IHCA Bulletin - 05/22/2006 (Plain Text Version)

CMS survey memo: Nursing facilities and Part D

On May 11, 2006, the Centers for Medicare & Medicaid Services (CMS) released a survey and certification memorandum "Nursing Homes and Medicare Part D" (S&C-06-16) to all state survey agency directors that addresses Medicare Part D in relation to the Medicare and Medicaid requirements of participation. AHCA has provided a summary of the highlights of the memo.

The CMS memo gives advice on how surveyors should review nursing facilities’ compliance with requirements that appear “pertinent to the implementation of the Medicare Drug Benefit (Part D)." The policies are effective immediately.

AHCA has concerns about some of the items in the CMS memo and has brought them to the attention of CMS staff. For example, the third paragraph on page 3 appears to limit contact between facility staff and the resident who is making a choice about a Part D plan. This section stresses prohibited activity rather than clearly telling surveyors what facilities are allowed to do to facilitate the resident’s selection without violating any rules. AHCA staff will continue to communicate with CMS staff to resolve these concerns.

Nursing Facilities and Part D (S&C-06-16) direct link: http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter06-16.pdf
AHCA summary direct link: http://www.ahca.org/members/finance/medicare/part_d/wu060519-3.htm

Changes to AL occupancy agreements

Iowa Center for Assisted Living has been made aware of certain provisions that may need to be amended to comply with Iowa law. If your occupancy agreement provides for late fee charges for delinquent statements, be aware that Iowa law limits such late fee charges to $10 for the first day and a $40 maximum for the month. DIA is enforcing this law, quoting Iowa Code 535.2( 7). If you have any questions, please contact Lisa Uhlenkamp at 515.327.5020 or lisa.uhlenkamp@iowahealthcare.org.

Iowa Code Chapter 535.2 direct link: http://www.legis.state.ia.us/IACODE/2003SUPPLEMENT/535/2.html [return to top]

HHS, CDC release pandemic checklist

The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed a pandemic flu checklist to help long term care and other residential facilities assess and improve their preparedness for responding to pandemic influenza. Based on differences among facilities (e.g., patient/resident characteristics, facility size, scope of services, hospital affiliation), each facility will need to adapt this checklist to meet its unique needs and circumstances.

Thanks go out to the AHCA/NCAL members who provided critical input and feedback during the list's development. AHCA/NCAL worked collaboratively with HHS, CDC, Alzheimer's Association, American Medical Directors Association (AMDA), National Association of Directors of Nursing Administration in Long-Term Care (NADONNA), and other stakeholders in compiling the checklist.

We also remind facilities seeking additional preparedness information to check out AHCA's Disaster Planning Guide.

Pandemic flu checklist direct link: http://www.pandemicflu.gov/plan/pdf/LongTermCare.pdf
Disaster Planning Guide direct link: http://66.153.70.186/AHCA_eBiz/Default.aspx?tabid=44&action=ShowProductDetails&args=283 [return to top]

Register now for Summer Quarterly

Summer Quarterly is the place to be on June 21! You'll find great topics and great presenters that will zero in on what you need to know.

Keynote address
Conflict management and dealing with difficult people — Talking through the differences presented by professional trainer Chris Battell and performance consultant Donna Honold

Survey
Preparing for a nursing home survey
Preparing for survey in an assisted living facility
Tips and Techniques for Successfully Challenging DIA Allegations of Noncompliance
Interactive Discussion on Countering Insufficiencies in an Assisted Living Facility

Plus
Fair Labor Standards Act
MDS: Friend or Foe

Summer Quarterly is Wednesday, June 21 at the Airport Holiday Inn in Des Moines. You can find the brochure at www.iowahealthcare.org, Members Only, Education. To register go to www.iowahealthcare.org, Calendar or fax your registration form to 515.327.5019. [return to top]

Scholarship deadline NEXT WEEK - APPLY NOW

Every nursing home, assisted living program, RCF, senior housing and elder group home has at least one person who is working toward that next level of long term care nursing or administration education. The IHCA Foundation is looking to reward 21 of those hard working people at our member facilities with a $500 scholarship for the 2006-2007 academic year.

Administrators are encouraged to inform everyone on their staff about the John R. Grubb Health Care Scholarships and the Tom Juckette Long Term Care Scholarship offered by the IHCA Foundation. Entry materials are now available at www.iowahealthcare.org, Members Only, Scholarships.

Please be sure the information gets passed on to those employees who are the next generation of long term care leaders! Deadline for applications is June 2, 2006. Past winners are welcome to apply again!

Questions can be directed to Claire Seely at claire.seely@iowahealthcare.org. [return to top]

Dependent Adult Abuse: Cover all the bases!

Make sure you're safe from the threat of dependent adult abuse! Register now for our upcoming IHCA• ICAL Dependent Adult Abuse Conference on Thursday, June 1. Your dependent adult abuse questions, concerns and situations will all be addressed by presenters who specialize in this topic and professionals who have confronted the problem head-on. Your facility leadership will not want to miss this important and valuable education!

