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Position Announcement

Posted By Tom Akins, Wednesday, November 27, 2013

The LeadingAge North Carolina board of directors has approved a new position and is now advertising for a full-time Director of Member Services. This new position will increase the Association’s capacity to deliver consistent, timely information to our members, provide needed administrative support, and help bring the vision of our Foundation to the forefront. A special emphasis of the new position will revolve around better utilizing our website and its capabilities in bringing value to our members. In addition, the new position will increase our ability to recruit new business partners and do a better job of serving the business partners we currently have.

The Association is currently accepting applications for the new position. Interested applicants should forward a resume and cover letter no later than Thursday, December 12, 2013 to:

LeadingAge North Carolina

ATTN: Director of Member Services search

100 Carolina Meadows

Chapel Hill, NC 27517

For a copy of the job description,click here. As always, Please contact us if we can provide additional information or answer any questions.

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Thanksgiving Holiday Schedule

Posted By Leslie Roseboro, Saturday, November 23, 2013
The LeadingAge North Carolina office will be closed on November 28 and 29 for the Thanksgiving holiday.  Have a wonderful holiday!

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NCTracks Provider Help Center Now Available

Posted By Tom Akins, Wednesday, November 6, 2013
Updated: Wednesday, November 27, 2013

We received word yesterday from Dewey Cassell, communications manager with CSC-NC MMIS, that the NCTracks team is now offering an in-person Provider Help Center. This initiative begins today in Winston-Salem and will be offered over the next two weeks in five other locations across the state. A complete listing of dates and locations appears below.

NCTracks staff from provider enrollment, provider relations, claims, and prior approval will be on-site at locations across the state to assist you and other North Carolina providers with questions or concerns regarding NCTracks. No appointment is necessary. Providers will be assisted on a first come, first served basis.

We’re grateful to Dewey and the folks at NCTracks for making this service available and hope that you will take advantage of this initiative.

Dates and locations for the Provider Help Center include:

Nov. 6(10a-4p). CCNC Network Office, 1920 West First Street, Winston-Salem (Kitty Hawk Conference Room)

Nov. 8(9a-4p). Carolinas Health Care Systems, 5039 Airport Center Parkway, Building K, Charlotte

Nov. 14(8:30a-4p). Fayetteville Technical Community College, 2201 Hull Road, Fayetteville (Advanced Technology Center Room 116)

Nov. 15(8:30a-4:30p). CSC Wycliff Building, 2610 Wycliff Road, Raleigh (Lobby Room 160)

Nov. 19(9a-5p). NC Legislative Office Building, 300 N. Salisbury Street, Raleigh (Room 424)

Nov. 21(8:30a-4:30p). CSC Wycliff Building, 2610 Wycliff Road, Raleigh (Lobby Room 160).

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September 23, 2013 Update

Posted By Tom Akins, Tuesday, September 24, 2013


Update


September 23, 2013


Policy & Advocacy

Pre-employment drug testing law takes effect October 1. As we reported in our August 8, 2013 Update, legislation passed by the North Carolina General Assembly mandates pre-employment drug testing in nursing homes and adult care homes. The new statute requires that an offer of employment by a skilled nursing facility or adult care home to an applicant be conditioned upon a pre-employment screening. While most of our member communities already have pre-employment screening provisions in place it is important that communities understand the full breadth of the new law, including consulting with legal counsel.

New electronic plans of correction. The Department of Health Service Regulation will be sending out information next week about signing up for ePOC (electronic Plans of Correction). North Carolina is one of only three states in the United States chosen to pilot this initiative.The information coming from the DHSR will include links for a webinar, registration details, and a password for your account (sent under separate cover).

Health insurance exchange notice due October 1. Despite some delays in implementation, a major piece of the Patient Protection and Affordable Care Act (PPACA) still requires all employers -- regardless of whether or not they offer health care coverage -- to provide their current employees with a health insurance exchange notice no later than October 1, 2013.The notice must inform employees of the existence of the exchange, the services offered, and contact information, allowing them to make informed decisions about health insurance. The U.S. Department of Labor has provided model notices for employers offering insurance coverage to employees, as well as for those not offering coverage. The purpose of the notification is to inform employees about the new health insurance exchanges and subsidies that will be available to individuals effective January 1, 2014, and to provide information about the employer’s current offerings to employees. Both notices are available in a Microsoft Word format and can be found on DOL.gov.

Legislative Committee to examine Department of Health and Human Services issues. The North Carolina General Assembly’s Joint Legislative Oversight Committee on Health and Human Services will meet all day on October 8 with turmoil at the Department of Health and Human Services the subject at hand. The hearing has taken on added significance with the resignation of Carol Steckel, the state’s Medicaid Director. LeadingAge North Carolina has met with other association executives to collaborate on potential solutions to the state’s challenge around NC Tracks and other software issues.

3-day stay legislation introduced. Medicare beneficiaries would be eligible for Part A coverage of skilled nursing care without a preceding hospital stay under a new bill introduced by Rep. Jim McDermott (D-WA). Currently, Medicare Part A only reimburses for skilled nursing facility care after a person has spent at least three days as a hospital inpatient. However, SNFs now can provide services that used to be available only in hospitals, McDermott stated when introducing his legislation Thursday. Eliminating the three-day inpatient rule would also resolve the urgent problem of hospitals keeping people for extended stays under "observation” status, which does not qualify a person for SNF coverage.Under McDermott's proposal, a physician or other qualified healthcare professional would have to certify the need for skilled care.

New HIPAA models unveiled.Long-term care providers can now utilize three new models of Notice of Privacy Practices documents to maintain Health Insurance Portability and Accountability Act compliance, two government agencies have announced. These were created based on input from "consumers and key stakeholders,” and reflect recent regulatory changes in the HIPAA Omnibus Rule. The notices come in three different styles and are customizable, allowing providers to enter their own information prior to distributing and posting to the web. Each field in the models contains instructions for what information to include, and the agencies also released the instructions as a separate PDF.Click here to access the three different models.

Companion and home care providers qualify for minimum wage protections. Beginning in January 2015. Workers who provide companionship services to the elderly and are employed by home care or other third party agencies will be entitled to the minimum wage and overtime protections afforded by the Fair Labor Standards Act under a final rule issued by the Department of Labor. According to the agency, the rule will affect nearly two million direct care workers. The final rule, however, continues to exempt from minimum wage and overtime protection individual workers who are employed only by the person receiving services (or that person’s family or household) and are engaged primarily in fellowship and protection, as well as care incidental to such activities. The rule becomes effective on January 1, 2015.

CMS interpretations on new regulations impact SNF hospice providers and discharge assessments. The Centers for Medicare & Medicaid Services recently addressed provider questions related to regulations pertaining to discharge assessments and agreements between skilled nursing and hospice providers. In June, CMS issued a final rule regarding contract requirements for hospice providers operating within SNFs. The rule is intended to create clear definitions about which services the hospice operator will be responsible for and which the SNF will provide. The rule mandates a single contract between the skilled nursing operator and an associated hospice provider. It does not require a separate contract for each individual hospice patient, CMS officials said in an Open Door Forum late last week. Surveyors are expected to begin to issue citations for noncompliance with this hospice rule "in the near future,” although a precise date has not been set, the officials said. Last month, CMS issued a memorandum clarifying the steps skilled nursing facilities and nursing facilities must take to comply with Minimum Data Set requirements for incomplete or unsubmitted discharge assessments. Providers have until Oct. 1 to comply with the memo. Some providers have discovered that residents continue to appear on the facility roster even after a discharge assessment is completed, according to CMS' Jemima Drake, M.P.H., R.N. This occurs for residents with multiple resident IDs. Providers that encounter this situation should contact the state RAI or automation coordinator, Drake advised. Officials on the call could not provide an anticipated release date for the new RAI manual, which will include changes to take effect October 1. However, they said CMS soon will issue a transition memorandum providing more detail about the new items.

