HFAM Update – The Good, the Bad, and the Ugly
Friends:
First, thank you for all you are doing to provide quality care to Marylanders in need amid this challenging environment. The good (really the great) part of today’s update is that you are providing quality care, COVID cases are currently down, census is slowly growing, and the Medicaid rate will soon incrementally increase more than it has in years.
Also great is that 99 percent of skilled nursing and rehabilitation centers are reporting daily in the Maryland Department of Health (MDH) PROPS system. Also, vaccinations and first boosters are continuing to rise in our sector. In addition, our colleagues at MDH continue to work as a resource with organizations in our sector in terms of their NHSN reporting. I want to offer our special thanks to John Watson, Marty Griffin, Haymanot Nadew, and Alyss Langello at MDH for their ongoing partnership.
As we have shared before on the vaccination front, there will be increased pressure to administer second booster doses, as well as seasonal flu vaccination, in our sector as the year progresses. On March 29, the FDA and CDC expanded the eligibility for COVID-19 boosters to allow a second booster shot for everyone over 50 years old and for those who are immunocompromised. It is our hope that we will rally to get second boosters into the arms of people in our sector as clinically determined by medical professionals relative to the timing of first booster doses. Should you need help or guidance regarding vaccinations in the near term, please reach out to John Watson via email at john.watson@maryland.gov.
Three final “goods” before we get to “bad” and “ugly” (all three have to do with AHCA/NCAL):
- The AHCA CEO Summit which begins on April 26 is sold out, meaning our members are engaged!
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The AHCA Quality Summit beginning on May 16, is rapidly filling up! It will be a high quality and actionable event. I urge folks to sign up ASAP, CLICK HERE to register.
- AHCA/NCAL is pulling out all the stops and organizing to fight against possible Medicare cuts to our sector.
There is one harsh reality in terms of the “bad” we all face— we are not yet in a place where we can stop our fight against COVID or the seasonal flu. Nor can we assume that census will increase in an orderly way. The road ahead will include ups, downs, turns left, and turns right. Our sector is indispensable to families in need and to the healthcare continuum. However, our restoration will not occur in a straight line for all in our sector.
The “ugly” – we are still seeing historically high direct wages, benefits, staffing shortages and agency costs. We are also seeing the worst inflation in 40 years. And, we are all operating in a part of healthcare where we have no control over our revenue because the government sets Medicare and Medicaid reimbursement rates. Thank goodness that Maryland’s elected leaders included in the FY23 budget incremental increases to the Medicaid rate not seen in years. But, on the federal front we could face potential cuts to Medicare. With census still historically low, costs through the roof, and revenue in the cellar, this remains a challenging time to ensure access to quality care for Marylanders in need.
Of course, the GREAT news in all of this is that as members of AHCA/NCAL and HFAM – we are in this together and we are stronger together! Much of this situation is not in our control, but we do have a strong voice and expertise. We are powerful when we are unified, focused, and data-driven. What is in our control:
- Quality care.
- Workforce innovation.
- Sector-directed care delivery redesign.
- Strategic expansion of SNFs into home and community-based care and assisted living.
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Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers
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Reminder on AHCA Revenue Cycle Management Academy Training
AHCA offers a five-module online training program titled Revenue Cycle Management (RCM) Academy which offers training about a holistic interdisciplinary approach toward revenue management. RCM can be implemented in a building, more broadly or as an organization-wide approach to enhance revenue by minimizing losses from payments that too often are unnecessarily lost or overlooked. Individuals will need to login to ahcancalED with their AHCA/NCAL usernames and passwords to register for Revenue Cycle Management Academy. For assistance obtaining usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information.
As Always
- Focus on what is in your control and not what is out of your control.
- Let’s get those boosters and the flu vaccine in the arms of people.
- Overcommunicate – with residents, patients, families, staff, and government partners.
- Adapt and innovate.
- Rely on your partnerships.
- Speak up when you need help.
- Double efforts on infectious disease protocols, training, and operations.
- Take and document your action; keep a timeline.
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Joe DeMattos
President and CEO
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Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers
CMS has issued QSO-22-15-NH & NLTC & LSC, which provides an update to COVID-19 emergency declaration blanket waivers for specific providers.
CMS will end specified waivers in two groups:
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60 days from issuance of this memorandum - Monday, June 6, 2022
- Physical Environment
- Life Safety Code (LSC) and Health Care Facilities Code (HCFC) ITM
- Outside Windows and Doors
- Life Safety Code-Fire Drills & Temporary Construction
- Paid Feeding Assistants for LTC facilities
- In-Service Training for LTC facilities
- Training and Certification of Nurse Aides for SNF/NFs
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30 days from issuance of this memorandum - Saturday, May 7, 2022
- Resident Groups
- Physician Delegation of Tasks in SNFs
- Physician Visits
- Physician Visits in Skilled Nursing Facilities/Nursing Facilities
- Quality Assurance and Performance Improvement (QAPI)
- Detailed Information Sharing for Discharge Planning for Long-Term Care (LTC) Facilities
- Clinical Records
Please refer to the memo for specific details around each of the waiver categories.
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CMS Releases Revised Guidance on Vaccine Mandate IFR
The revisions were made to clarify the expectations for assessing compliance with the requirement to ensure all staff are vaccinated. AHCA/NCAL has highlighted key revisions, but providers are encouraged to review the Long-Term Care and Skilled Nursing Facility Attachment A-Revised, as well as the applicable memo listed above, for detailed changes.
