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The Latest Wrinkle August 11, 2017
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Provider Tax Debate Continues


The Michigan Medical Services Administration (Medicaid) for the past several months has been working with provider organizations to resolve issues around a reported $8.2 million shortfall in the provider tax. According to the Department, the fund falls short of covering QAS payments for FY2017.

Currently, there is not much consensus between Associations and the Department about the shortfall itself or how to address it. Part of the issue may have been that the Department anticipated a decrease in the number of Medicaid bed days from the FY 2015 base year. Currently, the Department estimates in increase of almost 20,000 days, while providers report no increase in bed days to date.

Associations continue to work with the Department to more clearly identify facts and budgeting assumptions – particularly around the actual number of bed days for FY 2017 to date, how Integrated Care Organization payments and days are factored into the payment structure, and the number and amount of providers who have not paid their provider tax payments to date.

LeadingAge Michigan has submitted a letter to the Michigan Medicaid Director requesting additional data to support the state’s claim that the number of Medicaid days unexpectedly trended upward when earlier estimates projected a decline in Medicaid days. To get a sense of actual utilization, we are asking members who have not already submitted their utilization data to complete this survey.

LeadingAge Michigan will continue to monitor and keep members informed as additional information becomes available.


Across the Continuum


Compliance Made Easier - Phase 2 Preparedness

 This past week, Shelly Vrsek, the Director of Quality Analytics at Samaritas recently shared with their President Vicki Thompson-Sandy her opinion about The Compliance Store. “I just wanted to let you know that I think the investment in the Compliance Store is some of the best money we've spent. It is really a great resource. I think I log into it once daily.” Is your organization ready for the Phase 2 implementation scheduled for November 28, 2017?

You can learn more about The Compliance Store by attending their session being held at Crystal Mountain on Wednesday, August 16 at 1:15 pm.
To learn more about how this partnership can help you and your organization efficiently and successfully navigate the complexities of the ever changing long-term care regulatory environment, contact Kasia Roelant at Kasia@LeadingAgeMI.org or 517-323-3687


A New Vision for Long-Term Services and Supports


LeadingAge recently published its proposal for a new vision of long-term services and supports (LTSS) in America. The paper posits that the United States must find a more fair and rational way of financing services for all who need them considering the disparate and poorly coordinated approach in the past, as well as the growing elderly population. The emphasis is on consumer choice and flexibility that will reward quality and innovation.

The paper identifies three features that are important to a new and better system:

  • A universal approach to coverage in which risk is spread over a large population. Such an approach would extend coverage to everyone, and decrease both overall and out-of-pocket costs in the long run.
  • A catastrophic benefit period in which care is provided to those with high needs for LTSS. Persons who find themselves in need for long term services and supports would be required to pay for services for the first two years before benefits would apply.
  • A “managed cash” benefit structure in which individuals would determine how they want to spend their funds for LTSS rather than purchase a covered service from a qualified provider. Consumers would be better able to individually address their needs.

Seven Practical Ways to Reduce Bias in Your Hiring Process


We all have unconscious biases. This article from the Harvard Business Review offers practical ways to remove bias from the hiring process. Suggestions are offered for job descriptions, resume review, the interview process, and more. Read and learn from this article to make sure you are getting the best person for the job.


USCIS Releases New Form I-9


The U.S. Citizenship and Immigration Services (USCIS) has released a new version of Form I-9, Employment Eligibility Verification. By September 18, 2017, employers must use only the new version.

Compliance Dates for New Form I-9
The new Form I-9 features a revision date of July 17, 2017. While employers may continue using a Form I-9 with a revision date of November 14, 2016 through September 17, 2017, as of September 18, 2017, employers must use only the new version.

Changes to Form I-9
The following revisions have been made to the List of Acceptable Documents section of the new Form I-9:

The Consular Report of Birth Abroad (Form FS-240) has been added to List C. Employers completing Form I-9 on a computer are now able to select Form FS-240 from the drop-down menus available in List C of Section 2 and Section 3.

All the certifications of report of birth issued by the U.S. Department of State (Form FS-545, Form DS-1350, and Form FS-240) are now combined into selection C#2 in List C.

All List C documents have been renumbered except the Social Security card. For example, the employment authorization document issued by the U.S. Department of Homeland Security on List C has changed from List C #8 to List C #7.

