CMS Posts Specifics For Five Star Rating System For LTC

Under a new payroll system scheduled to become mandatory in July 2016, CMS has posted technical specifications to show long-term care facilities how to electronically submit staffing information based on payroll data. Long-term care facilities will now be able to voluntarily submit data beginning in October 2015. The new Payroll-Based Journal (PBJ) system will be posted on the CMS Nursing Home Compare website and used in the Nursing Home Five Start Quality Rating System to help consumers understand the level and differences of staffing in long-term care facilities.

Click here for more information from CMS.

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Senior Housing Prices Soared In 2014

In 2014, average per-unit prices in the assisted living market increased by 25 percent. Assisted living average unit prices hit a record $188,700 per unit and average per bed prices for nursing homes jumped 4 percent to $75,500, setting records in the industry for the second straight year. The average price for independent living communities also set a new record of $246,800 per unit, 28 percent higher than in 2013. The new prices came in a year that also saw record levels of mergers and acquisitions. In 2014, close to 300 mergers and acquisitions, representing approximately $26 billion, were announced in the senior housing market. As prices increased, cap rates, or the ratio of net operating income to property asset value, plunged last year, providing more cash flow for investments. Rates for assisted living and nursing homes also decreased.

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CMS Expected To Change Five Star Rating System For LTC Facilities

According to industry sources, CMS is expected to unveil major changes to Nursing Home Compare today that could cause long-term facilities to lose rating stars. Sources believe CMS is changing the overall cut-off points related to achieving certain star levels. 15% of facilities could lose one or two stars virtually overnight if 11 new quality measures go into effect under the new system. So far, CMS has declined to comment. There is a Skilled Nursing Open Door Forum, where the matter is expected to be discussed, starting at 2 p.m. ET today.

In addition to the changes in the ratings system, CMS will add measures for short-stay and long-stay antipsychotic use to the ratings matrix. CMS Chief Medical Officer Patrick Conway, M.D., confirmed last year that the Five Star system would start including antipsychotics measures in 2015.

Click here to see the agenda with the call-in information.

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Nearly 20% Drop In Antipsychotic Use In LTC Facilities

The National Partnership to Improve Dementia Care in Nursing Homes, a public-private coalition under the guidance of CMS, has recently released findings showing a nearly 20% three-year decline in antipsychotic use.  Leaders at the American Health Care Association (AHCA) say they plan to keep the momentum going to further curb antipsychotic use in nursing homes. According to CMS data, 19.2% of nursing home residents were receiving an antipsychotic medication in the third quarter of 2014 – down from 23.9% in the fourth quarter of 2011. The AHCA’s goal is to further reduce off-label use by another 10% this year and 5% more by the end of 2016. The decline in antipsychotic use is evidence of the success of the Quality Initiative the AHCA embarked on three years ago. The coalition was originally “developed to improve dementia care through the use of individualized, comprehensive care approaches” and seeks to “promote a systematic process to evaluate each person and identify approaches that are most likely benefit that individual.”

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Flu Rampaging In LTC Facilities Nationwide

Long-term care facilities across the country are being hit hard by the seasonal flu, partly due to a problem with this year’s vaccine. This year, the main virus strain is H3N2, which is especially dangerous for older adults. During the first week of January, people 65 and older were hospitalized at a rate of 91.6 per 100,000, according to the CDC. Additionally, as opposed to the flu vaccine’s effectiveness at 60% during good years, this year’s vaccine is only 23% effective at warding off the flu. Researchers say the dominant virus strain is “drifted,” meaning that it underwent genetic changes and is therefore resistant to the vaccine that was developed in the spring. Because the flu does not peak at the same time every year, it is possible that this season will improve going forward, but it could also worsen. The CDC urges all Americans to get vaccinated and recommends that healthcare providers begin antiviral treatments promptly if the flu is suspected in people at high risk for complications or death.

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Special Notice About Medicaid Applications For Long-Term Services & Supports

We have recently been notified that effective January 5, 2015, three of the four Connecticut Long-Term Services and Supports (LTSS) Application Processing Centers will receive and process all new nursing home applications and the remaining Center will receive and process all new applications for Medicaid waivers for home and community based services. 

