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

 

 

November 2018

Changes in New Nursing Home Quality Reporting from Both CMS and U.S. News and World Report
The Centers for Medicare and Medicaid Services (CMS) announced the addition of new data to Nursing Home Compare. In addition, U.S. News and World Report has announced changes in its methodology for rating nursing homes. Read more on the LeadingAge website Note: Your Quality Metrics and 5 Star Reports will be sent out next week.

New LeadingAge Center for Managed Care Solutions
We are delighted to announce the launch of the LeadingAge Center for Managed Care Solutions & Innovations, a new resource for all LeadingAge members. The Center for Managed Care Solutions & Innovations offers members a one-stop shop filled with the tools, resources, and education you need to succeed in managed care, integrated services, and other alternative payment models.

DSS Rebalancing Report
At the October Medical Assistance Program Oversight Council (MAPOC) meeting, DSS presented on the status of the state's rebalancing plan. Click here to view the PowerPoint presentation.

CT DPH Reports IJ Citations for Inappropriate Infection Control of Glucometers
DPH has notified us that they have recently cited Immediate Jeopardy in nursing homes due to incorrect infection control practices on common use glucometers. DPH informs us that infection control procedures should be determined by the manufacturer's guidelines. Please see the 2010 CMS S&C Letter attached regarding Point of Care Devices and Infection Control in Nursing Homes.

Emergency Planning and Water Management Plans
DPH has reported that several facilities have been cited for not fulfilling emergency planning requirements, stating that participation in the LTC-MAP alone is not enough to fulfill the requirements and that a nursing home needs a workable, actionable plan that engages local officials. DPH is also finding many homes with insufficient water management plans.

DPH Staffing Update
At our recent quarterly meeting with the DPH Facility Licensing and Inspection Section (FLIS), it was announced that Donna Ortelle has been named the new FLIS Section Chief. FLIS is also in the process of hiring several new nurses who will be trained in survey and inspection.

Reminder of State Law that Can Assist in Debt Collection
A member recently requested a copy of the Wiggin and Dana Advisory on 2013 law regarding transfer of assets and applied income that can be helpful to skilled nursing facilities' debt collection efforts. We are including the link in today's newsletter for others who may be interested in the information.

What Your Community Needs to Know About Copyright Compliance Before You Shout, "Action!"
By Stephen Maag, LeadingAge
With all the activity within your senior living or health care community, residents and staff may not give a second thought to something as simple as showing a movie. "It's just for residents," some might say. "We're not charging admission." It seems simple enough, but maybe you remember the FBI warning at the beginning of the movie? The one we all too often fast forward through? Have you ever considered how copyright law applies when movies are shown within your community? Probably not, but you should. More
Note: Steve Maag will be visiting LeadingAge Connecticut on November 16 to present to the DSS Continuing Care Advisory Committee and to the LeadingAge Connecticut Members - Save the Date!

State of Connecticut Nonprofit Grant Program
The Office of Policy and Management (OPM) Nonprofit Grant Program (NGP) information can be found on the following webpage: Link to webpage. The purpose of the NGP fund is to improve the efficiency, effectiveness, safety and/or accessibility of health and human services being delivered by nonprofit organizations. The eligible projects include facility alterations, renovations, improvements, and additions; new construction; health, safety and Americans with Disabilities Act (ADA) projects; energy conservation improvements; information technology systems; technology that promotes client independence; purchase of vehicles; and acquisition of property. The NGP is funded by proceeds from State General Obligation Bonds. The State capital budgets for fiscal years 2017 and 2018 include $30 million for the NGP.
Eligibility
Eligible applicants are health and human services organizations that are exempt under Section 501(c)(3) of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time and that receive funds from the State to provide direct health and human services to State agency clients. Applications involving a collaboration between two or more eligible nonprofit organizations may also be eligible for award.
 
SNF Final Rule Correction and Updated Rate Calculator
CMS has published a correction notice for the FY 2019 SNF Final Rule, which corrected some errors in the case-mix adjusted rate tables, and also updated the wage index file. Here is a link to the LeadingAge article announcing the correction with a link to the updated SNF rate calculator. It was only a few minor changes to the wage index.

DPH Blast Fax - MDS Section K
DPH issued the attached blast fax to all the state's nursing homes on October 2, 2018 regarding Section K of the MDS titled, "Minimum Data Set (MDS) 3.0 Section K 0510 Nutritional Approach and K 0710 Swallowing/Nutritional Status." Our Gold Partner, HealthPro Heritage/Partners Pharmacy has also provided the attached article regarding the information contained in the blast fax. The main point of the blast fax is that while CMS has made Sections K 0510 C and D optional, Connecticut will still require the completion of Swallowing/Nutritional Status K 0710 A and B. More information can be found in the attachments.
 
Candida Auris Information
Attached please a link to the CDC website new targeted fact sheet resources with information about Candida auris for patients, Infection Preventionists, and Laboratorians. CDS Candida Auris Information Link

Trauma Informed Care Resources
Link to the resources - Part of LeadingAge's Tools & Information
Trauma Informed Care (TIC) will be a requirement as part of the CMS, Phase 3, Requirements of Participation, implemented, November 29th, 2018. The treatment framework and structure of trauma-informed care involves understanding, responding and recognizing the effects of all types of trauma. LeadingAge working with Resilience for All Ages (RFAA) and LeadingAge Maryland, has created tools and resources for members to understanding the impact of TIC and create a culture in your organization.
 
Hand in Hand: A Training Series for Nursing Homes
CMS has released an Updated Hand in Hand: A Training Series for Nursing Homes
Self-Paced Online Training: Hand in Hand: A Training Series for Nursing Homes Online.
Downloadable Materials for Instructor-Led Training: Hand in Hand: A Training Series for Nursing Homes Download 
 
CMS announces 2019 Medicare Parts A & B premiums and deductibles
The Centers for Medicare & Medicaid Services (CMS) announced the 2019 premiums, deductibles, and coinsurance amounts for Medicare Parts A and B.
 
Medicare Part B Premiums/Deductibles
Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A. The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, a slight increase from $134 in 2018. An estimated 2 million Medicare beneficiaries (about 3.5 percent) will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory hold harmless provision, which limits certain beneficiaries' increase in their Part B premium to be no greater than the increase in their Social Security benefits. CMS also announced that the annual deductible for Medicare Part B beneficiaries is $185 in 2019, an increase from $183 in 2018.
 
Medicare Part A Premiums/Deductibles
Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment. The Medicare Part A inpatient deductible that beneficiaries will pay when admitted to the hospital is $1,364 in 2019, an increase of $24 from $1,340 in 2018.
 
Medicare Advantage Premiums
Medicare beneficiaries can choose to enroll in fee-for-service Medicare (Parts A and B) or can select a private Medicare Advantage plan to receive their Medicare benefits. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans are already finalized and are unaffected by this announcement. Last month, CMS released the benefit, premium, and cost sharing information for Medicare Advantage plans in 2019. On average, Medicare Advantage premiums will decline while plan choices and new benefits increase. On average, Medicare Advantage premiums in 2019 are estimated to decrease by six percent to $28, from an average of $29.81 in 2018.

For a fact sheet on the 2019 Medicare Parts A & B premiums and deductibles, please visit: https://www.cms.gov/newsroom/fact-sheets/2019-medicare-parts-b-premiums-and-deductibles.

Update from DSS Eligibility Operations
Update on the W-298
In June we informed the membership that they 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. (At that time, many facilities were submitting unsigned forms.) DSS has now provided follow-up information on additional language providers should include on the W-298, Authorization for Disclosure of Information, form when an individual appoints a facility as their authorized representative. 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
DSS has also provided follow up information on the [email protected] email Escalation Tool Process. DSS hopes that this escalation tool that is to be used only for flagging renewals that are stalled in the process or inappropriately denied*, has been useful and would appreciate any feedback about the process. Please let us know if you have any feedback.
 
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.
 - Place the facility name 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.

DSS Medicaid Rate Update
Nursing Home 2% Wage Increase
The Department of Social Services has issued a Frequently Asked Questions document which is intended to answer questions received by the Department regarding the 2% increase on nursing home rates that will be effective November 1, 2018. The Department has stated that the increase is specifically intended to support a permanent increase of no less than 2% to the compensation of employees directly employed by the
nursing home. The FAQ document has been posted to the DSS webpage dedicated to providing information regarding this 2% increase.