LaVon Yeggy, Memory Loss Nurse Specialist with Elder Services, Inc., will discuss issues related to resident-to-resident verbal and physical aggression, unwanted sexual contact, and other forms of violence within long term care that fall outside the clear definition of dependant adult abuse.

Ken Watkins, IHCA's legal consultant from the Health Law Department at Davis, Brown, Koehn, Shors & Roberts, P.C. will present an analysis of federal certification requirements, state statutes and regulations relating to definitions of dependent adult abuse, and identify a broad range of fact patterns that may constitute abuse. Staff education requirements and conducting effective investigations (including required protocols, documentation procedures, and notification requirements) and the legal ramifications of failure to investigate and report abuse will be covered.

Ann Marie Brick, Administrator of the Abuse Coordinating Unit in the DIA will lead a panel discussion with a long term care facility administrator; director of nursing; and director of operations for several long term care facilities. You'll hear their insights into the prevention and response to dependant adult abuse and examples of various situations and discussion of the roles and responsibilities of the staff and facility when it comes to dependant adult abuse.

CEUs are available for administrator/owners, department heads, nurses, social services and assisted living management certification. Brochures have been mailed to members. You can also find the brochure at www.iowahealthcare.org, Members Only, Education. Register online at www.iwoahealtcare.org, Calendar. [return to top]

Deadline ahead: complete workforce survey; be eligible for FREE district meeting

Complete the IHCA•ICAL workforce survey and you'll be entered in a drawing to win a free July IHCA•ICAL District meeting registration! From all members who complete the survey, we will draw four names — one from each district — and award a free registration for the July District meeting (up to a $40 value).

The survey results will help assess health workforce shortages in Iowa and enable us to work with the IDPH Center for Health Workforce Planning to provide recommendations for strategies that IHCA·ICAL, Iowa long term care facilities, AHCA/NCAL, policymakers and others can implement to minimize this potential workforce crisis.

We are asking administrators or your organization's HR person to please review the instructions, complete the survey and return it by May 31, 2006, to IHCA by one of these methods:

E-mail: ihca@iowahealthcare.org
Fax: 515.327.5019
Mail: IHCA·ICAL, 6750 Westown Parkway, Suite 100, West Des Moines, IA 50266

This survey was sent to members directly via e-mail on Friday, May 5. You can also access the workforce survey at www.iowahealthcare.org, Members Only, What's New. If you have any questions on the survey, please contact Cindy Baddeloo, IHCA Deputy Director at cbaddeloo@iowahealthcare.org or 800-422-3106.

Direct links
Survey instruction: http://www.iowahealthcare.org/userdocs/Workforce_Survey_2006.pdf
Survey form: http://www.iowahealthcare.org/userdocs/Workforce_Survey.xls [return to top]

News from AHCA/NCAL

Immigration reform
AHCA/NCAL and the Essential Worker Immigration Coalition (EWIC) are actively lobbying for the continued inclusion of a guest worker program in the Senate's comprehensive immigration bill currently being debated. Our main issue in the context of this debate is the creation of a new guest worker program for essential workers – in our case CNAs. Last week, AHCA/NCAL participated in a special White House briefing with other EWIC members. The briefing by Secretary of Commerce Carlos Gutierrez and Deputy Assistant to the President Barry Jackson was to discuss strategy surrounding moving this legislation forward in the Senate and later with the conference committee.

New LTC caucus created
We are happy to announce the new Congressional Long Term Care Caucus (LTCC), a “bi-partisan coalition of members dedicated to advancing long term care priorities in health care policy with the goal of improving the access, quality, and affordability of long term care for individuals of all ages.” AHCA was proud to work with the offices of Representatives Shelley Moore Capito (R-WV), Earl Pomeroy (D-ND), Nancy Johnson (R-CT) and Tom Allen (D-ME) to help form this group of legislators who will address challenges faced by the long term care profession. Please click here to read the letter being sent to Congressional representatives. [return to top]

OIG report examines CMS enforcement in nursing homes

On May 17, 2006, the Department of Health and Human Services, Office of Inspector General (OIG) released a report entitled, "Nursing Home Enforcement: Application of Mandatory Remedies". The purpose of this OIG investigation was to determine to what extent the Centers for Medicare & Medicaid Services (CMS) applied the statutorily required “mandatory remedies” for nursing homes found out of compliance with federal quality of care standards. The OIG looked at termination and denial of payment for new admissions (DPNA) cases during the years 2000 through 2002.

The OIG reports two major findings from their investigation. First, that in 55 percent of potential termination cases reviewed, CMS did not apply the mandatory remedy as required by law. Second, of the 706 cases in 2002 requiring a DPNA remedy, the remedies were never applied in 28 percent of the cases and the remedies were applied late in 14 percent of the cases. According to the OIG, in the case of late remedies, the states were late in referring the cases to CMS.

In its recommendations, the OIG asks CMS to encourage state survey agencies to further prioritize termination cases; raise awareness of termination deadlines; and implement special monitoring of pending termination cases by CMS regional offices. The OIG also encourages CMS to address late referral of enforcement cases by monitoring states timeliness using a shared data system and issue a written directive to the states reinforcing referral requirements.

