|The Latest Wrinkle February 17, 2017|
LeadingAge Michigan Members Collaborate to Serve West Michigan
A new and exciting joint venture will provide a broad range of skilled and private duty services to over 3,000 seniors and families in Kent, Ottawa, Barry, Ionia, and Montcalm counties this year.
Atrio Home Care, a collaboration of Holland Home, Resthaven, and Clark, extends the mission of these faith-based, not-for-profit providers who have century’s long histories of service to seniors and the community. “By combining our individual home health and help at home operations under a single umbrella, we can continue to offer the kind of exceptional care that serves our non-profit missions while remaining competitive in today’s fast changing environment,” said Brian Pangle, president and CEO of Clark.
Their combined strength brings best-in-class expertise and will provide clinical excellence to those who need skilled care services and private duty. Atrio Home Health and Atrio Home Health Lakeshore will be housed in Holland Home and Resthaven respectively. Atrio Health at Home – private duty services – will be offered from Clark and Resthaven.
A six member board of directors representing each participating organization will be led by Board Chair Mina Breuker of Holland Home. For more information, visit www.atriohomecare.org.
“We are excited about the increased expertise and scope that Atrio Home Health partnership affords our communities in West Michigan. The many strategic conversations that have occurred at LeadingAge Michigan meetings play an important role in the initial discussions and final success of this alliance of three well-respected providers. Atrio Home Health will position us well for the ever changing reimbursement, regulatory, and service delivery environment,” shared Charlie Vander Broek, president and CEO of Resthaven.
Governor’s Budget Recommendation for FY 2018
Across the Continuum
Tom Price Confirmed as Secretary of the US Department of Health and Human Services
A budget of more than $1 trillion dollars for human services now falls under the guidance of Tom Price, recently confirmed as the Secretary of DHHS for the Trump Administration. Long an opponent of the Affordable Care Act, expectations are that changes may be implemented whether Congress repeals or replaces. Also skeptical of many of the alternative payment demonstrations, Price may well slow down or scale back such programs as ACOs or Bundled Payments. Much of these program requirements were developed by HHS and not covered by law.
States are mixed on the Medicaid expansion – also covered under the Affordable Care Act. Many states, including Michigan, have found significant cost savings with the federal government covering much of the cost.
Other issues, such as CMS criteria that may push hospitals to place patients in observation status rather than inpatient, may also be reviewed. Many have felt that these program rules thwart the professional decision of the physician and provoke high co-payment costs as well as difficulty in accessing skilled rehabilitative services in a nursing facility.
Congress though, remains divided on next steps and the timeline to implement changes. Regulatory reform for nursing homes may also be subject to changes, with support from LeadingAge working to slow the implementation down.
MI Health Link Ombudsman Program
Michigan’s program financial alignment demonstration program for dual eligibles, MI Health Link (MHL), is required to have an ombudsman program for program enrollees. In keeping with the requirement, the Michigan Department of Health and Human Services has a contract with the Michigan Elder Justice Initiative to serve in the role of the MI Health Link Ombudsman (MHLO). The MHLO serves as an advocate and problem-solver for beneficiaries enrolled in MI Health Link. All services are free to program enrollees, and beneficiary information is confidential. As the MHLO, MEJI can:
Note: The MI Health Link Ombudsman program is not the same as the Long Term Care Ombudsman and is not intended for the same purpose. The MHLO is intended to assist enrollees through questions and issues with MI Health Link only. If you have a resident or person you are serving who is enrolled in MI Health Link and who requires assistance, the MHLO is available through the following contact information Monday through Friday from 8:00 AM to 5:00 PM:
The Advocate’s Guide to MI Health Link is a comprehensive overview of the MHL program. The guide is designed to assist advocates and others to understand and navigate MHL, including specific information on enrollment/disenrollment, continuity of care, and appeals and grievances. A link to the guide can be found here.
MI Health Link operates in the entire Upper Peninsula, southwest Michigan, Macomb, and Wayne counties.
Applying the Quality Assurance Act
Last week, a skilled nursing facility was required under court order to produce internal documents related to a negligence lawsuit. The Appeals Court denied the facility argument that the documents were privileged since the information was developed for and reviewed by the Quality Assurance Committee.