The new Form I-9 can be downloaded here.

-Our thanks to business partner, Voss Financial Group, for this timely update.


Skilled Nursing


 

LeadingAge MI Meets with the President of CVS/Omnicare


On Wednesday, August 2, LeadingAge Michigan was privileged to host Robert (Rocky) Kraft, President of CVS/Omnicare, along with interested member organizations. Omnicare has been a dedicated Business Partner for more than a decade and has helped to support the association with professional development and generous contributions to the Education Foundation.
 

Since being acquired by CVS Health in 2015, Omnicare has been aggressively working to reinvent pharmacy across the spectrum of senior care. They have implemented new organizational initiatives to develop a more engaged culture, are redesigning the assisted living/independent living model, and are working to enhance the client experience and standardizing operations.

Some new enhancements to be rolled out include an improved service model. With the addition of new staff, members will receive at least two proactive visits a month from a field nurse, account manager or consulting pharmacist, as well as a Quarterly Business Review and an annual pre-survey readiness review. Also, the Omniview Dashboard will now allow members to see the status of medication orders on new admissions, prescription alerts and Omniview training courses.

One of the most exciting programs Omnicare will roll out by 2018 is a partnership with Epic EHR and PCC (PointClickCare) EHR. Through this program Epic, on discharge from the hospital, EPIC will send the patient’s chart directly to PCC and Omnicare to expedite the first dose. In Omnicare’s test pilot program, first doses were received within two hours of admission, saving nursing staff 30 – 40 minutes of order entry time for each admit.

As the result of CVS’s scale and our longstanding relationship, we are pleased to announce the LeadingAge MI Business Alliance has obtained a dramatic price decrease for our members, resulting in an annualized savings of approximately $1.5 Million for members on our GPO contract.

Look for further innovations and collaborative efforts with CVS/Omnicare and LeadingAge Michigan.


Five-Star Update


Nursing Home Five Star ratings are currently reviewed by consumers, regulators, insurers and provider networks to help select which facilities they will form relationships with. As noted in the chart below, LeadingAge Michigan members perform well with the large majority of members achieving three or more stars in both overall ratings and quality.
 

Governor Snyder has approved an expansion of the Quality Assurance Program (Provider Tax) within this year’s state annual budget to create new incentive payments for nursing homes. These incentives will be based on member quality measure ratings, underlining the overall importance of performance on the CMS Five Star Rating system. LeadingAge Michigan will continue to provide information to members as this program is developed.

LeadingAge Michigan continues to provide avenues to assist members in all areas of compliance especially with the new SNF Mega Rule requirements. Additionally, we encourage members to consider joining our collaboration with The Compliance Store, a virtual online library of policies, procedures and tools for every Federal and State agency that regulates nursing homes. The Compliance Store team will also be presenting at the Leadership Institute on August 16 at Crystal Mountain. To learn more about this exciting member benefit please contact Kasia@LeadingAgeMi.org.


Health Survey Ratings


The Centers for Medicare and Medicaid Services CMS) Five-Star quality ratings for the health inspection domain are based on the relative performance of facilities within a state. CMS determines the “cut points” for each star rating which are re-calibrated each month so that the distribution of star ratings within states remains relatively constant over time. Keep in mind, the lower the health inspection weighted score, the higher the star received.

CMS calculates scores based on individual state performance because of the variability among states. Michigan has a record of survey outcomes with higher number of citations and greater severity/scope levels. Between October 2016 and July 2017, the cut points had risen by 29.997 points to get a one-star health inspection rating. This implies that CMS needed to decrease the number of facilities falling in the one star category. Cut points for Michigan facilities at the five star level rose a little over three points. Overall this relaxes the scoring for members in Michigan a bit and members who may have slightly increased their points based on a poor survey have a bit more room before losing a star rating.

However, it also means that overall Michigan facilities are receiving more points from an increasing number or scope of citations. No other state in CMS Region V has had such a drastic increase in cut points and survey points over the past year. Ohio was the closest at 7.833. Other states in the region saw increases of less than one point.

Between 2014 and 2016, the volume of Michigan citations has risen approximately 9%. For the first 6 months of 2017, there has been approximately an 8% increase. The current average number of citations is now 9.23 per recertification survey. Michigan has also had an increase in average health citations compared to other Region V states for this same time period.

