Links and Articles from Recent Issues of LeadingAge Connecticut’s
Weekly Capitol Line Newsletter

 

 

October 2017

State Budget Update
The Governor signed into law the bipartisan budget, SB 1502, passed by the Senate and House, but in doing so he also took advantage of his rarely used authority to issue a line item veto relative to the hospital supplemental payment provisions tied to the increased hospital provider tax contained in the budget. The Governor has maintained his assertions that the hospital provider language needs to be changed in order to achieve CMS approval. It is not clear whether the legislature shares those concerns and the issues are under review.  At this juncture, the legislature could choose to override the veto or let it stand and work toward a consensus oriented solution. Either way, it seems pretty clear there will be at least one more session day before we officially close the books on the current fiscal year.  A summary of the budget can be found here.
The bill that was passed can be found at the following links:

SB 1502 As Passed

Full OLR Summary – an easier document to read


Resources for Phase 2 of the Nursing Home RoPs
LeadingAge has several excellent resources available to the membership to help with compliance. The resources can be found on the LeadingAge website and

include:

Staff Competency QuickPATH

Abuse, Neglect, and Exploitation QuickPATH

Transfer, Notice, and Discharge QuickPATH

QAPI QuickPATH

Resident Rights QuickPATH

Antibiotic Stewardship QuickPATH

Baseline Care Plan QuickPATH

Infection Prevention QuickPATH

Medication Management QuickPATH

Psychotropic Medication QuickPATH

Self-Administration of Medications QuickPATH

Smoking Policy QuickPATH

RoP Facility Assessment Toolkit §483.70(e)


Information is also available on the CMS website, including this link to the surveyor training for providers: New Survey Process Training and the following information from the September 7 MLN Nursing Home Facility Assessment Tool call: Nursing Home Facility Assessment Tool and State Operations Manual Revisions.

Connecticut's CT211.org Resources Presentation
Connecticut's 2-1-1 administrator, United Way, gave a very thorough presentation of the services and vast resources that are available to both consumers and providers who are seeking information on available services and supports in the state. 2-1-1 information can be accessed through their website, www.ct211.org.

Connecticut Department of Consumer Protection Releases Guide for Consumers Seeking to Hire Homemaker Companions
The Department of Consumer Protection (DCP) has released a new fact sheet for consumers seeking to hire homemakers and companions. The fact sheet is meant to help families understand the process of working with homemaker companion agencies so they are able to make the best decisions possible for their specific needs. A copy of our fact sheet can be found here.

DSS Advises Us on Nursing Home Residents Arriving from Puerto Rico and US Virgin Islands
The Department of Social Services has informed us that they are ready to help any evacuee from Puerto Rico or the US Virgin Islands. If such an individual is admitted to a nursing home in Connecticut, they will need to establish level of care in ASCEND and if applicable, submit a Medicaid application for nursing home coverage (W-1LTC). Evacuees may also apply for other LTSS Medicaid coverage. DSS has informed us that LTSS eligibility staff will review all such applications and staff are ready and willing to help these individuals obtain proofs that may be difficult to obtain given the circumstances. DSS also provided us with the following link to CMS regarding Medicare and hurricanes: https://www.cms.gov/About-CMS/Agency-Information/Emergency/Hurricanes.html

Community Health Workers
Please find below a linked Office of Legislative Research report on Community Health Workers and how they are regulated in Connecticut and other states that may be of interest. Community Health Workers
 
Deposit of Personal Needs Allowance
Please find attached an important correspondence from DSS regarding a change in how DSS will send nursing homes the $30 personal needs allowance for those residents who are recipients of SSI. This change became effective on September 1. LeadingAge Connecticut and CAHCF do not agree with the new process and continue to work with DSS to modify this practice.

Voices Forum Encourages Person Centered Care
At the annual Voices Forum for nursing home resident council presidents held at the Aqua Turf and hosted by the State's LTC Ombudsman Nancy Shaffer, residents were encouraged to express their personal preferences to their caregivers and to participate in their person-centered care plans.  Consumer Voice has published a useful form for residents to use communicate their preferences which was distributed at the Voices Forum. We thought that the membership might also find it helpful. The following is a link to the preferences form and the Consumer Voice website which has additional person-centered care materials that may be of interest.  