The Hartford office is the LTSS Application Processing Center designated to process only Medicaid waiver applications for home and community based services. The Bridgeport, New Haven and Waterbury offices are the LTSS Application Processing Centers that are designated to process applications for nursing facilities within the assigned towns and cities.

Application packets with the required documentation that is available at the time of submission should be mailed directly to the appropriate LTSS Application Processing Center. 

LTSS Applications should not be directed to the DSS ConneCT Scanning Center.

If you have any questions or concerns, please contact the DSS Benefits Center staff at 1-855-626-6632.

Report: More Than 65% Of Medicaid Is Now Managed Care

According to recently released report, Medicaid managed care may have reached a “tipping point” in 2014, as the number of managed care beneficiaries increased while fee-for-service enrollment dropped. The number of people on private managed care plans has increased by 9.3 million, while the number in traditional fee-for-service or public managed care plans decreased by 300,000. The growth can be attributed to two factors. The first is that states expanding Medicaid eligibility through the ACA are opting for private managed care for new populations. The second is that states are relying more on private plans to “better control costs and deliver services.” Typically, states achieve these cost controls by providing capitated payments to the private plans. Many long-term care providers have protested that managed care organizations may prioritize efficiency over quality care. They also believe many managed care organizations do not have the expertise in working with specialized beneficiary populations-like the ones utilizing long-term services and supports.

Click here to see the report.

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New Program Decreasing Antipsychotic Use In This Minnesota Nursing Home

Antipsychotic drugs, typically used to treat serious mental diseases, are prescribed to nearly 300,000 nursing home residents nationally. The FDA says the drugs can increase the risk of death for people with dementia. Although many nursing homes continue to use antipsychotic drugs to treat dementia, some nursing homes are finding alternative methods to treat residents. Doctors at a nursing home in Minnesota have been able to reduce the use of antipsychotics by 97 percent, far exceeding their initial goal of 20 percent. Doctors started seeing positive changes in residents as the use of antipsychotics dropped. Residents started interacting with each other and people who had not been speaking started speaking again.

How did they do this? A program called Awakenings. The program is designed to address what makes residents unhappy. The head of the Awakenings program says that everyone on the staff is trained to know and understand the residents’ likes, dislikes, and life stories. This way, any staff member can spot a problem behavior. Once the problem is identified, staff can works towards curbing it. Awakenings borrows elements from various techniques, including aromatherapy, white noise, pet therapy and validation. Experts say the key to the success of the program is relieving agitation that is common with people with dementia-something other nursing homes usually manage with antipsychotic drugs.

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New CMS Rule Allows Agency To Bar Providers From Medicare

Under a final rule released earlier this week, long term care providers that consistently submit improper claims could have their Medicare enrollment revoked. The rule states that CMS understands that Medicare has many rules and regulations which may sometimes result in claims being improperly submitted. However, CMS notes that “constant, repeated and systemic claims denials” could show that “a provider is not trying in good faith to understand and follow Medicare rules and should no longer be allowed to participate.”

This is the first time that CMS will have the ability to revoke Medicare certification based solely on repeated improper claims being submitted. CMS identified a number of factors that will be weighed before revocation, including the percentage of claims denied and how long the provider has been enrolled in Medicare. The rule also includes a number of other provisions to expand CMS’ ability to revoke Medicare enrollment. For example, if a manager has been convicted of certain felonies, or if an owner owes money to the Medicare program due to a former venture, the provider could lose Medicare certification.

Click here to access the document from CMS. Please note, it is scheduled to be published later today in the Federal Register and will take effect on February 3, 2015.

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LTC Liability Costs Anticipated To Increase 5% In 2015

According to a recent analysis, long term care providers should prepare for higher liability costs, which are expected to increase by 5% in 2015. In 2015, the projected loss rate is $2,030 per occupied bed, up from $1,940 this year. However, the report authors say that liability expenses may differ significantly from state to state. Kentucky, West Virginia and Florida are among the costliest states for providers due to their high liability costs, and Texas has one of the lowest liability costs of the states profiled in the report. The analysis is based on about 13,700 claims from 34 providers, representing 17% of long term care beds nationally.

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