The Court found that the Quality Assurance Act was intended to promote transparent discussion and improve patient care – however the witness statements and reports are not protected simply because they were reviewed by the Quality Assurance Committee.
Home and Community Based Services
Michigan’s Home and Community Based Services Programs Update
In Michigan, the MI Choice Home and Community Based Services Waiver program and the Program of All-Inclusive Care for the Elderly (PACE) offer long term supports and services to people who qualify for these programs and live in the community. People who are served by these two programs must meet the eligibility requirements for the respective program in addition to meeting the Michigan Nursing Facility Level of Care definition.
MI Choice provides home and community based services to Medicaid-eligible people who are elderly or disabled, providing a wide variety of support that can enable people to reside in their own homes. The MI Choice Home and Community Based Services Waiver program is available to qualifying individuals in every county in Michigan through 20 waiver agencies, six of which are members of LeadingAge Michigan. The LeadingAge members include: A&D Home Health Care, Inc.; MORC Home Care, Inc.; Northern Healthcare Management; Reliance Community Care Partners; Senior Services of Southwest Michigan, Inc.; The Information Center, Inc.
The number of persons served through the MI Choice program from October 2016 through January 2017 was 12,805. This number reflects those who may have been receiving services over a period of time as well as those who were enrolled and then changed settings (such as moving into a nursing home). MI Choice is reimbursed through capitation payments to each waiver agency and the rates are actuarially set based on allowable costs.
During state fiscal year 2016, 1,488 individuals were transitioned from a nursing home to the community with services provided through MI Choice, Home Help, or another service setting. This number was down from 2015 when 1,631 people were transitioned to an alternative setting.
Information about MI Choice services can be found here.
Program of All Inclusive Care for the Elderly (PACE)
Michigan currently has 10 PACE organizations operating in the state, with three of them operating at more than one location. Most PACE enrollees are dually eligible for Medicare and Medicaid and receive the majority of their services through PACE centers. Both medical care and support services are covered through capitation payments from the state for Medicaid and from the Centers for Medicare and Medicaid Services for Medicare.
LeadingAge Michigan member, United Methodist Retirement Communities, Inc. (UMRC) is a sponsor of three PACE organizations in Michigan, including Huron Valley PACE in Ypsilanti (80 percent), Thome PACE in Jackson (80 percent), and Senior CommUnity Care of Michigan in Lansing (20 percent). Huron Valley PACE was recently featured in an article in repertoire.com. John Thorhauer, President and CEO of UMRC, discussed with the article author the importance of older adults living well and noted that PACE allows promotion of independence and quality of life, in addition to providing necessary services.
Michigan’s PACE enrollment as of February 2017 was 1,872 enrollees across all the PACE sites, which is approximately 60% of PACE statewide capacity, with varying levels of enrollment depending on each individual PACE center. There are three more PACE sites that are anticipated to begin operation between now and the end of 2018. More information can be found on PACE by here.
HCBS in Governor’s Proposed Fiscal Year 2018 Budget
Governor Snyder’s proposed budget for fiscal year 2018 includes $3.7 million for the purposes of outreach and education, and coordination of housing to assist individuals choosing to move from a nursing home to the community. The funds may also be used for other quality improvement activities. The department is instructed to work with AAAs, non-AAA waiver agencies (LeadingAge Michigan members), and the Disability Network to develop a sustainable plan for transitions. Federal funding for Money Follows the Person will no longer be available to the state and the inclusion of this funding in the proposed budget indicates Governor Snyder’s intent to continue the program.
RoP Tools and Resources
A workgroup consisting of representatives from the State Agency and the associations has been assembled to address the revised Requirements of Participation (RoP) for long-term care facilities. The first RoP being discussed is the abuse allegation reporting requirement and associated issues. The workgroup is currently exploring more sign-on user access to MI-Acts, the minimum fields needed in MI-Acts for initial reporting, the volume and type of allegations being reported, and an in-depth review to determine if what is being reported meets the requirements for reporting. The workgroup is scheduled to meet monthly. Please let us know any issues you are experiencing regarding the revised abuse RoP and if you have suggestions for improvement, please share those too. LeadingAge Michigan will keep members informed as this work progresses.
