Region V Long Term Care Provider Association Meeting December 15-16, 2015

Printer-friendly versionPrinter-friendly version

Provider Associations from the 6 CMS Region V states were invited to a day and a half regional meeting with CMS in Chicago. The Region V states are Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin. Kathy Johnson, VP of Clinical and Regulatory Services, represented LeadingAge Indiana and developed the following summary of the meeting.

Day one agenda included:


  • Bundled Payments, Comprehensive Care for Joint Replacement Model and CMS Innovations. Presented by Dr. Robert Furno, Chief Medical Officer, Region V: The model being used is one in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement. This model will be implemented in 67 metropolitan areas. The first performance period for the model will begin on April 1, 2016, instead of the proposed January 1, 2016 start date. Care of Medicare beneficiaries is included if Medicare is the primary payer and the beneficiary is: enrolled in Medicare Part A and Part B throughout the duration of the episode and they are not enrolled in a managed care plan and not covered under a United Mine Workers of America Plan. Hospitals bear the financial responsibility. Providers (SNF and Home Health) and suppliers continue to be paid via Medicare FFS. Skilled Nursing Facility participating in this model will have the SNF 3 day rule waived following the hospitalization, the beneficiaries discharged pursuant to the waiver must be transferred to a SNF’s rated 3 –stars or higher for at least 7 of the previous 12 months. Beneficiaries must NOT be discharged prematurely to SNFs, and they must be able to exercise their freedom of choice without patient steering. SNF Billing will remain the same. Deductibles and copayments will not change and Beneficiaries still are able to select any provider of choice.
  • Use of Federally Imposed Civil Money Penalty (CMP) Funds by States: Presented by Jean Ay, Anna Olson CMS Region V: These funds that are meant to benefit nursing home residents are currently going underutilized. The proposed goal is to assist states in seeing that these funds are distributed for the direct purpose of benefiting nursing home residents by educating stakeholders on the availability and application process for the program. States may direct collected CMP funds to a variety of capable organizations as long as funds are used in accordance with statutory intent (To benefit the residents). Examples of Approved Uses: culture change, resident and family councils, direct improvement of quality of care, consumer information, resident transitions, and training.
  • Severe Sepsis – Diagnosis and Treatment across the Care Continuum: Dr. Steven Q Simpson MD has been asked by CMS to help develop Sepsis awareness and training. He presented via Webinar a 1 ½ hour presentation on what sepsis is and what SNF most know about Sepsis. Sepsis is the major cause of morbidity and mortality worldwide. There are more than 750,000 cases of severe sepsis in US annually. For Severe Sepsis – faster treatment improves survival. There are time sensitive interventions that need to be initiated. To Stop Sepsis- we need to: Provide Training for all staff, with workshops and online tools, teach staff that early recognition is crucial as well as rapid aggressive treatment.

Day two agenda included:

A review of F23 Related to Falls - Marilyn Hirsh CMS Region V: Facility compliance with this regulation is when:

  • The facility has identified hazards and risk for an avoidable fall based on the facility’s assessment of the resident’s environment, and the resident.
  • Evaluated/analyzed the hazards and risks.
  • Implemented interventions to reduce the risk of a fall consistent with a resident’s needs, goals, plan of care and current standard of practice.
  • Provided assistive devices consistent with the resident’s needs.
  • Properly deployed and maintained resident specific equipment.
  • Provided a safe environment.
  • Assured equipment is used in accordance with manufacturer’s recommendations and resident’s needs.
  • Provided and maintained a secure environment to prevent negative outcomes.
  • Monitored the effectiveness of the interventions and modified them as necessary and appropriate.

Medicare Advantage Update: Ray Swisher CMS Region V

  • Medicare Advantage Trends for 2015 were presented for state enrollment and by plan type.
  • Medicare Advantage Contracts have Star Ratings. With the 3-5 star ratings having the greatest percent of contracts.
  • Average out of pocket limit for Enrollees in Medicare Advantage for 2015 was $5014.
  • If a provider has exhausted the plan’s internal dispute process and still maintains it has not been reimbursed fairly, the provider may file a complaint through 1-800-Medicare in addition to taking other actions it deems appropriate. CMS does not offer advice to providers on their potential rights in a payment dispute.
  • CMS is committed to ensuring that MAOs and other payers follow regulations when reimbursing non-contracted providers for services provided to Medicare beneficiaries. Non-contracted providers are required to accept as payment, in full, the amount that the provider could collect if the beneficiary was enrolled in Original Medicare. Survey Issues: Gregg Brandush CMS
  • New survey rules are in the rule making process. Comments are being seriously reviewed and considered.
  • MDS Special Surveys are ongoing. CMS is still analyzing the results. The #1 cited tag related to these surveys is F278 MDS Accuracy. CMS recommends that RAI manual instruction be used for coding the MDS. These surveys will continue through 2016.
  • Antipsychotic Medication reduction project is at 24%. CMS is happy with the progress, but states “more work is needed”. Special Focus Surveys will occur in 2016.
  • SNF Quality Reporting will begin October 1, 2016. Additional items will be included in the MDS and there will be Quality Measures to correlate. This will affect reimbursement.
  • The requirement for Payroll Based Journal (PBJ) staffing electronic reporting is in a voluntary period: Oct. 1, 2015 –June 2016. July 1, 2016 will be the beginning of the required reporting period for all Nursing Homes. Providers are encouraged to register and summit data on a voluntary basis. This will be helpful for Providers. Data is required to be summited 45days after the end of the quarter. It can be summited daily, weekly, monthly or quarterly. Requirements for participation are the same as any regulation would be: use a reasonable method to determine how you count staff (medical staff, director, consultants with contracts); translate to hours when they are there; for Universal workers determine primary function and use that; information must be auditable.
  • The 5 Star Rating system - There is no special exceptions for any facility. All facilities are treated the same.
  • QIS implementation for other states is on hold. CMS is looking at a Survey process that would combine traditional with QIS process. CMS said this will take time. They will use best practice for both and combine into one survey process throughout the country.
  • Special Focus Surveys are not considered Complaint Surveys. They will be used in the 5 Star rating however.

Tables and charts provided regarding a variety of survey issues comparing the states in Region V can be found here.

Average Number of Deficiencies by State162.83 KB
IJ and Harm Citation Trends809.21 KB
Top 10 citation trends1.34 MB
Top 10 Life Safety Deficiencies and Helpful Hints1.01 MB
Top 10 Life Safety Deficiencies by State391.58 KB


    Is Professional Development on your calendar?
    Quality Care starts with well-informed staff.