2018 Social Security COLA Announced
The Social Security Administration announced today that a 2.0 percent cost-of-living adjustment (COLA) will be implemented for 2018. The COLA will begin with benefits payable to more than 61 million Social Security beneficiaries in January 2018. Increased payments to more than 8 million SSI beneficiaries will begin on December 29, 2017. For additional information, visit the Social Security Administration website at: www.socialsecurity.gov/cola. Information about Medicare changes for 2018, when announced, will be available at www.medicare.gov.

Opioid Factsheet
The following is a link that was posted on the DMHAS website entitled, "What You Need to Know about Prescription Opioids" that may be of

interest. 

Factsheet: What You Need to Know About Prescription Opioids

Several New State Laws Effective October 1
Several new state laws went into effect on October 1, including several that may be of interest to aging services and housing providers. This link will take you to the recent Wiggin and Dana overview of key legislation passed this session where you can find the laws of interest that are effective October 1. Specifically, new nursing home laws can be found on slides 4, 5, 6, 8 and 9. New housing laws can be found on slides 13, 14 and 15. Home health care notice requirement changes are on slide 18, opioid prescription directives on slide 27, and probate and employment laws on slides 31-35. The detailed information on these and other laws passed this session can be found in the Wiggin and Dana 2017 Legislative Summary.

Electronic Plan of Correction - October 1
DPH has transitioned to an Electronic Plan of Correction for nursing homes effective October 1, 2017. Information on how you can prepare for this new EPoC can be found in Blast Fax 2017-16c

 

September 2017

LTC Survey Process Posting on CMS website
Information regarding the Entrance Conference, Facility Matrix, and Pathways for the new  nursing home federal survey process have been posted to the CMS website. These forms will be used by surveyors for the LTC Survey Process starting November 28, 2017.

Entrance Conference and Facility Matrix

Critical Element (CE) Pathways and Facility Tasks (large file)


Nursing Home Facility Assessment Information
The Centers for Medicare & Medicaid Services (CMS) has published the much-anticipated Facility Assessment Tool for care centers to meet the Phase 2 Requirements of Participation effective November 28, 2017. The facility assessment will be extremely important and CMS hosted a call last week to discuss the tool and other outstanding questions with the RoPs. The link to the presentation slides from the call is listed below. State Operations Manual Appendix PP for Phase 2 of the Reform of Requirements for Long-Term Care Facilities final rule. Presentation Slides

Nursing Facility Assessment Toolkit on the LeadingAge Website
LeadingAge partnered with Pathway Health to develop Phase 2 tools, resources and quickpaths and they have begun by releasing the Facility Assessment Toolkit complete with an overview and guidelines for each section.  This is an in-depth toolkit with sections that will help organizations understand the intent of the facility assessment and gather the necessary information to complete it.
 
New Items in the Nursing Home RoP Phase 2 Toolkit on the LeadingAge Website
LeadingAge partnered with Pathway Health to develop Phase 2 tools, resources and QuickPaths* and more resources are now available on the LeadingAge.org website. Please use the following link to access all the tools.

CMS Emergency Preparedness Training Online Course
The Centers for Medicare & Medicaid Services (CMS) has developed the new Emergency Preparedness Training Online Course which is available on demand and learners may access it at their convenience: 24 hours a day, 7 days a week, and 365 days a year. This course is required for all State Survey Agency (SA) and Regional Office (RO) surveyors and reviewers who conduct or review health and safety or LSC surveys for emergency preparedness requirements. Non-survey professionals and other SA or RO support staff responsible for ensuring compliance with regulations are also encouraged to take the course. Additional information is available on this flyer or enroll at https://surveyortraining.cms.hhs.gov.

DPH Issues Blast Fax on Electronic POC for Nursing Homes
The Department of Public Health has issued the attached Blast Fax to nursing home administrators and directors of nursing regarding the Department's transition to an electronic plan of correction effective October 1, 2017.