Education & Events

September 25, 2013: Human Resources Workshop, High Point (Pennybyrn at Maryfield)

October 3, 2013: Nursing Lunch & Learn, Charlotte (The Cypress of Charlotte)

October 27-30, 2013: LeadingAge Annual Meeting & Expo, Dallas, Texas

October 28, 2013: North Carolina State Night Out, Dallas, Texas

November 17-20, 2013: IAHSA 10th International Conference, Shanghai, China

November 22, 2013: Membership Roundtable, "The Neuropsychology of Managing Change," Winston-Salem

Strategic Knowledge

New technology solutions from CAST. LeadingAge's Center for Aging Services Technologies (CAST) recently released two new resources designed to help long-term and post-acute care organizations identify and select telehealth products. Telehealth, which includes remote patient monitoring, is the delivery of health-related services and information via telecommunications technologies, including a selection matrix. The matrix is a resource containing 23 products from 16 vendors, compared across more than 200 different functionalities and features. The two resources are the first available from a new telehealth selection portfolio that will also include an online tool and a set of six provider case studies, slated for release in October 2013. Once completed, the telehealth selection portfolio will exist as a companion to CAST's electronic health record (EHR) selection and implementation portfolio.

Electronic health record challenges. Some nursing homes are "stuck in neutral" when it comes to installing electronic health records (EHR), according to a recent article inHealth Data Management. About three-fourths of physicians are now using EHRs, up from 12% in 2001, according to the article. But the nation’s 16,000 skilled nursing homes are adopting EHRs at a significantly slower rate.Why the lag in adoption rates? Health Data Management suggests several possibilities, including lack of funds, changing ownership, and nursing home culture.

Readmission rate report. The rate at which nursing home residents are hospitalized bears a close relationship to how well a state provides healthcare for low-income people, according to a new report from The Commonwealth Fund. The Scorecard on State Health System Performance for Low-Income Populations 2013 ranked states based on 30 indicators, including the percentage of nursing home residents hospitalized within a 30-day period and the percentage of short-stay residents rehospitalized within 30 days of discharge to a nursing home. Minnesota was the top performer for its low percent of hospitalizations within a 30-day period, at 7%. The state was the fourth best overall for providing quality care to low-income populations. Mississippi and Louisiana ranked worst on this metric, each with a 31% rehospitalization rate. Mississippi was the lowest-ranked state overall on the scorecard, while Louisiana and Oklahoma were tied at No. 49. Louisiana also ranked at the bottom for 30-day hospital readmissions, at 26%. At 12%, Utah led in this category. Utah ranked No. 11 overall on the scorecard. In many cases, low-income populations in the top performing states receive better healthcare than high-income populations in the lowest-ranked states, the report found. Hawaii was the No. 1 state overall.

News & Notes

State Night Out sponsorship opportunities. The LeadingAge NC Night Out event will be held on October 28 in Dallas, TX in conjunction with the LeadingAge Annual Meeting. This is one of our best-attended events of the year and business members are invited at no additional charge. We are seeking sponsors for our event that will be held at the Omni Dallas Hotel. Sponsorships are available in $500 increments. Thank you to those who have committed support in advance. Please contactLeslie Roseboroif you are interested in being a sponsor.

CDC Letter to Providers on 2013-14 flu season. The Centers for Disease Control and Prevention website offers health professionalskey information about vaccination, infection control, prevention, treatment, and diagnosis of seasonal influenza with a specific emphasis on the 2013-14 season.

Strategic planning process begins. LeadingAge North Carolina has started work on its strategic plan. Members of the strategic planning task force include Kevin McLeod (chair), Anne Moffat, Anita Holt, Bob Wernet, David Broughton, David Kidder, John Cowan, Jonathan Erickson, Pam Fox, Sara Flynn, Sarah Spellman, and Suzanne Pugh. The task force hopes to complete its work with specific recommendations ready for the board of directors to consider at its February 2014 meeting.

SNF occupancy continues to decline nationwide. Occupancy in skilled nursing facilities is expected to decline about 80 basis points, hitting about 88% by the end of the year, according to a recent seniors housing analysis from real estate investment services firm Marcus & Millichap. Assisted living occupancy also is expected to decrease, to about 90%, while occupancy in both independent living and continuing care retirement communities will increase, the report states. Improvements in the housing market are driving these trends, according to the analysis, as more people are freed from negative equity and can relocate from their current homes to senior living communities. Skilled nursing operators will continue to see occupancy eroded by residents going to assisted living and hospice, although average rents are up 2.6% from the first half of 2012, reaching $273 per bed per day. The report attributes this to rising care costs and newer facilities that offer therapy and other Medicare-reimbursed services. Average rent is expected to hit $275 per bed per day by the end of the year.Texas leads the nation in senior housing units under construction, at more than 2,000. Thirteen states, including Florida, Minnesota and Tennessee, have between 1,000 and 1,999 units under construction. The report was based in part on data from the National Investment Center for the Seniors Housing & Care Industry.

40 million Americans provide unpaid senior care. Sixteen percent of the U.S. civilian non-institutional population age 15 and over (39.6 million people) provide unpaid eldercare, according to the U.S. Bureau of Labor Statistics. Nearly one-fourth of eldercare providers engage in unpaid eldercare on a given day, spending an average of 3.2 hours providing this care. Eldercare providers are defined as individuals who provide unpaid care to someone age 65 or older who needs help because of a condition related to aging. This care can be provided to household or non-household members, as well as persons living in retirement homes or assisted care facilities. Eldercare can involve a range of care activities, such as assisting with grooming, preparing meals, and providing transportation.

Health expenditures predicted to surge past $250 billion. By 2022, national health expenditures are expected to be around $264 billion a year on nursing care facilities. That's compared to the $157 billion expected to go toward SNFs and CCRCs in 2013. Recently, Medicare outlays have grown modestly. The category is projected to grow 4.2% in 2013, down from 2012, because of the 2% reduction in Medicare provider payments under sequestration. Restrained Medicare payments factors in"slower growth in the use of Part A services, particularly skilled nursing facility and home health services,” the report notes.Medicare spending is expected to increase from 2015 to 2022, as more baby boomers move into the program. Growth in Medicare spending will accelerate between 2019 and 2022, as boomers continue to enroll and 2% sequestration cuts end.

Home healthcare is expected to outpace other categories, with 7.5% average annual growth between 2015 and 2018 and 8% average annual growth anticipated for 2018-2022. At the same time that aging boomers will increase Medicare outlays, Medicaid rolls will swell due to expansions under the Affordable Care Act. Federal funds will also go to premium and cost-sharing subsidies for policies offered through health insurance exchanges.

State Chamber offers annual health care conference. The North Carolina Chamber wants to provide you witha better understanding of the changing health care environment from all angles. The 5th Annual Health Care Conference will be held on Thursday, Oct. 17 at the Sheraton Hotel in Chapel Hill.

7 Resources for Free Outreach & Education Materials. The National Council on Aging’s Center for Benefits has made available materials to use at outreach events, health fairs, conferences, and more.

Congratulations!

Congrats to The Forest at Duke’s Leslie Jarema who was featured recently in a Raleigh News & Observer article on skilled nursing facilities’ reduction in the usage of anti-psychotic medications!

A new Sprint commercial featuring NASCAR was filmed at Covenant Village in Gastonia. Congrats to Tom Hauer and his great residents and staff!

Please send your submissions to Tom Akins.

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August 8, 2013 Update

Posted By Tom Akins, Monday, August 12, 2013


Update

 

August 8, 2013

LeadingAge has announced the 2014 Leadership Academy Fellowsand three North Carolinians are on the list!Congratulations to L.D. Burton from Arbor Acres, Thomas Chang from Carolina SeniorCare, and Liz Tomajko from Carol Woods. They join 33 other leaders from across the country for a year-longprogram that strengthens nonprofit leadership in aging services. Selection as a national Fellow is a significant honor for L.D., Thomas, and Liz and for their organizations.

Policy & Advocacy

 
With the General Assembly having completed its work
at the end of July, there are still a few loose ends being attended to. Gov. Pat McCrory still has nearly 40 bills on his desk awaiting action – he can either sign them, veto them, or allow them to become law without his signature. In addition, we (and others) are still analyzing several bills that have been signed to determine their specific impact on our members. These include the tax reform bill that eliminates the franchise tax on utilities and replaces it with an increased general tax on electricity and piped natural gas and a mandatory drug testing bill that requires skilled nursing facilities and adult care homes to do pre-employment drug screenings effective October 1, 2013. As we receive additional perspective from legal counsel we’ll be sharing it with members. In addition, we’ll be doing a comprehensive report on the session as soon as the Governor takes action on the remaining bills in front of him, a process he hopes to complete by the end of next week.


