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Membership Update

Posted By Jennifer Gill, Friday, December 1, 2017
Updated: Thursday, November 30, 2017
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December 1, 2017

Advocacy & Policy

At press time, the U.S. Senate was still considering its version of tax reform legislation (see yesterday's Advocacy in Action email). Watch your inbox for a comprehensive update in the next few days.

Temporary Enforcement Delays for Certain Phase 2 F-Tags and Changes to Nursing Home Compare

On November 24, CMS issued S&C 18-04-NH delaying enforcement for certain F-Tags for Phase 2 of the Long Term Care Requirements of Participation (RoPs). Phase 2 becomes effective on November 28, 2017 simultaneous with the start of the new survey process. This moratorium extends the moratorium previously announced in S&C 17-36-NH on June 30, 2017 by 6 months.

Enforcement Moratorium
Specifically, CMS will provide an 18-month moratorium on the imposition of CMPs, discretionary denials of payment for new admissions and discretionary termination when related to of the F-Tags listed below. NOTE: This moratorium does not apply to mandatory provisions such as mandatory denials of payment for new admissions and mandatory termination for failure to achieve substantial compliance within required timeframes.

• F655 (Baseline Care Plan); §483.21(a)(1)-(a)(3)
• F740 (Behavioral Health Services); §483.40
• F741 (Sufficient/Competent Direct Care/Access Staff-Behavioral Health); §483.40(a)(1)- (a)(2)
• F758 (Psychotropic Medications) related to PRN Limitations §483.45(e)(3)-(e)(5)
• F838 (Facility Assessment); §483.70(e)
• F881 (Antibiotic Stewardship Program); §483.80(a)(3)
• F865 (QAPI Program and Plan) related to the development of the QAPI Plan; §483.75(a)(2) and,
• F926 (Smoking Policies). §483.90(i)(5)
(CMS is not applying the enforcement moratorium to F608 related to reporting reasonable suspicion of a crime due to the concerns about significant resident abuse going unreported.)

CMS has directed state survey agencies to follow the standard enforcement process with all available remedies for all the other F-tags. Note that the moratorium may not prevent all CMPs and discretionary penalties for phase 2 depending on how the state survey agency classifies the citation. For example, F758 (psychotropic medications) is on a moratorium, but F757 (unnecessary drugs) is not; the state survey agency could potentially cite the noncompliance under F757 not F758 depending on the circumstances resulting in an enforcement action. CMS explicitly states that this 18-month moratorium does not change the implementation date for the Phase 2 provisions and state survey agencies should cite these tags as appropriate and continue to forward their findings to the RO as normal. State survey agencies will continue to follow standard enforcement procedures related to Phase 1 and will utilize additional new remedies for the F-tags included in the moratorium as explained below.

Additional Remedies During Moratorium
In lieu of the CMPs and discretionary remedies for the Phase 2 F-Tags listed above, CMS has created two additional remedies that may be applied for noncompliance, Directed Plan of Correction (DPOC) and/or Directed In-Service Training (DIST). Once the moratorium is over on May 29, 2019, enforcement for all cited tags will return to the normal enforcement policy.

A Directed Plan of Correction (DPOC) is a remedy developed by CMS or the state survey agency requiring the facility to take action within a specified timeframe to correct cited non-compliance. The DPOC will address the structures, policies and processes needed by the facility to demonstrate and maintain substantial compliance. It will be completed as verified by CMS or the state upon a revisit or credible written evidence that can be verified without a site visit. Site re-visits will be expected for any of the tags within the moratorium were cited for Substandard Quality of Care (SQC) or for actual harm or immediate jeopardy.

A Directed In-Service Training is an enforcement remedy that may be used when CMS or the state survey agency believes that education is likely to correct the deficiencies and achieve substantial compliance. This remedy will require the relevant staff of the facility to attend an in-service training program that will address a demonstrated knowledge deficit. The training programs should be developed by well-established centers of geriatric health services education. After the training has been completed, CMS or the state survey agency will assess whether substantial compliance has been achieved or as verified by CMS or the state upon a revisit or credible written evidence that can be verified without a site visit.