In response to the OIG’s report, CMS agrees that the enforcement and timely remedy of problems identified in nursing homes is “very important,” but does not agree with the OIG’s recommendations. CMS states that it currently has efforts underway that address the timely imposition of termination and DPNA remedies that are implemented in a manner that CMS “believes best protects the well-being of resident.” In follow-up to CMS comments, the OIG gives the final response in the report to recognize that CMS has taken positive steps toward ensuring that remedies are applied to meet deadlines, but that it remains concerned about CMS’s implied interpretation that the deadline for mandatory termination is flexible. As a last word in its reply to the CMS’ response, the OIG says it wants CMS to motivate facilities to make improvements and lasting corrections within the required timeframes for facility termination by utilizing active case management and earlier intervention. To obtain a complete copy of the report go to http://www.oig.hhs.gov/oei/reports/oei-06-03-00410.pdf. [return to top]

Liability issues in assisted living

Submitted by Sharon Anderson, Risk Manager, TrueNorth

Some assisted living providers are learning the hard way that an assisted living manager should always know the condition of residents and be able to verify they are receiving the proper care by contracted providers. At TrueNorth, we often encounter resistance from managers who say they don't employ "medical professionals" and thereby avoid responsibility/liability for residents' medical issues. Not true. The woman in the article "Woman admits neglecting assisted living patient" did not follow up on the medical needs because she didn't provide "hands-on" care. Though a devout Catholic who cared about her patients--often charging less than the standard $2,500 a month for patients who couldn't afford that much--she was sentenced and fined. [return to top]

Tops in Survey

Congratulations to our IHCA and ICAL members who have received a deficiency-free survey or insufficiency-free inspection.

Sunnycrest Nursing Center
Dysart
Jo Gruenwald, Administrator

Ruthven Community Care Center - Assisted Living
Ruthven
Dee Pyle, Administrator

Community Memorial Assisted Living
Hartley
Jeannine Bunge, Administrator
Linda Kunkel, Nurse Manager

To have your facility's deficiency-free survey or insufficiency-free inspection recognized, e-mail Claire Seely at claire.seely@iowahealthcare.org. Please provide facility name, city and administrator name. [return to top]

Get a jump on education this summer

Now's the time to register for these exciting IHCA•ICAL educations and seminars! To register go to www.iowahealthcare.org, Calendar or e-mail Georgene at georgene.olson@iowahealthcare.org.

Feeding Assistant Train-the-Trainer Program for Iowa Nursing Homes
May 23, 2006
IHCA Office, West Des Moines
CEUs approved for Adm, N

SE District Education
May 23, 2006
West Liberty Community Center, West Liberty
CEUs approved for Adm, N, DH, Act, ALMC

SW District Education
May 25, 2006
Atlantic Golf and Country Club, Atlantic
CEUs approved for Adm, N, DH, Act, ALMC

Dependent Adult Abuse Conference
June 1, 2006
Hilton Garden Inn, Johnston
5 CEU hours for Administrators, Dept. Heads,
Social Workers and Assisted Living Managers
6 CEU hours for Nurses

Director of Nursing Leadership Training Program
June 6 - 8, 2006
Hawthorn Suites, West Des Moines
2.1 CEU hours for Nurses

Non-Proprietary Conference (Watch for more info)
June 19, 2006
IHCA Office, West Des Moines

Summer Quarterly Education Conference
June 21, 2006
Airport Holiday Inn, Des Moines

MDS 201 - Advanced MDS 2.0 Training
June 28, 2006
Hawthorn Suites, West Des Moines
5 CEU hours for Administrators, Nurses, SS [return to top]

Mission Possible - Convention registration now open

Register today for Mission Possible! Join us at the AHCA/NCAL National Convention on October 8-11, in San Antonio, Texas. At this premier national event for long term care professionals, you can:

- EXPLORE more than 300 exhibits;
- LEARN from inspiring keynote speakers & long term care experts;
- CHOOSE from four pre-convention workshops & more than 75+ educational sessions;
- EARN up to 18 CEUs; and
- CONNECT with more than 3,000 of your colleagues in long term care.

Register before July 7 and save $100! Go to www.AHCAconvention.org or www.NCALconvention.org to register today. Housing reservations are now available online. [return to top]

Helping older consumers with credit card debt

The Life, Aging, and Debt workshop focuses on helping older consumers deal with credit card debt and teaching strategies for community presentations. Attorneys and lay advocates who work with older clients are welcome to attend this free event on Monday, July 17, 2006, at Des Moines University in Des Moines. For more information, visit the following link to view the brochure http://www.consumerlaw.org/conference_training/content/06iowaflyer.pdf. [return to top]

HIT Summit: Save the date!

Mark your calendar for the 2nd Annual Summit on Health Information Technology, August 24 at the Sheraton in West Des Moines. The event will include general sessions applicable to all provider types, topic-specific breakout sessions and over 30 technology vendors. The summit will focus on:

the need to implement an electronic environment
legal aspects of an EHR
the value of health information exchange
and much more!

The Iowa HIT Initiative is a collaborative partnership led by the Iowa Foundation for Medical Care and the Iowa Medical Society. Watch for registration information coming soon. [return to top]