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

 

 

February 2020

State Audit Report on Veyo
The State auditors have released the report of their recent audit of the non-emergency medical transportation broker, Veyo. Link to the State Audit on the Department of Social Services and Non-Emergency Medical Transportation (NEMT)

CMS to Revise PASRR
The Centers for Medicaid & Medicare Services announced Friday it's in the process of revising its Preadmission Screening and Resident Review regulations. It would be the first major change to the regulation since the early 1990s. Read more

Appropriations & Human Services Committees Informational Forum on Nursing Home Supports and Services
On February 6, DSS gave a presentation on the nursing home reimbursement system to the Appropriations and Human Services Committees. Included in their presentation was information on the current system as well as several slides on the new acuity based system they are developing. After the DSS presentation, LeadingAge Connecticut and CAHCF/CCAL were given an opportunity to present the provider perspective.
Link to Video of the forum.
DSS Presentation
LeadingAge CT/CAHCF Presentation

 

January 2020

Governor Lamont Issues Executive Orders Related to Healthcare
Last week Governor Lamont signed two executive orders that will directly address healthcare costs, primary care spending, and quality of care for individuals, businesses, and state government. The executive orders precede the upcoming 2020 legislative session, during which several bills addressing healthcare costs are also anticipated to be introduced by the Lamont administration and several legislators. The orders direct the Office of Health Strategy (OHS) to establish statewide healthcare cost growth and quality benchmarks and a primary care spending target, and the Department of Social Services (DSS) to improve public transparency of Medicaid costs and quality. The Governor made reference to similar benchmarks in Massachusetts that have been in place since 2013.

One of the executive orders - Executive Order No. 5 - directs  OHS to:
• Develop annual healthcare cost growth benchmarks by December 2020 for calendar years 2021-2025;
• Set targets for increased primary care spending as a percentage of total healthcare spending to reach 10 percent by 2025;
• Develop quality benchmarks across all public and private payers beginning in 2022, including clinical quality measures, over/under utilization measures, and patient safety measures;
• Monitor and report annually on healthcare spending growth across public and private payers;
• Convene a cost benchmark technical advisory team within 30 days; and
• Monitor accountable care organizations and the adoption of alternative payment models.

The second order - Executive Order No. 6 - directs DSS to convene an advisory board that will bolster ongoing efforts at DSS to control costs and increase quality of care standards for, a program that accounts for over 20 percent of state expenditures. Under the executive order, DSS will:
• Develop a transparency strategy for Medicaid cost and quality by December 2020 that examines performance over time and compares that to other state Medicaid programs;
• Convene an advisory board to provide input to the agency on the content and goals for the reporting;
• Establish strategic interventions for Medicaid members that improve outcomes and reduce health disparities; and
• Continue to monitor adoption of Medicaid cost, quality, and transparency reporting.

Nursing Home Acuity Rate System Development Update
Nursing Home Reimbursement Modernization Project Presented to Legislative Medicaid Oversight Committee
DSS continues to work toward transitioning the nursing home rate system to a case mix based system and last week their consultant, Myers & Stauffer, presented their planning process to the Legislature's Medical Assistance Program Oversight Committee (attached). This week we will continue to discuss the project with both DSS and legislative leaders at the scheduled meeting of the DSS Nursing Home Financial Advisory Committee. DSS Nursing Home Acuity Rate Transition Page

 

December 2019

Hospital Settlement Agreement Approved
Last week in Special Session, the General Assembly unanimously approved the hospital settlement agreement that had been negotiated between the administration and the state's hospitals. The Governor then signed the agreement that evening. As a result of the settlement, all pending legal claims filed against the state challenging the first hospital user fee, including the lawsuits filed in 2016, and all of the rate appeals brought by hospitals challenging Medicaid payments will be withdrawn. Executive summary and financial breakdown of agreement.

