Tuesday, October 15, 2019

Upcoming Events

October22nd: Bronze Commitment to Quality

Webinar

22nd: Silver Achievement in Quality

Webinar

24th: Strive for 5 Forum: Preventing

Falls

25th: AHCF Golf Tournament

November7th: Central Region NHICS Training

12th: CMS Initiative to Post a

Consumer Alert

21st: Strive for 5 Forum: Updates to

the MDS

December5th: Social Work Seminar

A2Z Video: This week on the A2Z Video (click here) join uson moving day (October 7). The AHCA office is beingremodeled over the remainder of the year, so we will betemporarily moving across the hall in the same officebuilding during construction and conducting business asusual.

Smart Guys Computing is the sponsor for A2Z Videos –check out their website at www.smartguys.net or contactJesse Castro, President at 480-722-9460 or by email atjcastro@smartguys.net. Thank you to Jesse and SmartGuys for your sponsorship and support!!!

AHCA Leaders Program – announce new leaders.

Dania Castruita - Bus Office Manager, Hacienda Del RayJean Cseley - Director of Nursing, Sapphire of TucsonTedd Glazebrook - Administrator, Camelback Post Acute Care and RehabValerie Grosso - Director of Dietary, Life Care Center of ScottsdaleCheyenne Hull - Assisted Living Manager, Boulder Gardens Assisted LivingSteven Hunt - Administrator, Villa Maria Care CenterTed Marcus - Executive Director, Haven of ScottsdaleNicole Ruiz - RN Unit Manager, Devon Gables RehabDustin Schaffer - Executive Director, Haven of ScottsdaleJadyne Schmidt - Administrator, Friendship Village of Tempe

NATIONAL

Last week President Trump signed an Executive Order on Protecting and Improving Medicare for OurNation’s Seniors directing HHS to propose regulations and implementing administrative actions toincrease beneficiary access to diverse plan choices. Areas of focus include: improvements in access,transparency, choice, and innovation in the Medicare Advantage (MA) and Medicare fee-for-service (FFS)programs. These initiatives are to be accomplished through value- based payment methodologies,improved choices for seniors, and reduced administrative burden for providers. More on this as we get it.

NCAL Releases Regulatory Review: NCAL published its annual Assisted Living State Regulatory Review,which can be found by clicking here.

Population Health Management Summit (All): AHCA NCAL is hosting the Population HealthManagement Summit December 9 – 10 in Washington, DC. Register HERE. The summit will bringtogether long term and post-acute care providers (LTC/PAC), health plans, regulators, and investors to:

Discuss the ways in which PHM models are improving quality and outcomes while reducing costsLearn new strategies to expand and improve your leadership capabilities in PHMNetwork with peers and nontraditional partnersGain a deeper understanding of CMS' view of provider-led PHM efforts

AHCA/NCAL CEO Announcement: AHCA/NCAL announces that the Board of Directors approved acontract to extend Mark Parkinson’s role as President and CEO for three more years, with the option fora two-year addition. Since Joining the association in January 2011 as President and CEO, Mark has been adedicated champion of long term care, representing the nearly 14,000 non-profit and proprietary skillednursing centers and assisted living member facilities. To read the full announcement, click here.

PDPM

PDPM Assessments and Grouper Update: CMS is aware of issues with the latest PDPM DLL Package(V1.0002 FINAL) and updated its MDS 3.0 Technical Information webpage on October 7, 2019. A revisionto the PDPM DLL Package (V1.0003 FINAL) was posted, and the previous version (V1.0002 FINAL) wasremoved. PDPM Grouper DLL Package V1.0003 [ZIP, 1MB] This version corrects four bugs that wereidentified after the V1.0002 release. The package contains updated test files anddocumentation. Contact your IT Vendors to determine when they will have a sense of how well theupdate works, Contact your MAC (click here for a map) and ask about their preparedness, and emailAHCA/NCAL at pdpm@ahca.org with any feedback.

PDPM Claims and Billing Manual Update: CMS posted the long awaited claims processing, benefit policyand entitlement manual updates for PDPM implementation on October 8, 2019. They are:

1. The Medicare General Information, Eligibility, and Entitlement Manual PDPM update containsminor updates to certification guidance.

2. The Medicare Benefit Policy Manual PDPM update contains minor updates to the SNF benefitperiod and benefit days sections in chapter 3, as well as major changes to the SNF PPS guidance inChapter 8.