Approximately 21% of Michigan’s annual surveys and 11% of complaint surveys resulted in a level of 3 or 4 during the first half of 2017. Combined, Michigan had approximately 32% more than the national average. The percentage of citations overturned and/or modified through the IDR/IIDR process between 2014 and 2016 has remained relatively constant at 32%. However, the percentage of those MPRO reviews that were overturned by BCHS has risen by 11% since 2015. For calendar year 2016, 40% were overturned by BCHS.

Members should also note that a new process for the certification/recertification surveys will be implemented in November. It requires minimum competency of all surveyors, experienced and newcomers. It will be computer-based that will enhance oversight by authorities to more readily identify inconsistencies. The Director of the Federal Survey and Certification Division with BCHS will present on what to expect with the new survey process at the September 14 Regulatory Day. So, please mark your calendars.

LeadingAge Michigan continues monitor survey practices and to advocate for the requirements of Public Act 322 of 2012 with the Bureau of Community and Health Systems (BCHS).


2018 SNF Payment Rates & Policy Changes


The Centers for Medicare & Medicaid Services (CMS) has issued a final rule outlining Fiscal Year (FY) 2018 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). Policies in the final rule continue to build on CMS’ commitment to shift Medicare payments from volume to value, with continued implementation of the SNF Value-based Purchasing (VBP) program.

Based on changes contained within this final rule, CMS projects aggregate payments to SNFs will increase in FY 2018 by 1.0% from FY 2017. This estimated increase is attributable to a 1.0% market basket increase required by section 411(a) of the Medicare Access and CHIP

Reauthorization Act of 2015 (MACRA).

Under the SNF Quality Reporting Program (QRP), SNFs that fail to submit the required quality data to CMS will be subject to a 2% reduction to the otherwise applicable annual market basket percentage update with respect to that fiscal year. In this FY 2018 final rule, CMS is finalizing its replacement of the current pressure ulcer measure with an updated version of that measure and adopting four new measures that address functional status beginning with the FY 2020 program year.

The SNF Value-Based Payment (VBP) program has adopted scoring and operational policies for its first year (FY 2019) and has specified measures and program features as required by statute. The FY 2018 SNF PPS final rule includes additional Program proposals, including an exchange function approach to implement value-based incentive payment adjustments beginning October 1, 2018. The SNF VBP Program’s scoring and operational policies for its first year (FY 2019) include:

  • The Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) is used in the SNFVBP Program.
  • Reduction of the adjusted federal per diem rate applicable to each SNF in a fiscal year by 2% to fund the value-based incentive payments for that fiscal year.
  • The total amount of value-based incentive payments that can be made to SNFs in a fiscal year will be 60% of the total amount withheld from SNFs’ Medicare payments for that fiscal year, as estimated by the Secretary.
  • The program will pay SNFs ranked in the lowest 40% less than the amount they would otherwise be paid in the absence of the SNF VBP.
  • Both public and confidential facility performance reporting will be conducted.

The final rule was displayed on July 31, 2017, at the Federal Register’s Public Inspection Desk and will be available under “Special Filings” on the Federal Register website.


Annual Inspection and Testing of Fire Doors

The Centers for Medicare & Medicaid Services (CMS) announced that it would extend the deadline for compliance with the requirements by six months from July 6, 2017 to January 1, 2018.

Key points covered in the Survey and Certification Letter No. S&C 17-38-LSC dated July 28, 2017 discuss smoke and fire door inspection requirements which include the following:

  • In health care occupancies, fire door assemblies are required to be annually inspected and tested in accordance with the 2010 National Fire Protection Association (NFPA) 80
  • In health care occupancies, non-rated door assemblies including corridor doors to patient care rooms and smoke barrier doors are not subject to the annual inspection and testing requirements of either NFPA 80 or NFPA 105
  • Non-rated doors should be routinely inspected as part of the facility maintenance program.
  • Full compliance with the annual fire door assembly inspection and testing in accordance with 2010 NFPA 80 is required by January 1, 2018

Life Safety Code (LSC) deficiencies associated with the annual inspection and testing of fire doors should be cited under K211 – Means of Egress - General. Members who receive a citation and are unable to complete the work on a timely basis should be able to use the new compliance date in your Plan of Correction.