 

November 2019

LTSS Rebalancing Update
DSS recently presented an update on the state's Long-Term Services and Supports Rebalancing Plan. The presentation is very comprehensive and it provides a clear overview of the plan and of the state's goals and incentives. It might also be a helpful resource for your leadership team and/or board members. The PowerPoint slides are attached and a tape of the presentation can be found here.

My Care Options to be Rolled Out
One of the Governor's newest initiatives in the rebalancing plan is called "My Care Options" and it will be rolled out very soon. The initiative will reach out to participants enrolled in the Medicare Saving Program (MSP) who are nearing the Medicaid spend down for long term services and supports (LTSS). For these MSP enrollees, the state will reach out to provide them with information on the various options that they have regarding how Medicaid can pay for LTSS services, both in and out of the nursing home. These visits will be made to residents in the nursing home and information will be provided on the My Place CT website  for those in the community.

My Place CT Website Community Resource
MyPlaceCT.org is the state's web-based resource designed to help older adults and people with disabilities live with optimal independence, health and well-being. The information provided on this website helps people in the community explore options, make informed decisions and connect with a wide range of long-term services and supports.

 

October 2019

Laws Effective October 1
Several state laws passed in the legislative session become effective on October 1, including the following that may be of interest to LeadingAge Connecticut members:
Minimum Wage Increase (Public Act 19-4): The first of a phased-in increase goes into effect on October 1 with the minimum wage increasing from $10.10 to $11.00. Minimum Wage Chart
Sexual Harassment Prevention (Public Act 19-16): Increases the requirements on employers to train and inform all employees regarding the illegality of sexual harassment and the available remedies for victims. Wiggin and Dana Advisory
Nursing home staff level daily posting requirements (PA 19-89): We have issued a model staffing form and instructions to  all of our nursing home members and both are linked to this newsletter.
Social Worker Title Protection (Public Act 19-164): Prohibits anyone from using the title social worker unless they have a bachelor's or master's degree in social work from an accredited social work program or have a doctorate in social work.
Art Therapist Licensure (Public Act 19-117 section 176-182): Defines art therapist as a person who has been licensed as such and sets up the licensure process and criteria.
1% Rate Increase for Certain Home and Community Based Services (Provider Bulletin)
Please see our Legislative Summary or go to the www.CGA.ct.gov website for more information on any of these new public acts.

 

September 2019

Medicaid Waiver Services Rate Increase Effective October 1
LeadingAge Connecticut has been informed that several of the services provided within the Medicaid waiver programs will receive a 1% rate increase effective October 1, 2019. This rate increase is intended to assist providers in implementing the first phase of the state's minimum wage increase. We have also been told that the state intends to implement a similar increase on the effective date of each subsequent phase of the minimum wage increase. A provider bulletin will be released within the next two weeks, but we understand that homemaker, companion, adult day, assisted living and home health aide rates will be among the services affected by the increase.

Wiggin and Dana Legislative Summary
The Wiggin and Dana legislative summary of  the relevant outcomes of the 2019 Legislative Session for aging services and senior housing is now available.

New Nursing Home Staff Posting Requirements
There will be new state nursing home staff posting requirements effective on Oct 1. LeadingAge Connecticut is working together with CAHCF to develop a template form that will allow you to comply with both the state and federal posting requirements. The form will be available shortly and before the Oct 1 effective date.

Nursing Home Rate Update
The state has completed the rebasing of nursing home rates and recently posted the new rates on their website. Nine homes lost their stop-loss protection due to a low census (under 70%) and as a result, they saw their issued rates drop significantly down to their new calculated rates. During the legislative session LeadingAge Connecticut and CAHCF had fought against this policy change in the rate rebasing process, asking the state to first offer these low census homes the opportunity to permanently reduce their beds in order to avoid the punishing effect of the imputed days on their rate calculation. We thought this would be an opportunity to encourage the permanent reduction of hundreds of unused nursing home beds which is a goal of the state's rebalancing plan. We now continue to work with CAHCF to provide a new opportunity for the affected homes to reduce their beds and have their rates recalculated.
Link to the nursing home rates.

