Friends:
Skilled nursing and rehabilitation centers are life-saving resources for Marylanders in need. Often families are juggling caregiving, access to care, safety, and quality of life. In most cases, patients and residents in Maryland nursing homes would otherwise be in the hospital where they would be more disconnected from family and community. In addition, their care would be provided at a much higher cost to our healthcare system. Don’t get me wrong, I thank G_d every day for our world-class hospitals and medical systems. As a son, brother, and cousin with first-hand experience, I am also deeply thankful every day for the quality care that skilled nursing and rehabilitation centers provide.
In short, that is why we fight for adequate funding for quality care. Unlike other for-and not-for-profit enterprises, the vast majority of nursing home revenue comes in the form of non-negotiable Medicare and Medicaid rates. Also unique to healthcare, and specifically long-term care, the government directs how rates are spent in the form of direct care hours, staffing ratios, and the type of staff that need to be present. All of this, along with the underfunding of Medicaid rates and the financial issues brought on by the pandemic, are reasons why our top priority remains adequate funding for quality care.
The truly great news on the FY23 Maryland Medicaid Budget is, as previously reported, that our legislative efforts resulted in identifying and securing an additional 4 percent Medicaid rate increase. Along with our extended team, we have continued to lobby the General Assembly and Governor Hogan for a supplemental budget to fund the additional 4 percent increase. Recently, Governor Hogan issued that supplemental budget. The new part of this update is that a one-time additional several million-dollar bonus payment for nursing homes and other Medicaid providers is also expected to be funded in a supplemental budget.
As we all know, direct federal payments to nursing homes in 2020 kept our doors open during the first year of the pandemic.
Here in Maryland: The FY21 four percent Medicaid rate increase, along with the advancement of the FY22 four percent Medicaid rate increase to January 1, 2021, was much needed greatly appreciated. Maryland also issued a one-time $26 million payment in 2021, which was paid quarterly. In December 2021, Governor Hogan announced $25 million in grant funds to help nursing homes with staffing, testing, vaccination, and COVID therapies. These funds are currently being distributed by the Maryland Department of Health (MDH).
There is no doubt that Maryland’s prioritization of testing and vaccination in nursing homes, PPE distribution, staffing augmentation, and financial support saved countless lives in our sector. And, the state-supported and financial underwriting of PCR and POC testing in 2020 and 2021 was also critical to navigating COVID-19.
Looking forward:
- Census growth and restoration in skilled nursing and rehabilitation centers will continue to be slow.
- There will be increased regulatory pressure, around ownership and quality.
- The workforce recruitment and retention crisis that predates the pandemic and was dramatically worsened by it will continue. It will require innovative solutions and public/private partnerships.
- At least in the near term, inflation not seen in 40 years in the US will persist.
- Nationally, there will be proposed cuts to Medicare rates in our sector, the increase in consumer choice in Medicare Advantage Plans will continue, and the national government will advocate for more home- and community-based care and an increase in value-based purchasing.
- Here in Maryland, our sector will be more fully integrated into Maryland’s Total Cost of Care contract with the federal government.
Much of this is not in our sector’s control, but we do have a strong voice and expertise. We are powerful when we are unified, focused, and data-driven. What is in our control:
- Quality care.
- Workforce innovation.
- Sector-directed care delivery redesign.
- Strategic expansion of SNFs into home and community-based care and assisted living.
Finally, I want to thank you for the honor of the doing the work we do together. We do face rough roads and challenges and opportunities ahead. I feel blessed to share that with you and I am honored to be selected among the leaders of the Maryland Daily Record’s 2022 Powerlist in Health Care.
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AHCA Revenue Cycle Management Academy training:
AHCA offers a five-module online training program titled Revenue Cycle Management (RCM) Academy which offers training about a holistic interdisciplinary approach toward revenue management. RCM can be implemented in a building, more broadly or as an organization-wide approach to enhance revenue by minimizing losses from payments that too often are unnecessarily lost or overlooked. Individuals will need to login to ahcancalED with their AHCA/NCAL usernames and passwords to register for Revenue Cycle Management Academy. For assistance obtaining usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information.
As always:
- Focus on what is in your control and not what is out of your control.
- Let’s get those boosters and the flu vaccine in the arms of people.
- Overcommunicate – with residents, patients, families, staff, and government partners.
- Adapt and innovate.
- Rely on your partnerships.
- Speak up when you need help.
- Double efforts on infectious disease protocols, training, and operations.
