Tuesday, June 23, 2020

Learn New Workforce Recruitment and Retention Strategies in Just 45 Minutes

AHCA/NCAL offers an instructional webinar titled “Pioneering Solutions to the Workforce Crisis.”  This 45-minute webinar developed in collaboration with PHI delivers practical action steps and strategies assisted living and nursing facilities of all shapes and sizes can take to improve their employee and retention efforts. The webinar also covers ways to improve the hiring process and explains supportive supervision and coaching methods that positively impact employee retention.  

The webinar’s learning objectives include:
  1. Explain the key factors contributing to the workforce shortage
  2. Identify at least 3 strategies to improve employee recruitment
  3. Identify at least 3 strategies to improve employee retention
  4. Explain the impact of supportive supervision on retention
This webinar is part one to a more extensive on-line training for middle managers that will be released in the coming months. While no CEUs are offered for this webinar, participants can receive a certificate of completion. The cost of the course is $25 for AHCA/NCAL members and $60 for non-members.

The instructor is Sue Misiorski who served as Vice President of Workforce Innovations for PHI and currently serves as the New England Regional Director of Operations for SageLife. Starting as a CNA, she later held positions as a DON and VP of Nursing in multi-site skilled nursing homes in New England and has supported the construction of several assisted living and nursing facilities.

Follow this link to read more about this educational webinar and to register for the course.

To access ahcancalED and the Pioneering Solutions webinar, members will need to login with their AHCA/NCAL usernames and passwords. For assistance obtaining AHCA/NCAL usernames and passwords, individuals should e-mail educate@ahca.org with their name and facility contact information

New Interactive Online High Intensity Rehab Course Released for Physical and Occupational Therapists and Assistants

In collaboration with the University of Colorado (CU), AHCA/NCAL is launching a new online educational program titled High Intensity Physical Rehabilitation in Medically Complex Populations. This program is offered through ahcancalED and is designed for physical therapy and occupational therapy rehabilitation professionals (PT, PTA, OT, OTA).

The course presents an evidence-based approach for the implementation of a high intensity progressive rehabilitation model as part of an evolution from current lower intensity post-acute treatment approaches to address myriad patient needs. Rehabilitation professionals will have access to an interactive multimedia learning experience including responsive, self-paced presentation of foundational concepts, simulated case scenarios, and a moderated discussion environment for learning with fellow clinicians - all informed by the latest learning science and innovative technology.

The goal of the course is to teach rehabilitation professionals better methods of addressing functional decline due to underlying medical complexity and deconditioning from hospitalizations or illness. By the end of this course, rehab professionals will learn how to:
  1. Screen all patients for safe participation in high intensity rehabilitation
  2. Establish an appropriate high intensity plan of care for eligible patients
  3. Execute effective and engaging rehabilitation sessions informed by high intensity rehabilitation strategies
  4. Perform ongoing monitoring of patient response to activity and adapt high intensity plans of care throughout the length of stay
  5. Communicate and document completely and efficiently to facilitate continuity of care
  6. Identify current gaps in care for older adults that high intensity rehabilitation can address and advocate for its use in the skilled nursing setting
This self-paced course contains nine learning modules. Each module has an interactive lesson. Some modules have quizzes, some have Slack channel discussions, and some have case simulations to test the mastery of the subject matter. The course concludes with the Post-Assessment/Final Exam and survey.  All modules must be completed to take the Post-Assessment/Final Exam. 

CU recommends that the course be taken over an eight-week period to allow rehab professionals time to implement and practice the concepts as they are learned. Documentation will be provided by AHCA/NCAL to rehab professionals who successfully complete the course, so that they can apply to their respective state licensing boards for continuing education credits.

The course fee is $495 for an employee or contracted employee registering as affiliated with an AHCA member facility and $595 for all other non-member registrants. Individuals will register and pay for the course through the ahcancalED platform at this web site: ahcancal.org/restoreregistration. Then, within 48 hours, registrants will receive further instructions on how to go to the CU platform and enroll in the course and begin their coursework. 

Individuals will need to login with their AHCA/NCAL usernames and passwords to register for this course. For assistance obtaining AHCA/NCAL usernames and passwords, individuals should e-mail educate@ahca.org with their name and facility contact information. Questions about the program should also be directed to educate@ahca.org.

