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The Latest Wrinkle March 16, 2018
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Medicare Guessing Game

After many months of gloomy anticipation, members last week learned that CMS has no current plan to implement the new RCS-1 payment methodology for FY 2019. While that may give some members a little breathing room, MedPAC continues its quest to address inequity in payments across post-acute settings and ‘high margins’ in skilled nursing facilities.

According to MedPAC’s December 2017 reporting, the circumstances in general have not changed regarding SNF reimbursement - the Medicare margin of 11.4% in 2016 represents the 17th year of margins above 10%. However, not-for-profit provider margins average 2.3% compared to 14% for for-profits. There is a huge variation in profit margin among individual providers.

MedPAC focuses on the group of ‘relatively efficient’ SNFs – those meeting both relatively low cost but high quality benchmarks (and high Medicare margins). Eight percent of facilities nationwide met cost AND quality criteria. MedPAC focuses on this group of SNFs to support its contention that there is waste in the system. Efficient SNFs produced:

  • 26% higher discharge to community rates
  • 17% lower readmission rates
  • Higher daily census
  • 8% lower standardized cost per day
  • 10% higher average Medicare per diem rates

The graph below identifies the increases in high-intensive therapy groups since 2000. MedPAC notes that the mix of services as identified by RUG categories reflects biases in the PPS design.


Additionally, between 2015 and 2016 admissions decreased an average of 3.6%, length of stay decreased by 4%, and days overall decreased by 6.5% according to MedPAC. Occupancy continued to decrease in the 4th quarter of 2017 to end at 81.9% - down from 83.5% one year prior. Managed Medicare revenue changes are also pressuring members with a national average payment of $433. Medicaid revenue represented about 50% of all skilled nursing revenue in the 4th quarter of 2017 as well – Medicaid is growing in revenue mix as the higher payer (Medicare) continues to decrease.


 Skilled Nursing Occupancy National Average


 Medicare Managed Care - SNF National Average


Although CMS has not published its timeline to update the SNF reimbursement methodology, there are still plans to base payments on patient conditions rather than RUG levels, standardize payments among the four post-acute care provider groups, and move to an episode rather than per diem system in the next 5-7 years.

Calling all Creatives and Historians

In honor of our 50th anniversary we are looking to collect any sort of media you have about the past, present or future of your organization. Whether it be a stack of old photos, links to online videos or artist renderings of future projects we want it all! Help us celebrate the diverse and innovative growth of the membership. Examples of what we are hoping you will share with us include:

  • Photos
  • Videos
  • Architectural renderings
  • YouTube channel/online video links

If you have anything you would like to submit please do so by using the Dropbox link located here or by emailing it to

Across the Continuum

Direct Care Worker Demand Projections

Demand for direct care workers in the LTSS sector during the next several years may be affected by several variables according to a report released in March from the US Department of Health and Human Services. Direct care workers include certified nursing assistants, home health aides, personal care assistants and psychiatric assistants/aides – which together comprise 71% of the workforce providing long term services and supports (LTSS).

The report examines both facility and home and community based settings and studies two scenarios using 2015 as a baseline. The first model is based on current care utilization and delivery taking changing demographics into consideration. The second model considers how health care is improving from a population perspective and trends in unpaid care that may impact the need for paid care in the future. The first model projects that the need for direct care workers will increase by 48% between 2015 and 2030, compared to an increase by 7% mostly related to the increased longevity for the next several decades.

The study noted that 87% of people needing LTSS receive them in some fashion by unpaid caregivers (family and friends). In dollars and cents, these unpaid services were worth $470 billion in 2013.

Most importantly, the report concludes that many factors will impact demand for LTSS and the direct care workforce in the future – including reimbursement and Medicare/Medicaid coverage policies as well as population health factors.

Nominations Open for LeadingAge National Annual Awards

LeadingAge Awards Call for Submission is now open. These awards honor LeadingAge member organizations and individuals who embody excellence in not for profit aging services; make outstanding contributions to our field; and represent models of leadership, quality, and innovation.

Members can learn more about the nominations here and then use the online form to submit nominations. Deadline is April 30.

Reminder – Medicare Numbers Changing Beginning April 1

The Michigan Department of Health and Human Services issued a reminder to all providers that the Centers for Medicare and Medicaid Services (CMS) will begin removing Social Security Numbers from Medicare beneficiary cards in April 2018. The new Medicare Beneficiary Identifier (MBI) will replace the Health Insurance Claim Number (HICN) on the Medicare cards and provider systems must be ready to accept and process these numbers beginning April 1. CMS stated beneficiaries will begin receiving the new cards in April and the card replacement process will conclude December 31, 2019. During the transition period providers can use either the MBI or the HICN to exchange data and information with CMS.