3. The Medicare Claims Processing Manual PDPM update provides substantial updates to the

chapter 6 SNF PPS claims processing instructions.

PDPM Implementation – Member Resources and Feedback: How you Can Help Shape PDPMImplementation – Your Input Matters. To support the Arizona Health Care Association’s andAHCA/NCAL PDPM resource development for members and to inform AHCA/NCAL advocacy with CMS,we need your help. By completing this short PDPM Member Experience Survey each week, you canprovide AHCA/NCAL valuable, real-time information. This will help address your needs through membereducation, resources, and advocacy with CMS on regional or national issues. To complete the survey, clickon the button below!

COMPLETE THE SURVEY

CMS

CMS (SNF): Nursing Home Compare Website Change and 5-Star Change: CMSannounced a major change to the information available to nursing homeresidents, families, and caregivers on the Nursing Home Compare website.Starting October 23, a “stop” hand icon or symbol will be placed next tofacilities that have been cited for abuse, neglect or exploitation. Authoritiescall the open-palm display in a red circle “a consumer alert icon.” A nursingcenter will receive an alert icon on NHC if it falls under one of two categories:

1. If a nursing center has been cited for abuse that led to harm (G orabove) in the last year for one of three abuse F-tags; or

2. If a nursing center has been cited for abuse with the potential for harm(D and above) in each of the last two years.

CMS said the three abuse and neglect citations that will result in an icon are asfollows:1. F600: Free from abuse and neglect2. F602: Free from misappropriation/exploitation3. F603: Free from involuntary seclusion

AHCA/NCAL Urges CMS to Change New Nursing Home Abuse Alert Icon forConsumers. Last week AHCA/NCAL submitted a letter urging Centers forMedicare & Medicaid Services (CMS) Administrator Seema Verma to changethe new nursing home abuse alert icon on Nursing Home Compare that wasannounced last week. AHCA/NCAL believes these suggested changes willimprove the accuracy of information consumers access on Nursing HomeCompare. To view the letter, click here.

Please join AHCA’s Sylvia Balistreri and Kay Huff for a FREE informational webinar on Tuesday,November 12th at 10 a.m. to review and discuss this new CMS initiative to post a consumer alert in theform of a “Do not proceed” icon on Nursing Home Compare for facilities that have been cited for abuseor neglect. This appears to impact over 19 nursing centers throughout the state of Arizona. This numberwill certainly climb because of the increased focus on abuse and the definition changes in Arizona.

To join the webinar, please connect via the weblink below. This link will prompt you for an emailand a password. Please enter your email, then choose “log in as guest”. You may need todownload the Global Meet app, before you join the meeting (iPads, MACs, Windows 10).

Website: https://azhealthcareassocahca.pgimeet.com/-AHCA2Dial in number: 888.311.9051Guest code: 4700 5600

After a nursing center has been free from any of these three citations (at any level) for a full

year or inspection cycle, the icon will be removed. The NHC website will be updated with newinformation on a monthly basis. AHCA NCAL’s preliminary numbers show that about 750 of the15,500 nursing centers in the country will be impacted. A report is being drawn up for membersshowing the likelihood of having an icon displayed and guidance on further communicationwith residents, families, etc. Stay tuned. In addition, CMS will be removing two quality measures from the Five-Star Quality Rating System. Thesemeasures are:

1. Percentage of short-stay residents who report moderate to severe pain. 2. Percentage of long-stay residents who report moderate to severe pain.

As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QMratings will change starting later this month. These changes will overall maintain the same distribution ofshort-stay and long-stay QM ratings that were posted on Nursing Home Compare in July 2019. The newcut-points are shown in the table below. CMS Issues Two Final Rules: They issued two final rules of importance to our sector: First was the OmnibusBurden Reduction (Conditions of Participation) Final Rule, which removes Medicare regulations identifiedas unnecessary, obsolete or excessively burdensome. Click on these links to review the Final Rule, and theCMS Press Release. This rule advances the Patients over Paperwork initiative by saving providers anestimated 4.4 million hours of time previously spent on paperwork with an overall total projected savingsto providers of $800 million annually. This rule finalizes the provisions of three proposed rules:

Regulatory Provisions to Promote Program Efficiency, Transparency and Burden Reduction(“Omnibus Burden reduction”), published September 20, 2018Hospital and Critical Access Hospital (CAH) Changes to Promote Innovation, Flexibility andImprovement in Patient Care, published June 16, 2016Fire Safety Requirements for Certain Dialysis Facilities, published November 4, 2016.