The session had its ups and downs for aging services providers.
On the plus side, we were able to preserve both the property tax exemption and the ability for nonprofits to apply for a refund of sales tax – both issues, however, will be back next session. On the negative side, though we made some progress we were unsuccessful in gaining approval of legislation that would have exempted CCRCs from the certificate of need process for certified home health. Of even greater import, the General Assembly reduced Medicaid payments to providers by 3%, establishing a shared savings "fund” with the proceeds that they have promised they will begin paying out of January 1, 2015. We hope to be a productive part of discussions that will shape the dynamics behind the shared saving initiative.


Congress is headed home for the August recess
(August 5-September 6), leaving much of what they have been working on up in the air. LeadingAge has provided an excellent summary of the main issues concerning members. Of course, the recess also means our federal legislators will be returning to North Carolina for recess. Recess is an ideal time to host a visit and/or arrange a visit in district offices because it offers a chance for your member of Congress to meet with elder constituents and to learn more about your organization’s work for older adults. These meetings also provide an opportunity for you to become a valuable resource for your legislator in the future. Use LeadingAge's Congress To Home Guideto help plan your visit.


F-tag updates
. The Centers for Medicare & Medicaid Services released operations manual updates, including new F-tags for facility closures, late last week. The updates include amendments to Appendix PP of the SOM, with revisions to tags F203 and F204. Additional tags, F523 and F524, were also added.


Observation Days issue.
Hospitals' Use of Observation Stays and Short Inpatient Stays for Medicare Beneficiaries is a new report from the U.S. Department of Health and Human Services, Office of the Inspector General (OIG). While the OIG does not issue any formal recommendations, one of the key concerns raised includes access to skilled nursing facility (SNF) services for beneficiaries who remain in observation stays or long outpatient stays without being admitted as inpatients. IG does advise CMS to consider how to ensure that beneficiaries with similar post-hospital care needs have the same access to and cost sharing for SNF services.


CMS Final Rule Increases SNF Reimbursement by $470 Million.
The federal Centers for Medicare and Medicaid Services (CMS) issued its final rule Wednesday on FY 2014 Medicare payments for skilled nursing facilities (SNF). Effective October 1, 2013, aggregate Medicare reimbursement for SNFs will increase by $470 million, or approximately 1.3%. The proposed rule introduced in May called for a $500 million, 1.4% increase in SNF payment rates but CMS factored in updated economic data in the final rule that altered the "multifactor productivity adjustment,” resulting in the slightly lower figure.


Hospice rates.
The Centers for Medicare and Medicaid Services (CMS) issued a final rule to update the Medicare hospice wage index and Medicare hospice payment rates for fiscal year (FY) 2014. Hospices will see an estimated 1% increase in their Medicare payments for FY 2014.The hospice payment increase is the net result of an estimated 1.7% increase in the "hospital market basket” update, which is offset by a 0.7% decrease in payments to hospices due to updated wage index data and the 5th year of the CMS 7-year phase-out of its wage index budget neutrality adjustment factor (BNAF). The final rule also provides additional information on quality reporting and coding.


House Passes "Doc Fix” Bill
. The U.S. House Energy and Commerce Committee has unanimously passed legislation to repeal Medicare’s sustainable growth rate (SGR) formula used to reimburse physicians. The SGR formula regularly called for astronomical cuts in Medicare reimbursement to physicians and inevitably led to "doc fix” legislation which temporarily delayed those cuts. This legislation would replace the SGR formula with a more stable system of reimbursement payments to physicians. While good news for physicians, the bill has raised concerns with other Medicare providers because the legislation did not identify a funding source to pay for this $139 billion (over 10 years) item. In addition, the "doc fix” bill was used to address the therapy caps.

Education & Events


August 20, 2013: Executive Leadership Forum, Charlotte (Southminster)

September 25, 2013: Human Resources Workshop, High Point (Pennybyrn at Maryfield)

October 3, 2013: Nursing Lunch & Learn, Charlotte (The Cypress of Charlotte)

October 27-30, 2013: LeadingAge Annual Meeting & Expo, Dallas, Texas

October 28, 2013: North Carolina State Night Out, Dallas, Texas

November 17-20, 2013: IAHSA 10th International Conference, Shanghai, China

November 28, 2013: Membership Roundtable, Winston-Salem

Strategic Knowledge

 
A new study published by researchers
at the University of Rochester and the University of California-San Francisco indicates that nursing home residents are satisfied with their overall care but not with activities and food. In addition, researchers found that nursing homes with higher satisfaction rates often had higher staffing levels and fewer deficiency citations. Nonprofit and government-owned nursing homes tended to score higher than their for-profit counterparts.


Intimacy on campus.
We’ve all seen the statistics on the coming Baby Boomer demographic and its impact on our field. The tidal wave of boomers will impact CCRCs and affordable housing properties in a number of ways – and we can add one more to the growing list: sex. An article in the Louisville Courier-Journal examines the subject in detail, including a look at the Hebrew Home at Riverdale’s groundbreaking approach to intimacy among its elderly residents.


The Pew Research Center
recently released the results of a survey finding that most Americans don’t necessarily want to live much longer lives. Asked whether they, personally, would choose to undergo medical treatments to slow the aging process and live to be 120 or more, a majority of U.S. adults (56%) say "no.” But roughly two-thirds (68%) think that most otherpeople would. And by similarly large margins, they expect that radically longer life spans would strain the country’s natural resources and be available only to the wealthy The telephone survey – conducted during the spring of 2013 with a representative national sampling of more than 2,000 adults – also found that 81% of respondents said they were satisfied with their lives today and 70% thought most forms of cancer would be curable by 2050.


Suicide rates among the elderly.
A thought-provoking New York Times article examines the high suicide rate among the elderly. The story examines both the numbers and the causes, with an emphasis on strategies and resources for prevention.


Whole-person wellness.
Mather LifeWays Institute on Aging, in conjunction with Ziegler, is out with the results of their Second National Whole-Person Wellness Survey. The survey reported on the impact of whole-person wellness programs on the cost of health care operations, use of the health care center, and medication usage. In nearly two-thirds of CCRCs, staff used resident wellness programs. You can contact Michael Kelly at Ziegler for more information about the survey.

A new article from the National Council of Nonprofits provides excellent advice about providing additional information and transparency for your donors.


Green resources.
Recent posts on LeadingAge’s national listserv have inquired about "green” resources for CCRCs. Steve Maag, LeadingAge’s CCRC expert, has provided information about Gray Is Green, a national nonprofit devoted to green issues with an aging twist.

News & Notes


The North Carolina State Health Plan
is asking skilled nursing facilities, assisted living facilities and continuing care retirement communities for help to better serve residents who are covered by the Plan. The State Health Plan is offering a number of benefit changes for 2014, and they need assistance in communicating those changes to your residents and their families so they have the opportunity to make an informed decision. Beginning this month and continuing through October, your residents covered by the State Health Plan will receive several mailings. Medicare Primary retirees will have new choices in the form of Group Medicare Advantage (PPO) Prescription Drug Plans (MAPDP), which may help lower their out-of-pocket cost. Resources are posted on-lineand residents should go to the "Medicare Retiree Medical Benefits” portion of the website and look under "Open Enrollment.” Customer service representatives are also available to answer questions at (855) 859-0966 Monday through Friday from 8 am to 5 pm.


Antipsychotic Drug Use in Nursing Homes Trend Update
. On March 29, 2012, CMS launched a national Partnership to Improve Dementia Care in Nursing Homes whose mission is to improve quality of care provided to individuals with dementia living in nursing homes. The partnership has released a trend update on the use of antipsychotic drug use in nursing homes across the country. This update notes that in 2011 Quarter 4, 23.9% of long-stay nursing home residents were receiving an antipsychotic medication; since then, there has been a decrease of 9.0%, to 21.7%, in 2013 Quarter 1. Success has varied by state and CMS region, with some states and regions having seen a reduction of greater than 10%. Based on the 2013 Q1 data, North Carolina’s nursing homes collectively had the 4th lowest rate in the country of antipsychotic medication use for long-stay residents. North Carolina’s rate dropped from 21.45% in 2011 Quarter 4 to 16.45% in 2013 Quarter 1, the highest percentage change of any state in the country.


New CMS Data Shows Increased Use of Electronic Health Records
. CMS has released new data that demonstrate that doctors and hospitals are using electronic health records (EHRs) to provide more information securely to patients and are using that information to help manage their patients’ care. Since the EHR Incentive Programs began in 2011:

More than 190 million electronic prescriptions have been sent by doctors, physician’s assistants and other health care providers using EHRs, reducing the chances of medication errors.