Application of Discretionary Enforcement Remedies During 18-Month Moratorium

Discretionary Enforcement Remedies

Phase 1 Tags Only

Both Phase 1 and Phase 2 Tags

Phase 2 Tags Only

Normal Enforcement Remedies Apply OR 18-Month Moratorium Enforcement Policies Apply (DPOC and/or DIST)

Normal Enforcement Policies Apply

Normal Enforcement Policies Apply for the Phase 1 tag(s); and DPOC/DIST only may be imposed for Phase 2 tag(s) listed in moratorium (F655, F740, F741, F758, F838, F881, F865, F926)

18 Month Moratorium Enforcement Policies Apply (DPOC/DIST) to tag(s) listed in moratorium (F655, F740, F741, F758, F838, F881, F865, F926)

5-Star Changes
CMS also elaborated on the 5-Star “freeze” announced on June 30, 2017. CMS will be holding constant or “freezing” the health inspection star rating for health inspection surveys and complaint investigations conducted on or after November 28, 2017. They anticipate this freeze to begin in early 2018 and last approximately 1 year. Any survey activity conducted prior November 28, 2017 regardless of whether it is closed by then will be included in the rating as the survey was conducted prior to November 28, 2017.

Additionally, CMS stated that the health inspection star rating will no longer use information of the third oldest cycle of the health inspection survey and complaint investigation data. CMS will be dropping the third oldest year just as it would have been dropped from the score due to its age as part of the normal update process. This change will occur in early 2018 for all facilities. At that time, the most recent cycle will be weighted at 60 percent and the prior cycle will be weighted at 40 percent.

In addition to the freeze in score, CMS plans to add a summary of the facility’s most recent survey findings on nursing home compare to ensure transparency. This summary will include (minimally) the total number of deficiencies cited and the highest scope and severity level cited.

New Survey Process
CMS also released S&C 18-05-NH affirming that the new survey process will be effective November 28, 2017 and that Appendix P will no longer be accessible beginning November 28, 2017. Resources on the new survey process are available here.

OSHA Extends Electronic Submission Date

Skilled nursing providers now have until December 15 to begin submitting workplace injury and illness data electronically. OSHA issued a rule last year requiring those with high-hazard injury locations, including skilled nursing, to submit data electronically through OSHA’s Injury Tracking Application. The original compliance deadline was set for July 1, 2017, but was extended in May with no indication of a new date.

SNF Medicare Rate Calculation Tools Update

LeadingAge has updated Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System and Part B- Therapy calculators to help members assess and estimate the impact of payment changes. Please click here to access this tool that requires login via My.LeadingAge.

Professional Development

FULL-no more spaces available. Thank you for your interest!

Marketing Symposium
Tuesday, December 5th
Covenant Woods
Mechanicsville, VA

Registered participants may download brochure.

Save the Date!

2018 LeadingAge North Carolina Spring Conference and Trade Show

The Omni Grove Park Inn
May 14-17, 2018
Asheville, NC

Click here to submit a proposal to present.

Strategic Thinking

Hearing Loss and Listening Fatigue
Healthy Hearing, November 16, 2017

Did you know that 80% of nursing home residents have hearing loss? Americans are tired and energy is in short supply. While there are many possible causes for it, listening fatigue as a cause may be a surprise.

To address this issue the North Carolina Institute of Medicine recently hosted leaders from organizations around the state, including those from DHHS Division of Services for the Deaf and Hard of Hearing, Disability Rights NC, UNC, and LeadingAge NC. Leaders discussed how to improve accommodations for the deaf and hard of hearing. A wealth of information was shared by professionals who specialize in this area.

Please click here to access information and resources on this topic featuring four powerpoint presentations you can adapt, guidelines for audiology services in nursing homes from the American Speech-Language-Hearing Association, a meeting summary and more.

The Digital Experience Must Also Be a Human(e) Experience
New England Journal of Medicine Catalyst, November 21, 2017

The physician author of this article differentiates between a consumer and a patient in order to highlight patients' vulnerability. The article includes an infographic summary of the article entitled, "From Consumer to Patient, and All That Comes Between." This might be a helpful reference in clinical meetings with staff where patient-centered care is a focus.

Glossary of Nonprofit Terms
BoardSource, November 2017

This glossary might be a great resource for new, as well as existing, board members. Click here to view the document BoardSource created that defines legal terms specific to nonprofits, governance committees, and essential documents. Senior staff might also appreciate this information.

View Responses to Recent Member Question

Thanks to everyone who took time to respond to the member question about armed intruder training last month. To download a spreadsheet of the 9 responses that we received, including a (redacted) policy on the topic, please click here.

News and Notes

Submit Your RFP for Spring Conference 2018 Today!

LeadingAge North Carolina invites you to share your expertise in the field of aging services. Submit a proposal to be a presenter at our largest event of the year, the Spring Conference and Trade Show May 14-17, 2018 at The Omni Grove Park Inn in Asheville, NC. We seek proposals that demonstrate best practices, exemplify creativity, and inspire innovation in the field of aging. Submissions may be made online by December 31, 2017.