Monday, June 22, 2020

HHS Updates Provider Relief Fund FAQs

On June 22, made several updates to the Provider Relief Fund FAQs.
HHS added detail on calculating lost revenue and revenue (page 7) 

“You may use any reasonable method of estimating the revenue during March and April 2020 compared to the same period had COVID-19 not appeared. For example, if you have a budget prepared without taking into account the impact of COVID-19, the estimated lost revenue could be the difference between your budgeted revenue and actual revenue. It would also be reasonable be the difference between your budgeted revenue and actual revenue. It would also be reasonable to compare the revenues to the same period last year.”  

On page 38, HHS also notes that patient out-of-pocket costs should be counted as revenue. Later on page 39, HHS indicates that revenue lost under Medicaid value-based purchasing programs may be counted as lost revenue.  

Duration of Terms and Conditions (page 9) 

“Some Terms and Conditions relate to the provider’s use of the funds, and thus they apply until the provider has exhausted these funds. Other Terms and Conditions apply to a longer time period, for example, regarding maintaining all records pertaining to expenditures under the Provider Relief Fund payment for three years from the date of the final expenditure”. 

Change in Ownership Additional Detail (page 9)

HHS elaborates upon scenarios in which sellers may not transfer funds.  

Medicaid Allocations (page 38) 

HHS notes that even a small General Distribution payment makes a provider ineligible for the Medicaid Allocation. The Department also added detail on who may apply noting that if a provider did not bill Medicaid/CHIP during the eligibility window, providers may apply  for Medicaid allocation funding as long as they provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 after January 31, 2020 and can produce evidence of such care.  

Additionally, HHS limits on page 39 which providers who enrolled as Medicaid/CHIP providers in 2020 may apply. Also, on page 39, the Department notes that providers who bill under Medicaid Managed Care may apply.  

Tax Information 

On pages 38 and 41, HHS clarifies needed tax documentation information.  

Additional Information on This Week’s Webinars 

On Tuesday, June 23 and Thursday, June 25, HHS will be offering webinars on the Medicaid Allocation application process. To register for one of the webinars, click here

Thursday, June 18, 2020

HHS Offers Medicaid Allocation Application Tutorials

The HHS Provider Relief Fund Medicaid Application Process while a positive step also has come with a number of questions. Unlike Tranches 1-3, the Medicaid Allocation requires an application requiring an array of data. Today, HHS announced two Medicaid Allocation Application online tutorials. The date options are below and please note: you must pre-register.  
Meanwhile, AHCA/NCAL has submitted a list of questions about the application process, along with other provider groups and are awaiting responses from HHS. 

Medicaid Allocation Applications on due on July 20. View AHCA/NCAL’s Medicaid Allocation FAQs in our recent blog post

AHCA/NCAL Webinar on Economic Impact Payments for Social Security and SSI Beneficiaries with Representative Payees

AHCA/NCAL recently put together a webinar recording on economic impact payments (EIPs) from the Internal Revenue Service (IRS) and important facts for skilled nursing facilities, ICFs/IID, and assisted living communities to know on the use of them. IRS began issuing electronic EIPs on or about April 15 to people who received a tax refund electronically.  

The webinar covers what EIPs are and what steps providers should take to protect beneficiaries receiving this benefit. EIP funds belong to the resident and they make decisions about fund use or may request assistance and guidance (such supports are acceptable). The recording also covers whether a resident can give their EIP funds to a family member and what to do if EIP funds are being misused. Finally, a variety of resources from the Social Security Administration to the National Center on Elder Law and Rights are available at the end of the webinar to find further information that will be of assistance.  

This webinar is available on-demand and for free to member providers and the general public. Viewers must create an account with or log in to ahcancalED. 

Also see our blog post, which offers guidance on this topic. 

If you have any questions around EIPs, please email COVID19@ahca.org.  


Wednesday, June 17, 2020

Outlook for Three-Day Hospital Waiver

In the past months, CMS has issued an array of national, “blanket” waivers to reduce administrative burden, improve access to care, and expedite provider payment in both the Medicare and Medicaid programs. Important Medicare SNF waivers include waive of the 3-Day Stay Rule and Spell of Illness while an important Medicaid waiver is the elimination recertification requirements. These waivers, included under a national, blanket waiver called a Section 1135 waiver, remain in place while a Public Health Emergency (PHE) is in force.