How Will Medicare Changes Impact Your Skilled Nursing Facility's Profitability?
George Thomas, Blum Shapiro
For most skilled nursing homes, Medicare is a small portion of the overall patient mix. It usually falls within the 15% to 25% range of total patient days-but that small percentage can have a powerful effect on the overall profitability of the facility. There are a number of pending Medicare reimbursement changes that are scheduled to take effect over the next two years. Based on the details released to date, these changes could have a significant impact on the overall financial results for most skilled nursing homes.

Read the full article here >>

LeadingAge article: Clearing Up the SNF Quality Reporting Program Confusion


CMS Reveals New Medicare Card Design
The Centers for Medicare & Medicaid Services (CMS) gave the public its first look at the newly designed Medicare card. The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number.  CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. For more information, please visit: www.cms.gov/newcard

Seasonal Influenza Prevention Information
LeadingAge Connecticut is pleased to annually deliver timely information regarding seasonal influenza prevention to our members. The following link will provide you with the Center for Disease Control's Flu Season Information, including information on the Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2017-18 Influenza Season. Please utilize this information as you consider appropriate. We also encourage you to monitor the Connecticut Department of Public Health's website at www.ct.gov/dph for additional flu related information throughout the season.

Connecticut State Plan on Aging Approved
Connecticut's new State Plan on Aging has been signed by Governor Malloy and approved by the federal Administration for Community Living (ACL). The State Plan on Aging can be found on www.ct.gov/agingservices.


August 2017

New LTC Survey Process:  Posting to CMS website
Entrance Conference, Facility Matrix, and Pathways for the new  nursing home federal survey process have been posted to the CMS website at the links below and are fillable forms.  These forms will be used by surveyors for the LTC Survey Process starting November 28, 2017.

Entrance Conference and Facility Matrix
Critical Element (CE) Pathways and Facility Tasks (large file)

Hebrew Healthcare Reorganized and Renamed as Hebrew Senior Care
Hebrew HealthCare announced on August 11 that its Plan of Reorganization has been confirmed by the United States Bankruptcy Court for the District of Connecticut.  As part of its emergence as a reorganized entity, Hebrew HealthCare will now be called Hebrew Senior Care. In December 2016, as part of its plan of reorganization, Hebrew HealthCare's 257-bed skilled nursing facility located on Abrahms Boulevard in West Hartford was transferred to Hebrew Center for Health and Rehabilitation, LLC, a National Health Care Associates affiliate.   The sale of the nursing home eliminated the main challenge to Hebrew HealthCare's financial stability, while assuring that skilled nursing care provided in a kosher facility and in accordance with Jewish tradition would continue to be available in the Greater Hartford community.  Hebrew Center, a for-profit healthcare provider, and Hebrew Senior Care, a non-profit senior care provider, will operate as separate organizations within the same building on Abrahms Boulevard. Under the new organizational branding of Hebrew Senior Care Specialized Health & Living Services, the service lines will each be identified distinctly as The Hospital at Hebrew Senior Care, Connecticut Geriatric Specialty Group, Senior Day Center, Dementia Services, Assisted Living Service Agency, and Hoffman Summerwood.

Affordable Housing Land Use Appeals
The Office of Legislative Research has published a brief on the 8-30g Affordable Housing Land Use Appeals Procedure as it was amended by PA 17-170. OLR Issue Brief: Affordable Housing Land Use Appeals Procedure