Operating tip: the state’s document titled “Facility Reported Incident Guidance” dated 10/17/16 currently does not align with the Federal reporting requirements. Since the Federal reporting requirements are more stringent than this guidance you will be held to the higher expectations.
Through member updates, LeadingAge Michigan has communicated the availability of tools and resources to assist in your compliance readiness with the Phase 1 regulatory process. These tools and resources are broad in nature and currently reflect the Federal requirements. As the workgroup progresses, revisions to the tools will be made where applicable to also reflect any state-specific requirements. Use this link to access tools.
Additionally, LeadingAge Michigan has developed a series of webinars to help you successfully manage the impact and comply with recent regulatory changes. To learn more, click here.
Staffing Star and Case Mix Index
The CMS Five Star rating for staffing compares a facility’s actual hours of staffing against “expected hours of staffing” determined by resident acuity using the facility case mix index (CMI). When a facility’s CMI increases without major change to the staffing hours such as a staff restructuring or layoff the facility’s rating will go down, perhaps significantly. Members should be cognizant of this before undertaking an effort to boost CMI. In general, higher CMIs drive higher RUG scores and resulting reimbursement.
The recently released CMS Five Star analysis report has a button at the end of the staffing section that links to a staffing template. This template predicts the amount of staffing needed to maintain the star rating if the CMI changes. To learn more about how to best utilize and interpret these interactive reports see the LeadingAge website.
CMS Recommendations Regarding Cyber Security
CMS recently issued a Survey and Certification Letter that identifies best practices toward mitigating the threat of cyber security attacks. Primary focus areas include:
A series of potentially adverse events, including incomplete discharge instructions, missing patient information or orders, potential compromise of Public Health Information (PHI), personal identifiable information (PII), which ultimately could lead to violations of HIPAA when a cyber-attack is successful. Additionally, depending on the facility’s ability to provide patient care when there is a loss of electronic health records or other critical computer based systems, the facility may need to close or temporarily suspend operations.
A review of current policies and procedures by the facility’s leadership (governing body, nursing services and medical records) to ensure adequate plans are in place in the event of an attack.
While the new Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers regulation does not specifically address elements of cyber-security, the regulation requires providers and suppliers to have an emergency plan and risk assessment based on an “all-hazards” approach.
See the CMS Survey and Certification Letter, for more information.
Quality Reporting - Teleconference
The Improving Medicare Post-Acute Care Transformation (IMPACT) of 2014 requires the reporting of standardized patient assessment data by Post-Acute Care (PAC) providers. Through the use of a teleconference, on Thursday, February 23, CMS experts will discuss goals, requirements, progress to date, and key milestones for 2017. A question and answer session follows the presentation. To register for the teleconference or for more information, visit MLN Connects Event Registration.
The National Quality Forum's (NQF) Measure Applications Partnership (MAP) submitted 74 performance measures for consideration and use across 16 federal healthcare programs. This is the sixth consecutive year that MAP has submitted guidance to the Department of Health and Human Services (DHHS) on standardized performance measures. Important themes from this year's review of measures under consideration include: identifying the need for high-value measures, including a focus on composite measures, outcomes, and patient-reported outcomes; balancing the effort required for data collection and reporting with the potential to improve quality and patient outcomes; and, encouraging shared accountability and improving cooperation and communication across the healthcare system.
MAP will issue four final reports with recommendations on overall measure sets and guidance on measure reduction in federal programs. The reports on the post-acute and long-term care and hospital settings were due to DHHS by February 15.
Use the highlighted link to view the NQF measure recommendations.
New Focus in Office of Inspector General 2017 Work Plan
Of the seven areas of concern for skilled nursing facilities noted in the Office of Inspector General’s (OIG) 2017 work plan, there are four new areas that possibly deserve consideration for your corporate compliance efforts:
OIG will determine how timely the State Agency has investigated the more serious nursing home complaints. States are required to investigate allegations prioritized as an immediate jeopardy situation within two days and allegations prioritized as actual harm within ten days. Even though this focus is on the State Agency, it is prudent to ensure with individual member policies and procedures for reporting time frames.
