Nursing Home News

Nursing Home Medicaid July 1, 2012 Rate Update – The Agency for Health Care Administration is putting the final touches on the July 1, 2012 nursing home rates. Even though there was a $35 million budget cut passed during the 2012 Legislative Session, we expect rates to increase somewhat since the Legislature provided moneys for inflation adjustment. We also expect a slight increase in the Nursing Facility Quality Assessment rates, with a commensurate increase in the Medicaid rates for nursing homes.

Please monitor the AHCA website for the release of the final July 1 rates. We anticipate the posting of the rates early next week.

AHCA Sends 2012 Legislative Updates to Providers – A letter dated June 26 was mailed to all nursing home providers this week related to provisions of HB787 which will become effective July 1, 2012. The letter will also be placed on the AHCA website. Should you have any questions regarding the adverse incident provisions, please contact the AHCA Risk Management and Patient Safety Unit at (850) 412-3731. To access the full text of these new laws, please click here.

Specifically, the new law does the following:

• Amends the definition of "geriatric outpatient clinic" to include staffing by a licensed practical nurse under the direct supervision of a registered nurse, advanced registered nurse practitioner, physician assistant, or physician.
• Eliminates the requirement for the resident-care plan to be signed by the director of nursing or another registered nurse.
• Defines "therapeutic spa services" as a new service provided in a nursing home.
• Eliminates the requirement for nursing homes to report grievances at the time of re-licensure.
• Removes the requirement for the Agency for Health Care Administration (Agency) to adopt rules for respite care in nursing homes, and 
• Provides guidance on respite care delivered in nursing homes and provides guidance regarding the maintenance of residents' clinical records.
• Removes the requirement that nursing homes submit management company changes within 30 days of the effective date of the management agreement.
• Eliminates the requirement of submission of staffing reports to the Agency.
• States that nursing homes are subject to a $1,000 fine for failure to self-impose a moratorium for failure to comply with state staffing standards.
• Deletes the requirement to report filing of bankruptcy protection by nursing homes.
• Removes the requirement to report notices of intent or complaints filed with the clerk of courts.
• Outlines the staffing standards for residents less than 21 years of age in nursing homes.
• Eliminates the State 1-Day Adverse Incident notification to the Agency. The facility must complete the investigation and submit an Adverse Incident report to the agency on those events that have been determined to be adverse incidents within 15 calendar days after the adverse incident occurred.

While the Agency completes the new adverse incident reporting system, please follow this procedure:

• After you complete your investigation, submit a one-day report with the resident's demographic information, the date of the incident, all outcomes of the incident that apply, and person who is reporting. Do this within 15 calendar days of the adverse incident. Do not check the "abuse/neglect/exploitation" outcome, as this is no longer part of the definition of adverse incident. Do not complete the "narrative circumstances" section. Instead, enter XXXXX.
• The one-day report will be closed by AHCA staff without being reviewed. As soon as the one-day report is in closed status, the 15-day adverse incident report can be submitted.
• ALL reports submitted by nursing homes will be considered to be adverse incidents effective July 1. As a reminder, an adverse incident is an event resulting in one or more of the outcomes, with the exception of elopement that could have been prevented by facility staff and the elopement placed the resident at risk of harm or injury. Although the report form still gives the choice, do not change the default status from "adverse" to "not adverse."
• All 15-day adverse incident reports must have at least one facility staff member listed as directly involved in the incident.
• All 15-day adverse incident reports must include the circumstances, analysis, and a plan of correction.

Changes were made as follows under Chapter 408, Part II: Health Care Licensing, for all provider types regulated by the Agency, with the following being of specific interest:

• States that any licensee provider who alters, defaces, or falsifies a license certificate is subject to an administrative fine of $1,000 for each day of illegal display.
• Allows the Agency to send a courtesy notice, at least 90 days before the expiration of a license, to inform the licensee of the upcoming expiration date. It is important to note that the courtesy notice will be provided electronically or by United States mail and not via certified mail.
• Mandates an applicant must pay the late fee before a late application is considered complete and failure to pay the late fee is considered an omission from the application.
• Requires that the controlling interest shall notify the Agency within 10 days after the initiation of bankruptcy action, foreclosure, or eviction proceedings concerning the provider in which the controlling interest is a petitioner or defendant.
• Grants the Agency authority to impose an administrative fine for unclassified violations.

Should you have questions about this information or any other Agency activities related to nursing homes, please contact:

Bernard E. Hudson, Manager
Long Term Care Unit
Florida Agency for Health Care Administration
2727 Mahan Drive, Tallahassee, FL 32308

Hospice Patients Living in Nursing Facilities Who Revoke Hospice – Beginning July 1, a change in the manner in which nursing home claims are processed will make it especially important that hospices report hospice revocation to the Department of Children and Families (DCF) hospice coordinators.

DCF must terminate eligibility for hospice services and determine eligibility for long-term care services before Medicaid will pay for nursing facility claims. On or after July 1, 2012, nursing facility claims will be denied with EOB 2107 when the long-term care benefit plan is not on the recipient’s file for the date(s) of service billed.