- Take and document your action; keep a timeline.
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Joe DeMattos
President and CEO
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Diamond Medical Laboratories - COVID Testing and Staying Prepared
Moving forward, there may be ongoing PCR testing needed, especially this coming Fall with the potential for unknown “yet to come” variants. We all hope we find ourselves getting back to a level of normality, however it is incredibly important to be prepared. That said, please see the below information on Diamond Lab's COVID testing:
- The new rate for members would be $55 per test.
- Diamond Labs bills promptly for services, with no surprise billing. This enables clients to keep current and understand what their costs are for testing at their locations.
- Diamond also compliantly participates with Insurances that cover testing.
- The turn around time remains the same with in 24 hours of receiving the specimens in the lab (48 hours if the weekend is involved).
- For clients that are on Diamond Lab's clinical blood level services, results will be sent to the PCC / EMR platform, if they are integrated.
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Don’t Miss the April Sale on High Intensity Rehab Training
To celebrate National Occupational Therapy Month, ahcancalED is announcing a big sale on an online educational program titled High Intensity Physical Rehabilitation in Medically Complex Populations for physical therapy and occupational therapy rehabilitation professionals (PT, PTA, OT, OTA). All registrants can save $195 on the course registration fee through April 30.
Researchers from the University of Colorado Anschutz Medical Campus released study findings in Fall 2020 showing that the average SNF length of stay patients decreases by 3.5 days when physical therapists use a high-intensity rehabilitative training program for their patients. In addition, walking speed from evaluation to discharge increased by 0.13/m/s which exceeds clinically meaningful changes in walking speed.
The course presents an evidence-based approach for the implementation of a high intensity progressive rehabilitation model as part of an evolution from current lower intensity post-acute treatment approaches to address myriad patient needs. Rehabilitation professionals will have access to an interactive multimedia learning experience including responsive, self-paced presentation of foundational concepts, simulated case scenarios, and a moderated discussion environment for learning with fellow clinicians - all informed by the latest learning science and innovative technology.
The goal of the course is to teach rehabilitation professionals better methods of addressing functional decline due to underlying medical complexity and deconditioning from hospitalizations or illness. By the end of this course, rehab professionals will learn how to:
- Screen all patients for safe participation in high intensity rehabilitation
- Establish an appropriate high intensity plan of care for eligible patients
- Execute effective and engaging rehabilitation sessions informed by high intensity rehabilitation strategies
- Perform ongoing monitoring of patient response to activity and adapt high intensity plans of care throughout the length of stay
- Communicate and document completely and efficiently to facilitate continuity of care
- Identify current gaps in care for older adults that high intensity rehabilitation can address and advocate for its use in the skilled nursing setting
This self-paced course contains nine learning modules. Each module has an interactive lesson. Some modules have quizzes, some have Slack channel discussions, and some have case simulations to test the mastery of the subject matter. The course concludes with the Post-Assessment/Final Exam and survey.
CU recommends that the course be taken over a six to eight-week period to allow rehab professionals time to implement and practice the concepts as they are learned. Documentation will be provided by AHCA/NCAL to rehab professionals who successfully complete the course, so that they can apply to their respective state licensing boards for continuing education credits.
The course fee is just $300 through April 30, 2022 for employees or contracted employees registering as affiliated with an AHCA/NCAL member facility. All other registrants will pay $400. After April 30, registration is $495 for an employee or contracted employee registering as affiliated with an AHCA member facility and $595 for all other non-member registrants.
Individuals should register and pay for the course through the ahcancalED platform at this web site: ahcancal.org/restoreregistration. Then, within 48 hours, registrants will receive further instructions on how to go to the CU Anschutz Medical Campus platform and enroll in the course and begin their coursework.
Individuals will need to login with their AHCA/NCAL usernames and passwords to register for this course. For assistance obtaining usernames and passwords, individuals should e-mail educate@ahca.org with their name and facility contact information. Questions about the program should also be directed to educate@ahca.org.
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HCS Nursing Home Study Underway
Hospital & Healthcare Compensation Service (HCS) is conducting its annual Nursing Home Salary & Benefits Study and requests your participation. Nursing Home providers are asked to complete the study’s questionnaire by May 9th. The study is published by HCS in cooperation with AHCA. The results will be published in July.
There is no cost to participate. Participants may purchase the results at the reduced price of $185, versus the $375 nonparticipant rate. Questionnaires may be downloaded at: www.hhcsinc.com.