OIG will determine whether incidents of abuse and neglect were properly reported and investigated. The recently revised Requirements of Participation now reads in part, “…shall report not later than 2 hours after forming the suspicion, if the events that cause the suspicion result in serious bodily injury, or not later than 24 hours if the events that cause the suspicion do not result in serious bodily injury”.
OIG will drill deeper into SNF documentation for coding activities of daily living and therapy minutes reported on the Minimum Data Set. Previously, OIG focused on the billing for higher levels of therapy than was necessary. Now, the reviews will focus on whether patient documentation meets the RUG requirements for skilled care.
OIG will review the utilization of the “Skilled Nursing Facility Adverse Event Screening Tool” developed in 2014 as a resource to help facilities identify adverse events. The goal of this focus appears to be that of disseminating information about the tool’s use.
Attorney Margaret Chamberlain will present on the 2017 OIG work plan at our Regulatory Day scheduled for March 9. To view and register for this informative day of presentations see the LeadingAge Michigan website.
The OIG Work Plan can be viewed by using this link.
Laura Funsch Appointed to AFC Licensing Advisory Council
LeadingAge Michigan is pleased to announce that staff will be representing members on the Adult Foster Care Council effective January 1, 2017. The Director for Regulatory Strategy, Laura Funsch, has been appointed to a two-year term. The Adult Foster Care Licensing Advisory Council’s mission is to advise the Department on the content and enforcement of the administrative rules related to Adult Foster Care (AFC) and supports in the successful delivery of foster care services for Michigan’s vulnerable adults. The February 8 meeting included a brief update on issues related to unlicensed settings and TB testing rules. Division Director Calewarts stated they did not receive opposition regarding returning to a ‘full inspection model’ which includes observation, interview and record review. Additionally, he added that a goal for using this model was to prevent issues from occurring by providing a full inspection.
Revised HFA TB Rules Public Hearing
The Homes for Aged administrative rules establish the standard of quality care requirements for that setting. The public hearing held on February 8 received no opposition regarding the proposed revisions related to outdated tuberculosis testing requirements for residents and employees that have worked to add unnecessary costs to the provider/resident as well as unnecessary exposure to ionizing radiation. Conducting screening assessments instead of requiring blanket chest x-rays for all admissions is the current standard of practice.
The revised TB screening rule is expected to be officially finalized within the next three months. Division Director Calewarts expects this rule to be promulgated and has communicated that facilities can begin operating under the proposed rule without concerns of being cited for following current standards of practice. To view the proposed revision, click here.
Assisted Living Listserv
lLeadingAge Michigan believes it is vitally important during this increased time of flux for us all to stay connected. Participating in planned education and networking opportunities are great ways to accomplish this but it does not allow for real time connection. To that end, we have established an ‘ALnetwork’ listserv. This listserv will provide an opportunity for discussion and an exchange of information for our licensed and unlicensed members. Please watch for an email invitation to join the ‘ALnetwork’ over the next few days. Once you receive the invitation, please accept to participate in the connections. If you have any questions or issues with accessing the listserv, please contact Dalton at Dalton@LeadingAgeMI.org.
MSHDA Housing Choice Annual Plan
Michigan State Housing Development Authority’s (MSHDA) Rental Assistance and Homeless Solutions Division has posted the proposed MSHDA Housing Choice Voucher FY 2017-18 Annual Public Housing Authority (PHA) Plan and Administrative Plan to the MSHDA website. Plans are listed under “Spotlight” on the main page.
Members are invited to make comments on the proposed PHA Plan or the changes to the Administrative Plan. Written comments must be sent to the attention of Lisa Kemmis either by U.S. Mail at PO Box 30044, Lansing, MI 48909 or via email to firstname.lastname@example.org by 5:00 pm Friday, February 24, 2017.
Two public hearings are scheduled for receiving oral or written comments. The public hearing dates and times are:
Friday, February 24, 2017 at 9:30 am at the MSHDA Lansing Office
lease contact Lisa Kemmis at 517-241-2427 or email@example.com if you have any questions or comments about the proposed PHA Plan and Administrative Plan.
Food Service RoPs
The Phase 1 Requirements of Participation (RoPs) include many areas relevant to food and nutrition services. In addition to the Food and Safety tools/resources available here, another available resource to assist in compliance with this rule is being provided. Please click here for a summary of the changes most likely to impact your food and nutrition services department.