Payroll-Based Journal Reporting Deadline


The Payroll-Based Journal (PBJ) reporting requirement is intended to ensure the public posting of staffing levels for consumers and residents is accurate, and will assist in analyzing how staffing levels and turnover impact resident care. As a reminder, the staffing data from April 1 – June 30 must be submitted no later than 45 days from the end of the quarter. The final submission deadline for this quarter is Aug. 14, 2017.

Providers are advised to submit early and avoid delay of submission until the last 24 hours before the deadline. Data must be submitted successfully to be considered timely. After a facility uploads its data file, verification of successful data submission can be found by checking a facility’s Final File Validation Report (which can be accessed in the Certification and Survey Provider Enhanced Reporting or CASPER folder). It may take up to 24 hours to receive the validation report, so providers must allow for time to correct any errors and resubmit if necessary. For more information about accessing and interpreting Final File Validation Reports, see the PBJ Provider User’s Guide and the CASPER Reporting User’s Guide for PBJ Providers, both available here.


Anticipated New Items Sets to MDS Restraint Section


Effective October 1, 2017, item sets added to section P0200 to the MDS includes the following alarms: bed alarm, chair alarm, floor mat alarm, motion sensor alarm, and wander/elopement alarm. Section P of the MDS generally is the restraint section, but now alarms will be coded there as well. The RAI manual that provides the coding instructions for the new section has not yet been updated by CMS. The draft comprehensive assessment (see page 38) is provided here.

Facilities utilizing alarms may want to ensure staff is confident about what qualifies as a restraint and that policies and processes are in place to meet the new requirements at F604 to be effective November 28, 2017. The newly released interpretive guidance for this regulation provides examples of facility practices that meet the definition of a physical restraint. It includes using a position change alarm to monitor resident movement and the resident is afraid to move to avoid setting off the alarm.


Assisted Living


AFC Council update


The Adult Foster Care (AFC) Council met this week to discuss a scheduled plan to continue reviewing/updating the AFC licensing rules. The rules for Certification of Specialized Programs are currently under review. Members interested in the modifications being considered can contact Laura Funsch at lfunsch@leadingagemi.org or telephone the office at (517)323-3687.


Housing
HUD

The Rent Comparability Study (RCS) is a tool for estimating market rents for Section 8 projects. HUD has undertaken steps to improve the RCS and has recently revised instructions for the RCS as part of their reform process. These revisions in Chapter 9 of the Section 8 Renewal Guide do not create new policy but clarify instructions to appraisers who create or review the document.

HUD recently posted a series of four video training sessions on Chapter 9 of the Section 8 Renewal Policy Guide, “Rent Comparability Studies” on YouTube (to accompany the revised Chapter 9 guidance in the new Section 8 Renewal Policy Guide).

The first session describes alternatives to the RCS in Option Two and contains a better explanation of non-shelter services. The second session discusses what happens if an appraiser cannot find sufficient comps, how to value non-shelter services and common errors that have occurred in the past. The third session describes the process if a project’s rents exceed 140% of the Census Bureau’s median rent estimate. The fourth session contains information on the review of the RCS.


Education Center

2017 Leadership Institute
Crystal Mountain Resort & Spa
August 16th-18th

There's still time to register and rooms are available at our group rate!

Click Here for conference brochure and to register.  

Room types are limited and our group rate is based on availability. Please call the Association at 517-323-3687 if you need assistance with your reservation.
Click Here 
for reservation information.


Building Better Working Relationships
August 29 ~ Heritage Community of Kalamazoo
September 7 ~ Masonic Pathways, Alma
Thank you to our members who have graciously agreed to host our programs.

As shown by Daniel Goleman'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.

Click Here to register or for more information


Mega Rule Phase 2:
Implementation Strategies to Support Staff Competencies
August 30 ~ Okemos

CMS has embedded the requirement of demonstrating clinical competence throughout many of the new LTC regulations.  The newly released interpretative guidelines reflect more emphasis on outcomes and the capability of staff to perform acceptably those duties directly related to resident care. Our expert presenters will provide an overview of the new behavioral health, infection preventionist and caring for pressure injuries in the LTC regulations. Participants will leave with teaching tools and implementation strategies to support quality in-services for their staff. We will share information regarding the appropriate training and supervision, as well as how to demonstrate competency and skill sets that increase knowledge and practice for meeting the requirements of the these new regulations.

Click Here 
for
 more information and to register.