Under the President’s March declaration of a PHE under Section 319 of the Public Health Service Act, the Secretary of the Department of Health and Human Services (HHS) has the authority to declare a PHE exists in 90-day increments. Effective April 26, HHS Secretary Azar announced a PHE 90 day extension through July 26. In late July, Secretary Azar has two options:
  1. Allow the PHE and the Section 1135 to expire; or 
  2. Allow the PHE to expire but extend the Section 1135.

The Secretary has the authority to extend the Section 1135 in 60-day increments. As an example, Secretary Azar could allow the PHE to expire on July 26 but extend the Section 1135 waiver until September 26 and then, again, until November 26.

Outlook for Other Important Resources

In addition to the waivers, important resources are increased federal Medicaid funding for states with a 6.2 percentage point increase and the CARES Act Provider Relief Fund. Increased federal Medicaid funding to the states is tied to the PHE. The increased federal dollars are available for qualifying expenditures that were incurred on or after January 1, 2020 and through the end of the quarter in which the public health emergency including any extensions, ends. Following the example above, if the Secretary allows the PHE to end on July 26, the increased federal matching percentage would end on September 30. 

The CARES Act Provider Relief Fund is not tied to any date in the CARES Act statutory language nor the PHE. The Fund is entirely at the discretion of the Secretary.

Tuesday, June 16, 2020

Register Today for AHCA/NCAL’s Infection Preventionist Training

AHCA/NCAL’s expanded version of its popular Infection Preventionist Specialized Training (IPCO Version 2) online training now includes COVID-19 bonus content.

IPCO Version 2 is designed to train nursing facility Infection Preventionists and is approved for 25 ANCC contact hours. The online course is also now approved for 22 NAB CEUs for Administrators.  AHCA/NCAL recognizes Administrators will not serve as designated Infection Preventionists but recommends that Administrators consider taking the course to gain a deeper understanding of infection prevention and control in facility operations. The training is also highly recommended for assisted living communities because they care for a similar population with similar infection risks.

The registration fee is $450 for AHCA/NCAL members and $650 for non-members. Members will need to login with their AHCA/NCAL usernames and passwords to register for IPCO Version 2. For help obtaining AHCA/NCAL usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information. 

Whether You Need to Know Some, a Lot, or Just Need Updates, AHCA’s Online SNF ICD-10 Coding Trainings Have You Covered

AHCA has partnered with the American Health Information Management Association (AHIMA) to offer two updated online in-depth ICD-10 trainings and two new 2.5-hour update trainings for staff with ICD-10 coding experience/knowledge.  

The Patient Driven Payment Model (PDPM) relies on rapid and accurate patient assessment and diagnosis, and on MDS and ICD-10 coding to determine payments for each SNF patient. Incorrect or insufficient coding can significantly impact the payment rate for each patient.  

More than 40,000 ICD-10 codes can be used to report the primary reason for a SNF stay on the PDPM MDS assessment. Building ICD-10 coding proficiency and capacity are essential to ensure proper reimbursement for needed care and services.  

The 2020 ICD-10 trainings are:
  • AHCA/AHIMA ICD-10 Training for PDPMFull Length Coding and Documentation Training 16 CNEs for nurses or 16 AHIMA CEUs for Health Information Management (HIM) professionals upon completion. Intended for New SNF Staff (or staff interested in a full re-fresher) with Responsibilities for MDS and Billing.  $499 AHCA Member | $599 Non-Member  
  • AHCA/AHIMA ICD-10 Training for PDPMFull Length Training for Non-Coding Roles 4 CNEs or 4.5 NAB administrator CEs or 4 AHIMA CEUs upon completion. Intended for New SNF Staff (or staff interested in a full re-fresher) Who Need Knowledge About ICD-10-CM Coding to Support Other SNF Staff (e.g., Administrators, Regional Managers, etc.)  $199 AHCA Member | $249 Non-Member 
  • AHCA/AHIMA ICD-10 Coding Updates for PDPM and Expanded Case Examples -- Updates Only Version  2.5 CNEs or 3 NAB administrator CEs or 2.5 AHIMA CEUs upon completion.  Short Update Training on CMS Changes to PDPM ICD-10-CM Codes Intended for Experienced  SNF Staff with Responsibilities for MDS and Billing.  $99 AHCA Member | $149 Non-Member  
  • AHCA/AHIMA ICD-10 General Updates for PDPM and Expanded Case Examples for Non-Coding Roles -- Updates Only Version 2 CNEs or 2.25 NAB administrator CEs or 2 AHIMA CEUs upon completion. Short Update Training on CMS Changes to PDPM ICD-10-CM Codes Intended for Experienced SNF Staff Who Need Knowledge About ICD-10-CM Coding to Support Other SNF Staff (e.g., Administrators, Regional Managers, etc.)  $99 AHCA Member | $149 Non-Member   
Participants must pass a short test at the end of each module for all courses with a score of 70 or greater to receive CNEs/CEUs. 