Hospice providers must notify DCF within two days of a recipient revoking Hospice by forwarding the original copies of the following two signed and dated forms to the local DCF Hospice Coordinator:

• Florida Medicaid Hospice Care Services Revocation or Change Statement, AHCA 5000-22; and,
• AHCA 5000-23, Notice of Change in Recipient’s Hospice Status.

Medicaid reimbursement of nursing facility services requires DCF to have determined the recipient eligible for Medicaid nursing home services. DCF must determine ICP (Institutional Care Program) Medicaid eligibility for SSI (Supplemental Security Income) recipients and individuals who were eligible for Medicaid in the community before entering the facility. There is one policy exception: providers may bill Medicaid for Medicare Part A coinsurances (level of care “X”) and Medicare Part B Crossover claims when the recipient is not ICP Medicaid eligible but is eligible for Qualified Medicare Beneficiary (QMB).

Please refer to the Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook, the Florida Medicaid Hospice Services Coverage and Limitations Handbook and the Florida Medicaid Provider General Handbook for details regarding this policy, or contact your local Medicaid area office. You may access Provider View, Florida Medicaid handbooks, and contact information for your local Medicaid area office on the Public Provider Web Portal.

NH Providers Given Opportunity to Participate in Landmark Quality-Improvement Initiative – CMS is giving nursing home providers the opportunity to participate in a bold, new quality-improvement initiative mandated through the Affordable Care Act. The Affordable Care Act requires CMS to establish standards relating to Quality Assurance and Performance Improvement (QAPI) and provide technical assistance (TA) to facilities on the development of best practices for QAPI.

CMS QAPI Initiatives:

• Five Elements: CMS has identified the following key concepts that are found throughout effective quality systems and are the framework for establishing a QAPI program: Design and Scope; Governance and Leadership; Feedback, Data Systems, and Monitoring; Performance Improvement Projects; and Systematic Analysis and Systemic Action.
• QAPI Tools and Resources: CMS, in collaboration with their contractors, University of Minnesota and subcontractor Stratis Health, are continuing to identify and design effective QAPI tools and resources specifically for nursing homes.
• Technical Assistance: CMS contractors are testing QAPI tools, resources, and approaches to providing TA in a multi-year demonstration project with a small group of nursing homes. These materials will be made available to all nursing homes following testing.
• The Nursing Home Quality Improvement Questionnaire: In another collaborative effort, CMS’ contractor, Abt Associates, Inc., and their subcontractor, the Colorado Foundation for Medical Care, designed a questionnaire to identify the quality systems and processes nursing homes currently have in place, as well as assess the extent to which these systems and processes function to help nursing homes recognize and address quality issues. This information will help CMS and our contractors refine the QAPI components.

The Nursing Home Quality Improvement Questionnaire will be administered to a representative sample of 4,200 randomly selected nursing homes in two waves:

• Summer 2012: First wave of data collection
  • Objective: Establish a baseline of QAPI practices in nursing homes and gather information on the challenge and barriers to implementing effective QAPI programs
• 2013-2014: Second wave of data collection
  • Objective: Assess the development of QAPI systems, determine what types of TA to make available to nursing homes in the future, and determine the potential impact of TA in advancing QAPI in nursing homes

Nursing home providers participating in the data collection effort will be given the option of completing an electronic questionnaire available via the internet or a hard copy questionnaire mailed directly to their facility. The questionnaire will take approximately 20 minutes to complete. Nursing homes participating in the data collection will not be identified by name or any other identifying information.

Your participation in this survey effort is crucial to the goals of CMS in aligning QAPI Technical Assistance with provider needs. Check your Quality Improvement & Evaluation System (QIES) mailbox for notification that you have been selected to participate in this important information gathering.

CMS is being supported in this effort through partnership with the following organizations: American College of Health Care Administrators, American Health Care Association, Leading Age, Advancing Excellence in America’s Nursing Homes, American Medical Director’s Association, and the National Association of Directors of Nursing Administration in Long Term Care.

CMS Issues Survey and Certification SC12-37 – Centers for Medicare and Medicaid Services (CMS) is launching the re-designed Nursing Home Compare website on July 19, 2012. In designing the site, CMS adopted industry-best practices for design and usability while incorporating a considerable amount of new information. The result of this effort will be to hopefully increase transparency and web usability for consumers.

CMS launched Nursing Home Compare in 1998 as part of a number of initiatives to improve nursing home quality of care. Since that time, CMS has added information on staffing, quality measures, enforcement actions and complaints to the existing survey results. In 2008, CMS added the Five Star Nursing Home Quality Ratings to Nursing Home Compare. The ratings summarize the information on the site and allow consumers to more easily make meaningful distinctions between high- and low-performing nursing homes. With the July 19, 2012 Nursing Home Compare website release, CMS is adding several new types of information:

• Quality measures based on MDS 3.0 data. The MDS 3.0 assessments will replace the MDS 2.0-based quality measures previously posted on Nursing Home Compare. In addition, CMS will post data on two measures of use of anti-psychotic medication use (short-stay incidence and long-stay prevalence). 
• Detailed Inspection Reports (Form CMS-2567). 
• CMS will post information on the legal business names of nursing homes.

Please watch for future details on the CMS website.