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FY 2022 Q4 Supplemental Payment for Nursing Facilities
Please note that the final FY 2022 supplemental payment for nursing facilities will be included in this weekend's remittance. The quarterly payment will appear as a single lump sum by way of an adjustment (Adjustment Reason Code - N2).
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Diamond Medical Laboratories - COVID Testing and Staying Prepared
Moving forward, there may be ongoing PCR testing needed, especially this coming Fall with the potential for unknown “yet to come” variants. We all hope we find ourselves getting back to a level of normality, however it is incredibly important to be prepared. That said, please see the below information on Diamond Lab's COVID testing:
- The new rate for members would be $55 per test.
- Diamond Labs bills promptly for services, with no surprise billing. This enables clients to keep current and understand what their costs are for testing at their locations.
- Diamond also compliantly participates with Insurances that cover testing.
- The turn around time remains the same with in 24 hours of receiving the specimens in the lab (48 hours if the weekend is involved).
- For clients that are on Diamond Lab's clinical blood level services, results will be sent to the PCC / EMR platform, if they are integrated.
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CMS NEWS: Biden-Harris Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests
As of April 4, 2022, people with Medicare Part B, including those enrolled in a Medicare Advantage plan, will be able to go to eligible pharmacies and health care providers that are participating in this initiative to receive up to 8 free over-the-counter COVID-19 tests per calendar month. People with Medicare Part B coverage can get up to 8 free over-the-counter tests for the month of April any time before April 30, and then get up to 8 more free over-the-counter tests during each subsequent calendar month through the end of the COVID-19 PHE. Note that there can be multiple tests per box, so eight tests may come in fewer than eight boxes.
A list of pharmacies that have committed publicly to participate is available here (https://www.medicare.gov/medicare-coronavirus ). Because this initiative is voluntary, more eligible pharmacies and health care providers may also participate. Medicare beneficiaries should check with their pharmacy or health care provider to find out whether they are participating in this initiative. If so, they can provide the tests under this initiative and will bill Medicare on the beneficiary’s behalf. Information about where to find a test is also available by calling 1-800-MEDICARE (1-800-633-4227).
This initiative applies to all individuals with Medicare Part B, including individuals enrolled in a Medicare Advantage plan. Please note that individuals should present their red, white and blue Medicare card to get their free over-the-counter COVID-19 tests, even if they are enrolled in a Medicare Advantage plan. If a Medicare card is lost or misplaced, call 1-800-MEDICARE.
People with Medicare will be able to obtain up to 8 over-the-counter COVID-19 tests per calendar month without cost-sharing from a participating eligible pharmacy or health care provider. This means that there is no applicable co-payment and the beneficiary’s annual deductible does not apply. Medicare will only make payment directly to eligible pharmacies and health care providers that are participating in this initiative, which will allow people with Medicare Part B coverage, including individuals enrolled in a Medicare Advantage plan, to receive up to 8 tests per calendar month at no cost at the point of sale and without needing to be reimbursed
People with Medicare who are only entitled to Part A, and not enrolled in Part B, are not eligible to receive over-the-counter tests under the initiative, but can receive free over-the-counter COVID-19 tests provided through other government programs such as covidtests.gov.
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Reminder! Call for Data: Professional Liability Benchmark Report for Senior Living and Long-Term Care Providers
Marsh’s Senior Living & LTC Industry Practice and Oliver Wyman’s Actuarial Practice are conducting a 2022 update to and expansion of their General and Professional Liability Benchmark Report for Senior Living and Long-Term Care Providers. AHCA/NCAL has partnered again this year with Marsh and Oliver Wyman and other leading national trade organizations including the American Seniors Housing Association, Argentum, and LeadingAge.
The information presented in this study is critical information for industry stakeholders interested in understanding important trends, loss drivers and other factors impacting resident care and quality. Included in this review will be an estimation of countrywide and state-specific trends separately for claim costs, severity, and frequency; an estimation of countrywide and state-specific claim costs; an examination of the relationship between indemnity costs compared to expense costs; and an analysis of the cause of loss descriptions. Especially relevant for 2022 will be the effect that the pandemic has had on losses.
We hope you will consider participating in this benchmark study in order to enhance the quality of this initiative.
The information Marsh and Oliver Wyman are collecting includes:
- Individual claim listing (excluding Protected Health Information) in Excel-readable format including as much detail as possible, valued as 12/31/2021. Please include claim information for the last 10 calendar years, if available.
- Occupied unit equivalent exposure information for the past 10 calendar years, if available.
HOW TO PARTICIPATE
As the 2022 study kicks off, we welcome and would appreciate your participation for the upcoming analysis. Upon data submission we will provide diagnostic information about your own data including various metrics, e.g., frequency and severity claim statistics; closing year, report year, and accident year statistics; open and closed claim statistics; and an exposure analysis. We will review the diagnostics and contact you to discuss any high-level observations or data anomalies.
There is no cost to participate, and all participants will receive a copy of the report and an invitation to the presentation of the results. We only ask for your assistance in obtaining the necessary data.
If you’re interested in participating, please contact Oliver Wyman regarding the data collection process or with any additional questions at LTCBenchmark@oliverwyman.com.
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Want to see previous HFAM updates?
Visit our website to view all previous HFAM alerts, as well as guidance
from our federal and state partners.
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