

Florida Medicaid Health Care Alert
Provider Type(s): All

Nursing Home Prospective Payment System Working Group Meeting October 19, 2017

The Agency is hosting a working group meeting regarding transition to a prospective payment system for nursing home reimbursement under the Florida Medicaid program.

The 2017 Legislature required the Agency to convene a working group to review relevant issues and make recommendations specific to the transition to a prospective payment system for nursing home reimbursement under the Florida Medicaid program. The group shall consist of representatives of nursing home providers and other interested stakeholders. The working group’s focus shall include, but not be limited to: any adjustments needed to existing targets and ceilings applicable to rate calculations; any adjustments needed to existing direct care and indirect care subcomponents; development and refinement of quality measures to be used; the frequency of rebasing under prospective payments; any exemptions from prospective payments; considerations for supplemental payments as part of prospective payments; and a phase-in timeline, if needed, including the need for any transition payments during phase-in. The working group shall submit a report and any recommendations to the agency, the Governor, the President of the Senate, and the Speaker of the House of Representatives by December 1, 2017.

The public meeting is scheduled for October 19, 2017, from 1:00 p.m. – 4:00 p.m. ET at the following location:
Agency for Health Care Administration
2727 Mahan Drive
Building 3, Conference Room A
Tallahassee, FL 32308.

You can access information and details about the nursing home prospective payment reimbursement public meetings, including schedules for upcoming meetings and meeting agenda materials through our website:
http://ahca.myflorida.com/Medicaid/Finance/finance/nh_rates/nhppwg.shtml

A copy of the agenda may be obtained by contacting: Lauren Pigott at
Lauren.Pigott@ahca.myflorida.com or by calling 1 (850) 412-4671.

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this meeting are asked to advise the agency at least 7 days before the meeting by contacting: Lauren Pigott at Lauren.Pigott@ahca.myflorida.com or by calling (850) 412-4671. If you are hearing or speech impaired, please contact the Agency using the Florida Relay Service, 1 (800) 955-8771 (TDD) or 1 (800) 955-8770 (Voice).

An operator assisted conference number will also be available for those unable to attend in person.
Dial-in Number: 1 (888) 419-5570, Conference Code 918-743-66

A link to the Florida Administrative Register with additional information can be accessed through the following link:

https://www.flrules.org/gateway/View_Notice.asp?id=19522140

QUESTIONS? FLMedicaidManagedCare@ahca.myflorida.com

COMPLAINTS OR ISSUES? ON LINE https://apps.ahca.myflorida.com/smmc_cirts/ | CALL (877) 254-1055

If you have any Advocacy related questions please contact Susan Langston, Vice President of Advocacy at Susan@LeadingAgeFlorida.org or call her directly at (850) 702-0318.

Agency for Health Care Administration has rescheduled the Joint Training Series on the Following Dates

AHCA Joint Trainings for Skilled Nursing Facilities: Offers a forum for the Agency for Health Care Administration and leading long-term care experts to brief providers, advocates and state surveyors on regulatory compliance with enforcement provisions explained. Networking tables will be available from Florida's Long-Term Care Ombudsman and other LTC stakeholders.

November 15 - Sunrise
December 4 - Tallahassee
December 7 - Tampa
December 11 - Orlando

AHCA Joint Training for Assisted Living Facilities: offers interpretations of regulatory compliance by leaders from the Agency for Health Care Administration and Department of Elder Affairs. Clinical and legal professionals will also highlight best practice guidelines and professional guidance. Networking tables will also be available from Florida's Long-Term Care Ombudsman and other LTC stakeholders.

November 16 - Sunrise
December 6 - Tallahassee
December 8 - Tampa
December 12 - Orlando

HOUSING NEWS

Urge Congress to Preserve and Expand Housing for Older Adults

Congress has given itself until Dec. 8 to decide its next steps on housing funding for fiscal year 2018. We need Congress to enact a final HUD spending bill by Dec. 8 so affordable housing programs can continue to serve older adults with very low incomes without interruption.

Urge Congress to fully fund HUD programs because:

• The need for affordable housing for older adults has exploded, with seniors representing 66% of the recent increase in “worst case housing needs” households.
  
• HUD programs like the Section 202 and Section 8 Project-Based Rental Assistance programs are critical to providing currently-assisted seniors affordable housing.
  
• Only 34% of very low income seniors receive the housing assistance they are eligible for because the programs are small compared to real need; new production funding is critical.
  

• Dial this toll-free number: (855) 318-6656.
  
• After leaving your message with your first office, allow the staff person to hang up and the automated system will then connect you to your other federal officials.
  