Health care professionals sent 4.6 million patients an electronic copy of their health information from their EHRs.

More than 13 million reminders about appointments, required tests, or check-ups were sent to patients using EHRs.

Providers have checked drug and medication interactions to ensure patient safety more than 40 million times through the use of EHRs.Providers shared more than 4.3 million care summaries with other providers when patients moved between care settings resulting in better outcomes for their patients.


LeadingAge national advocacy department expansion.
Four new LeadingAge national positions will be created to better meet members needs now and for the future. Over the next several months LeadingAge will be recruiting for the following positions:

Senior Vice President for Housing and Capital – emphasis on housing/services and capital/funding for development

Vice President Integrated Systems – expertise in managed care; knowledge of how to integrate aging services into the broader world of health care delivery and payment

Associate Director Quality and Measurement – a clinician who understand QI and measurement across the continuum

Director of Member Advocacy– will focus on grassroots and "grasstops” activity.


Please send your submissions to Tom Akins.


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July 8, 2013 Update

Posted By Tom Akins, Monday, July 8, 2013
Updated: Monday, August 12, 2013


Update

July 8, 2013

Policy & Advocacy


Tax reform.
The Senate passed tax reform legislation late last week; the House will likely receive it tonight -- or tomorrow at the latest -- and then vote to either agree with the Senate or not. At this point it would appear that the House will probably not agree to the changes. In that case a conference committee comprised of representatives and senators will be appointed to hash out some type of compromise. The Senate version caps the sales tax refund at $2.85 million in 2017 and that's a figure that in all probability will not impact any of our member communities. The House version includes no cap at all on the sales tax refund question. Neither chamber's version includes any change in the property tax exemption and no sales tax being applied to the monthly service and care fee.


State budget.
On the budget front it still appears that Medicaid payments will be reduced somewhere between 2 and 4%. The current plan has the money that the cut generates for the state (perhaps upwards of $40 million) being placed in a "shared savings" fund to be distributed back to facilities in mid to late 2014. No details on how the money would be distributed or how many facilities might receive money back.


Affordable Care Act.
The White House and U.S. Department of the Treasury have announced the Affordable Care Act mandatory employer shared responsibility provisions and the insurer reporting requirements have been delayed for 1 year. LeadingAge North Carolina is working on developing an educational opportunity focusing on what the delay means for member communities, what requirements remain in place, and what things should be at the top of your planning list. Industry experts are still assessing the ramifications of the delay and we’ll continue to work with them in bringing you relevant information.


HIPPS coding.
The Centers for Medicare and Medicaid Services (CMS) expects the Health Insurance Prospective Payment System (HIPPS) code to be entered on Medicare Advantage claims beginning on July 1, 2013. CMS is requiring the HIPPS codes on home health claims in order to accurately price home health encounters.


Fair Housing issues.
LeadingAge has a helpful summary of recent Fair Housing requirements. In addition, a detailed analysis from a member of the LeadingAge legal committee is now available regarding the Service Animal rule.


Nursing Home Compare.
The Centers for Medicare and Medicaid Services (CMS) will update the Nursing Home Compare website to include facility complaint data and enforcement actions on July 21. CMS began providing facilities with their preview information as of June 15. To access your information, select the Certification and Survey Provider Enhanced Reports (CASPER) link located at the top of your Minimum Data Set (MDS) State Welcome page. Providers can write to BetterCare@cms.hhs.govfor more information.


Nursing Home Compare data submissions.
The Centers for Medicare and Medicaid Services (CMS) issued a new Survey and Certification Letter announcing that beginning July 2013, all users of the Nursing Home Compare website wishing to download data will be redirected to Data.Medicare.Gov.

Education & Events


July 24, 2013: CFO Workshop, Colfax (River Landing at Sandy Ridge)

August 9, 2013: Membership Roundtable, Burlington (The Village at Brookwood)

August 9, 2013: Nursing Lunch & Learn, Burlington (The Village at Brookwood)

August 20, 2013: Executive Leadership Forum, Charlotte (Southminster)

September 25, 2013: HR Workshop, High Point (Pennybyrn at Maryfield)

Ocotber 3, 2013: Nursing Lunch & Learn, Charlotte (The Cypress of Charlotte)

October 27-30, 2013: LeadingAge Annual Meeting, Dallas, Texas

October 28, 2013: North Carolina State Night Out, Dallas, Texas

November 28, 2013: Membership Roundtable, Winston-Salem

Strategic Knowledge


CAST and electronic health records.
LeadingAge's Center for Aging Services Technologies (CAST) offers a portfolio of free tools designed to help long-term and post-acute care (LTPAC) organizations identify electronic health records (EHR) products that might meet their needs. The portfolio includes an online tool for identifying products that meet an organization's requirements, an accompanying whitepaperthat guides organizations through an interdisciplinary planning for EHRs process and defining the needed specifications, and a set of 13 case studies of providers' implementations of EHRs.


Tech news.
The latest edition ofLeadingAge Magazine is hot off the press and includes a special focus on better services through technology. This issue features must-read tech articles on electronic health records, home care services, wellness, wireless infrastructure, the latest apps, and more.


Your board and fundraising.
GuideStar regularly publishes blog excerpts from fundraising guru Kivi Leroux Miller. The latest offering is a real gem and includes three concise tips on incorporating fundraising into your regular board agenda.

An interesting article from McKnight's editorial director gives details on the recent settlement of a class-action lawsuit that may impact funding streams for skilled nursing facilities. John O’Connor writes that "under the accord, Medicare can no longer deny people coverage for skilled care services simply because they have reached a plateau and their conditions have stopped improving. In other words, residents with chronic conditions and disabilities can continue to receive skilled care for as long as it's needed, provided they meet other coverage requirements.” We’ll continue to watch further analysis of the settlement terms, including CMS’s perspective.

News & Notes


Upcoming educational sessions.
A number of excellent educational opportunities are right around the bend, including the CFO Workshop (July 24), the Nurse Lunch & Learn (August 9), the Membership Roundtable (August 9), and the Executive Leadership Forum (August 20). Please see the EDUCATION section of this update for additional information and links to registration forms for each event. On-line registration is now open for each of the educational opportunities. If you are not registering on-line, fax your completed form (no emails, please!) to (919) 869-1811.


Wage and Benefit survey.
The deadline for the annual LeadingAge North Carolina Wage and Benefit Survey is July 30. Please access the survey on-line and complete it by the deadline. An important reminder: please have only one person from your community complete the survey on-line.


LeadingAge North Carolina Membership Directory deadline.
The deadline to submit changes to your listing has been extended to this Friday, July 12. Community information is linked to the community CEO profile. Login as the community CEO to update information online. You can also mark up and fax a copy of what is already listed – please fax a corrected version to Leslie Roseboro at (919) 869-1811 or CONTACT HER with any questions.


Innovations Fund accepting proposals.
Now in its 2nd year, the LeadingAge Innovations Fund is looking for projects that address the critical importance of bringing housing and services together the meet the needs of lower income elderly. The fund will award up to 8 grants, with a maximum amount of $25,000.


Functional Reporting FAQ.
CMS has posted a new document containing 22 new frequently asked questions on the required Functional Reporting of physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services.

Physician Compare, a website that allows consumers to search and compare information about hundreds of thousands of physicians and other health care professionals, has been redesigned to make the site easier to use and provide new information for consumers.

Congratulations!

NEVER SLOW DOWN…now THIS is cool! Trinity Oaks in Salisbury is prime sponsor for a Pro All Stars Series race car -- and the driver is a 14 year old from New York! Congrats to Bill Johnson, Mike Walsh, Ann Pressly, and Ted Goins for this innovative way of changing perceptions about aging.

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June 6, 2013 Update

Posted By Tom Akins, Thursday, June 6, 2013
Updated: Monday, August 12, 2013


Update

June 6, 2013

Policy & Advocacy


THIS JUST IN:
The House Appropriations Committee voted out a new version of the tax bill that caps the personal deduction on mortgage interest and property taxes but does not cap charitable donations. Sales tax refunds are not capped. A vote on this bill on the House floor is expected to happen on Friday, June 7.


Webcast on employer responsibilities under health reform slated for June 12.
A special webcast put together by LeadingAge on "Employer Shared Responsibilities Provisions under Health Reform” will take place on Wednesday, June 12 from 2-3 pm. Participants will learn the impact of the new health care reform law on employee health insurance benefits programs, understand the pros and cons of offering employee coverage, and hear practical tips that will enable providers to meet the requirements under the law. A special registration form provides more information about the program.