New VP of Grassroots Advocacy at LeadingAge National

Joe Franco has joined LeadingAge as VP of Grassroots Advocacy. Joe comes to LeadingAge from American Diabetes Association, where he was VP of Grassroots and Internal Advocacy. Prior to that, he held similar positions at Blue Cross Blue Shield Association, Alzheimer's Association and American Cancer Society. Before relocating to Washington, Joe served as campaign manager for several Mayoral and State House races in Colorado. He will be reaching out to learn more about our members and how our respective and collective grassroots activities can support each other.

Can You Quantify the Benefits of Living in Your Life Plan Community?

Mather LifeWays and Northwestern University are conducting a landmark study that will determine the impact of living in a Life Plan Community on residents’ long-term health and wellness. The Age Well Study will measure residents’ self-reported health and wellness metrics through a convenient survey taken annually for five years. In return for participating, your organization will receive an annual report on key findings, such as quality of life, self-reported health, and other health-related measures.

This study is being conducted in partnership with ASHA, LeadingAge, Ziegler, National Investment Center, Life Care Services, and Novare. To learn more or to enroll your community in the study, visit the Age Well Study web page or email

Give to the LeadingAge Disaster Relief Fund

To mitigate the impact of recent fires in California, as well as the destruction that Hurricanes Harvey, Irma and Maria caused, LeadingAge established a Disaster Relief Fund. The LeadingAge community has rallied to support our
peers and we have raised more than $580,000 toward a goal of $1 Million. If you haven't already, please consider giving today.

100% of your donation will go directly to members and their staff to cover a range of needs including basic supplies such as food and water. We are working with the management of these communities to help serve resident and staff needs. Please give now to the LeadingAge Disaster Relief Fund. If you would like to make a donation by check, please make it payable to “LeadingAge” and send to:

2519 Connecticut Avenue, NW
Washington, DC 20008
ATTN: Jody Moeller

Final 2017 Employee Benefits Compliance Webinar

Senn Dunn Insurance, a Marsh & McLennan Agency LLC Company, invites community members to participate in their free Employee Benefits Compliance Webinar Series. The last webinar this year will be held December 21 from 2pm-3pm EST. The topic will be a review of the Affordable Care Act and other benefits-related guidance released in 2017 and discussion of what employers need to do to remain in compliance in 2018.  Click here to download the brochure. Click here to register.



The Joy of the Job

Congratulations to 77 members from across the state who gathered to learn how to infuse joy and meaning into their work at "The Joy of the Job" presented last month. We laughed, got real, and learned how to appreciate ourselves, our work, and our co-workers. Thanks to The Forest at Duke in Durham and Salemtowne in Winston-Salem for hosting Jody Urquhart's uplifting program for direct service professionals.


"You control the project. We help reduce the cost of material and equipment."

Major Renovations and Construction Projects

■Whether your project is under $1 million or over $500 million Value First can help your community achieve savings on major renovations and construction projects.

■Many of the vendors, architects and designers you do business with are market leaders that are also part of the Value First Construction Services program.

■Value First works with the architects, designers, and general contractors you choose.

■We serve as your cost savings advocate and consult with your architect to develop a vendor line-up to the basis of design (spec alignment). Value First can help you save on:

Fire alarm systems
Building controls
Roofing systems
Drywall and wall components
Doors and hardware
Custom wood products
Furniture, beds, lifts and more…

■ Connect Value First with your architects, project managers and key staff as early in the process as possible. Higher savings result from early engagement.

Program Benefits

♦Transparency in construction pricing.
♦Assistance with planning and procurement of materials, furniture, fixtures, and equipment.
♦Aggregate of purchases across multiple projects to ensure cost containment.
♦3% to12% project savings.

Step 1. Consultation
Consult with Brian Smidt, Director of Construction Services, to discuss type of construction project (new building/campus, addition or renovation); number of units/beds being added; phase of construction you are currently in; your chosen architect, engineer, interior designers, etc.
(651) 659-1418

Step 2. Collaboration
After consultation, if you decide to use Value First as your cost savings advocate a Construction Services Participation Agreement and Statement of Work are signed to make us an official part of your strategic team.
We will assign a project manager to guide you through cost savings, and we can begin to work with designers and contractors that may already be a part of the project.

Step 3. Completion
As your trusted partner and cost savings advocate, Value First will be involved in the bidding process to make sure you are getting the best possible price and quality in your material purchases.

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