Background
Both the House-passed and Senate committee-passed HUD funding bills would provide the needed significant increase for renewals under the Section 202 Housing for the Elderly program. Both bills also include the needed expansion of HUD’s Rental Assistance Demonstration to include Section 202 communities with Project-Rental Assistance Contracts.

Congress must raise its budget caps to secure funding necessary for full Section 8 Project-Based Rental Assistance renewals, which provide operating subsidy for 2/3 of Section 202 homes.

Secretary: HUD is here to help South Floridians

In the past four weeks, the people of Florida have demonstrated their spirit is far tougher than any hurricane, including Irma, one of the most powerful storms ever recorded.

Our fellow Americans in the Sunshine State are standing tall, exhibiting their resolve to recover, rebuild, and thrive in the wake of nature’s recent wrath. But they are not alone. They have backup.

At the Department of Housing and Urban Development (HUD), hundreds of men and women are working to ensure safe, affordable housing for those affected by the disaster.

Request for Applications No. 2017-111 Housing Credit Financing for Affordable Housing Developments Located in Medium and Small Counties

On October 6, 2017, at 2:10 p.m., Florida Housing Finance Corporation issued RFA No. 2017-111 Housing Credit Financing for Affordable Housing Developments Located in Medium and Small Counties. To apply for funding, interested parties may access the complete RFA and the online Application, as well as the Development Cost Pro Forma and the Principals of the Applicant and Developer(s) Disclosure Form, at http://www.floridahousing.org/programs/developers-multifamily-programs/competitive/2017/2017-111

Any modifications that occur to the Request for Applications will be posted at the web site and may result in an extension of the deadline. It is the responsibility of the Applicant to check the website for any modifications prior to the deadline date.

The Application Deadline for RFA 2017-111 is 11:00 a.m., Eastern Time, on December 20, 2017.

Request for Applications No. 2017-112 Housing Credit Financing for Affordable Housing Developments Located in Miami-Dade County

On October 6, 2017, at 2:25 p.m., Florida Housing Finance Corporation issued RFA No. 2017-112 Housing Credit Financing for Affordable Housing Developments Located in Miami-Dade County. To apply for funding, interested parties may access the complete RFA and the online Application, as well as the Development Cost Pro Forma and the Principals of the Applicant and Developer(s) Disclosure Form, at http://www.floridahousing.org/programs/developers-multifamily-programs/competitive/2017/2017-112

Any modifications that occur to the Request for Applications will be posted at the web site and may result in an extension of the deadline. It is the responsibility of the Applicant to check the website for any modifications prior to the deadline date.

The Application Deadline for RFA 2017-112 is 11:00 a.m., Eastern Time, on December 18, 2017.

Request for Applications No. 2017-113 Housing Credit Financing for Affordable Housing Developments Located in Broward, Duval, Hillsborough, Orange, Palm Beach, and Pinellas Counties

On October 6, 2017, at 2:30 p.m., Florida Housing Finance Corporation issued RFA No. 2017-113 Housing Credit Financing for Affordable Housing Developments Located in Broward, Duval, Hillsborough, Orange, Palm Beach, and Pinellas Counties. To apply for funding, interested parties may access the complete RFA and the online Application, as well as the Development Cost Pro Forma and the Principals of the Applicant and Developer(s) Disclosure Form, at http://www.floridahousing.org/programs/developers-multifamily-programs/competitive/2017/2017-113

Any modifications that occur to the Request for Applications will be posted at the web site and may result in an extension of the deadline. It is the responsibility of the Applicant to check the website for any modifications prior to the deadline date.

The Application Deadline for RFA 2017-113 is 11:00 a.m., Eastern Time, on December 28, 2017.

MEMBERS IN THE SPOTLIGHT

WWII Veteran Celebrates 100-years with Friends and Family at Cypress Village
WWII veteran, Larry Lawson of Jacksonville celebrated his 100th birthday with a party in his Cypress Village apartment complex that included nearly a dozen relatives from Australia, other family members and friends from the Cypress Village community. The celebration was held three days before he turns 100 on Oct. 10th.

Source: Florida Times-Union

Moorings Park to Expand Again in Naples

Moorings Park is growing again, with plans for a second satellite community in Naples.

This time the nonprofit continuing care retirement community is teaming up with London Bay Homes, a Naples-based luxury homebuilder and developer, to create an independent living project with 275 residences in 17 buildings.

All of the buildings will be six stories over parking.

The development, called Grande Lake, will be built on 55 acres off Golden Gate Parkway, between Airport-Pulling and Livingston roads. The property includes a 28-acre freshwater lake and sits in front of the private Naples Grande golf course, which has several lakes of its own.