 

Notice to Nursing Homes - September 17, 2018
Frequently Asked Questions - September, 27 2018

Residential Care Home Rate Increase
The Secretary of the Office of Policy and Management (OPM) has approved a 1% increase to Residential Care Home rates effective July 1, 2018. The rate increase has rules similar to the nursing home rate increase and is intended for employee compensation increases. Information regarding the rate increase is posted below for your
information.

 

RCH Rate Increase Guidance Letter - October 3, 2018

 

RCH Rate Increase Cost Analysis

 

RCH Rate Increase Frequently Asked Questions - October 19, 2018

DSS Issues Second FAQ on Nursing Home Rate Increase
DSS has issued a second FAQ document in response to additional questions proposed to the department. You can find this second FAQ document as well as all of the other information regarding this rate increase on the DSS website. Reminder,nursing homes have until October 24 to notify DSS if they choose not to receive this increase.

Governor's Cabinet on Nonprofit Health and Human Services Toolkit
The Governor's Cabinet on Nonprofit Health and Human Services was established in  2011 and serves as a vehicle for providing, up-to-date information for nonprofit health and human service providers. The Cabinet has published a toolkit (link below) that may be of help to members. In addition, we have provided a link to information on the nonprofit collaboration grant program.

Nonprofit Toolkit 2018

 

Nonprofit Collaboration Incentive Grant Program (NCIP) Summary

Medicaid 101
The State's Office of Legislative Research has produced a brief report entitled "Medicaid 101" that we thought may be of interest and which may be helpful to your new board members and others. Medicaid 101

DEEP Resources for Skilled Nursing & Senior Living Facilities
The Department of Energy and Environmental Protection (DEEP) along with their utility partners will continue to assist skilled nursing homes and senior living communities with environmental issues in 2019 and is seeking input on past and future activities, environmental accomplishments and assistance needs.  They have put together a short survey (7 questions) that they are requesting providers complete by October 11. The following is a link
to the survey.

DEEP has also created the following new materials for nursing homes and senior living communities that have also been reviewed by CT DPH Licensing Division and has a webpage focused on this sector.

 



September 2018

CDC Flu Vaccine Recommendations for the 2018-2019 Flu Season
CDC's vaccine recommendations for the 2018-2019 flu season now available. The CDC recommends yearly flu vaccination for people 6 months and older.
The Society for Post-Acute and Long-Term Care Medicine, or AMDA, also released its latest recommendations related to vaccines last week. Link to AMDA article

DSS Medicaid Rate Update
DSS has issued additional information regarding upcoming rate increases for specific Medicaid providers.
•    CT Home Care Program: Last week DSS issued an update on rescinded Provider Bulletin PB18-61 had announced rate increases in the Medicaid waiver programs, stating that it was rescinded solely for the purpose of revising the bulletin to better describe and clarify the rate increases referenced in the bulletin. They then stated that the primary purpose of these rate increases is to increase wages and benefits for direct caregivers serving Medicaid members and that the revised bulletin will be issued in the near future. DSS subsequently issued Provider Bulletin DXC PB18-63 announcing the October 1, 2018 increase in the Companion Services Rate Increase.
•    Nursing Homes: LeadingAge Connecticut submitted a series of questions to DSS last week seeking clarification of the requirements for the anticipated 2% rate increase for nursing homes effective November 1, 2018. DSS has indicated that they will issue a written response to these and other questions and will post them on a special section of their website. We will keep members updated as we learn more.

Fair Housing Guidance
LeadingAge has provided new guidance that summarizes the Fair Housing Act (FHA) and Americans with Disabilities Act (ADA). The FHA and the ADA are the two main anti-discrimination statutes that affect senior living providers. Knowing how these statutes apply to various settings is important to all staff - from marketing personnel at the beginning of the process through the front-line and maintenance staff upon move-in. In addition to this new guidance, look for our upcoming Fair Housing Seminar on October 18!

2018 LeadingAge Connecticut Annual Awards
LeadingAge Connecticut is pleased to announce this year's recipients of our prestigious annual awards to be presented at the 2018 Annual Meeting on
October 9, 2018 at the Aqua Turf Club in Plantsville.
Distinguished Service Award
David V. Hunter, President and CEO, Mary Wade
Rick Wallace Award of Merit
Kelly Papa, MSN, RN, Corporate Director of Learning, Masonicare
Volunteer of the Year Award
Reverend James P. Morgan, Volunteer at Connecticut Baptist Homes
Spirit of Innovation Award
Andrew Banoff, President and CEO, Jewish Senior Services
Trustee of the Year Award
Harold Spitzer, Mary Wade
Media Award
The Towers
Congratulations to all our honorees!

SNF Medicare Rate Calculation Tools Available
LeadingAge has updated the Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) calculator and the Medicare Part B therapy rate calculator to help members assess and estimate the impact of final payment changes for FY 2019, which begins on Oct. 1, 2018. Additionally, the Medicare Part A SNF PPS and Medicare Part B therapy rate calculators for FY 2018 are available. Access to these tools requires login via My.LeadingAge.

August 2018

CMS Finalizes PDPM Rule

LeadingAge Report
The Centers for Medicare and Medicaid Services (CMS) released for public inspection the fiscal year (FY) 2019 skilled nursing facility (SNF) prospective payment system final rule on July 31, 2018. A CMS fact sheet on the final rule, effective October 1, 2018, is also available highlighting the three main provisions of the rule, those being the new case-mix classification system, the Patient-Driven Payment Model (PDPM), and policy updates to the SNF quality reporting program (QRP) and value-based purchasing program (VBP). Of note, CMS states that the rule "moves Medicare towards a more value-based, unified post-acute care payment system" which signals that this is likely foundational to the future concept of a unified post-acute care prospective payment system as mentioned in the IMPACT Act of 2014.
SNFs will receive a 2.4% payment update for FY 2019 based on the Bipartisan Budget Act of 2018. CMS took the recommendation of LeadingAge that organizations that failed to meet the QRP requirements have an update of 0.4% as opposed to -0.1% in the proposed rule with the 2% reduction for reporting noncompliance.

The PDPM proposal retains the implementation date of October 1, 2019. LeadingAge provided comments on the PDPM and other aspects of the proposed rule based on our analyses and input received from our members. CMS has indicated that information on training and education resources and opportunities associated with implementing the PDPM will be available on the CMS website. LeadingAge has joined other stakeholder groups in asking CMS for a PDPM stakeholder workgroup to proactively address transition and implementation challenge issues as well as aiding with education and dissemination of CMS guidance.

The Patient Driven Payment Model (PDPM) is a significant change for how Medicare is paying for skilled nursing. The focus on beneficiary clinical characteristics appears to be the clear direction of the future as CMS considers other payment systems, home health as an example, and post-acute care as a Medicare segment. LeadingAge will strive to ensure our members are positioned to transition successfully and in an educated manner.  

As we analyze the final rule, we will provide additional information through multiple communication channels. LeadingAge is developing educational resources and opportunities for members and will be announcing initial resources in the coming weeks.

CMS also finalized the 2019 Medicare payment rules for the Inpatient Rehabilitation Facility PPS and Inpatient Psychiatric
Facility PPS.

For a fact sheet on the FY 2019 Inpatient Rehabilitation Facility PPS final rule
For a fact sheet on the FY 2019 Inpatient Psychiatric Facility (IPF) PPS final rule 

LeadingAge Connecticut to Provide Input into State's LTSS Planning Process
As a member of the Long-Term Care Advisory Council, LeadingAge Connecticut is preparing comments to submit to the Long-Term Care Planning Committee regarding our input into the State's Long-Term Services and Supports (LTSS) Plan that is currently being updated by the state's Long-Term Care Planning Committee and which is due to the legislature in January 2019.
We have been asked to identify three priorities from either the recommendations contained in the current plan or from any new recommendations we would suggest. We will be identifying the following three priorities:

1. Achieve adequate and sustainable provider reimbursement levels that support the cost of LTSS and quality requirements for all segments of the LTSS continuum in order to ensure capacity to meet the evolving needs and demographics of Connecticut residents.

2. Continue and expand State investment in the development of housing that is affordable and accessible for older adults and persons with disabilities.