Large Turnout for the Fall Prevention Safety Summit
Over 300 people attended the Fall Prevention Safety Summit sponsored by DPH and CMS last week. The keynote address by Dr. Jaclyn Olsen was very well received and was followed by several other presentations that provided helpful ideas, tools and resources for use within a fall prevention strategy.

 

August 2019

Newly Revised CCRC Consumer Guide Book
ConnCCRA, the Connecticut CCRC Resident Association, has revised and updated their consumer guide book for Life Plan Communities. The new consumer guide can be found here. LeadingAge Connecticut links to the Guide Book on both our Consumer page and our Life Plan Community

Nursing Home Rates Issues
The Department of Social Services (DSS) last week issued new Medicaid rate letters to the nursing homes in the state. In compliance with the legislative mandate passed in the biennial budget, the state rebased the cost based rates utilizing the 2018 cost reports and implemented a 2% stop loss for homes with calculated rates lower than their currently issued rates. However, based on the 2019 legislation, nursing homes with a census of less than 70% were not afforded the stop loss protection. There are nine such homes, some of which have been featured in the media. The state has provided the attached Overview of Nursing Home Rate Adjustment regarding  the rebasing process.

The state then implemented a 2% increase intended to be used for enhancing wages, salaries and benefits effective July 1, 2019. Information regarding how this increase must be spent is posted on the DSS's Medicaid Nursing Home Reimbursement page which contains information regarding the implementation of the July 1, 2019 Nursing Home Wage Increase:
July 1, 2019 Nursing Home Rate Increase Information - June 27, 2019
Frequently Asked Questions - June 27, 2019

State's Medicaid Long-Term Care Demand Projections Updated
Study Previews Long-Term Care System for Older Adults, People with Disabilities in 2040
State officials have released a detailed report that previews the landscape for long-term care of Connecticut's population of older adults and people with disabilities in the year 2040 and confirming the popular trend toward aging in place and community living. This is an update to the long-term care demand study conducted by Mercer Human Services Consulting that has guided the state's rebalancing initiative. The report, titled State of Connecticut Medicaid Long-Term Care Demand Projections, uses  data to predicatively model long-term care trends over the next 20 years-including nursing home, home care and associated workforce-at the state level and for each of the 169 Connecticut cities and towns. The report projects a major increase in demand for and use of home care provided through Medicaid, from 67.6% of long-term care enrollees in 2017 to 82.3% by 2040. Over the same period, the report projects a concomitant drop in demand for nursing home care, with a reduction in demand of nearly 6,000 beds.
The report and its town-by-town appendices are posted at www.ct.gov/dss/medicaidlongtermcarereport.

 

July 2019

Governor Lamont Creates Task Force on Housing and Supports for Vulnerable Populations
Governor Lamont has convened a task force that will be responsible for providing his administration with a coordinated response in support of those who are facing homelessness and in need of other forms of housing assistance. LeadingAge Connecticut is pleased to be represented on this task force.

The Governor's Task Force on Housing and Supports for Vulnerable Populations will be co-chaired by Lisa Tepper Bates, the governor's Senior Coordinator for Housing and Transit Oriented Development, and David Rich, CEO of the nonprofit housing provider Supportive Housing Works. Its mission will be to enhance coordination across agencies to ensure that the state evaluates vulnerability and prioritizes resources consistently, coordinates effectively to serve shared clients, and implements best practices reliably to meet residents' housing and housing support needs with the goals of improving outcomes and conserving resources.

Governor Lamont Announces the Renaming of the Department of Rehabilitation Services
Agency Will Be Known as the Department of Aging and Disability Services
Governor Ned Lamont has signed legislation renaming the Department of Rehabilitation Services (DORS) to the Department of Aging and Disability Services (ADS).

Spotlight Video: Making a Career Out of Making a Difference
The LeadingAge Connecticut website hosts a video produced by LeadingAge PA promoting careers in the aging services field. Making a Career Out of Making a Difference is a terrific three minute video that highlights the benefits of working in our field. We encourage you to view and share this video.