They also issued a final rule that empowers patients preparing to move from acute care into Post-AcuteCare (PAC), a process on discharge planning. For more on this rule, you can check out the CMS Fact Sheetand Final Rule. The rule puts patients in the driver’s seat of their care transitions and improves quality byrequiring hospitals to provide patients access to information about PAC provider choices, includingperformance on important quality measures and resource-use measures, including:

Number of pressure ulcersProportion of falls that lead to injuryNumber of readmissions back to the hospital

RoP III Deadline Quickly Approaching: Three areas are centered upon in the upcoming RoP III deadline(Nov. 28th). They are:

1. Designation and training of the infection preventionist2. Compliance and ethics program, and3. Quality Assurance Performance Improvement (QAPI)

The rule delays implementation of some of the provisions in these three areas for a year. The change tothe requirements related to the infection preventionist (IP) removes the need to hire for this role,allowing facilities the flexibility to contract with an individual or in some other way ensure they have thecapacity to meet the needs of the infection prevention and control program (IPCP). Check out ProviderMagazine’s recent article for more details by clicking here.

STATE / PUBLIC POLICY

AHCCCS Provider Enrollment Portal (APEP) to Launch in 2020: In Spring 2020, the AHCCCS providerenrollment process will move from a manual, paper-based system to a new, online system. This systemwill allow providers to:

Enroll, reactivate and re-validate as an AHCCCS provider.Update provider file information (such as phone numbers and addresses).Upload and/or update licenses and certifications.And more, all online and available anytime of the day.

Providers will receive a tracking number in order to be able to check the status of application submissions.

Initial applications, as well as changes for current enrolled providers, will be processed more quickly andwithout the burden of printing and faxing paper documents. Provider training and additionalimplementation information will be the coming in the next few months.

QUALITY AND REGULATORY

Check out the latest newsletter from NAHCA: https://conta.cc/2oWC8U3.

International Infection Prevention Week: Join colleagues and friends thisweek in celebrating International Infection Prevention Week (IIPW), October13 – 19, 2019. See sample Twitter posts that you can use here and submitphotos of the creative ways your team prevents infections and celebratesIPPW here. To view the flyer, click here.

DHS Harm level and IJ Deficiencies cited from October 1, 2018 throughSeptember 30, 2019 (LTC):

G Level DeficienciesF580 – Notify of Changes – Cited once for failing to notify a resident’sNP or physician of their refusal to take ordered medications.F600 – Free from Abuse and Neglect - Cited 16 times. Deficienciesincluded involuntary seclusion, failing to reposition a residentappropriately, heat exposure and dehydration, failing to transferresident as care planed, staff to resident abuse, failing to assessresident for change of condition, and resident to resident abuse. F603 – Free from Involuntary Seclusion- Cited once for placing aresident on a secured unit without his consent. F658 – Services Provided Meet Professional Standards – Cited oncefor failing to administer an anticoagulant as ordered. F686 – Treatment to Prevent/Heal Pressure Ulcer – Cited Five times.Deficiencies included failed to assess or obtain orders to treat, failed toprovide care and treatment to prevent an unstageable pressure ulcer,failed to provide care plan interventions and wound deteriorated, andfailed to remove splints as ordered resulting in a pressure ulcer. F687 – Foot Care – Cited once for failing to provide nail care resulting inan infection.F689 – Free of Accident Hazards/Supervision/Devices – Cited sixtimes. Deficiencies included failed to implement fall precautions, andresident fell out of bed during care. F697 – Pain Management – Cited twice for failing to treat residents’complaints of pain.F760 – Residents are Free of Significant Med Errors - Cited twice.Deficiencies include failing to administer an anticoagulant as ordered.

H Level Deficiency

F686 – Treatment to Prevent/Heal Pressure Ulcer – Cited once forfailing to assess and monitor multiple residents’ pressure ulcers woundsand from failing to obtain orders to treat pressure ulcers.

Immediate Jeopardy

F600 – Free from Abuse and Neglect – Cited once at a K Level forfailing to protect residents from inappropriate sexual behaviors ofanother resident.F 880 – Infection Prevention & Control – Cited twice at a K Level forfailing to ensure contact precautions were implemented.