3. Address the LTSS workforce shortage.

We will also be asking that the plan add a recommendation to study the economic status of the aging demographic to understand the future demand that will be placed on public financing of LTSS and the supply of affordable senior housing.
Link to a copy of the  2016-2019 LTSS Plan

Update on CMS HCBS Waiver Settings Rule Transition Plan
Last week, DSS and DDS held a forum at the Legislative Office Building to discuss the current status of the state's transition plan that is being submitted to CMS. LeadingAge Connecticut provided comments at the forum and we continue to work together with DSS and other stakeholder organizations on the plan details. In particular, we are working with DSS, DPH, CARCH and Legal Assistance to create an option for residential care homes to achieve compliance with the settings rule if they choose to do so. Toward that goal, DSS's Community Options staff has organized an RCH Best Practices Task Force and they will be scheduling site visits to the RCHs again this September. Each RCH will be contacted in advance and we will be sending out more information to our members shortly.

Hospice Final Rule
LeadingAge Silver Partner BKD summary of the hospice FY 2019 final rule
On July 31, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1696-F) outlining fiscal year (FY) 2019 Medicare payment updates and quality program changes for skilled nursing facilities (SNF). This final rule includes provisions that advance CMS' overall direction in shifting Medicare payments from volume- to value-based, with continued implementation of the Skilled Nursing Facility Quality Reporting Program (SNF QRP) and Value-Based Purchasing (VBP) ProgramCLICK HERE to reada quick summary of the major provisions from LeadingAge Silver Partner BKD.

HUD Service Coordinator Online Learning Tool
The HUD's Office of Multifamily Housing Programs has announced 

that the Service Coordinators in Multifamily Housing Online Learning Tool and a companion resource guide, HUD's Service Coordinators in Multifamily Housing Program Resource Guide are now available on HUD Exchange.

The Service Coordinators in Multifamily Housing Online Learning Tool is a self-paced, self-directed training provides guidance on how to run an effective service coordination program. It is designed for service coordinators who are new to the program as well as experienced practitioners who want to refresh their skills. The tool includes up-to-date information on program standards for the Service Coordinators in Multifamily Housing; video interviews with practitioners highlighting best practices; and short quizzes to test your knowledge. This training is not required, but is highly recommended by HUD. Service coordinators who complete the training will receive credit towards ongoing training requirements.

The companion resource guide, HUD's Service Coordinators in Multifamily Housing Program Resource Guide, expands on the Online Learning Tool to provide additional detail about all aspects of the program. The Resource Guide also provides an overview of what to expect during an on-site or remote review by HUD Regional or Satellite office staff.

An additional toolkit for HUD grantees and sub-recipients, the Multifamily Housing Finance and Grants Management Toolkit, provides supplemental guidance on fulfilling fiduciary grants management responsibilities.

All three resources are available on HUD Exchange. If you are new to trainings on HUD Exchange, visit the Getting Started page to learn more about how to take trainings and document completion for HUD.

Home Health Proposed Rule
LeadingAge has posted an article highlighting aspects of the home health CY 2019 proposed rule. They encourage you to share any comments, concerns, and/or questions with them for incorporation into LeadingAge's public comments. Your voices are crucial feedback for CMS as they consider the implementation of the Patient Driven Groupings Model for CY 2020. Please submit your comments to Aaron Tripp, Director, Long-Term Care Policy & Analytics, at [email protected].

CT Money Follows the Person Quarterly Report
The Quarter 2 2018: April 1, 2018 - June 30, 2018 MFP report has been released by the UConn Health Center on Aging and is attached to this newsletter. The report is based on the latest data available at the end of the quarter.

Medicaid Eligibility Backgrounder
The Office of Legislative Research has recently released a report on Medicaid Eligibility that we thought may be of interest.  This report describes Medicaid income eligibility requirements in Connecticut and discusses recent changes.  OLR Backgrounder: Medicaid Eligibility
 
Two Nursing Homes to Close
Bridgeport Manor in Bridgeport and Rosegarden Health and Rehabilitation Center in Waterbury, both under the same ownership and both of which filed for bankruptcy earlier this year, have filed notice with the state that they plan to close in September. As reported by the NH Biz, a U.S. bankruptcy court judge in New Haven ordered the closings in July, according to trustees appointed to oversee the nursing homes' finances during the Chapter 11 proceedings.

CT LTC-MAP Annual Exercises Scheduled
CT LTC-MAP Annual Exercises have been scheduled for the first week of October 2018.
Regional Disaster Exercises - All LTC-MAP members participate

10/1 Region 5, 12:00 PM - 3:45 PM
10/2 Region 3, 9:00 AM - 12:45 PM
10/3 Region 1, 9:00 AM - 12:45 PM
10/4 Region 2, 9:00 AM - 12:45 PM
10/5 Region 4, 9:00 AM - 12:45 PM

Updated New Haven Ascend Breakdown
Attached is the updated New Haven Ascend break-down which is effective August 6, 2018.  

SNF Medicare Rate Calculation Tools Available
LeadingAge has updated the Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) calculator and the Medicare Part B therapy rate calculator to help members assess and estimate the impact of final payment changes for FY 2019, which begins on Oct. 1, 2018. Additionally, the Medicare Part A SNF PPS and Medicare Part B therapy rate calculators for FY 2018 are available. Access to these tools requires login via My.LeadingAge.

2018 Legislative Summary, Webinar and Election Information
Legislative Summary
Great news! The Wiggin and Dana "Review of Key Legislation Related to Providers of Services to the Elderly" for the 2018 Legislative Session is completed and the document is attached for your use and information. We hope that you find this annual summary to be helpful to you and others in your organization.

Elections 2018
As you are aware, there is an election coming up in November and we can't stress enough how important it is for our non-profit members to understand the Internal Revenue Service rules on permissible political activity for nonprofits. The LeadingAge publication, Guiding Principles for Nonprofit Providers, was published just for this purpose and should be extremely helpful to you and your organization.  In addition, if you should have any questions or concerns in this area, please do not hesitate to contact us.
We do want to be sure that you are able to access the complete list of candidates if needed, and a good resource for that and other election information is the Secretary of the State's website which can be found at this link.
 
Text-to-911
Text-to-911 capability has been launched in Connecticut. This new Emergency Telecommunications System allows people to text their emergency situations to 9-1-1 if they are unable to place a voice call for any reason. This technology will work from any handheld device that allows texting, and is intended to provide equal access of emergency communications to Connecticut residents who are Deaf, Hard of Hearing, or may have another disability that affects speech. It is also intended for situations that would be unsafe to make a phone call, such as in an active shooter or domestic violence situation. For further information, go to www.Text911CT.org.

LeadingAge Connecticut Members Accepted As 2019 National Leadership Academy Fellows
We are delighted to announce that the following three individuals from Connecticut have been accepted as fellows to the 2019 LeadingAge National Leadership Academy:
Katy Bannister, LiveWell
Edward Dooling, Masonicare
Michelle Pandolfi, Whitney Center

 

June 2018

Anti-Ageism Quick Guide
LeadingAge national has released a new Anti-Ageism Quick Guide to share with staff, members, business partners and other members of your networks. The guide is designed to help organizations and individuals to become more mindful of the language and messaging we use around aging. It offers very practical guidance which we hope you all will find useful as we continue this very important work.

CMS Makes Corrections to SNF Patient-Driven Payment Model (PDPM) Tools
In order to address a few typographical and usability issues, CMS has posted revised versions of the tools for the SNF PDPM. Stakeholders should use these revised SNF PDPM files (Version 2) to inform their comments on the proposed rule. Link to CMS SNF PPS Payment Model Research webpage

State Housing Schedule of Competitive Funding Rounds
Just a reminder that The Department of Housing (DOH) and the Connecticut Housing Finance Authority (CHFA) have published the schedule for competitive housing funding rounds for state fiscal year 2018. The linked chart below provides an overview of these funding opportunities. Additional detail regarding releases of notices of funding availability (NOFAs) can also be found onthis page.  Link to the state housing funding schedule
 
OLR Report on Public Acts Affecting Seniors
Linked below is a new report from the Office of Legislative Research regarding legislation passed this past session having to do with Seniors. Acts Affecting Seniors

Special Notice from DSS Regarding Restored Funding for all Three Tiers of the Medicare Savings Programs (QMB, SLMB, ALMB)
The Department of Social Services (DSS) has issued a notice to inform providers that the funding for the Medicare Saving Programs (MSP) has been restored. This means the reduction in program income limits that DSS expected to start on July 1, 2018 will not happen. The DSS will continue to use the same rules to determine eligibility for the MSP programs. Individuals who are on the program will remain on the Medicare Savings Program, unless they have had a change, such as an increase in income. If you have any questions about this DSS notice please contact [email protected] or Laura Catarino at [email protected].
 