CMS has posted a fact sheet that will help providers know if they are prepared for the MBI. Additional information is available on the CMS website.

Skilled Nursing

Registration Reminder for 2018 Spring Joint Provider Surveyor Training

The Bureau of Community and Health Systems would like to remind providers that Friday, March 23rd is the last day to register for the Spring Joint Provider Surveyor Training (JPST) being held on April 10 at the Lansing Center. There will be an opportunity to register after March 23rd, however an additional cost of $25 will be incurred.

Nursing Facility CON Annual Survey

The 2017 Certificate of Need (CON) Annual Survey opened Wednesday, March 14, and will be available for completion until 5:00 p.m. on Wednesday, April 25. Click here for a complete list of instructions and contact information.

SNF Medicare Reimbursement Model Not Changing Any Time Soon

During the March 8 SNF open door forum, CMS stated that the resident classification system (RCS-I) detailed in last year’s advanced notice of proposed rulemaking is not ready for implementation and will not be included in the upcoming fiscal year 2019 proposed rule. Currently, there is no established timeline for implementation. CMS received a large number of comments and an equally large number of questions regarding implementation timelines. CMS has not proposed or finalized any policy with RCS-I and hope that the announcement alleviates confusion and concern.

LeadingAge actively supports members by communicating its positions and concerns about Medicare reimbursement policy directly with CMS. As they track potential revisions to SNF and other post-acute care payment systems, the Association will provide analysis and education for its members.

Michigan Medicaid New Provider Enrollment Webpage

The Michigan Medical Services Administration announced on March 6, 2018 that a new webpage has been created for Provider Enrollment. This webpage offers updates on a regular basis announcing information such a CHAMPS outages and other systems-related material. Member billing staff should be aware of this resource. Questions can be directed to Provider Inquiry at

F6587 and the 2017 Food Code

The Food and Drug Administration utilizes the Food Code to help fulfill its responsibility to protect public health by assuring the safety, effectiveness, quality, and security of most of the nation’s food supply. The Food Code provides a uniform system of addressing the safety and protection of food offered in food service. The guidance is updated every four years; the 2017 edition was recently released.

CMS recognizes the Food Code as a national standard for serving food safely and in a sanitary manner in long-term care facilities. Although the 2013 edition is mentioned in current dietary sanitation regulations, the "professional best practice standard" at F658 asserts that facilities follow current standard of practice. LeadingAge Michigan will provide an in-depth presentation on the 2017 revised code in the near future. Details will be announced soon.

Enforcement Remedy Changes

For nursing home surveys conducted on or after March 1, 2018 the Bureau of Community and Heath Systems (BCHS) is under direction from CMS to use the remedy Discretionary Denial of Payment for New Admissions (DDPNA) when a single G has been cited and when an immediate imposition of remedy is required. This is consistent with CMS S&C 16-31-NH.

Division Director Roepke from BCHS will present on this and other changes to the enforcement options and what they will mean to members at the SNF Regulatory Day set for March 27.


HUD Releases Updated Resident Rights and Responsibilities Brochure

The Office of Multifamily Housing Programs has released an updated Resident Rights and Responsibilities brochure - available to download and print from the HUD website. Owners/agents must provide applicants and tenants with a copy of the Resident Rights and Responsibilities brochure at move-in and annually at recertification.

This document provides a summary of key resident rights and responsibilities for tenants living in Multifamily assisted housing along with resources and contact information for tenants needing assistance. Please note: the Office of Multifamily Housing Programs now encourages owners and agents to distribute this brochure electronically. In addition, printed copies should be made available for tenants who prefer hardcopies. If the brochures are emailed to residents in lieu of hard copies, HUD recommends retaining a printed copy of the transmittal email to be able to demonstrate compliance should the question come up at a Management and Occupancy Review.

According to HUD’s notice, translation of the updated brochure to other languages is currently pending and will be posted to HUD's Fair Housing and Equal Opportunity website.

Printed copies are not currently available from the Multifamily National Clearing House but may be available in limited quantities later this year.

HUD Releases Updated Median Gross Rents by Zip Code

Updated Median Gross Rents by Zip Code are now available on the Section 8 Renewal Policy Site, on the HUD website.

Median Gross Rents are used to determine when HUD will procure a third party rent comparability study (RCS) in conjunction with Section 8 Project Based Rent Assistance rent setting. Section 9-14 of the Section 8 Renewal Policy Guide provides instructions for comparing the median rents as derived by an owner’s appraiser in a RCS with Census Bureau estimates of the median rents in the project's zip code. When the median rent in the owner's study exceeds 140 percent of the median gross rent by zip code, then HUD must commission a third party RCS for comparison purposes.

The new median gross rents will be effective for any RCS signed by the owner's appraiser on or after February 11, 2018.