 

June 2019

2019 State Legislative Session Overview

Reports from DSS

At the recent Medicaid Assistance Program Oversight Council (MAPOC) meeting, DSS provided an update on both the Electronic Visit Verification system and the new Medicaid Supportive Housing Benefit that is included in the new state budget. The following handouts were provided
by DSS:

EVV Update to MAPOC - June 14, 2019

Medicaid Supportive Housing Benefit PowerPoint

New CCRC Resident Guide Book
ConnCCRA, the Connecticut CCRC Resident Association, has revised and updated their consumer guide book for Life Plan Communities. The new consumer guide can be found here.

No-cost Recycling Program for Healthcare Facilities
The Mattress Recycling Council (MRC) was formed as a result to Connecticut's mattress stewardship law to implement and manage the recycling program in the state.  Through this program, MRC can provide no-cost mattress recycling to healthcare facilities in the state. The attached information sheet provide information on the program and how healthcare facilities can benefit.

Sign up for the HUD REAC NSPIRE Email Listserv
HUD's Real Estate Assessment Center (REAC) has created a NSPIRE subscription mailing list as a way to share updates.  HUD will use this a vehicle so subscribers will receive periodic messages about the new inspection model and the demonstration.
 
The following is the HUD message on this new listserv:
HUD's Real Estate Assessment Office invites you to subscribe to its National Standards for the Physical Inspection of Real Estate (NSPIRE) mailing list.  This is an easy way to stay informed.  Sign-up by clicking on the link below and provide your email address.  You will receive an email message shortly, asking to confirm your registration.  Once confirmed, you will receive periodic messages.  You may cancel your subscription at any time.  Link to sign up

Home and Community Based Provider Conference a Success!
Last week, LeadingAge Connecticut, together with the Connecticut Association of Adult Day Services, proudly co-sponsored the 2nd Annual Conference for Providers in the CT Home Care Program for Elders. Over 175 providers attended the conference which featured speakers from the Department of Social Services and included information on the "Myths and Facts regarding the Universal Assessment" and the state's MyPlaceCT.org which is a web-based resource designed to help older adults and people with disabilities live at home or in the community with optimal independence, health and well-being. Thank you to those who presented and to all of you who attended!

Wiggin and Dana Advisory on Expanded Coverage of FMLA
Connecticut's legislature has approved comprehensive legislation establishing paid family and medical leave and drastically increasing both the employers covered by the state family and medical leave law and the employees eligible for such leave. While employees will not be eligible to take paid leave until 2022, the law will bring significant changes and obligations for Connecticut employers of all sizes. Wiggin and Dana has prepared an advisory on the new law which you can access through the ffollowing link. Wiggin and Dana will also be providing a full report on the outcomes of the 2019 Legislative Session and this report will be available later this summer.
 
Your Benefits of Your Membership Webinar
We recently developed and distributed a publication describing the Benefits of Your Membership in LeadingAge Connecticut and provided a presentation at the March Board and Membership Meeting. We have now recorded and posted that presentation on the website and hope that you will find it helpful!

LeadingAge Connecticut has several other videos posted on our website that may be of interest to you as a member:
•    LeadingAge Connecticut - The Leading Advocate for Aging Services and Senior Housing: click here to view the video
•    The Advantage of Choosing a LeadingAge Connecticut Member: click here to view the video
•    The LeadingAge Connecticut Member: click here to view the video
•   
Make a Career Out of Making a Difference


May 2019

New BFCC-QIO for Connecticut
Effective June 8, 2019, Livanta will no longer serve in this function and KEPRO will become the new BFCC-QIO. Information regarding the update to your beneficiary notices and KEPRO's contact information are included on the attached bulletin. Providers will need to update their beneficiary notices.

CMS Releases MDS 3.0 RAI Manual Update Early
The MDS 3.0 RAI Manual v1.17
October 1, 2019 contains many updates including information related to the implementation of PDPM and can be found on the CMS website. You will find the manual at the bottom of the webpage in the Related Links section.  