Are you ready for July 1?
NC Department of Health and Human Services Secretary Aldona Wos has written a letter to providers about NCTracks, which was mailed out to all NC DHHS providers over the last week. The letter included comments from the Secretary regarding the upcoming implementation of NCTracks as well as a reminder of actions that need to be taken prior to July 1. The letter also included the Authorization Code for the Currently Enrolled Provider (CEP) Registration process, in case providers did not receive or misplaced the previous CEP letter. Questions about the letter or the preparations for NC Tracks can be directed to DHHS at (866) 844-1113 or by email. In addition, information can be found in the May 2013 NCTracks Connections newsletter. DHHS has also provided a very helpfulGo-Live provider checklist.


MDS 3.0 Provider Update training series video no.1 set to go live.
"Discharge Assessments and the Use of Dashes” video will soon be activated on the DHHS YouTube site. Access to this video will be made available on the MDS 3.0 Training page in the Related Links section. This training series is the first web-based training offered in 2013 to providers addressing post-acute care topics. Video No. 1 covers MDS 3.0 updates for the Nursing Home setting. It includes a CMS Introduction, a panel presentation explaining what the MDS 3.0 RAI Manual and the MDS 3.0 Assessment Instrument are, and includes two training topics. The first training topic focuses on the relatively new discharge assessments, and the second topic explains how to properly code with dashes.


CMS clarifies guidance for care of persons with dementia.
A new Survey and Certification letter from CMS issued in late May revises Appendix P and PP in the State Operations Manual for both F309 (Quality of Care) and F329 (Unnecessary Drugs regarding care of persons with dementia). According to CMS, the revised guidance highlights and reemphasizes many of the dementia-care elements and key principles already required under current regulations, including person-centered care, quality and quantity of staff, and critical thinking related to the use of antipsychotic medications. Changes have also been made to the to the survey resident sampling process, intended to ensure the sample includes an adequate number of residents with dementia who are receiving an antipsychotic medication.


CMS issues revised guidance for hospital discharge planning.
A new Survey and Certification letter from CMS that updates guidance to hospitals includes expectations for outreach and/or communication with post-acute care settings. Included throughout the revised guidelines are "blue boxes" that offer advisory practices intended to help promote better patient outcomes, such as development of collaborative partnerships with post-hospital care providers to improve transitions of care. The advisory boxes provide resource information and references for process improvement, but clarify that the practices displayed are not required and not used for determining compliance.


Small business health options program final rule released.
CMS released the Small Business Health Options Program (SHOP) final rule, which will assist small employers with health insurance options for their employees. CMS also released the application the application for those small businesses that cannot apply online or that are not using an insurance broker for such coverage.


Efforts to limit charitable deductions would impact North Carolina’s most vulnerable.
Current efforts – both in North Carolina and at the federal level – to limit the deductibility of charitable deductions would have drastic consequences on the poor and disadvantaged. A new article from the Charitable Giving Coalition makes a compelling argument for retaining and strengthening this 100-year old tax incentive.

Education & Events


June 19, 2013: Wellness Workshop, Durham (The Forest at Duke)

July 24, 2013: Chief Financial Officer Workshop, Colfax (River Landing at Sandy Ridge)

August 19, 2013: Executive Leadership Forum, Charlotte (Southminster)

September 25, 2013: Human Resources Workshop, High Point (Pennybyrn at Maryfield)

October 27-30, 2013: LeadingAge Annual Meeting, Dallas, Texas

October 28, 2013: North Carolina State Night Out, Dallas, Texas

Strategic Knowledge


Will 2013 and 2014 be strong years for the NC Economy?
John Connaughton, a UNC Charlotte economist, predicts they will. In his quarterly economic forecast released earlier this week, Connaughton contends that 2013 will show modest growth, but is poised for an even stronger 2014. More information about his findings, including a a comprehensive forecast report, help bolster his contentions.


Medicare Trustees report slower growth in Medicare spending.
A slowing rate of growth in Medicare spending has extended the projected solvency of the Medicare Trust Fund for an additional 2 years, to 2026, according to the Annual Report released by the Medicare Trustees on May 31. CMS attributes the positive trend to provisions of the Patient Protection and Affordable Care Act that have held the growth in Medicare spending per beneficiary to below the per-person rate of growth in the nation's economy.


Day One basics for a new hire.
A great article from The NonProfit Times includes a simple Day 1 checklist that can be used for new hires. As the article points out, "some of them might seem like no-brainers, but it is the no-brain manager who can make a new employee’s arrival even more stressful.”


Older drivers more open to talking about "driving retirement.”
Clinicians often wait too long before talking to elderly patients about giving up driving even though many may be open to those discussions earlier, according to a new study from the University of Colorado School of Medicine and the CU College of Nursing. The study found that while clinicians were often the first to raise the subject of elderly drivers handing over their car keys, they tended to wait for 'red flags' before bringing it up. They also reported that those conversations were usually "unpleasant." Elderly drivers, meanwhile, said they were open to these discussions and generally saw their medical providers as "fair minded." At the same time, the majority said they didn't believe their providers were aware of their driving status or ability. The elderly also tended to see a smaller role for family members in conversations about whether they should stop driving.


How to make the iPad more accessible for older adults?
National Public Radio’s Science Friday program recently offered 5 Ideas to make the iPad more accessible to older adults. The tips are easily shared with residents and family members.

RWJF Blog on the health care workforce. The Robert Wood Johnson Foundation publishes a blog on diversifying the health care workforce. Bloggers address topics ranging from pain management to chronic disease to health disparities to cultural competence. All seek to weigh in on why it is important to diversify the health care workforce, the best ways to do so, and what a health care workforce that better reflects the population it serves can mean for the country.

News & Notes


Recognize Outstanding Nurse Leadership by submitting a nomination for the
8th Annual Joan Anne McHugh Award for Leadership in Long-Term Care Nursing.
LeadingAge’s Center for Applied Research is accepting nominations for the Joan Anne McHugh Award for Leadership in Long-Term Care Nursing. Honor those nurses in your organization who provide excellent clinical care to their residents, while demonstrating leadership and a commitment to the field of long-term care nursing. The McHugh Award is an opportunity to grow and affirm your rising nurse leaders. The recipient will receive a cash award to further their professional and leadership development and will be recognized at the 2013 LeadingAge Annual Meeting in Dallas. All entries must be postmarked by July 13, 2013, so start your nomination form today! Questions? Contact Natasha Bryant at (202) 508-1214 or email her.


Dramatic spike in suicide rates among baby boomers.
A thought-provoking article in The Washington Post details an alarming uptick in the number of suicides among middle-aged people. It has long held true that elderly people have higher suicide rates than the general population but new number released this past month so disturbing increases among men in their 50s and women in their early 60s.


National Senior Wii Bowling Day is July 16.
The National Senior League, founded in 2009, brings aging services providers from around the country together for fun and competition. As a fundraiser for Alzheimer’s/dementia research, they’ll be attempting to set a world record for most seniors Wii Bowling in one day. More information – including how to register your community – can be found at a special websitecreated just for the event.


LeadingAge 2012 Annual Report.
LeadingAge has released its 2012 Annual Report and it includes a number of excellent pieces, including a listing of accomplishments, a social accountability report, and its financial performance.

Congratulations!

Congratulations to Aimee Reimann! Aimee has accepted the position of Senior Vice President of Operations and Chief Operation Officer with United Church Homes and Services.


Welcome to Jonathan Cook, the new Executive Director at the Cypress of Raleigh
…and best wishes to the retiring Regina Dreisbach!

 

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May 7, 2013 Weekly Update

Posted By Tom Akins, Tuesday, May 7, 2013
Updated: Monday, August 12, 2013


Weekly Update

May 7, 2013

Policy & Advocacy


Resources for Employers on Responsibilities Under the Affordable Care Act.
Starting in 2014, employers with at least a certain number of employees will be subject to the Employer Shared Responsibility provisions of the Patient Protection and Affordable Care Act (ACA). Under these provisions, employers must offer affordable health coverage that provides a minimum level of coverage to their full-time employees or face an Employer Shared Responsibility payment if at least one of their full-time employees receives a premium tax credit for purchasing individual coverage on one of the new Affordable Insurance Exchanges. The IRS has a "Questions and Answers" publication on employer provisions and LeadingAge has an excellent listing of resources as well.