HUD's Proposed Revision of Mission Statement

LeadingAge joined multiple national organizations in responding to HUD’s proposed changes in its mission statement that removes the words “build inclusive and sustainable communities free from discrimination.” The National Fair Housing Alliance coordinated the sign on letter.

HUD reported that the new mission statement was “an effort to align HUD’s mission with the Secretary’s priorities and that of the Administration.” The draft mission statement states “HUD’s mission is to ensure Americans have access to fair, affordable housing and opportunities to achieve self-sufficiency, thereby strengthening our communities and nation.”

In addition to the potential removal of clear fair housing enforcement and promotion language, LeadingAge is also concerned that the draft mission statement would remove the phrase “utilize housing as a platform for improving quality of life.” HUD’s current statement is noted below.

“HUD's mission is to create strong, sustainable, inclusive communities and quality affordable homes for all. HUD is working to strengthen the housing market to bolster the economy and protect consumers; meet the need for quality affordable rental homes; utilize housing as a platform for improving quality of life; build inclusive and sustainable communities free from discrimination, and transform the way HUD does business.”

Member Value

Food Prices Got You Down?

Well, cheer up! Value First just completed a total renegotiation of its Food Programs. Vizient, Value First’s national GPO partner, performed a nationwide bid of major food distributors, leveraging the buying power of the largest GPO in the country.

Value First/Vizient is now the primary GPO partner for both Sysco and US Foods. Numerous concessions were made on prices, markup, rebates and other incentives; Vizient now has the best food pricing GPO contract in the industry for both distributors.

Vizient also has a large food buying program in-house with many of the top food manufacturers that helps drive down costs further. In addition, many members like to utilize local produce and dairy producers. Vizient has a contract with Pro-Act, the premier national network of fresh produce; Simon & Leeman; and VanEerden as local Michigan distributors.

For great savings on food prices and access to some of the best food distributors in the industry, sign up for a free no obligation Food Cost Study. Please contact Rob Ervin at to learn more.

Sherwin-Williams Group Buy Savings for March and April 2018

Freshen up your community in time for spring with a new coat of paint and Sherwin-Williams healthcare savings on applicators, tools and equipment. Sherwin-Williams offers a wide range of high-performance coating systems for walls, floors, roofs, and concrete surfaces in an assortment of popular styles and colors ideally suited for Long Term Care communities. Click here for the March and April sales flyer.

Education Center


Join us for our 50th anniversary celebration!

Click Here for more information. 

Orienting New Managers to HUD Regulations

Live Webinars

This live webinar series will review the important processes unique to HUD subsidized properties that new managers need to understand to be able to perform their job responsibilities.


Each session will focus on an essential component of HUD's regulatory environment and demonstrate how this knowledge will benefit the new manager in performing day-to-day operations successfully.


Mark your calendars and plan to join us for:

  • Session 1 - March 15 ~ HUD 101: So What Do All Those Housing Regulations Mean
  • Session 2 - March 2 ~ Fair Housing: Because It's The Law
  • Session 3 - March 29 ~ Secure Systems: A Focus on EIV and TRACS
  • Session 4 - April 12 ~ Occupancy: Tune Up Day-to-Day Operations
  • Session 5 - April 19 ~ Financial Compliance Overview

To best meet your learning needs, registration options will allow you to select the full series at discounted rate or individual sessions.

Click Here  for more information and to register.

Regulatory Day
March 27 ~ Okemos

As expected, 2018 began with continued regulatory changes for providers. We have already been addressing a lot of changes and we know more are 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 regulatory changes. Join us for our full-day of regulatory updates provided by Larry Horvath, Bureau Director, LARAMichelle Roepke, Director of Federal Survey & Certification Division, LARAMargaret Chamberlain, Partner, Rolf Goffman Martin LangJames Wiggins, Health Facility Professional and Nurse Aide Section Manager, LARALaura Remus, Environmental Health & Safety Manager, LARA; and Carolyn Stramecki, Project Director, Honoring Healthcare Choices-Michigan.

Click Here for more information and to register.

Building Better Working Relationships
March 29 ~ Lansing

Many of us who are managers or supervisors spend time thinking about the statement we have all heard “people leave managers, not companies.” According to a Gallup poll, 50% of employees who quit cite their manager as the reason for leaving the organization. A manager’s relationship is highly correlated with employee engagement and retention. As shown by Daniel Goleman's research, it is Emotional Intelligence (EQ) that makes and develops relationships and strong leaders. When an organization has managers and supervisors with higher EQ they will be effective leaders who interact with their staff, residents/patients, families and management more successfully.

Join us for this highly interactive session to learn more about your personal EQ, how to adapt your style to be more effective with others, how to build better working relationships and become an exceptional leader.

Click Here for more information and to register.