Source: Naples Daily News

WWII Veterans Revive History at Bob Hope Village

World War II came to life at the Bob Hope House on Thursday afternoon when three veterans from the 86th Fighter-Bomber Group came for a tour during their 38th annual reunion.

“My wife was a Rosie the Riveter. She worked at night while I was at war and that’s how America works,” said Bill Colgan, a 96-year-old WWII veteran who also fought in Korea and Vietnam. His grandson was also in attendance.

“He was in the Mediterranean theater during World War II, he enlisted the day after Pearl Harbor,” Dallas Lowe, Colgan’s grandson, said. “He flew combat missions in Europe, Spain, they started in North Africa and then France. He flew all the way until the end of the war and stayed until occupation was complete.”

Source: Northwest Florida Daily News

JTEN Students and Seniors Enjoy Each Other's Company

After a postponed start (Irma), the seniors at Village on the Green were happy to see the students return as the Jewish Pavilion kicked off the second year of its intergenerational programming. As JTEN students from Ohev Shalom greeted their senior "buddies" with open arms, the beaming seniors were clearly happy to see their young friends return for a multi-generational friendship and discussion.

Source: Heritage Florida Jewish News

Nestor Plana, Chairman and CEO of Independent Living Systems, Honored as a Golden Age Award Recipient

The Latino Center on Aging has presented Nestor Plana, Chairman and CEO of Independent Living Systems (ILS), with the organization's prestigious Golden Age Award. The Latino Center on Aging advocates for improved services for Latino seniors and provides information on the availability of community resources. Presented to individuals who have made significant contributions to Latino communities throughout the world, the Golden Age Awards has honored effective leadership, lifetime contributions, public policy initiatives, corporate contributions, and community involvement since 1993.


Source: CISION PR Newswire

REGULATIONS!

Compliance with the Mega Rule

I have been assisting members with completing all the requirements for the Mega Rule. My one observation is that our members are more in compliance than they might realize. Florida state law incorporates some of the requirements in the Mega Rule - sometimes they are called something different.

For example, Florida state law has the requirement for an interim care plan. I suggest changing the document to a baseline care plan to satisfy the requirement in the Mega Rule. Review your interim care plan to ensure it does have resident goals, pertinent physician orders i.e. therapy, O2, diet, etc. and any recommendations from PASSAR.

All facilities have transfer forms. Review your transfer forms to ensure you have contact information of the treating practitioner, resident representative contact information, advanced directives, specific care instructions and comprehensive goal for the resident ie. return home, long term care, etc. Update your transfer form if all the required information is not on the form.

With the implementation date a little over a month away it is important to ensure you use your existing systems and simply update them to ensure compliance.

Reach out to LeadingAge Florida's Clinical & Compliance Specialist, Connie Cheren, RN, MSW at (678) 778-0561 or via ccheren@LeadingAgeFlorida.org. Connie is available to all members as a value-added service, paid for by LeadingAge Florida, to help answer questions before, during and after surveys! She can help nursing home and assisted living facility members improve regulatory compliance and clinical outcomes and offer suggestions about survey results and corrective plans of action.
 

QUICK HITS— IN THE NEWS… 

State Trims Medicaid HMO Payments

Florida has reduced by 3.7 percent the rates it pays HMOs and provider-sponsored networks in the biggest part of the Medicaid managed-care system but has given a 2.4 percent hike to plans that offer managed long-term care.

The net result: The state is projected to spend $16 billion-plus on premiums to Medicaid HMOs to care for the poor, elderly and disabled between October 2017 and October 2018. That's about a $300 million premium reduction from what they were paid last year, according to Milliman, an accounting firm that helps state Medicaid officials establish actuarially sound HMO rates.

Agency for Health Care Administration spokeswoman Shelisha Coleman said the new rates went into effect Oct. 1.

Source: Health News Florida

COMING ATTRACTIONS

OCTOBER

18 - Analyzing 5-Star Functional Mobility Quality Measures and Applying QAPI Principles Webinar
This webinar will review the increase in ADL help, the ability to move independently worsened, and improvement in function quality measures that impact the Quality Measure component of the Nursing Home Compare Five-Star Quality Rating system. During the session, we will review how these measures are calculated and how they impact your overall Five-Star Quality Rating.

24 - Preparing for Medicaid and Medicare PPS Reimbursement
Changes Workshop: This workshop will address the proposed upcoming changes in Medicaid reimbursement from a cost-based reimbursement model to a prospective payment system and how understanding the quality measures can positively impact the per patient day reimbursement. The proposed Medicare reimbursement methodology revisions under RCS-1, which removes therapy minutes as the basis for payment, will also be reviewed.