DHS Top Ten Cited Deficiencies from October 1, 2018 through September30, 2019 (LTC):

1. F609 Reporting of Alleged Violations –Was most often cited for failingto report allegations to DHS within the 2-hour time frame.

2. F607 Develop/Implement Abuse/Neglect Policies – Cited for failing tofollow the facility’s policy and procedures for reporting allegations and

failing to conduct thorough investigations.3. F600 Free from Abuse and Neglect -Cited for staff failing to follow

safety measures or care planned interventions (neglect), staff toresident abuse, and resident to resident abuse.

4. F610 Investigate/prevent/correct alleged violations – Was mostoften cited for failing to thoroughly investigate allegations ofabuse/neglect/misappropriation.

5. F641 Accuracy of Assessments –Was cited most often from failing toreflect the resident’s status at the time of the assessment.

6. F658 Services Provided Meet Professional Standards – Cited forfailing to ensure medications were administered as ordered anddocumented on the MAR, crushing extended release medications, forfailing to assess and provide treatments to skin tears, and failing toadminister medications separately through a feeding tube.

7. F880 Infection Prevention & Control –Was cited for improper handlingof clean linens, not following the facility’s infection control policy forwound care/dressing change, no parameters for monitoring laundrysanitation, not following contact precautions and not having alegionella risk assessment or not having a water management programin place.

8. F761 Label/Store Drugs and Biologicals – Cited for having expiredmedications available for use, failing to ensure medications weremaintained in recommended temperature range in the refrigerator,failing to date mediation when they were opened (Lantus) and forfailing to ensure medications were stored in locked compartments.

9. F757 Drug Regimen is Free from Unnecessary Drugs – Cited for failingto administer pain medication as ordered and per pain scale, and forlack of monitoring for antidepressants use.

10. F684 Quality of Care – Cited for failing to provide care and treatmentsas ordered.

CDC COCA Call: The CDC is hosting a call on preventing the Spread of Novel orTargeted Multidrug-resistant Organisms (MDROs) in Nursing Homes throughEnhanced Barrier Precautions. For more information, click here.

Date: Thursday, October 24, 2019Time: 11:00am – 12:00pm Arizona TimeClink the Link to Join: https://zoom.us/j/535497188Or join by iPhone one-tap:US: +16468769923,,535497188# or+16699006833,,535497188#Or join by Telephone:US: +1 646 876 9923 or +1 669 900 6833Webinar ID: 535 497 188

AzCHER Facility Survey: As part of AzCHER’s 2019-2020 Community Hazard Vulnerability Assessment(CHVA), please participate in the coalition’s annual facility survey. We ask that each facility of eachmember organization complete this online survey by 11:59 p.m. on Monday, November 4th. You can findthe survey here: https://www.surveymonkey.com/r/AzCHERCHVA. The survey is intended for healthcareorganizations, but other partners are welcome to participate as well. Responses will be aggregated intoa Member Survey Report and shared along with Regional Vulnerability Profiles as well as results fromeach region’s functional work group discussion-based assessments. The final CHVA will be utilized toinform coalition planning, training, and exercise activities. Should you have any questions in completingthis survey or regarding the CHVA, please reach out to our Statewide Planning Manager, Kim Tham, atKTham@AzHHA.org.

IMPORTANT Please Complete this Survey: The ADHS and U.S. HHS Office of the Assistant Secretary forPreparedness and Response (ASPR) has asked for our assistance in helping to collect data for situationalawareness in disaster planning. Please click here to access their survey. Please complete this to the bestof your ability as soon as possible. If you are unable to answer a question, enter N/A. Note: If you havemultiple locations, fill out the form separately for each location.

Western Region General BodyTuesday, October 29, 2019, 10 am to 12 pmHavasu Regional Medical Center, 101 Civic Center Ln., Lake Havasu City, AZ

EDUCATION

2020 Call for Presentations: The 2020 Call for Presentations is closing in three days. Please submit yourapplication by October 18, to be reviewed by the AHCA Convention & Education Committee. Sessionproposals for the annual convention, AHCA Forums, or other workshops can be completed by clickinghere.