Operating tip: With the Bureau of Community and Health Systems’ new Environmental Health Section, you can expect a Sanitarian to inspect for your compliance with the food safety requirements. The State Agency has communicated they are already seeing an increase in deficient practice in this area as many providers have not been routinely inspected by a surveyor with this skill set in the past.
Pilgrim Manor Announces $3 Million Renovation Project
LMI On the Go
LeadingAge Michigan is a busy place; this newsletter item will give you a snapshot of what is happening here in our Lansing office and with our outreach activities. If you see something you have questions about, please reach out. We love to hear from you!
SAVE THE DATE
LTC Regulations Webinar Series
It’s a new year and 2017 is expected to be full of additional regulatory changes for nursing home and assisted living providers. We expect to see revisions in the survey process’s, licensure and certification requirements. We’ve assembled a team of high-level content experts; professionals who have first-hand knowledge of the anticipated changes.
MDS RAC Certification Workshops
Did you know you can become RAC Certified in just three days?
LeadingAge Michigan, in partnership with the American Association of Nurse Assessment Coordination (AANAC), is pleased to offer the highly esteemed Resident Assessment Coordinator-Certified (RAC-CT) a certification program for long-term care professionals. This workshop is designed to increase knowledge of clinical assessment and care planning, completion of the MDS, and the regulations surrounding the RAI/MDS process. Earning the RAC-CT designation gives you the credentials to prove your assessment expertise; making you an invaluable asset for your facility, your residents, and the long-term care profession.
Nurse Aide Train-the-Trainer
Strategies for LTC Billing, Receivables & Collections
QAPI Certified Professional (QCP) Workshop
Building Better Working Relationships
As shown by Daniel Goldman's research, it is Emotional Intelligence (EQ) that makes and keeps someone employed. He has found that IQ takes second position to EQ in determining outstanding job performance because it is the human talents and qualities that makes and keeps one employed. When an organization has employees with higher EQ they will interact with leadership, management, co-workers, residents/patients and families more effectively. All participants will complete an online Everything DiSC Workplace Personal Profile which will be reviewed and assessed during the training. This valuable assessment tool will be included in the cost of the training. Join us to learn more about your personal EQ, how to adapt your style to be more effective with others and how to build better working relationships.
Become the Medicare leader in your facility with this comprehensive three-day workshop. This in-depth program will help you manage the reimbursement system, navigate audits, avoid risky practices, and stop drowning in confusing and ever-changing regulations.
Certified INTERACT 4.0 Champion (CIC)
Director of Nursing Services-Certified (DNS-CT) &
Take your skill set to the next level. This three-day workshop offers a specialized American Association of Directors of Nursing Services DNS-CT certification for nurses; as well as relevant content for nursing home administrators, vice presidents of clinical services, administrators in training and other long-term care professionals with facility management responsibilities.
The academy is designed to equip new and emerging leaders with the essential insights, knowledge, and skills to directly improve leadership effectiveness.
The academy integrates adaptive and technical learning for a comprehensive training experience. We will focus on what it takes to be a successful and effective leader in today's workplace; specifically within the aging services industry. Each class will provide unique, thought-provoking, opportunities for dialogue with aging services coaches, mentors, and executives. The academy will cultivate your leadership excellence, develop your leadership potential, and assist you in making a positive impact within your organization.
We encourage applicants from various positions, disciplines, experience, industry knowledge, and companies of different sizes to ensure a vibrant exchange of ideas and discussion. The academy is for high-potential professionals who want to learn to become better managers and leaders.
For more information ~ please contact the Association at 517-323-3687.
Modular Education Program for Activity Professionals (MEPAP)
The MEPAP course prepares the activity professional for all aspects of their role. The nationally approved course curriculum is designed to enhance the skills and knowledge required to properly facilitate the activity needs for all residents in aging services settings. The 18-day course offers 180 hours of instructor-led training and 180 hours of supervised practicum assignments. After successfully completing the course, individuals will be prepared for the National Certification Council for Activity Professionals (NCCAP) exam and certification application process.
For more information ~ please contact the Association at 517-323-3687.
Mark Your Calendars and Plan to Join Us for …
2017 Annual Conference & Trade Show
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