By the numbers: an update on the current legislative session.
Now that the NC General Assembly has been in session almost three months, it is a good time to take a moment to review where things stand. The deadline for filing bills has passed and a total of 1,769 bills have been filed – 1,044 in the House of Representatives and 725 in the Senate. 29 bills have been passed and the Governor has signed 28 of these. The deadline for crossover (the date when bills other than those related to budget or finance have to pass one house in order to be considered) is May 16 so the next few weeks will be hectic as committees race to debate bills before this deadline passes.


Home health exemption to receive hearing.
The North Carolina House of Representatives Health and Human Services will hear testimony from LeadingAge North Carolina members and others about House Bill 900, legislation that would grant an exemption from the certificate of need determination for Medicare-certified home health agencies for CCRCs wanting to serve only their own residents. Rep. Marilyn Avila is the primary sponsor of the legislation and its has 15 co-sponsors.


All quiet on the property tax front – for now.
House Bill 972, legislation that would repeal the property tax exemption for nonprofit CCRCs across the state, is in the House Committee on Finance. Sponsored by Rep. Nathan Ramsey, the bill has yet to receive a hearing and has no co-sponsors. We will continue to monitor the legislation.


Skilled Nursing Facilities to receive 1.4% Medicare increase October 1.
On May 1, the Centers for Medicare and Medicaid Services (CMS) issued CMS-1446-P, a proposed rule outlining fiscal year 2014 Medicare payment rates for skilled nursing facilities (SNFs). Based on proposed changes contained within this rule, CMS estimates that aggregate payments to SNFs will increase by $500 million, or 1.4%, from payments in FY 2013. Of course, barring any relief from sequestration, Medicare SNF rates beginning October 1, 2013 will be (on average) 0.6% LESS than they were on October 1, 2012.


Medicaid cost overruns.
Governor Pat McCrory is warning that the state health care program for the poor will cost $135 million more than anticipated. The cost overruns for Medicaid now total $248 million. The Medicaid program – one of the largest areas of state spending – consistently exceeds expected costs, prompting lawmakers to put extra money in the prior year’s budget to cover overruns.


Sales tax reform.
As the North Carolina General Assembly gets ready to consider a state budget, sales tax reform is at the top of many legislators’ list. An excellent article in the Raleigh News & Observer outlines some of the key issues facing policymakers.

Education & Events


May 13-16:
LeadingAge North Carolina Annual Spring Conference and Trade Show, Asheville

May 20: Use of Non-Pharmacological Interventions in the Prevention and Treatment of Agitation and Anxiety in Dementia, Greensboro

April 30-May 2, 2014: 2014 Eden Alternative International Conference, Nashville TN

Strategic Knowledge


Consumer brochure on antipsychotic drugs and dementia care.
The calls that CMS has been having on the National Partnership to Improve Dementia Care in Nursing Homes have included a brief discussion on the availability of the two-pager that was developed with CMS support to give consumers and other stakeholders some background information and links to resources on antipsychotic drug use. Access a copy of the brochure here.


LeadingAge’s OSCAR reports now available.
OSCAR reports for the first quarter of 2013 are now available for download. Individualized OSCAR reports, a one-page summary of a facility’s specific data on staffing levels, inspection results, and other statistics compared to that of their state, region, and the country have been posted and are accessible via My.LeadingAge.org, using your provider number.


Could BYOD become required by 2016?
A new study finds that a growing number of companies expect to stop providing devices to employees by 2016. What will it mean for IT departments? Read more about it.


Cost of Dementia Tops $157 Billion Annually in the United States.
The RAND Corporation has released an article highlighting the results of a recent study of Alzheimer’s disease. The study estimates that 14.7 percent of Americans aged 71 or older suffered from dementia in 2010, a number somewhat lower than what has been found in other, smaller studies. The total economic cost of dementia in 2010 was estimated to be $109 billion for care purchased, and $159 billion to $215 billion when the monetary value of informal care was included. The range of estimates reflects two different methods researchers used to place a value on unpaid care. The per-person cost of dementia was $56,290 or $41,689. Medicare paid about $11 billion of dementia-related costs. Read the full article.


Post-acute providers have improved across a broad range of quality measures
, according to a comprehensive report released by the Alliance for Quality Nursing Home Care. In preparing the report, analytics firm PointRight considered measures of quality tracked by the Centers for Medicare & Medicaid Services. Providers improved outcomes in 13 of 15 measures — such as pain, pressure ulcers and pneumonia vaccination — between 2011 and the second quarter of 2012. However, incontinence worsened for long-stay residents, and the influenza immunization measurement rate also dropped. Click here for the full report.


"A Profile of Older Americans: 2012” now available online.
This annual summary has proven to be a very useful statistical summary in a user-friendly format. The Web based publication provides the latest statistics on the older population and covers 14 topical areas including population, income and poverty, living arrangements, education, and health.


Fundraising tips.
Andrea Kihlstedt, author of "How to Raise $1 million (or more) in 10 Bite-Sized steps,” was recently interviewed by GuideStar. A copy of the interview contains a number of insightful tips on building and maintaining a successful fundraising program.

News & Notes


May is National Stroke Awareness Month.
Did you know that every 20 minutes someone in North Carolina is hospitalized from a stroke? That’s 72 North Carolinians each day who are suffering from a brain attack that can be prevented with proper diet, exercise, and blood pressure control. The Justus-Warren Heart Disease and Stroke Prevention Task Force, the North Carolina Heart Disease and Stroke Prevention Program, and The Carolinas Center for Medical Excellence invite you to help spread this important public awareness message by sharing this stroke infographic with your online audience. Please follow the link, which provides instructions on how to download and share this infographic.


2013 Joan Anne McHugh Award for Leadership in Long-Term Care Nursing.
LeadingAge’s Center for Applied Research is pleased to announce a call for nominations for the 8th Annual Joan Anne McHugh Award for Leadership in Long-Term Care Nursing. This award recognizes nurses who provide excellent clinical care, while demonstrating leadership and a commitment to the field of long-term care nursing. Nurses working for LeadingAge member organizations and meeting other eligibility criteria may be nominated. The winner receives a $1,000 professional development award and national recognition at LeadingAge’s 2013 Annual Meeting in Dallas, TX. All entries must be postmarked byJuly 13, 2013. Download the McHugh Award Nomination Brochure for complete details. For more information, contact Natasha Bryant at 202-508-1214.

Congratulations!

Congratulations to Beth Wyckoff! Beth Wyckoff has joined the staff of Friends Homes West in Greensboro as Marketing Director.

Please send your submissions to Tom Akins .

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April 16, 2013 Weekly Update

Posted By Tom Akins, Tuesday, April 16, 2013
Updated: Monday, August 12, 2013


Weekly Update

April 16, 2013

Policy & Advocacy


PASRR public announcement released.
Drexdal Pratt, Director of the Division of Health Service Regulation, communicated with all continuing care retirement communities in the state that "on April 9, 2013, the Department was informed by the Reviewer of the Department of Justice Settlement that preadmission screening rule, 10 A NCAC 14K.0101, will not be a requirement for individuals admitted into the adult care home portion of a licensed nursing home which is a part of a CCRC campus.” If you have questions about the exemption, please contact Beverly Speroff with DHSR at (919) 855-4555.


Repeal of property tax surfaces.
Representatives from five Buncombe County member communities (including Brooks-Howell Home, Deerfield, Givens Estates, Highland Farms, and Pisgah Valley) met with state Representative Nathan Ramsey (R-Buncombe County) on April 15 to visit about his plan to introduce legislation repealing the property tax exemption for those five communities. The Mayor of Asheville and the Mayor of Black Mountain, as well as two county commissioners and the city managers and county manager were in attendance at the meeting. While it is unknown at this time if Rep. Ramsey will indeed introduce legislation, the meeting gave those present an opportunity to learn more about CCRCs and their business model, as well as the community and economic benefit provided by them. We will continue to stay actively engaged on this issue but one thing is clear – it continues to be a good idea to make a habit of inviting local officials to your communities on a regular basis to ensure they are aware of the value we bring.


Home health certification exemption.
A major part of our 2013 Public Policy Priorities, adopted by the board of directors,included working "to permit not-for profit continuing care retirement communities to provide home health service to their residents and exempt them from the necessity of obtaining a certificate of need.” In support of this priority, Representative Marilyn Avila (R-Wake County) introduced legislation on April 11 that seeks to accomplish this priority. As of today, ten other legislators have signed on as co-sponsors of House Bill 900. The legislation passed a procedural hurdle on April 15 and has been referred to the House Committee on Health and Human Services.