DPH Blast Faxes
Please find attached the following two documents sent out be DPH last week:

Blast Fax 2018-25: Legionella Webinar

Blast Fax 2018-26: Sent on behalf of DPH's HAI Program regarding upcoming Train the Trainer Program

DSS Bulletins and Messages
Rescission of previous bulletin regarding Supervision of Licensed Master Social Workers View Message

TO: Acquired Brain Injury, CHC Access Agencies, CHC Service Providers, Community First Choice, Home Health Agencies and Personal Care Services regarding Reporting a Change in Client Condition Functionality Update (Posted 6/13/18)
View Message

TO: All Providers and Trading Partners regarding DXC PB18-34 Enhanced Secure Web Site Features for Password Resets, Locked Accounts, and Disabled Accounts
View Bulletin

TO: All Providers regarding Revised Provider Manual Chapters (Updated 6/14/18)
View Message


TO: Electronic Visit Verification (EVV) Service Providers regarding Mobile Visit Verification (MVV) App Update
View Message

 
TO: Home Health Agencies regarding Follow-up to the Face-to-Face Requirements for Initial Orders of Home Health Services
View Message

 
TO: All Providers regarding DXC PB18-31 Revised Medicaid (HUSKY) Spend-down Procedures View Bulletin

May 2018

Lobbying and Election Activity: Guiding Principles for Nonprofit Providers
As another election cycle approaches, many in the nonprofit community are concerned about what they can and cannot do under IRS guidelines with respect to political candidates and issues. The following article contains information to help keep you in compliance with the tax laws and out of trouble with the IRS. Link to article
 
New SNF ABN
LeadingAge Gold Partner, HealthPRO-Heritage, held an informative teleconference for our members to review the revisions to the Skilled Nursing Facility Notice of Non-coverage (SNF ABN) effective April 30 and which are addressed in this MLN article: MLN Article on SNF ABN.  Please find the following additional information provided by HealthPRO-Heritage as a follow-up to our call:
CMS Transmittal 4011, outlining the changes to this process
SNF ABN 2018 (CMS-10055) [DOCX, 27KB]
SNF ABN Instructions [DOCX, 33KB]


General Assembly Session Ends
The Connecticut General Assembly's 2018 Legislative Session ended yesterday at midnight after the adoption of a bipartisan budget agreement and the traditional last minute frantic passage of several bills. Governor Malloy was then invited in to give his final end of session address to both chambers.
 
The following is a brief report on the end of session results. Wiggin and Dana will be preparing a detailed report on the results of the session which will then be provided to all members. In the meantime, to access information or to view any of the bills mentioned in this report, you can go to the Connecticut General Assembly website at www.cga.ct.gov. If you have any questions, please feel free to contact us.
 
Bipartisan Budget Agreement Passed
Budget negotiations final got underway in earnest in the last few days of the session and on Wednesday afternoon, hours before the end of the session, the leadership of the House and Senate announced that a bipartisan budget agreement had been reached which would address the deficit and a limited number of other major items that both caucuses felt needed to be addressed. The agreement (Senate Bill 543) was then passed by both the Senate and the House and will be sent to the Governor for his signature. The agreement includes:
•    The restoration of the Medicare Savings Program eligibility which was cut in the original biennial budget passed in November. The program eligibility was previously restored for just the current fiscal year and now that restoration is extended.
•    In Section 69 of the bill there is a human services provider COLA of 1% that is intended for employees who provide state-administered human services. The interpretation of this section is that it is to go toward employee wages of the private providers who contract with the state for services such as DDS group homes. We will seek clarification of this appropriation to determine whether other providers might be eligible for this funding.
•    There is no designated rate increase for Medicaid providers of aging services.
•    The bill does not restore funding for the assisted living demonstration program line item that was cut in the November biennium budget. We are hopeful that the administration will find the funding from other sources to fund this line item in the next fiscal year.
•    The funding proposed by the Governor to develop a new acuity-based nursing home rates system is not included in this agreement.

Links to the bipartisan budget documents:

SB 543, An Act Concerning Revisions to the State Budget for FY 19 and Deficiency Appropriations for FY 18

Fiscal Note

OFA Bill Analysis

Governor Signs Budget Bill
Governor Malloy has signed into law the budget fix passed on the last day of the regular legislative session. The bill is  SB 543, An Act Concerning Revisions to the State Budget for FY 2019 and Deficiency Appropriations for FY 2018 and the links to the bill analysis and fiscal note are below for your review. 

Bill Analysis for SB-543

Fiscal Note for SB-543

Although Governor Malloy signed this bill, he wrote a letter to the members of the General Assembly regarding its content. Governor's letter


Legislature Approved Home Care Workers Agreement and State-Contracted Human Services Providers
The Connecticut General Assembly approved with bipartisan support a new negotiated contract for unionized personal care attendants (PCAs), which raises wages and adds workers' compensation for thousands of PCA workers across the state. These are the PCA workers who are directly employed by Medicaid recipients and who were unionized by SEIU 1199 several years ago through the Governor's executive order. The contract will raise these unionized PCA wages from $13.25 an hour to $16.25 an hour over time.
 
These wages will certainly impact the workforce market place and therefore we joined with other advocacy groups in asking for Medicaid rate increases for all home and community based providers to help these providers keep pace with both the private personal care assistant contracted wages and the increased wages for DDS group home employees anticipated as a result of the newly passed legislation (House Bill 5460 An Act Concerning Minimum Employee Wages for Providers of State-Contracted Human Services) increasing the DDS private provider contracts which was passed to avoid a threatened strike. While we were unsuccessful in achieving the across the board rate increase, we will continue this battle into the next session.

Major Public Acts of the 2018 Legislative Session
The Office of Legislative Research (OLR) with the assistance of the Office of Fiscal Analysis (OFA), have prepared the following summary which briefly describe the most significant, far-reaching, and publicly debated acts adopted by the General Assembly in its 2018 regular session.  https://www.cga.ct.gov/2018/rpt/pdf/2018-R-0121.pdf

New State LTC Ombudsman Named
Mairead Painter has been named the State's LTC Ombudsman, stepping into the office formerly held by Nancy Schaffer who retired from state service earlier this year. Ms. Painter should be familiar to many of you as she served as a regional ombudsman for seven years before taking a position as Program Manager within the Money Follows the Person Strategic Planning Unit of DSS. As an MFP Program Manager, she was responsible for overseeing several initiatives including nursing home diversification grants and monitoring nursing home bankruptcies, receiverships and closures. We send our congratulations to Ms. Painter and look forward to working with her!

ROI Calculator for Community-Based Organizations that May Be of Interest
The Commonwealth Fund has launched an updated return on investment (ROI) calculator to help health systems/community-based organization partnerships evaluate various payment arrangements and terms.  This calculator is designed to assist community-based organizations and their medical partners in creating mutually advantageous financial arrangements for funding the delivery of social services to high-need, high-cost (HNHC) populations. These populations, which account for a disproportionately large share of health care expenditures, often have clinically complex conditions, cognitive or physical limitations, and/or behavioral health problems. These complex care populations are likely to benefit most from a holistic model of care that addresses the social determinants of health.    

NEMT: Where's My Ride?
Return rides continue to be a problem for many members utilizing the NEMT system for residents and clients. If you are requesting a return ride using the will call process, the transportation provider has one hour to to provide the return ride. If the provider does not arrive within the hour after you call, you can contact Veyo directly (1-855-478-7350) and use either the "Where's my ride?" prompt or the facility prompt, explain the situation and ask them to escalate your request for a return ride.

DSS Bulletin on Information Required When Scheduling NEMT
Please find the following link to a DSS bulletin regarding Information Required When Contacting the Transportation Broker to Schedule Non-Emergency Medical Transportation. View Message

DSS Provider Bulletins and Messages
To: Providers Participating in the EHR Incentive Program regarding 2018 Information Sessions
View Message

 
To: Home Health Agencies, CHC Access Agencies, CHC Service Providers, Acquired Brain Injury, Autism Waiver Providers and Personal Care Services regarding DXC PB18-27 New Proc/Mod List Codes for Nursing Management and Evaluation of the Plan of Care under the Autism, Acquired Brain Injury (ABI), Connecticut Home Care (CHC) and Personal Care Assistance (PCA) Waiver Programs
View Bulletin

Attention: Acquired Brain Injury (ABI), Connecticut Home Care (CHC) Service Providers, Access and Case Management Agencies and Personal Care Assistance (PCA) regarding Service Authorization Changes and Reminders (Posted 5/8/18)
View Message

DXC PB18-29 Expedited Medicaid Eligibility Processing for Individuals with Medical Emergencies View Bulletin
 
To: Acquired Brain Injury (ABI), CHC Access Agencies, CHC PCA Fidicuaries, CHC Service Providers, Community First Choice, Home Health Agencies and Personal Care Services regarding Electronic Visit Verification Implementation Important Message
View Message

New Bridgeport Ascend Worker Assignment List
Please find attached the new DSS Ascend Worker Assignment List for the Bridgeport office.