Train the Trainer Skills Fair in Basic Infection Prevention & Control Practices
The CT DPH HAI program is announcing a monthly educational program on 'Train the Trainer' Skills Fair in Basic Infection Prevention & Control (IP) Practices. The skills fair will offer seven basic IP skills stations with return demonstration of: Hand Hygiene, Injection Safety, Foley Catheter Insertion/Maintenance, Central Line Maintenance, Personal Protective Equipment, Blood-borne Pathogens and Environmental Cleaning.  A 'Train the Trainer' toolkit will be provided to each participant. The development of this training is based on the pilot project of the Centers for Medicaid & Medicare Infection Control & Prevention regulations in Long Term Care and Hospitals (Ref: S&C 17-09 ALL). The Skills Fairs will be held monthly beginning in September 2017 on the following dates and locations. Space is limited to 35 participants per session. Attached is the registrations form for the following skills fair sessions.
•    Wednesday, September 27, 2017, 8 - 1 pm, Radisson Cromwell, Cromwell, CT
•    Tuesday, October 24, 2017, 8 - 1 pm, Farmington Marriott, Farmington, CT
•    Thursday, November 16, 2017, 8 - 1 pm, Farmington Marriott, Farmington, CT
•    Thursday, December 14, 2017, 8 - 1 pm, Qualidigm Meeting Space, Wethersfield, CT

How to Create Age- and Dementia-Friendly Communities

Workforce Center is Open for Business

 

Important Long Term Care Antibiotic Stewardship Education Offered by DPH
The educational programs are for infection preventionists and associated staff who work in various CT health care settings, including hospitals and long-term care facilities. The half-day trainings are free to attend. Attached is the registration form for each training.

How to Implement the Centers for Disease Control (CDC) Core Elements of Antibiotic Stewardship Program

Wednesday, September 6, 2017 and Wednesday, September 13, 2017


Report on the 2017 State Legislative Regular Session Outcomes
Wiggin and Dana has prepared the 2017 Review of Key Legislation Relating to Providers of Services to the Elderly for LeadingAge Connecticut members. We hope that you will find this summary of the new laws passed in the most recent state legislative regular session useful to you and your staff. We will also be holding a member-only teleconference on September 19 at 9:00 a.m. to review the new laws. Please contact me at mmorelli@leadingagect.org if you would like the call in information.
Please note: The State Legislature adjourned the regular session without passing a state budget. They have called a special session for the purpose of passing a budget and once a state budget is passed, Wiggin and Dana will prepare an addendum to this report.

New LTSS Financing Report Released by LeadingAge
LeadingAge has been at the forefront of long term-services and supports (LTSS) financing reform for more than a decade. The organization strongly believes that America must create a new system of paying for LTSS so families alone don't shoulder the burden of paying for care their loved ones need. On August 9th, LeadingAge unveiled its vision for the future of long-term services and supports (LTSS) in a new report: A New Vision for Long-Term Services and SupportsFull Article

Deadline Extended for Compliance with New Fire Door Regulation
In Survey and Certification Letter No. S&C 17-38-LSC dated July 28, 2017, the Centers for Medicare & Medicaid Services (CMS) provided clarification regarding the requirement for annual inspection and testing of fire doors.  It also announced that it would extend the deadline for compliance with the requirements by six months from July 6, 2017 to January 1, 2018.

Medication Management Tool Update: Lessons Learned
CAST has updated its Medication Management Selection Tool with a revised product and vendor matrix and a new case study. This year, CAST added a summary of all the lessons learned from past Medication Management initiative case studies so that users can quickly find key points from their pioneering peers' experience and wisdom.


July 2017

Care Decisions Connecticut Initiative Provides Resources for Providers
LeadingAge Connecticut is among the organizations leading a new statewide movement, Care Decisions Connecticut, which is empowering patients across the state to become educated on end-of-life issues including advance care planning, palliative care, and hospice care.  The initiative, created by the Connecticut Hospital Association, healthcare partners across the continuum of care, payers, and state government, will integrate patient-directed care strategies to improve palliative/hospice care and quality of life for persons in Connecticut with serious illnesses.  Visit www.CareDecisionsCt.org  for helpful national and Connecticut-specific resources for providers.