CMS NF Survey Changes Due to Sequestration Cuts.
The Centers for Medicare and Medicaid Services (CMS) has issued notice that it will change some nursing home survey procedures in response to the 5% budget cut it received from sequestration. One other key notice is a new short form survey process states may use to help surveyors enforce the Aug. 13, 2013 deadline for all facilities to be fully equipped with automatic sprinklers.


Medicare coverage of 'maintenance therapy' determined by need for skilled care.
Providers must sufficiently document the need for skilled care in order to obtain Medicare coverage for so-called "maintenance therapy,” the Centers for Medicare & Medicaid Services stressed in a recent fact sheet on the Jimmo v. Sebelius settlement agreement. CMS never established an "improvement standard” that said Medicare payments would be withheld for treatment given strictly to maintain, rather than improve, a resident's condition, the agency stated in the fact sheet. Therefore, the settlement in Jimmo — a case alleging improper withholding of Medicare payments for this type of maintenance —did not eliminate the improvement standard or otherwise expand Medicare coverage. Instead, CMS agreed to take certain actions to ensure that claims are correctly evaluated "in accordance with existing Medicare policy.” In determining whether a particular maintenance treatment is eligible for Medicare coverage, providers must demonstrate that the needs of the resident can only be met through skilled rather than nonskilled care, CMS stated in the fact sheet.


Medicaid changes proposed.
From AARP North Carolina: "Gov. Pat McCrory has announced that he wants to overhaul the state’s Medicaid program by having managed care companies offer health care plans for poor children, the elderly and the disabled by 2015. Approximately 1.5 million North Carolinians, including almost 400,000 aged, blind, and disabled persons, are enrolled in this health insurance program. Under the proposal, managed care companies would receive a set amount of money for each person enrolled in their health-care program. The state and federal government spend about $13 billion on Medicaid in the state, with the federal government picking up approximately 66% percent of the cost. The Governor notes that the change would bring predictability to Medicaid expenses, which the state has trouble estimating from year to year. In recent years, the state has relied on a state based non-profit managed care agency called Community Care North Carolina (CCNC) to create networks of doctors to care for Medicaid patients and to work with people with chronic illnesses. CCNC, which has been widely nationally recognized as a model for Medicaid management, would be able to compete for a contract to offer one of the health plans, but would likely not continue in its current form.”

Education & Events

April 18: Essential Techniques for the Implementation of Non-Pharmacological Interventions with Older Adults,Greensboro

May 13-16:LeadingAge North Carolina Annual Spring Conference and Trade Show, Asheville

May 20: Use of Non-Pharmacological Interventions in the Prevention and Treatment of Agitation and Anxiety in Dementia, Greensboro

April 30-May 2, 2014: 2014 Eden Alternative International Conference, Nashville TN

Strategic Knowledge


Revised I-9 form issued.
Significant changes to the Form I-9 have been issued by the US Citizenship and Immigration Services. All employers are required to complete this form for all employees – the new form is effective immediately and must be used exclusively starting May 7, 2013.


OSHA issues deadline for employee training on revised hazard communication standard.
Employers must train workers on the new Hazard Communication Standard label elements and safety data sheet by December 1, 2013.


New study indicates dual-stiffness flooring helps reduce fractures from falls.
Nursing home residents who fall on dual-stiffness flooring may be less prone to fractures, according to a recent study in the Journal of the American Medical Directors Association. Researchers from the Bruyere Research Institute in Canada reviewed falls that occurred at an Arizona nursing home in 2008-2010. Eighty-two falls occurred on dual-stiffness flooring, which was flooring that incorporated a layer of compressible material meant to cushion falls. No resident who fell on the dual-stiffness flooring experienced a fracture. Of 85 falls on regular flooring, there were two fractures.


New Medicare resource provides data on beneficiaries with multiple chronic conditions.
A new Medicare Chronic Conditions Dashboard provides an easy-to-use tool to get current data on where multiple chronic conditions occur, which services they require, and how much Medicare spends helping beneficiaries with multiple chronic conditions. The data includes 30-day readmission rates and emergency room usage by number of conditions by Hospital Referral Region.


LeadingAge Leadership Academy.
Applications are now available for the 2014 LeadingAge Leadership Academy. The Leadership Academy is a year-long leadership program designed to strengthen not-for-profit leadership in aging services. The program provides a challenging and engaging learning environment that enhances the leadership capacity of leaders at all levels so they are better equipped to serve our field. Nine North Carolinians are Leadership Academy alumni and each would tell you that the experience has been both a professional and personal highlight. The application deadline is May 3, 2013.

News & Notes


Register now for the spring conference!
On-line registration for LeadingAge North Carolina’s 57th annual spring conference is now available! This year’s edition promises to be among our best ever – more sessions, a redesigned trade show (we’ve already sold out all of the boothspace), and a daily "Wake up to Wellness” segment including yoga, Zumba, walking, and running. LeadingAge CEO Larry Minnix will keynote our opening general session on Tuesday and Roger Landry with Masterpiece Living will keynote Wednesday morning’s general session. An added attraction this year is an opening breakfast session Tuesday morning that features Chris Taylor with the Medical Care Commission and Steve Johnson with the Department of Insurance sharing the stage for a panel discussion and Q&A.


Department of Insurance CCRC Advisory Committee to meet April 25.
The North Carolina Department of Insurance CCRC Advisory Committee will meet April 25 in Greensboro at WhiteStone: A Masonic and Eastern Star Community. The meeting, which begins at 10 am, will feature updates on proposed and in-progress CCRC development, an update on accounting standards from Keith Seeloff with Dixon Hughes Goodman, information on the department’s approach to mergers/affiliations, and discussion of annual filing reviews.


2013-2014 influenza vaccine can now be ordered.
The Centers for Disease Control and Prevention has announced the influenza vaccine for the 2013-2014 season can now be ordered at this time from manufacturers and distributors. As the 2012-2013 flue season has shown, it’s important to pre-book vaccine as soon as it is available. Most of the flu vaccine offered for the 2013-2014 season will be trivalent (three component). More information is available on the CDC website.


Nursing home costs approach $84,000 per year.
The cost of long-term care continues to rise, according to the 10th annual Cost of Care Survey from insurance company Genworth. The median annual cost of a private nursing home room reached $83,950 this year, up 3.6% from 2012, the report showed. Over the last five years, the cost of a private nursing home room has outpaced inflation, going up 4.5% on an annualized basis. Assisted living costs increased even more dramatically over the last year. The median annual cost for assisted living increased 4.6% year-over-year, to reach $41,400 for a single-occupancy one-bedroom. Costs for in-home services rose more modestly, according to the report. The 2013 median hourly cost for home health aide services is $19, up 2.3% from 2012


May is National High Blood Pressure Month.
The Carolinas Center for Medical Education, the Justus-Warren Heart Disease and Stroke Prevention Task Force, and the North Carolina Heart Disease & Stroke Prevention Program, have made available website banners that help raise awareness. The banners can be found at this link. If you don’t see a size that fits your website requirements, please email CCME and they’ll be happy to make one especially for your site.


LeadingAge board of directors.
The 2013 Nominations and Awards Committee is now accepting nominations for Board of Directors and Directors at-Large. The "Call for Nominations" booklet provides complete information.


LeadingAge national awards.
Applications for the 2013 LeadingAge national awards are now being accepted at www.leadingage.org/awards. Winners in nine award categories will receive free registration to the national LeadingAge Annual Meeting in Dallas, TX, Oct. 27-30, 2013, where they will be honored. Nominate yourself, your organization, or someone you know who is making a difference. The deadline to enter is April 30, 2013.If you have questions, contact Deborah Cloud at dcloud@leadingage.org.

Congratulations!


Congratulations to Lee Syria!
Lee Syria, President/CEO of United Church Homes and Services was elected to the Board of Council for Health and Human Services Ministries (CHHSM) of the United Church of Christ at their 75th annual meeting in Chicago. CHHSM has 73 corporate members that operate 363 communities and programs for children, youth, families, older adults, and people with disabilities.


Congratulations to Charlie Harris!
The Piedmont Health Coalition presented Charles Harris with its 2013 Healthcare Leadership Award. The Piedmont Health Coalition is a group of employers in the Piedmont region who work together to enhance the existing health delivery system for their employees through education, information exchange, combined purchasing strength for lower costs, and jointly sponsor programs to improve the overall health of the community.