APIC Annual Conference October 25th: This is quickly approaching – the Association for ProfessionalsInfection Control and Epidemiology (APIC) all-day conference will be held on October 25th at the DesertWillow Conference Center in Phoenix. The theme this year is Bridging the Gap Across the Continuum ofCare and is designed to provide a forum for contemporary methods of infection prevention and control.Click here to register and for more information.

FOUNDATION

Apply for Live a Dream Awards for Residents …All Year Long: Do youhave a resident in your facility with a special need, a wish or a lifetimedream? Please, let us know! The Arizona Health Care Foundation (AHCF)is committed to making those dreams come true. Click here to fill out theapplication and allow us to make dreams come true. Please know thatAHCF is actively soliciting "Live A Dream" applications from all memberskilled nursing and assisted living communities. No doubt each of you hasat least one compelling resident "dream" and we would love to hearabout it. If you would like an application, please contact Krysten Dobsonat kdobson@azhca.org or 602-265-5331. A few minutes of your timecould change someone’s life! 2019 AHCF Golf Tournament: The AHC Foundation (AHCF) annual golftournament will be held Friday, October 25th at the McCormick RanchGolf Course. Please let us know if you would like to sponsor any part ofthe tournament or sign up to golf! Premier Sponsorship includes golf forfour, signage at two holes and at the registration area, plus recognitionin printed materials. There are a lot of great opportunities including aHole-in-One sponsorship, lunch sponsorship, driving range… and muchmore! To register to play in the 2019 Golf Tournament, click here. Pleasecall or email Krysten at kdobson@azhca.org if you are interested or wantfurther details.

ElderTLC’s Third Annual Holiday Shop and Gift Giving Program.Imagine a different holiday season this year for you and yourresidents. Imagine a complimentary invitation to shop, no walletsneeded, at a very special place where items are arranged for youto select for gifts your residents. ElderTLC’s Third AnnualHoliday Shop and Gift Giving Program is in progress andthey want to give your low-income seniors the bestholiday season ever! Santa’s elves are ready to takeyou shopping, with a cookie in hand—all as our gift to you.

This is a true story! They love to give. Last year they helped37 local facilities bring very special gifts to 2,379 residentsand they have increased the number of gifts to give thisyear, so you will want to act fast! Every single item in theshop is brand new. They remember fondly some of the gifts givenlast year—Charlie missed his Golden Retriever so much, so theyfound him a stuffed Golden with a red ribbon around hisneck! Ethel, who suffers from dementia, was given a baby dollwrapped in a pink blanket—she held that doll as if it were a realbaby! Sylvia is often chilled, so they found her a beautiful hand-knitted shawl in her favorite color purple! So manymore heartwarming stories we would love to share. The shop isfilled with gifts such as clothing, slippers, jewelry, religious items,blankets, scarves, adult coloring books and so much more. Theshop is located in North Scottsdale, and is only open for a fewmore days until October 18th so you will want to sign up for yourappointment soon! You will receive an email invitation to shopthrough Signup Genius. We can only offer this to facilities whorespond to the email! Please visittheir website www.eldertlc.org or email them withquestions at eldertlcinc@gmail.com. We don’t want you or yourfacility to miss out on this special giving season.

ASSOCIATION

Business Affiliate Member Appreciation Luncheon: Took place on October, 8th. Thank you to all of thebusiness affiliates that were able to join us for a great time.

AHCA 1st: Remember to choose AHCA 1st when selecting a vendor partner. To view current AHCAbusiness members, go to https://www.azhca.org/business-affiliates/.

AHCA/NCAL Quality Awards Now Open for 2020: The National Quality Award Program announces thenew 2020 application packets are now available online. The Intent to Apply (ITA) for the AHCA/NCAL2020 is open in the Quality Award Portal. While not mandatory, applicants who submit an ITA will savemoney on their overall application fee and receive extra educational resources. No paperwork orapplication is needed to submit the ITA, which is due to AHCA/NCAL by November 7, 2019, at 8:00 p.m.EST. More information about the AHCA/NCAL National Quality Award Program and key dates areavailable here. Please visit the Bronze, Silver or Gold application pages to download your respectiveaward level application materials to learn how your center should begin preparing. If you are planning tosubmit an intent to apply application please join AHCA for a FREE webinar on the Bronze or SilverAward. To register for the Bronze Commitment to Quality, click here or to register for the SilverAchievement in Quality, click here.

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