Listing of State Programs for Older Adults
Below is a link to a state Office of Legislative Research report regarding State Programs for Older Adults.  This report describes select state programs and services to assist older adults.  2017-R-0146

CMS Releases Provider Impact File for New Proposed Reimbursement Model
As a response to LeadingAge and other association and advocacy groups, the Centers for Medicare and Medicaid Services (CMS) has released a provider-specific impact analysis file, which details the estimated impact of the resident classification system (RCS-I) model discussed in the advanced notice of proposed rulemaking (ANPRM) on Medicare Part A payments to each skilled nursing facility (SNF) in the country. The ANPRM proposes revisions to the skilled nursing facility prospective payment system (SNF PPS) and should be reviewed by all member nursing homes.  Link

New Medicare Card (formerly called SSNRI)
CMS is removing Social Security Numbers from Medicare cards to help fight identity theft and safeguard taxpayer dollars. CMS has said that providers must be ready by April 2018 for the change from the Social Security Number based Health Insurance Claim Number to the randomly generated Medicare Beneficiary Identifier (the new Medicare number). Up to now, CMS referred to this work as the Social Security Number Removal Initiative (SSNRI). Moving forward, they will refer to this project as the New Medicare Card. To help you find information quickly, CMS designed a new homepage linking you to the latest details, including how to talk to your Medicare patients about the new Medicare Card.  Bookmark the New Medicare Card homepage and Provider webpage, and visit often, so you have the information you need to be ready by April 1.

DSS Provider Audit Trainings Scheduled
As required by statute, DSS has scheduled a series of provider audit trainings. Training sessions have been scheduled for Dental Providers, Pharmacy Providers, Physician Providers, Hospital Outpatient Providers, Alcohol and Drug Abuse Centers, CT Home Care Providers, Home Health Providers, Durable Medical Equipment Providers, and Transportation Providers. Please use the View the Bulletin and the upcoming training calendar.

Long Term Care Provider Electronic Plan of Correction (ePOC)
The Department of Public Health has announced the implementation of Centers for Medicare and Medicaid Services (CMS) Electronic Plan of Correction (ePOC) project. The ePOC system enables CMS and the State Survey Agency (SSA) to electronically manage and track Plans of Corrections for ePOC-enrolled health care providers under their oversight. ePOC will be used for all Health, Life Safety Code, Revisits, and Complaint surveys. More information can be found on the DPH webpage www.ct.gov/dph/epoc. DPH will be holding instructional webinars this week and you can register for the webinars on the DPH webpage.

Housing Study Released
The Harvard Joint Center for Housing Studies released its 2017 State of the Nation's Housing report.  Declines in the availability of affordable housing, the lack of available accessible housing, and the increasing demand for new and modified units meeting the needs of seniors of modest and low incomes are detailed.

CMS Releases Nursing Home RoP Guidance

CMS Releases Revised Appendix PP with Renumbered F Tags

The Centers for Medicare and Medicaid Services (CMS) has released a new Survey & Certification letter, S&C: 17-36-NH, detailing revisions to the State Operations Manual (SOM) Appendix PP for Phase 2, F-Tag revisions, and related issues.   The revisions will be effective on November 28, 2017.

Gov. Malloy Signs Executive Order to Continue Funding State Government While Budget Talks Continue
Due to legislative inaction on a budget to take effect at the start of the fiscal year on July 1, Governor Malloy has signed an executive order to ensure the continued operation of state government until a new, two-year state budget is passed and signed into law. The Governor's  plan on how he will do this is outlined in the Proposed Resource Allocation Plan. He must operate within current appropriations as his authority is limited and he cannot raise additional revenue. His allocation plan includes a suspension on intake into the state-funded Home Care Program, elimination of the home health rate add-ons, and other cuts to non-entitlement programs administered by DSS.

June 2017

DSS Provider Audit Trainings Scheduled
As required by statute, DSS has scheduled a series of provider audit trainings. Training sessions have been scheduled for Dental Providers, Pharmacy Providers, Physician Providers, Hospital Outpatient Providers, Alcohol and Drug Abuse Centers, CT Home Care Providers, Home Health Providers, Durable Medical Equipment Providers, and Transportation Providers. Please use the View the Bulletin and the upcoming training calendar.
 
Medicaid Face-to-Face Requirement for Home Health
As required by federal law, effective for home health services ordered on or after July 1, 2017, a face-to-face visit and physician certification will be required for home health services that are paid under the Medicaid State Plan for HUSKY Health members (HUSKY A, B, C, and D). All home health services paid under the Medicaid State Plan as well as those provided to Medicaid waiver members must also comply with these requirements. The full DSS bulletin (found here) includes the details of the requirement.