Congratulations to Platinum business member Sodexo!
Sodexo was recently named the most admired company in its sector according to Fortune Magazine's 2013 corporate reputation survey. Nearly 4,000 business executives, directors and analysts rated close to 700 companies from 30 countries on nine criteria, from innovation to global competitiveness, for the survey.


Congratulations to skilled nursing facilities across the state of North Carolina!
North Carolina was one of only three states in the United States that met the 15% reduction target for anti-psychotic medication usage. Cindy Deporter and her colleagues with the Division of Health Service Regulation are to be congratulated, as well, for their pioneering work in this effort. A recent study advised that the first step toward reducing the number of residents with dementia who are on antipsychotics starts with reassessment.

Please send your News & Notes and Congratulations to Tom Akins .

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March 25, 2013 Weekly Updatae

Posted By Tom Akins, Monday, March 25, 2013
Updated: Monday, August 12, 2013



Weekly Update


March 25, 2013


Policy & Advocacy


Observation Status legislation.
Legislation introduced at the federal level would specify that hospital stays under observation would count toward the 3-day hospitalization requirement for Medicare coverage of post-acute care. Patients that receive hospital care on "observation status" do not qualify for this benefit, even if their hospital stay lasts longer than 3 days. The observation days problem affects residents and clients of all LeadingAge members, including residents of senior housing or home-based services clients who are hospitalized and released to nursing homes. They are all at risk of substantial out-of-pocket costs for post-acute care without this corrective legislation. Want to help? Contact your legislators and urge them to cosponsor this important legislation – the "Improving Access to Medicare Coverage Act" (S. 569 and H.R. 1179). Its supporters include AARP, the American Medical Association, the American Health Care Association, the American Nurses Association, and the National Committee to Preserve Social Security and Medicare.


Governor unveils budget.
Gov. Pat McCrory's first proposed budget is heavy on setting aside money for emergencies, building repairs and Medicaid costs but light on creating new programs. The new Republican governor recommended that the state spend $20.6 billion in state funds - a roughly 2 percent increase over the current year's budget - in the first year of the plan beginning July 1. Keeping to his narrative that state government is broken and must be fixed to generate new revenues and help create jobs, McCrory wants $300 million over two years for state building renovations, $180 million to deal with potential Medicaid shortfalls and $77 million for upgrading information systems. Another $400 million would go to the rainy-day reserve fund, considered key in preserving the state's top fiscal rating from bond agencies. The governor's budget office says the higher year-over-year bottom line will benefit from a 3.6 percent revenue increase next year. McCrory wants $2.7 million this coming year to rebrand and retool the state's economic development strategy. He said he would fight to restore funding for local drug treatment courts and needs $9.1 million next year to add 5,000 slots for preschool for at-risk 4-year-olds. He also wants to give monetary compensation to the victims of North Carolina's former forced sterilization program, which ended in the early 1970s.


Thank you!
A special LeadingAge North Carolina THANK YOU to those individuals who participated in Capitol Hill visits last week in Washington, DC. Lending their voice and perspective to our advocacy efforts were Kathlene Hendrick, Emily Nunn and Suzanne Pugh (from Aldersgate), Kevin Parries, Jon Renegar, and Alex Tucker (from Carolina Village), Lee Syria (from United Church Homes and Services), Steve Fleming (from Well-Spring), and Leslie Roseboro (from LeadingAge North Carolina). These nine people did our Association proud, visiting both United States Senators from North Carolina and six of our Members of Congress.


Health care reform updates.
With key mandates of health care reform set to take effect on January 1, 2014, employers can anticipate an influx of regulatory guidance and a long list of decisions that must be made regarding their employer-sponsored group health plans. Here are some recent developments – provided by CliftonLarsonAllen – that employers should be aware of and act on in the coming months.

Education & Events


March 27: Caregiver Training Opportunity, Abernethy Laurels, Newton. For further information or to reserve your training slot, please call Abernethy Laurels Director of Social Services (Kim Cloer) at (828) 465-8527.

April 18: Essential Techniques for the Implementation of Non-Pharmacological Interventions with Older Adults,Greensboro

May 13-16:LeadingAge North Carolina Annual Spring Conference and Trade Show, Asheville

May 20: Use of Non-Pharmacological Interventions in the Prevention and Treatment of Agitation and Anxiety in Dementia, Greensboro

April 30-May 2, 2014: 2014 Eden Alternative International Conference, Nashville TN

Strategic Knowledge


Spurring Innovation.
An insightful article in the Wall Street Journal features "The Experts,” a group from across the business spectrum, offering their individual perspectives on how leaders should spur innovation.


LeadingAge Leadership Academy.
Applications are now available for the 2014 LeadingAge Leadership Academy. The Leadership Academy is a year-long leadership program designed to strengthen not-for-profit leadership in aging services. The program provides a challenging and engaging learning environment that enhances the leadership capacity of leaders at all levels so they are better equipped to serve our field. Nine North Carolinians are Leadership Academy alumni and each would tell you that the experience has been both a professional and personal highlight. The application deadline is May 3, 2013.


Gift annuity program.
LeadingAge’s Philanthropy Network has a monthly "Lunch & Learn” program that last month featured Paul Ogier and staff from Lutheran Senior Services discussing the "Homes Conversion Program” that LSS began in 2008 to allow prospective residents to use their home to fund a gift annuity. The LSS initiative helped prospective residents overcome the problem they were having with selling their homes. The program has been extremely successful towards this goal, with over 130 residents using the program since its inception, creating significant gifts for LSS and helping LSS return to occupancy levels experienced prior to 2008. Audio from the call is now available.

Member Questions


The results are in!
Member communities have responded to recent questions about handgun and firearm policies and about welcoming areas and free coffee. A reminder: the views expressed by members in response to questions appearing in this section are neither endorsed nor advocated by LeadingAge North Carolina.

News & Notes


Register now for the spring conference!
On-line registration for LeadingAge North Carolina’s 57th annual spring conference is now available! This year’s edition promises to be among our best ever – more sessions, a redesigned trade show (we’ve already sold out all of the boothspace), and a daily "Wake up to Wellness” segment including yoga, Zumba, walking, and running. LeadingAge CEO Larry Minnix will keynote our opening general session on Tuesday and Roger Landry with Masterpiece Living will keynote Wednesday morning’s general session. An added attraction this year is an opening breakfast session Tuesday morning that features Chris Taylor with the Medical Care Commission and Steve Johnson with the Department of Insurance sharing the stage for a panel discussion and Q&A.

 

LeadingAge national awards. Applications for the 2013 LeadingAge national awards are now being accepted at www.leadingage.org/awards. Winners in nine award categories will receive free registration to the national LeadingAge Annual Meeting in Dallas, TX, Oct. 27-30, 2013, where they will be honored. Nominate yourself, your organization, or someone you know who is making a difference. The deadline to enter is April 30, 2013.If you have questions, contact Deborah Cloud at dcloud@leadingage.org.


Nonprofit Sector Stewardship awards.
The Nonprofit Sector Stewardship awards pay tribute to nonprofits whose organizational practices further the public's understanding of and trust in our state's nonprofit sector. Award recipients are recognized at the N.C. Center for Nonprofits conference, Sept. 19-20 in Concord and receive $500 to invest in board and staff development. Nominate your organization or another that you admire! The deadline isTuesday, April 30, 2013.

Position Announcement. Retirement Living Associates, Inc. is seeking an Executive Director for a new CCRC that will open October 2013 in Cary. Applicants should have a minimum of 3-5 years experience as an Executive Director of a CCRC, Associate/Assistant Executive Director of a CCRC, or licensed Nursing Home Administrator in a CCRC. The position begins June 1, 2013. This will be a start-up CCRC and the Executive Director must have a current NC Nursing Home Administrator License. Please send resumes to Kyle Dilday with Retirement Living Associates, Inc. by March 29.

Congratulations!


Congratulations to the fine folks at Givens Health Center in Asheville!
They are recipients of a $10,000 Culture Change grant awarded by the North Carolina Coalition for Long Term Care Enhancement. Way to go!


Congratulations to Salemtowne Retirement Community on their deficiency free annual Medicare/Medicaid compliance inspection on Feb. 28!
Salemtowne has been a health care provider of excellence to older adults in Winston-Salem since 1972.


Please send your Member Questions, News & Notes, and Congratulations to Tom Akins.

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