30 - LeadingAge Florida's State Night Reception
Several state associations hold their state’s own reception every year, in conjunction with LeadingAge's Annual Meeting and Expo in New Orleans. Join us for the Florida reception on Monday, October 30 for a fun-filled networking experience with your fellow state colleagues at the BB's Stage Door Canteen at the National World War II Museum located four blocks from the convention center. Florida community members can attend the reception for free, but we require you to register. Your event confirmation email is your entrance ticket to the reception. Click here to register to attend.

NOVEMBER

8 - Discharge Planning Requirements: Analyzing 5-Star Quality Measures/Applying QAPI Principles Webinar
This webinar will review discharge to community, hospital readmissions, and emergency room visit quality measures that impact the Quality Measure component of the Nursing Home Compare Five-Star Quality Rating system. During the session, we will review how these measures are calculated and how they impact your overall Five-Star Quality Rating.

15 - AHCA Joint Training for Assisted Living Facilities:offers interpretations of regulatory compliance by leaders from the Agency for Health Care Administration and Department of Elder Affairs. Clinical and legal professionals will also highlight best practice guidelines and professional guidance. Networking tables will also be available from Florida's Long-Term Care Ombudsman and other LTC stakeholders.
Training Location: Sunrise


16 - AHCA Joint Trainings for Skilled Nursing Facilities: Offers a forum for the Agency for Health Care Administration and leading long-term care experts to brief providers, advocates and state surveyors on regulatory compliance with enforcement provisions explained. Networking tables will be available from Florida's Long-Term Care Ombudsman and other LTC stakeholders.
Training Location: Sunrise

29 - Prevention, Assessment and Treatment of Pressure Injuries & Lower Extremity Ulcers Workshop: This workshop will focus on the prevention, assessment and treatment of pressure injuries and lower extremity ulcers (arterial, venous, and peripheral neuropathy/diabetic). The participant will get hands-on training with risk assessment tools, development of a care plan, wound measurement, staging and assessment and differentiating lower extremity ulcers from pressure

DECEMBER

6- Abuse Prevention & Reporting Webinar
This webinar will include an overview of elder abuse prevention in SNF/NF settings and the Elder Justice Act, including updated Requirements of Participation Emphasis will be on the application of facility best practices and QAPI programming to reduce the risk of abuse incidents and to ensure compliance.

AHCA Joint Trainings for Skilled Nursing Facilities: Offers a forum for the Agency for Health Care Administration and leading long-term care experts to brief providers, advocates and state surveyors on regulatory compliance with enforcement provisions explained. Networking tables will be available from Florida's Long-Term Care Ombudsman and other LTC stakeholders. Training locations isted below.
4 - Tallahassee
7 - Tampa
11 - Orlando

AHCA Joint Training for Assisted Living Facilities: offers interpretations of regulatory compliance by leaders from the Agency for Health Care Administration and Department of Elder Affairs. Clinical and legal professionals will also highlight best practice guidelines and professional guidance. Networking tables will also be available from Florida's Long-Term Care Ombudsman and other LTC stakeholders. Training locations isted below.
6 - Tallahassee
8 - Tampa
12 - Orlando

VALUE FIRST
FREE!
A cost study is a detailed “apples to apples” comparison process. At Value First, we won’t try to gain your business with numbers that we can’t back up.

Value First will sit across from the table with you and dive into exactly where you want to save money in four purchasing categories – Medical, Food, Office Supplies, Environmental/Janitorial/Sanitation.

Value First will work hand-in-hand with your purchasing team to analyze your current expenses and give you line item comparisons on exactly how much you can save. We will also assist you in capital equipment quotes, just give me a call with the specifics and we will reach out to our contracted partners.

We currently have over 225 LeadingAge Florida members signed on and using our Value First partners on a regular basis. We thank you for your vote of confidence but there is still have much more work to do. We look forward to our continued communication, and please look out for upcoming group buys from our partners.

So far we have had a record breaking year as far as sales though our program, cost studies and overall participation in the program. For this we thank you for your vote of confidence.

For information about how Value First can help you and your community, please give me a call at (850) 671-3700.

In addition we are looking forward to see all of you at the National Convention in New Orleans this year. Please come visit your Value First Booth # 2065. I will be there as well as all the other state Value First. Click here to view our chalkboard.

Partner Specials:

Take a look at the specials for your transportation needs from our friends at Fleet Assets.

FILING CABINET

Webinar: Preparing for the New Survey Process:

Tuesday, Oct. 17, 2017 | 2-3 p.m. ET | Rate: $99. Starting on Nov. 28, surveyors nationwide are required to use the new protocols and interpretive guidelines to determine compliance with federal requirements. The framework of the new process rests on the “human element,” which directs surveyors to use observations to assess a nursing home’s performance and practices. Hosted by: LeadingAge