AMA Considers Advocating That CCRCs Be Part of ACOs
The American Medical Association will lobby the Centers for Medicare & Medicaid Services to allow continuing care retirement communities to initiate investment models of accountable care organizations if its board of trustees approves a resolution that the AMA's House of Delegates referred for a decision last week at the delegates' meeting in Chicago. House of Delegates members' reaction to the resolution, which AMDA-The Society for Post-Acute and Long-Term Care Medicine said was proposed by AMDA members, were "mixed," according to an account of the body's meeting posted on the AMA website.

Read more on McKnight's Senior Living

Health Information Technology Update
Earlier this year, LeadingAge Connecticut members participated in the state's Health Information Technology (HIT) environmental scan and engagement process. The resulting "Summary of Findings of Current State, Future Needs, and Recommendations for Actions" can be found HERE. The report outlines recommendations that will inform the planning and eventual delivery of HIT services in the State.

Update on the Procurement for Non-Emergency Medical Transportation Services (NEMT)
The Department of Social Services (DSS) is now in the final stage of procurement for Non-Emergency Medical Transportation (NEMT) Services after evaluation of proposals, pursuant to the Request for Proposals, and selection of a respondent to be awarded the right to negotiate a contract. Upon successful negotiations, DSS will execute a three-year contract for NEMT services, effective January 1, 2018, through December 31, 2020.

After review of information and options, and based on experience since the last program redesign, DSS decided to change the program structure going forward.  DSS concluded that the current structure is not the best approach to administer this challenging program, which provides over 4 million rides annually to Medicaid enrollees. The program is being restructured based on a ‘capitated’ payment system, designed to provide the contractor with greater flexibility and capacity to engage local transportation providers.  In the interim, DSS has extended the contract of the incumbent NEMT contractor, LogistiCare Solutions LLC, to keep NEMT services operating while the state competitive procurement process is completed.

PROCUREMENT AUTHORITY’S DECISION:
The decision of the Department of Social Services is to award the right to negotiate a contract to Total Transit, Inc., with subsidiary Veyo, LLC.  DSS believes that the best interests of the State of Connecticut and Medicaid beneficiaries will be met through this procurement decision, which is based in part on lower proposed costs than other respondents and advanced technological approaches to NEMT services.  Should negotiations with the selected respondent not be successfully concluded with a contract execution, DSS would move to another qualified respondent for contract negotiations.  Maximum administrative services three-year contract value is $23,031,974.  

New S&C Letter: Water Management Policies
The Centers for Medicare and Medicaid Services (CMS) on June 9 posted a Survey and Certification Letter that outlines the responsibilities of health care providers, including Medicare-certified Skilled Nursing Facilities (SNFs), to develop and implement water management policies and procedures to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in building water systems.  CMS Issues S&C Letter Outlining Facility Responsibilities Relating to Water Management Policies

Advanced Beneficiary Notice Update
In March 2017, the Office of Management and Budget approved the Advance Beneficiary Notice (ABN) (Form CMS-R-131) for another 3 years.  There are no changes to the form, except the new expiration date of March 2020.  Starting June 21, 2017, you must use the most recent version of the CMS-R-131 to deliver a valid ABN; however, you may begin using the new form immediately. For more information, visit the FFS ABN Webpage.
Note: Skilled nursing facilities (SNFs) must use the ABN for items/services expected to be denied under Medicare Part B only.

LeadingAge Insights Tools for Members Seeking to Improve Performance and Market Position
LeadingAge Insights is a collection of tools to help you better understand your own performance and your market position. Use this link to access the LeadingAge Insights website for useful market intelligence tools. LeadingAge Insights

Access Your Member Benefits through My.LeadingAge.org
My.LeadingAge.org is a portal created specifically for members to access and take advantage of exclusive benefits. Take a look at our short video that gives you an overview of some of the more commonly used features. It will also help you through the process of updating your information and signing up for newsletters to ensure that you are receiving the content that's most relevant to you. Check out our video for more information.