Veyo Specialized Transportation Form
Veyo has announced that they have modified their Specialized Transportation Form and the process for requesting specialized transportation.  Based on provider feedback, Veyo has tried to streamline and ease the process of providing medical necessity justifications. They have created a new "Medical Necessity Form" which is a simpler version of the old form, and is live on the Veyo website. If a member requires a public transit or mileage override, or requires a companion to travel with them on their trips, then please use the new Medical Necessity Form.

State Medical Journal Issues Special Edition on the Opioid Overdose Crisis
The Connecticut State Medical Society (CSMS) Journal Connecticut Medicine has published a special edition "Finding Hope in the Battle Against the Opioid Overdose Crisis". Link to the Journal Edition

April 2019

CMS Announces Plan for Nursing Home Quality Care
Centers for Medicare & Medicaid Services (CMS) reviewed a five-part plan for ensuring quality care in nursing homes. Link to LeadingAge article
                                           
DSS Update on Redeterminations
Here are some important items to remember when dealing with eligibility and redeterminations:
 
W-298 Must Be Signed to be Effective
The facility must be sure to have the resident or their authorized representative sign the W-298 form authorizing the facility to receive eligibility information from DSS. When a facility is designated as an authorized representative (AREP) for an individual, the employee from the facility signing forms, including applications or renewals, should include their printed name and indicate what position they hold at the facility.
 
Renewal Escalation Tool for Redeterminations
The [email protected] email Escalation Tool process is to be used to send to DSS the escalation tool that is to be used only for flagging renewals that are stalled in the process or inappropriately denied.* (The Escalation Tool can be obtained through LeadingAge Connecticut.)
 
In order to ensure DSS is providing the best service possible related to renewals, they have issued the following conditions:
 - The facility must put their name and business manager on the Excel escalation tool.
 - The facility name should be placed in the subject line, and include a thorough
    explanation of what the issue is on each case.
 - Only send one list at a time with no more than 5 cases. After the facility receives a
   response, an additional list can be sent.
 
*As a reminder, only cases that involve renewals that were submitted on time with all proofs necessary to determine eligibility, authorization to disclose is on file, a discontinuance notice has been received, or the facility has been denied room and board payment due to lack of coverage are eligible for this escalation email. All other inquiries must go through the Benefit Center, assigned application staff member, or Ascend staff member. Documentation that has been requested should not be attached but already sent to scanning.
 
Most importantly, please do not share the
[email protected] email with family members. This email is only for facilities.
 
In addition, DSS cannot emphasize enough how important it is to update Ascend timely and to make sure the level of care process is completed as quickly as possible.

Section 202 Capital Advance Notice of Funding Availability
The FY 2018 Section 202 Supportive Housing for the Elderly Program Capital Advance Notice of Funding Availability (NOFA) is now posted on grants.gov.

HUD Notice on Delaying Inspections Beyond Notification Timelines
Notice PIH-2019-02 (HA) H-2019-04 went into effect March 25 requiring contract inspectors and those who schedule Quality Assurance (QA) inspections at HUD to start giving Owner and Management Agents 14 calendar days notification of an inspection.  The memorandum "Approving the Delay of a Physical Inspection Beyond the New Real Estate Assessment Center (REAC) Inspection Notification Timelines" provides guidance on when a field office may approve a POA's request to delay an inspection and explains what an Account Executive or Resolution Specialist should do once a delay is approved/denied.

Letters Sent from the CT Fair Housing Center
A housing member recently reported the receipt of a letter from the CT Fair Housing Center requesting copies of their Tenant Selection Plan and Affirmative Fair Housing Marketing Plan. While the letter implies that the CT Fair Housing Center is working on behalf of a government entity, they are not making this request on behalf of HUD or any other government entity. If you have received such a letter and have any questions, please feel free to contact us.

LeadingAge Monthly Calls for Stand-Alone Nursing Homes
LeadingAge has begun holding monthly informational conference calls for members of stand-alone nursing homes. Their next call is April 22 at 2:30 p.m. If you are interested in becoming involved with the calls, please let us know!