Cybersecurity Action Plan for Connecticut Announced
Governor Malloy last week released a Cybersecurity Action Plan for Connecticut and called for enhanced cybersecurity defense and resilience to meet the increasing array of cyber risks facing the state. The Cybersecurity Action Plan follows the release of the state's Cybersecurity Strategy last summer and the separate critical infrastructure plan launched in April 2016.

Link to the Connecticut's Cybersecurity Action Plan

March 2018

News from Capitol Hill

Last week several members of LeadingAge Connecticut attended the national LeadingAge PEAK Conference in Washington D.C. which was scheduled to end on Wednesday with the attendees storming Capitol Hill to advocate for aging services and senior housing. Instead a storm hit the district on Wednesday and Washington D.C. was closed! But that did not dissuade six hearty Connecticut members and staff from hiking up to the Hill in the snow to visit our federal delegation where we presented them with our 2017 Legislator of the Year Awards and advocated on behalf of aging services and affordable housing. Soon after our visits to the Hill, Congress passed the omnibus 2018 spending bill which the President later signed. LeadingAge has applauded the bill and you can read about the details using the following
links:

LeadingAge Applauds Omnibus 2018 Spending Bill

New HUD Funding, RAD for PRAC in Omnibus Spending Bill

LeadingAge Lauds Congress' Support for the Expansion and Preservation of Affordable Housing for Low-Income Older Adults


State Legislature Approves Home Care Workers Agreement
The Connecticut General Assembly has approved with bipartisan support the amended contract for unionized personal care attendants(PCAs), which raises wages and adds workers' compensation for thousands of PCA workers across the state. These are the PCA workers who are directly employed by Medicaid recipients and who were unionized several years ago through the Governor's executive order. The contract will raise these unionized PCA wages from $13.25 an hour to $16.25 an hour.
 
The Governor released a statement saying, "These professionals work around the clock to provide lifesaving, critical care for thousands of elderly residents and people who have disabilities - and they do it in homes, which ultimately is better for both patients and for taxpayers. And the agreement also provides a more stable workforce for the nearly 5,000 consumer employers who receive these services. These workers deserve a livable wage and to finally be covered for workers' compensation - and the agreement approved today with bipartisan legislative support does just that."

NEMT Transition Update
The Department of Social Services is posting all updated documents related to the Medicaid Non-Emergency Medical Transportation on their NEMT website page.
 
Seeking Reimbursement from Veyo for Self Help Rides
Nursing home providers and other providers who paid for transportation for residents, patients or clients in their care during the first two months of this year due to failures in the NEMT system are eligible to apply to Veyo for reimbursement for the costs incurred for that transportation. This is not a guarantee of reimbursement, but LeadingAge Connecticut has been informed by Veyo that they will review and consider all claims submitted for potential reimbursement. For more information on how to apply for reimbursement, please  the attached document.  
 
2030 Scenarios for Aging Services Providers
Is your community ready for the future?
In partnership with the Institute for Alternative Futures, LeadingAge has developed the 2030 Aging Services Scenarios to explore the future need for and delivery of aging services in the context of challenging and visionary futures.   
 
Tap in to this member-only, comprehensive toolkit created to assist provider member organizations in conducting their own scenario planning workshop and considering implications the scenarios may have on their own strategies and plans for the future. www.LeadingAge.org/2030Scenarios

New Regulatory Tool from LeadingAge Keeps You in the Know
With regulatory initiatives and developments often taking center stage in members' quest for operational compliance, the ability to quickly learn the basics and have access to more in-depth information about regulatory initiatives and developments becomes critical. With those needs in mind, LeadingAge has launched an exciting suite of products designed to do just that for nursing home, HUD housing and home and community-based services (HCBS) providers.
The Regulatory Round Up is a suite of three products designed to provide LeadingAge members an exclusive, all-in-one resource for valuable information about federal regulatory initiatives and developments. Learn more.

Updated CMS FAQs on the Nursing Home RoPs
CMS has updated and published the Frequently Asked Questions Guide about nursing home regulations, the survey process, technical questions, and other related areas.  Both questions and scenarios are explained in detail using specific F Tag and guidance.  Newly added questions are in red.  Areas to review are Resident Rights, Freedom from Abuse, Neglect and Exploitation, Admission, Transfer and Discharge, Comprehensive Care Plans, Pharmacy Services, and Facility Entrance. Link to the new FAQs

Alzheimer's' Resource Center Has Become LiveWell
The Alzheimer's Resource Center of Connecticut has changed its name to LiveWell to better reflect their approach and commitment to expanding the possibilities for living well with dementia. This exciting name change was announced earlier this year and their new website, livewell.org, will be available soon.

LeadingAge Welcomes Masonicare at Chester Village
We are pleased to welcome Masonicare at Chester Village to the LeadingAge Connecticut membership! Formerly known as Chester Village West, this Life Plan Community is now a Masonicare senior living community. Please join us in welcoming the staff and residents of Masonicare at Chester Village!

DSS Eligibility Update - Redeterminations
We want to remind members that the re-determination deadlines are strictly enforced with the new ImpaCT system. As a rule of thumb, DSS must receive at least the re-determination form by the 26th of the month in which it is due. If the form is received after that date, the case may be discontinued. In addition, if additional documentation is then requested by DSS, there is a strict ten-day deadline to provide it to DSS.

Escalation Tool Change - Completed forms to be sent to Laura Catarino
Jessica Carroll has taken a new position within DSS and so now all escalation tools reporting appropriately completed re-determination cases when payment has ceased should be emailed to Laura Catarino at [email protected].

February 2018

Governor Malloy Releases Budget Proposal
February 6: In a somewhat surprising move, Governor Malloy publicly released his proposed adjustments to the two-year state budget yesterday. It was anticipated that he would release his proposal on Wednesday when he is to address the General Assembly to open the 2018 Regular Session, but instead he released it two days early.
 
The Governor is asking for a combination of reduced spending and increased revenue in an effort to close the current $244 million deficit. What follows is a condensed summary of the items of interest contained in his proposal. Each item will be scheduled for a public hearing before the Appropriations Committee in accordance with the date noted.  The Committee then will have until April 5th to report out their own document which may, or may not reflect, what the Governor has
proposed. February 6 Update on the Governor's State Budget Proposal

First Statewide Standard Hospice Training for Skilled Nursing Facilities
We are pleased to announce that our collaborative partner, the CT Association for Healthcare at Home, has launched Connecticut's first statewide standard Hospice training for Skilled Nursing Facilities.
 
The Association's Hospice and Palliative Care Committee created the curriculum along with a post-test which will meet both the federal and state regulations for mandated Hospice training for all new direct care staff in the Skilled Nursing Facility (SNF).
 
The benefit of this approach is the SNF staff only needs to receive this information and complete the post-test one time during orientation.  It does not need to be repeated by each hospice provider!
 
To implement this training, the SNF designee responsible for orientation should incorporate this training and post-test into every orientation of new direct care staff.  All instructions on implementation and guidance along with the training material can be found by accessing the following link: SNF Hospice Training Implementation Package

Should you have any questions or feedback, please contact your contracted hospice provider or Tracy Wodatch at [email protected] at the Association.