To register for any of the four ICD-10 courses, go to ahcancal.org/icd10

Members will need to login with their AHCA/NCAL usernames and passwords to register. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information.  

AHCA/NCAL Launches New Population Health Management Innovation Lab for Members

AHCA/NCAL has launched the first phase of its Population Health Management (PHM) Innovation Lab.  Phase I contains free “AHCA/NCAL Member Only” foundational resources designed to introduce AHCA/NCAL assisted living, nursing facility and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.  

Phase I PHM Innovation Lab resources are ideal for familiarizing owners, operators, administrators and LTC managers about the fundamentals of various PHM models and how these models can better serve LTC organizations, residents and families. Members can also access the PHM Innovation Lab resources at: PHMInnovationLab.com.  

CMS continues to drive the healthcare system to one of value by shifting financial risk to providers through a range of fee-for-service (FFS) and managed care models. PHM is the application of interventions and strategies to improve the health outcomes and manage the costs of a targeted group.  PHM models vary based on the degree of risk, degree to which payments are tied to quality, reliance on data analytics and level of care coordination. Understanding these models is vital in today’s operating environment.

Historically, PHM models have been led by hospitals, health systems, physician groups and large insurance organizations. In recent years, LTC providers (including assisted living) and PAC providers have assumed leadership roles in developing and employing several PHM models. The new environment demands new models, and PHM helps LTC/PAC providers understand and integrate new strategies into SNF and AL buildings by integrating SNF/AL and primary care, enhancing care transitions, and using robust care management models.

PHM models have evolved to address targeted groups of individuals (SNF and AL residents in our case), to improve their health outcomes, and providers can use these models to drive better outcomes, strategies and interventions for handling the COVID-19 crisis. A PHM model, provider led Special Needs Plans (SNPs) can be an important solution in the current COVID-19 environment. With the deployment of on-site nurse practitioners providing primary care at the long term care bedside, costly and potentially dangerous hospital transfers can be avoided.  

The PHM Innovation Lab Phase I contains six different subject area modules with corresponding educational components including webinars and briefs.  
  1. Population Health Management Fundamentals -- Describes the who, what, where, and how of Population Health Management (PHM). It also introduces various PHM models including their specific characteristics, benefits, and implications.  
  2. Accountable Care Organizations -- Provides an overview of the structure, financial model, and regulatory requirements of different ACOs. Types of ACOs covered include Medicare Shared Savings Programs and Next Generation ACOs. 
  3. Bundled Payments -- Provides an overview of the basics of bundled payments (episode-based payments) including what are bundled payments, how they work, and their implications for LTC and PAC providers.  
  4. Emerging Models: Direct Contracting -- Provides a detailed overview of Direct Contracting including types of participants, payment, beneficiary alignment, quality incentives, and a model timeline.  
  5. Managed Care -- Provides an overview of Medicare Advantage/ Provider-led Special Needs Plans (SNPs) and explains how SNPs work, and discusses the implications for LTC and PAC providers.  
  6. Provider Networks --Provides an overview of the why, what, and how of provider-owned integrated care networks and explains the benefits of provider networks.  
Members will need to login with their AHCA/NCAL usernames and passwords to access PHM Innovation Lab materials. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information.  

Updated List of Excluded Individuals and Entities (LEIE) Database File

The US Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in March 2020. This new file replaces the updated LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

The updated files are posted on OIG’s website and healthcare providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines.

Instructional videos explaining how to use the online database and the downloadable files are available at http://oig.hhs.gov/exclusions/download.asp.

As a best practice, long term care providers should check the LEIE on a regular basis.