Last year’s Nursing Home Report contained data from 1,613 nursing homes. The Report covers management salaries, bonuses, non-management wages, and fringe benefits. Data will be reported by region, state, CBSA, revenue size, and bed size. Both for-profit and not-for-profit data will be separately covered. Information on eighteen fringe benefits, shift differentials, turnover rates, and other facility metrics will also be included.
Contact Rich Cioffe at RJCioffe@hhcsinc.com, (201) 405-0075, ext. 10 with any questions, or if a deadline extension is needed.
HCS publishes ten annual compensation studies. Nationally known, their reports are recognized as the standard for reliable, comprehensive, and affordable compensation data for healthcare.
Thank you for your continued support!
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Maryland Department of Health Updates & Reminders
"128-Beyond Statute" Special Project: Please see this memo attached from Molly Marra, Director for the Office of Medicaid Provider Services (OMPS). The memo details a Special Project for claims receiving a 128 (only) denial code, indicating that the claim is beyond the timely filing statute. Please ensure that your facility takes appropriate action on these claims as this is a time limited project.
MA Redetermination Extension: Please see the March 28, 2022 memorandum announcing that the Department has extended Medicaid redeterminations until July 31, 2022.
CHOW Workaround - Memo from Office of Medicaid Provider Services: Please see this memo from Molly Marra, Director for the Office of Medicaid Provider Services (OMPS). The memo details the Long Term Care Provider Resolution Unit (LTCPRU) workaround process for facilities undergoing a Change of Ownership (CHOW) following the December 4, 2021 MDH security incident.
Reminder on State and Federal Special Fund Reporting: Maryland State Revenue and Supplemental Schedule is due 30 days after 3-31-2022 Federal Attestation.
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Reminder! Invitation to Participate in Northern Virginia Hiring Fair for Newly Arrived Afghans Friday, April 1st
If you are interested in participating in this event as a employer, please fill out this short registration form. This will provide us crucial information to ensure you are properly supported and resourced on the day of the event. We are asking for a small tabling fee of $100 per organization, which will directly support our clients’ employment search and will help cover event fees and client transportation. We will share more logistical information with you next week including the agenda and parking information. We will host an informational session next Wednesday, March 30 at 4 PM EST, to share updates with participating employers and answer questions they might have. Here is the link to register for the information session.
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Reminder! Call for Data: Professional Liability Benchmark Report for Senior Living and Long-Term Care Providers
Marsh’s Senior Living & LTC Industry Practice and Oliver Wyman’s Actuarial Practice are conducting a 2022 update to and expansion of their General and Professional Liability Benchmark Report for Senior Living and Long-Term Care Providers. AHCA/NCAL has partnered again this year with Marsh and Oliver Wyman and other leading national trade organizations including the American Seniors Housing Association, Argentum, and LeadingAge.
The information presented in this study is critical information for industry stakeholders interested in understanding important trends, loss drivers and other factors impacting resident care and quality. Included in this review will be an estimation of countrywide and state-specific trends separately for claim costs, severity, and frequency; an estimation of countrywide and state-specific claim costs; an examination of the relationship between indemnity costs compared to expense costs; and an analysis of the cause of loss descriptions. Especially relevant for 2022 will be the effect that the pandemic has had on losses.
We hope you will consider participating in this benchmark study in order to enhance the quality of this initiative.
The information Marsh and Oliver Wyman are collecting includes:
- Individual claim listing (excluding Protected Health Information) in Excel-readable format including as much detail as possible, valued as 12/31/2021. Please include claim information for the last 10 calendar years, if available.
- Occupied unit equivalent exposure information for the past 10 calendar years, if available.
HOW TO PARTICIPATE
As the 2022 study kicks off, we welcome and would appreciate your participation for the upcoming analysis. Upon data submission we will provide diagnostic information about your own data including various metrics, e.g., frequency and severity claim statistics; closing year, report year, and accident year statistics; open and closed claim statistics; and an exposure analysis. We will review the diagnostics and contact you to discuss any high-level observations or data anomalies.
There is no cost to participate, and all participants will receive a copy of the report and an invitation to the presentation of the results. We only ask for your assistance in obtaining the necessary data.
If you’re interested in participating, please contact Oliver Wyman regarding the data collection process or with any additional questions at LTCBenchmark@oliverwyman.com.
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Want to see previous HFAM updates?
Visit our website to view all previous HFAM alerts, as well as guidance
from our federal and state partners.
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