Nursing Home Rates Posted
The Nursing Home Rate Computation letters have been issued and the new rates are now posted on the DSS
website. Link to the nursing home rates

DSS Medicaid Provider Bulletins
DSS bulletin regarding Peer-to-Peer Review and Reevaluation for Medically Necessary Determinations- Licensure Requirements. View Bulletin
 
DSS bulletin regarding AS Modifier.  View Bulletin

DSS bulletin regarding Electronic Health Records (EHR) Incentive Program: Attesting to Objective 8 and 9 for Modified Stage 2.  View Message 

Additional Guidance on the Use of the Home Health SOC/ROC and Recertification Service Codes for CHC, ABI, PCA and Autism Waiver Clients View Message

To: All Providers regarding DXC PB18-06 Billing Clients for Missed Appointments- Reissue of PB15-05. View Bulletin

DSS Eligibility Processing Updates
LeadingAge Connecticut continues to work with DSS on the ongoing issues of eligibility and redetermination processing. DSS has informed us that recently several requests for assistance were sent to the inappropriate offices at DSS and in such cases, the nursing home was not able to receive the assistance they were requesting. As a result, DSS has requested that send out the following guidance to our nursing home members regarding who at DSS the nursing home should contact based on the situation they are encountering.
To ensure that you receive a response timely and efficiently please follow the DSS guidance outlined below:
1.    General questions about LTSS please call 1-855-626-6632 and ask to speak to a LTSS Benefits Agent. You will be transferred to eligibility staff trained in LTSS.
2.    Questions about pending applications please call the LTSS eligibility staff member who is assigned to work the application. If you cannot reach the eligibility staff member working the application please contact their supervisor.
3.    Questions/issues with admits, discharges and level of care please contact the appropriate ASCEND worker.
4.    Pay-start issues and W-9 questions please contact the appropriate staff member in the Convalescent Payment Unit.
5.    Cases that meet the criteria for placement on the escalation tool that DSS developed with LeadingAge CT and CAHCF should be sent to Jessica Carroll and Laura Catarino. (This tool was emailed out by LeadingAge Connecticut in October.)
6.    Suggestions and recommendations regarding LTSS processing should be sent to Mag Morelli at [email protected] 

Escalation Tool
DSS would like us to remind members that the eligibility escalation tool for redeterminations is only to be used when the following criteria is met:
•    All listed individuals are Medicaid recipients residing in a nursing home
•    The renewal and all proofs necessary to determine continued eligibility were submitted on time
•    The individual has received a discontinuance notice
•    The nursing facility has been denied room and board payment due to a lack of coverage.

Uploading documentation through MyAccount
DSS has received concerns from providers that the renewal and proofs were submitted online, but DSS did not receive them. DSS believes that this may be an issue of not completing the online submission process. They want to remind providers that:
•    When submitting documents online, you will receive a message that states, "The document was loaded successfully. Please note that documents are NOT submitted to DSS until you click 'SUBMIT' below."
•    Then they have to click the submit button to receive a message that states, "You have successfully submitted your uploaded documents." 

ASCEND Update
DSS has provided the attached ASCEND breakdown for the New Haven LTSS Office effective 2/21/2018.

Redetermination Deadlines
We want to remind members that the re-determination deadlines are strictly enforced with the new ImpaCT system. As a rule of thumb, DSS must receive at least the re-determination form by the 26th of the month in which it is due. If the form is received after that date, the case may be discontinued. In addition, if additional documentation is then requested by DSS, there is a strict ten day deadline to provide it to DSS.

Nursing Home Closure Listing
The list of Nursing Home Closures from 1995 to 2017 has been posted on the DSS website. List of Nursing Home Closures

NEMT Transition Update
A reminder of the helpful tips that Veyo has provided to us at recent meetings:
•    If the person will be waiting inside for the ride, you can ask when making the ride reservation that the transportation provider either call or come to the door to let the person know they have arrived. While this is not required of transportation providers, there are ones that will do this and Veyo claims they will schedule them for these rides.
•    When scheduling a return ride from a medical office, it is helpful to have the scheduler note the name of the physician/provider and the suite number of the office to assist the transportation provider.
•    If there is an issue such as a no show ride and you cannot resolve it with the call center, ask for the call to be escalated.

 

January 2018

Nursing Home Rate Letters
The Nursing Home Rate Computation letters are expected to be mailed out in early February. While the State of Connecticut will not be providing a nursing home rate increase this fiscal year, the Department of Social Services has rebased the nursing home rates as required by statute. The rate letters, therefore, will include a full rate compensation report. To preserve your right to appeal the rate, you must file an appeal letter within 10 days of the date on the rate letter. It is important to note that the 10 days run from the date on the rate letter, not the date of receipt, so extra care should be taken to ensure that you can act promptly once the letter arrives. If you should have any questions or concerns once you receive your letter, please do not hesitate to contact us at LeadingAge Connecticut.
 
We expect the following to be reflected in the rebased rate calculations:
The state will be implementing a stop-loss of no more than 2% for those facilities whose new calculated rate falls below their current paid rate.
The rebased rates should reflect the reinstatement of any fair rent component that was removed on January 1, 2017.
The rate computation will include any adjustment made as a result of the recent audit review of wage enhancement funding.

DSS Provider Bulletins
TO: Acquired Brain Injury, CHC Access Agencies, CHC PCA Fidicuaries, CHC Service Providers, Community First Choice, Home Health Agencies and Personal Care Services regarding Electronic Visit Verification Implementation View Message

Vicki Veltri Appointed to Lead State's Office of Health Strategy
Governor Malloy has appointed Victoria Veltri to serve as Executive Director of the state's Office of Health Strategy, a new state office created through the consolidation of several existing resources as part of the bipartisan state budget that was adopted in October. The office, which begins operations on February 1, will be responsible for implementing data-driven strategies that promote equal access to healthcare, improve the value of healthcare, contain costs, and ensure better healthcare systems for Connecticut residents. It combines resources and personnel from several existing state offices. By combining experts, data and goals, the new office, which resides within the Department of Public Health for administrative purposes, will provide integrated, comprehensive leadership to improve healthcare systems and health in Connecticut. Veltri currently serves as Chief Health Policy Advisor in the Office of Lt. Governor Nancy Wyman. Prior to that role, she served as Connecticut's Healthcare Advocate.

DSS Eligibility Processing Reminder
LeadingAge Connecticut continues to work with DSS on the ongoing issues of eligibility and redetermination processing. DSS has informed us that recently several requests for assistance were sent to the inappropriate offices at DSS and in such cases, the nursing home was not able to receive the assistance they were requesting. As a result, DSS has requested that send out the following guidance to our nursing home members regarding who at DSS the nursing home should contact based on the situation they are encountering.
To ensure that you receive a response timely and efficiently please follow the DSS guidance outlined below:
1.    General questions about LTSS please call 1-855-626-6632 and ask to speak to a LTSS Benefits Agent. You will be transferred to eligibility staff trained in LTSS.
2.    Questions about pending applications please call the LTSS eligibility staff member who is assigned to work the application. If you cannot reach the eligibility staff member working the application please contact their supervisor.
3.    Questions/issues with admits, discharges and level of care please contact the appropriate ASCEND worker.
4.    Pay-start issues and W-9 questions please contact the appropriate staff member in the Convalescent Payment Unit.
5.    Cases that meet the criteria for placement on the escalation tool that DSS developed with LeadingAge CT and CAHCF should be sent to Jessica Carroll and Laura Catarino. (This tool was emailed out by LeadingAge Connecticut in October.)
6.    Suggestions and recommendations regarding LTSS processing should be sent to Mag Morelli at [email protected].

NEMT Transition Update
Veyo announces Clinical Coordinators to be contacted with NEMT problems:
Arrika Denbin, [email protected] for dialysis centers
Jamie Gallion, [email protected] for facilities including hospitals, nursing homes and home health care agencies

2018 Compensation and Benefits Survey is Open
LeadingAge Connecticut's 2018 Compensation and Benefits Survey is now open for participation!  This year's survey applies to hourly staff and senior executive management positions.  To participate, please visit the homepage of our website www.leadingagect.org to access the survey link.   New for 2018 - we are pleased to announce that salary survey results will be provided free of charge to all provider members who complete the survey in its entirety.  We encourage all provider member organizations to take advantage of this enhanced member benefit. Surveys must be completed by February 28, 2018.     Non-participating provider members are still eligible to purchase the survey results for $400.00.   Please contact Beth Ricker at [email protected] or (203) 678-4477 with any questions.

Recent DPH Blast Faxes
The Department of Public Health has sent out two recent blast faxes that are attached to this email:
Blast Fax 2018-02 Reminding Nursing Homes of their Workplace Violence Incident Report Obligation
Blast Fax 2018-04 Regarding the Reportable Events Requirements
If you are not receiving the blast faxes directly from the Department, please let us know.
 