QAPI Certified Professional (QCP) Prep Workshop
April 25-26 ~ Lansing

An effective QAPI process and program will take you beyond compliance and enable your facility to truly transform the care you provide residents. Increase your knowledge by attending a two-day QAPI education workshop that will help you prepare for the comprehensive QCP certification exam.

To implement quality assurance and process improvement (QAPI) strategies in long-term care effectively, you need strong nurse leadership. To achieve that leadership, follow the QAPI principles taught in this course to help you fulfill your mission to provide the best possible care and quality of life for your resident.

Click Here then scroll down for additional details and registration information.

LEAN Leadership Concepts
April 17 ~ Lean Problem Solving
June 12 ~ Lean Deep Dive

Workshops will be held in Lansing

As healthcare providers we must prepare ourselves for the new service delivery and payment models that are introduced from government and private payers. In this new world of managed care, bundled payments, value based purchasing, and accountable care, we know that organizations will need to be streamlined, efficient, and focused on outcomes in order to survive and thrive.

Lean is a system for making improvement that can be applied to any aging services provider. Doing things the way they have always been done is insufficient to keep pace with the rate of change. 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. 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.

Click Here for more information and to register.

Nurse Aide Train-the-Trainer: Adult Learning Principles
May 3, August 9, September 13 and November 15
The workshops will be held in Okemos

Due to new State of Michigan requirements, LeadingAge Michigan is now offering a full day Nurse Aide Train-The-Trainer: Adult Learning Principles workshop. This workshop is not required but will meet one of the State of Michigan's criteria to become an instructor.

If you are a registered nurse who would like to become a qualified nurse aide instructor, we strongly suggest you review the Nurse Aide Trainer Application before attending the workshop to make sure you meet the State of Michigan's trainer requirements.

NOTE: Completing the LeadingAge Michigan Nurse Aide Train-The-Trainer: Adult Learning Principles workshop does not guarantee a participant will meet all of the the requirements as a Qualified Instructor of Nurse Aide Training Programs with the State of Michigan.

Click Here for more information and to register.

The Quest for a Life of Quality
Practices, Perceptions and Interactions that Make or Break Resident/Client Satisfaction
June 14 ~ Lansing

Quality of Life is an individual's sense of well-being, level of satisfaction with life and feeling of self-worth and self-esteem. For every older adult, satisfaction is paramount to the way in which they experience their lives. Satisfaction for each of our residents/clients is defined uniquely and individually. A deeper understanding of satisfaction allows us to meet the needs and desires of the older adults we care for.

Under the revised nursing home regulations, the requirement for Quality of Life can be cited if a facility is found to have a significant deficiency to the degree that constitutes immediate jeopardy. In the senior living industry, providing an exceptional quality of life experience can be the difference between a great environment where every older adult wants to live or struggling to make ends meet because your residents or clients are unhappy. As leaders, our responsibility across all levels and departments is to purposefully know and develop relationships with every person in our care and assist our staff in understanding the importance of meaningful relationships. 

This full-day, interactive workshop focuses on enriching the essential connections with older adults, strengthening the rapport among employees to foster a more integrated organization community and developing collaborative communication partnerships between seniors you care for, their families and your staff.

Click Here for more information and to register.

Medicare University
July 31-August 2 ~Okemos

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.

Authored by the foremost experts in Medicare, this workshop will:

  • Increase your understanding the Medicare benefits, eligibility, and the difference between Part A, B, C and D;
  • Share the concepts of SNF skilled services, payment structures, and consolidated billing;
  • Define the qualifications and requirements for both Part A and B therapy;
  • Explain the Medicare claim review and provider appeal processes;
  • Allow you to gain confidence in the documentation process;
  • Assist you complying with billing requirements; and
  • Provide an understanding of the principles of the Beneficiary Notification Initiative.

Click Here then scroll down for additional details and registration information.

MDS RAC Certification Workshops 2018
September 18-20 ~ Mt. Pleasant
November 6-8 ~ Grand Rapids

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 additional details and registration information

Director of Nursing Services-Certified (DNS-CT) Prep Workshop
October 16-18 ~Okemos

Take your leadership and management talents to the next level with a preparatory workshop for AADNS’s Director of Nursing Services—Certified (DNS-CT) certification. Earning this credential validates your expertise, gives you the advantage among your peers, and helps you improve quality, communication, and resident care throughout your facility.

The DNS-CT credential from AADNS shows that you have the leadership and management skills and knowledge to excel as a DON. Certification indicates that you have met nationally recognized standards of expertise for directors of nursing services in long-term care, that you are up-to-date with the rules and regulations, and that you can lead and nurture your team.

This three-day workshop will complement your nursing expertise with leadership and management skills. Workshops are taught by individuals who go through rigorous requirements to become Master Teachers and who are experts in the field.

Click Here then scroll down for additional details and registration information.

Mark Your Calendars!

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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