Link to DPH List of Reportable Diseases
Here is an important link to the Department of Public Health (DPH) website on Reporting of Diseases, Emergency Illnesses, Health Conditions, and Laboratory Findings. The first attachment on the webpage, "list of Reportable Diseases," is a great resource. Link to DPH Webpage
   
New Heightened Scrutiny Guidance Answers Some Questions, Raises New Ones
On March 22, the Centers for Medicare and Medicaid Services (CMS) issued new guidance to states on how to implement the HCBS Settings Rule with respect to heightened scrutiny. This article summarizes the new guidance and what it means for LeadingAge members. Read the full article   

March 2019

CMS Nursing Home QSO Memos
CMS has recently issued the following four important QSO Memos:

Specialized Infection Prevention and Control Training for Nursing Home Staff in the Long-Term Care Setting is Now Available Memo # 19-10-NH, Posting Date 2019-03-11
The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) collaborated on the development of a free on-line training course in infection prevention and control for nursing home staff in the long-term care setting. * The training provides approximately 19 hours of continuing education credits as well as a certificate of completion.

April 2019 Improvements to Nursing Home Compare and the Five Star Rating System

Memo # 19-08-NH, Posting Date 2019-03-05

Enhanced Oversight and Enforcement of Non-Improving Late Adopters
Memo # 19-07-NH, Posting Date 2019-03-01
Regarding facilities that had not improved their antipsychotic medication utilization rates for long-stay nursing home residents, referred to as late adopters.

Revisions to Appendix Q, Guidance on Immediate Jeopardy
Memo # 19-09-ALL, Posting Date 2019-03-05

Have You Established Your DPH Online Account?
DPH has issued a nursing home Blast Fax 2019-5 regarding the E-Licensing System. While the system has been effective since December 1, 2018, many facilities have failed to establish an account. See the Blast Fax for more information.

LeadingAge to Affiliate with Visiting Nurse Association of America and ElevatingHOME
LeadingAge has announced their intent to affiliate with the Visiting Nurse Association of America and ElevatingHOME. Read Katie Sloan's message on this exciting news!
 
LeadingAge Hospice Member Resources
LeadingAge wants to make hospice members aware of their new webpage of resources that are available to hospice providers as LeadingAge members.

EPA Finalizes Hazardous Waste Pharmaceuticals Rule
An article from The Compliance Store, a LeadingAge Connecticut Gold Partner
The Environmental Protection Agency (EPA) is implementing new management standards for hazardous waste pharmaceuticals (HWP). When this rule becomes effective, long-term care facilities and other healthcare facilities will be subject to a new Subpart P of the Resource Conservation Recovery Act (RCRA), which governs the management, storage, and disposal of hazardous wastes. Notable requirements include:
•    Long-term care facilities are no longer exempt from the RCRA, as they were previously treated the same as residential households.
•    The disposal of HWPs down the drain, or sewered/flushed, is prohibited. (Effective August 21, 2019)
•    Facilities that are subject to the new rule must notify the EPA Regional Administrator.
•    Personnel must be trained to the extent that they are thoroughly familiar with the proper handling of HWPs relevant to their responsibilities.
•    Facilities may choose to manage all waste pharmaceuticals as HWPs, or make individual determinations.
•    Containers used to store HWPs must be structurally sound, appropriately labeled as "Hazardous Waste Pharmaceuticals", and shipped within one year to avoid penalty.
•    Manifests of all generated and shipped HWPs must be kept for three years.
•    If a HWP is spilled, it must be contained immediately, and any cleanup materials must be handled as hazardous.

The final rule has an effective date of August 21, 2019. However, states operating under their own EPA-approved hazardous waste programs have extended timelines for implementation, except for the sewer ban. Specifically, this new federal rule will NOT go into effect in Connecticut until such time as the State Department of Energy and Environmental Protection amends its hazardous waste rules to adopt it.  The one exception is the new sewer ban.  That provision will go into effect nationwide on August 21, 2019.