Alzheimer's Association Launches Comprehensive Dementia Care Practice Recommendations
Last week the Alzheimer's Association released new dementia care practice recommendations aimed at helping nursing homes, assisted-living facilities and other long-term care and community care providers deliver optimal quality, person-centered care for those living with Alzheimer's and other dementias. The recommendations are  posted online and will be published as a supplement to the February issue of The Gerontologist.

Announcing Our 2018 Partners
LeadingAge Connecticut is pleased to announce our 2018 Partners and we look forward to a productive year of working together in support of our membership.

2018 Platinum Partners
BlumShapiro, C.E. Floyd Company, Inc., Insurance Provider Group/The Schuster Group, ProCare LTC Pharmacy of Connecticut, Value First and Ziegler

2018 Gold Partners

Amenta Emma Architects, HealthPRO Heritage, IT Direct, KBE Building Corporation, M&T Bank, Mobilex/US Laboratories, OneDigital, Unidine and Wiggin and Dana 

Emerging Leader Partners

CliftonLarsonAllen, MatrixCare and Symbria


LeadingAge Connecticut Launches New Career Center Site
LeadingAge Connecticut is proud to announce the launch of our new Career Center!  We've been working hard on many website improvements and today we are excited to announce the release of this new job posting site.  By partnering with Web Scribble, a leading provider of job board platforms, we are pleased to offer this powerful resource to your organization.   You will be able to access this targeted and qualified pool of talent by advertising your jobs on our Career Center. Post your jobs at careercenter.leadingagect.org.   The Career Center can also be easily accessed from the homepage of the LeadingAge Connecticut website www.leadingagect.org.  Please select the Career Center tab on the right side of the navigation bar.

CMS Announces Initiative to Address Improper Facility-Initiated Discharges
CMS, in a Survey and Certification Letter dated Dec. 22, 2017 and posted on Dec. 26, 2017, announced an initiative designed to examine and mitigate facility-initiated discharges that violate federal regulations. CMS noted in the Letter that "discharge/eviction" was the most frequent nursing facility complaint category logged by Long-Term Care Ombudsman programs nationally in FY2015.  CMS stated that the reasons for non-compliant discharges can vary, but often are driven by payment concerns and behavioral/mental/emotional expressions or indications of resident distress. The changes announced in the Letter took effect immediately. S&C 18-08-NH
 
OLR Issue Brief on Medicaid
Linked below please find a new Issue Brief by the Office of Legislative Research on Medicaid that we thought may be of interest. Issue Brief: Medicaid 101


Update from DSS and DRS on Pension Withholding Requirements
We are pleased to inform you that the Department of Social Services (DSS) worked jointly with the Department of Revenue Services (DRS) to draft an important clarification regarding the new law that went into effect January 1, 2018 requiring payers of taxable pensions and annuities that maintain an office or transact business in Connecticut to withhold Connecticut income tax from distributions to Connecticut residents. The communication states that individuals active on Connecticut Medicaid and residing in a nursing home or receiving home and community based waiver services are not required to have CT income tax withheld from their pensions and annuities. They must, however, complete and submit the necessary form CT-W4P. Information regarding all of this is included in the attached communication. DSS has asked that all questions about the attached communication be directed to DRS at 800-382-9463 or 860-297-5962.

New S&C Memo
On December 28th, the Centers for Medicare and Medicaid Services(CMS), posted Survey and Certification (S&C) Memo 18-10-ALL that clarifies the position of CMS as it relates to texting. Information in the new memo includes:
•    Texting patient information among members of the health are team is permissible if accomplished through a secure platform.
•    Texting of patient orders is prohibited regardless of the platform utilized.
•    Computerized Provider Order Entry(CPOE) is the preferred method of order entry.

 

December 2017

New NEMT Contractor Reminder
Effective January 1, Veyo , a Total Transit company, is the Non-Emergency Medical Transportation (NEMT) contractor for the State of Connecticut and will be responsible for arranging transportation for HUSKY Health members. Their website is up and running and they are now taking reservations for transportation to healthcare appointments. When you access their website, click on the purple Facilities tab on the top to access information on how to arrange for rides for your residents. There is also a guide for facilities that can be accessed through the website. Please note that there is information provided as to how to request the appropriate level of transportation vehicle and a Companion Request Form to communicate to Veyo that the member needs to travel with a companion or attendant due to a physical, mental, or intellectual medical condition.

DSS Provider Bulletin regarding the new NEMT contractor 

Bulletin DXC PB17-94 Regarding Prior Authorization for all Non-Emergency Medical Transportation (NEMT) 

Veyo is replacing Logisticare and the new contract is an attempt to improve upon the NEMT services. Please let us know if there are questions or concerns that you may have with this new vendor so that we can work with DSS to continuously improve the services.

New OLR Report: Nursing Home Overview
Linked below please find a new report from the Office of Legislative Research which provides an overview of the nursing home industry in Connecticut. The report focuses on nursing home numbers including the amount of licensed nursing homes, recent closures, and the status of the moratorium. OLR Report on CT Nursing Homes

Addendum to the 2017 Legislative Summary
An addendum to the LeadingAge Connecticut 2017 Legislative Summary has been prepared providing members with a review of relevant legislation passed during the 2017 special session. The 2017 Review of Key Legislation Relating to Providers of Services to the Elderly and the addendum from the special session as prepared by Wiggin and Dana for LeadingAge Connecticut members can both be found on the LeadingAgeCT.org website. We hope that you will find these summaries of the new laws passed in the most recent state legislative regular and special sessions useful to you and your organization.

LeadingAge Silver Partner, CliftonLarsonAllen Releases Their 32nd Edition SNF Cost Comparison Report
CLA's 32nd Edition of the Skilled Nursing Facility Cost Comparison Report gathers financial data from the entire population of skilled nursing facilities (SNF) nationwide. This report, based on 2016 data, gathers financial and operational data from every SNF nationwide to help leaders make strategic decisions concerning solvency, cost efficiencies, and profitability. In addition to publishing their traditional report, this year, additional data is offered in a visual, interactive story format so you can compare nonprofit SNFs to proprietary SNFs. You can view the interactive web story and view the report here on the CLA website.
CLA is a LeadingAge Connecticut Emerging Leader Partner

LeadingAge Rate Calculators

SNF Medicare Rate Calculation Tools Update

Rate Calculator: Home Health Medicare Rates for CY 2018

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.  Remember this is a member only section and you may locate the resources by the Nursing Home Tools and Resources tabs on the site.  

Nursing Home Rate Rebasing Reminder
While the State of Connecticut will not be providing a nursing home rate increase this year, the Department of Social Services will be rebasing the nursing home rates as required by statute. We expect that the Department will be sending out the full rate compensation reports shortly.

We want to remind you that if you would like to preserve your right to appeal the rate, you must file an appeal letter within 10 days of the date on the rate letter. 

LeadingAge Connecticut Board Sets Advocacy Goals
The LeadingAge Connecticut Board of Directors has accepted the recommendation of the Legislative Committee by adopting a legislative agenda that maintains the association's current guiding public policy principle and goals, while pledging to lead the future of aging services, defend against harmful legislation and work with like-minded organizations.
 
Current Guiding Public Policy Principle
LeadingAge Connecticut supports the current systems change occurring in long term services and will work to create the opportunity and environment for individual providers to find solutions.
 
This policy position is based on the goals of:
•    Strengthening and investing in our entire system of long term services and supports.
•    Establishing a collaborative and efficient regulatory and reimbursement environment that is adaptive and receptive to forward thinking ideas and planning.
•    Encouraging and enabling providers of long term services and supports to adjust, modernize and diversify their models of care to meet current and future consumer needs and expectations.

Douglas Manor Sale Announcement
It was recently announced that while two of the Affinity Healthcare nursing homes in state receivership will close, it is the intent of the state to sell Douglas Manor of Windham. The following is the link to the notice of public sale. The two homes that will be closing are Blair Manor in Enfield and Ellis Manor in Hartford.

Resource Guide for Helping Evacuees from Puerto Rico and the US Virgin Islands
The Governor recently announced that in collaboration with Connecticut United Way 211 and the Department of Emergency Services and Public Protection (DESPP), the state has released a resource guide in both English and Spanish that provides detailed information on programs and services available in Connecticut that can help those arriving from Puerto Rico and the U.S. Virgin Islands.  The guide can be downloaded online by visiting uwc.211ct.org/maria.