Regulatory Day
September 14 ~ Lansing

As expected, 2017 has been full of additional regulatory changes for nursing homes and assisted living providers. We have already been addressing a lot of changes with more on the horizon. To assist our members, we’ve assembled a team of high-level content experts; professionals who have first-hand knowledge of the anticipated changes. Join us for our full day of regulatory updates. Read More..

Click Here for more information and to register.


Nurse Aide Train-the-Trainer
September 25 & November 13
Both workshops will be held in Okemos.

The Train-the-Trainer workshop is a program for registered nurses who are interested in becoming qualified instructors for Nurse Aide Training Programs with the State of Michigan. The workshop is designed to provide learners the components of a nurse aide training program, the basic Federal requirements for a nurse aide program.

Click Here 
for more information and to register.


Certified INTERACT 4.0 Champion (CIC)
Workshop will be this fall - dates coming soon!
Training will be held in Lansing.

Why become a CIC? This workshop is designed to train clinical leaders to serve as champion for implementing and sustaining the INTERACT 4.0 Quality Improvement Program (QIP) for their organization. As a clinical leader, you play an integral role in ensuring the delivery of quality care and reducing avoidable rehospitalizations. Becoming a Certified INTERACT Champion (CIC) emphasizes your commitment to ongoing quality improvement. During this 2-day interactive course, you will gain insight on strategies to improve the delivery of care, changes in condition, and how to prevent avoidable hospital transfers. Join our new Master Trainer, Betty Brunner with Pathway Health, as she provides an in-depth description of the INTERACT strategies, care processes, tools and other valuable resources. The CIC Master Teacher will share lessons learned that will allow you to be successful in implementing and sustaining INTERACT 4.0 for your organization. If you are interested in becoming certified, this training will also prepare you for the CIC Certification exam.

More information and registration coming soon!


LEAN Leadership Concepts
Training will be held this fall - dates coming soon!
Classes will be held in Lansing

Lean is a system for making improvement that can be applied to any aging services provider. Leaders and staff members performing the same process day after day can become blind to the inherent problems with that process. Using a Lean approach will aid in the identification of problems and provide the necessary tools to make sustainable process improvements. Many organizations solve problems by jumping to solutions before thoroughly understanding what problem they are trying to solve and/or not fully understanding the root cause of the problem. As a result, the solutions typically don’t work or are unsustainable. Most of the time it is impossible to know if the solution worked because results were not measured. Lean is often thought of as a tool for the frontline worker. In reality, the most effective Lean organizations start with leadership modeling the right behaviors which facilitate the desired culture of improvement. Using Lean leadership concepts will allow you to become a learning organization with a methodical system for process improvement and measured results.

More information and registration coming soon!


MDS RAC Certification Workshops
September 19-21 ~ Mt. Pleasant

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.


Click Here 
for more information and to register.


Director of Nursing Services-Certified (DNS-CT) &
Administrator in Training Course

October 10-12 ~ Lansing

Gain the skills and knowledge you need to be the support your team needs. Be a more effective facility leader and champion for quality care with validation of knowledge in facility management, risk management, QAPI, survey readiness,survey management and enforcement, human resources, quality indicator surveys, MDS and Medicare processes, care management, essential business skills, conflict resolution and leadership strategies.

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.

Click Here for more information and to register.


Leadership Academy

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) 
Second Edition Course

We are still accepting students for 2017!


Classes offered in Southeast and West.
Accelerated courses can be scheduled at your location!

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!

2017 Annual Leadership Institute
August 16-18, 2017 ~ Crystal Mountain Resort, Thompsonville

2017 National Annual Meeting & Expo
October 29 - November 1, 2017 ~New Orleans, LA
Michigan Night Out - Monday, October 30th - Napoleon House

2018 Annual Conference & Trade Show
Join us for our 50th Anniversary Celebration!

May 20-23, 2018 ~ Suburban Collection Showplace, Novi

2018 Annual Leadership Institute
August 22-24, 2018 ~ Mission Point Resort, Mackinac Island


Thank You Content Contributors!


201 N Washington Square, Suite 920
Lansing, MI 48933
Phone: 517-323-3687
Fax: 517-323-4569

Our Mission: To advance the mission of our members to enhance the lives of seniors.
Our Vision: To become the voice of aging services in Michigan.

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