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: CMS Emergency Information

DSS Stakeholder Meeting on the State's LTSS Rebalancing Strategic Plan
LeadingAge Connecticut staff and membership were well represented at last week's stakeholder meeting to provide input into the state's LTSS rebalancing strategic plan update. The state has received the last installment of federal funding to maintain the Money Follows the Person (MFP) operations until 2020 and they are updating the LTSS rebalancing plan accordingly. Linked below is a report from the Office of Legislative Research on the MFP program that may be of interest, as well as the latest quarterly MFP outcomes report.

Money Follows the Person OLR Report

Quarterly MFP Report


Nursing Home Regulatory Update
The second phase of the new Rules of Participation for nursing homes went into effect on November 28. Part of that second phase is a new nursing home survey process which also began last week. As a  follow up to the first week of the new survey enforcement, DPH issued three blast faxes for all nursing homes. The DPH issued three blast faxes for all nursing homes. The DPH Blast Faxes can be found here:

Blast Fax 17-35

Blast Fax 17-36

Blast Fax 17-36a

Just a reminder, LeadingAge has many RoP tools available to the membership at LeadingAge.org.

Ombudsman Guidance
Earlier this week the LTC Ombudsman issued an updated memo containing guidance on the federal rule as it relates to the requirement to provide the Ombudsman with the notice of involuntary transfer and discharge notices to residents/representatives. The memo also outlines the procedure for forwarding the notice to the Ombudsman. The  Ombudsman's notice can be found here

November 2017

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:

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

State Budget Update
The State Legislature has now passed SB 1503, An Act Making Minor and Technical Changes to the State Budget and Related Implementing Provisions for the Biennium Ending June 30, 2019, which makes the necessary modifications to the hospital tax provisions vetoed by the Governor in the previously passed budget. The bill also pushes out, from the 2018 tax year to the 2019 tax year, the start of the increase in the maximum income filers may have to qualify for the 100% income tax exemption for Social Security benefits.  Unfortunately, the budget that the Governor signed on October 31 is already showing a deficit and so he made $182 million in new budget cuts on Friday in order to balance it. The Governor's cuts include $91 million to municipalities and $55 million for program costs.
The summary of what is included in both bills can be found here here.

CMS Rule on Emergency Preparedness Now in Effect
The CMS rule on Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers is now in effect and we have been told that in Connecticut, nursing home compliance will be part of the life safety code survey. LeadingAge national has an entire suite of resources, including toolkits, resources, and templates available by clicking here.

 

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


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.

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


How to Create Age- and Dementia-Friendly Communities

Workforce Center is Open for Business

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 [email protected] 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.

June 2017

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.

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.

Governor Malloy Releases Budget Proposal

February 6: In a somewhat surprising move, Governor Malloy publicly released his proposed adjustments to the two-year state budget yesterday. It was anticipated that he would release his proposal on Wednesday when he is to address the General Assembly to open the 2018 Regular Session, but instead he released it two days early.

 

The Governor is asking for a combination of reduced spending and increased revenue in an effort to close the current $244 million deficit. What follows is a condensed summary of the items of interest contained in his proposal. Each item will be scheduled for a public hearing before the Appropriations Committee in accordance with the date noted.  The Committee then will have until April 5th to report out their own document which may, or may not reflect, what the Governor has proposed. February 6 Update on the Governor's State Budget Proposal

 

First Statewide Standard Hospice Training for Skilled Nursing Facilities

We are pleased to announce that our collaborative partner, the CT Association for Healthcare at Home, has launched Connecticut's first statewide standard Hospice training for Skilled Nursing Facilities. 

 

The Association's Hospice and Palliative Care Committee created the curriculum along with a post-test which will meet both the federal and state regulations for mandated Hospice training for all new direct care staff in the Skilled Nursing Facility (SNF). 

 

The benefit of this approach is the SNF staff only needs to receive this information and complete the post-test one time during orientation.  It does not need to be repeated by each hospice provider!

 

To implement this training, the SNF designee responsible for orientation should incorporate this training and post-test into every orientation of new direct care staff.  All instructions on implementation and guidance along with the training material can be found by accessing the following link: SNF Hospice Training Implementation Package

 

Should you have any questions or feedback, please contact your contracted hospice provider or Tracy Wodatch at [email protected] at the Association. 

 

Nursing Home Rates Posted

The Nursing Home Rate Computation letters have been issued and the new rates are now posted on the DSS website. 

Link to the nursing home rates

 

DSS Medicaid Provider Bulletins

DSS bulletin regarding Peer-to-Peer Review and Reevaluation for Medically Necessary Determinations- Licensure Requirements.
View Bulletin

 

DSS bulletin regarding AS Modifier. 
View Bulletin

 

DSS bulletin regarding Electronic Health Records (EHR) Incentive Program: Attesting to Objective 8 and 9 for Modified Stage 2. 
View Message

  

Additional Guidance on the Use of the Home Health SOC/ROC and Recertification Service Codes for CHC, ABI, PCA and Autism Waiver Clients
View Message

 

To: All Providers regarding DXC PB18-06 Billing Clients for Missed Appointments- Reissue of PB15-05.

View Bulletin

 

DSS Eligibility Processing Updates

LeadingAge Connecticut continues to work with DSS on the ongoing issues of eligibility and redetermination processing. DSS has informed us that recently several requests for assistance were sent to the inappropriate offices at DSS and in such cases, the nursing home was not able to receive the assistance they were requesting. As a result, DSS has requested that send out the following guidance to our nursing home members regarding who at DSS the nursing home should contact based on the situation they are encountering.

To ensure that you receive a response timely and efficiently please follow the DSS guidance outlined below:

  1. General questions about LTSS please call 1-855-626-6632 and ask to speak to a LTSS Benefits Agent. You will be transferred to eligibility staff trained in LTSS.
  2. Questions about pending applications please call the LTSS eligibility staff member who is assigned to work the application. If you cannot reach the eligibility staff member working the application please contact their supervisor.
  3. Questions/issues with admits, discharges and level of care please contact the appropriate ASCEND worker.
  4. Pay-start issues and W-9 questions please contact the appropriate staff member in the Convalescent Payment Unit.
  5. Cases that meet the criteria for placement on the escalation tool that DSS developed with LeadingAge CT and CAHCF should be sent to Jessica Carroll and Laura Catarino. (This tool was emailed out by LeadingAge Connecticut in October.)
  6. Suggestions and recommendations regarding LTSS processing should be sent to Mag Morelli at [email protected].  

 

Escalation Tool

DSS would like us to remind members that the eligibility escalation tool for redeterminations is only to be used when the following criteria is met:

  • All listed individuals are Medicaid recipients residing in a nursing home
  • The renewal and all proofs necessary to determine continued eligibility were submitted on time
  • The individual has received a discontinuance notice
  • The nursing facility has been denied room and board payment due to a lack of coverage.

 

Uploading documentation through MyAccount

DSS has received concerns from providers that the renewal and proofs were submitted online, but DSS did not receive them. DSS believes that this may be an issue of not completing the online submission process. They want to remind providers that:

  • When submitting documents online, you will receive a message that states, "The document was loaded successfully. Please note that documents are NOT submitted to DSS until you click 'SUBMIT' below."
  • Then they have to click the submit button to receive a message that states, "You have successfully submitted your uploaded documents."  

 

ASCEND Update

DSS has provided the attached ASCEND breakdown for the New Haven LTSS Office effective 2/21/2018. 

 

Redetermination Deadlines

We want to remind members that the re-determination deadlines are strictly enforced with the new ImpaCT system. As a rule of thumb, DSS must receive at least the re-determination form by the 26th of the month in which it is due. If the form is received after that date, the case may be discontinued. In addition, if additional documentation is then requested by DSS, there is a strict ten day deadline to provide it to DSS. 

 

Nursing Home Closure Listing

The list of Nursing Home Closures from 1995 to 2017 has been posted on the DSS website. List of Nursing Home Closures

 

NEMT Transition Update

A reminder of the helpful tips that Veyo has provided to us at recent meetings:

  • If the person will be waiting inside for the ride, you can ask when making the ride reservation that the transportation provider either call or come to the door to let the person know they have arrived. While this is not required of transportation providers, there are ones that will do this and Veyo claims they will schedule them for these rides. 
  • When scheduling a return ride from a medical office, it is helpful to have the scheduler note the name of the physician/provider and the suite number of the office to assist the transportation provider. 
  • If there is an issue such as a no show ride and you cannot resolve it with the call center, ask for the call to be escalated.