August 16, 2024

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The Latest News

Friday, August 16, 2024 - KDADS stakeholder meeting

CMS has begun "Risk based surveys" in several pilot states around the country. Kansas is currently not in the pilot. These Risk Based Surveys are shortened recertification surveys and we have heard positive things from other AHCA state affiliates. Kansas will not experience Risk Based Surveys (RBS) until the transfer of survey data to iQIES is complete. CMS sets the standard for choosing facilities that are eligible for the RBS. Based on other states, Kansas would likely have 10% of facilities eligible. One of the criteria is that a facility must have had a recertification survey within 15 months. On that basis alone, only 128 Kansas facilities would qualify. KDADS currently has 36 surveyor positions open. When the RBS program does begin in Kansas, a facility will not be able to qualify for participation 2 years in a row.

On the AL/Home Plus side, facilities are beginning to report facility initiated or involuntary discharges in the state's KOTA system. A question was asked about how to categorize a discharge when a resident goes to the hospital, and they will require more care than the facility provides when they are ready to discharge. KDADS is considering this a facility-initiated discharge that must be reported through KOTA. The reason they gave was that it was the facilities' decision to not provide that level of care and therefor an involuntary discharge. We will continue to explore this answer.

Some HCBS providers are expressing frustration with KMAP/Gainwell when trying to revalidate their provider agreement. We are working with Commission Andrew Brown to find solutions. If you are experiencing this problem, please let me know. lmowbray@khca.org

Finally, Medicaid applications that are over 45 days in processing are currently numbering at 238. Many of these are HCBS services and those claims cannot be backdated. KDH&E is beginning a liaison program for HCBS providers so that you will have your own pod or team of eligibility workers to help with your applications. This system has made great improvements on the nursing home applications. Training for providers will be rolled out soon.

As always, it's a pleasure to serve.

Linda MowBray President/CEO

Increase in Medicare Provider Enrollment Site Visit Contractor Activity

As you may recall, in the CY 2023 Physician Fee Schedule final rule, CMS changed the provider enrollment risk level for SNFs from limited to high. One of the requirements added was that all SNFs would be required to have a provider enrollment site visit contractor visit the SNF for a brief period to take some photos to verify the location existed and appeared to be operating as a SNF. These Monday through Friday visits (no weekends or holidays) are unannounced. The contractor then sends the photos and a brief report to the Medicare Administrative Contractor (MAC) within a couple days to add to the provider's enrollment file.

We are hearing that the frequency of these visits is increasing around the country.

This is not a state survey, and the site visit contractor is not affiliated with the state agency. The site visit contractor has a letter and photo ID badge with the CMS and their contractor's name logo. The contractors cannot leave a copy of the letter with the provider.

For more information, please see the links below:

RESOURCES:

AHCA Blog Article – June 21

CMS MLN Matters notice – June 20

Follow Up Resources from today’s NAC and Facility Standards Call

Participate in Medicare Advantage Experience Reporting Effort

AHCA/NCAL, in collaboration with other long term and post-acute care provider organizations, is launching an effort to collect data on Medicare Advantage (MA) provider experiences, particularly related to prior authorizations and MA plan compliance with the CY2024 MA Final Rule (CMS-4201-F). Your participation is crucial in gathering insights on how these MA plans and regulations impact skilled nursing care.

We are specifically requesting data on your experiences with MA plans and prior authorization denials during the periods of August 18-31, 2024, and September 2024. This data collection will help us better understand the challenges providers face and advocate for necessary reforms.

Why is This Important?

The data collected will be used to analyze the effectiveness of the CY2024 MA Final Rule and its impact on beneficiary access to care. We will aggregate and share these findings with the larger MA Workgroup and use them to advocate for improvements to Medicare Advantage policies. This is particularly important in light of recent findings from a KFF analysis showing a record number of prior authorization denials by MA plans in 2022, with 3.4 million requests fully or partially denied.

How to Participate

Download the MA Tracking Form: Complete the Excel tracking form (zip file) for the specified periods. Detailed instructions are included with the form. Be sure to go to your Downloads folder for the file.
Submission: Email the completed forms to Martin Allen, Senior Vice President for Reimbursement Policy, by September 5, 2024 (for the August reporting period) and October 5, 2024 (for the September reporting period).
Who Should Complete This? We recommend that facility administrators and business office managers handle the data compilation.

Confidentiality

Your responses will remain confidential and will not be attributed to specific facilities. The aggregated data will be shared within the MA Workgroup.

Please ensure that the appropriate staff review the reporting tool and understand the data collection process. If you need assistance or have questions, please contact Martin Allen directly.

Thank you for your support in this important effort.

Experts fear damage to long-term care pharmacies as CMS touts newly negotiated drug prices

Even as the federal government on Thursday touted the billions of dollars in savings seniors can expect to see from newly negotiated, lower drug costs, pharmacies that supply long-term care facilities are warning of dire consequences. READ MORE

KHCA Annual Business Meeting

The Annual Business Meeting, held during the Kansas Health Care Association’s 74th Annual Convention and Trade Show is scheduled as follows:

Friday, September 27, 2024

10:00- 11:00 AM

Kansas Star Event Center

785 Kansas Star Drive

Mulvane, KS 67110

Please plan to attend.

Click here to view reports as they become available. The member login information is required.

2024 Staff Recognition Program

Now is the time to nominate your staff!

The 2024 Staff Recognition Program is here again, and this is a way for you to honor your staff and volunteers. Our yearly awards ceremony is just a small way of honoring some of the great men and women who care for the elders of our great state! The time taken from your busy schedules to fill out this nomination is very much appreciated.

Winners will be honored at our Annual Convention and Trade Show on Friday, September 27, 2024.

Deadline to submit nominations is Friday, August 23, 2024.

CLICK HERE FOR THE NOMINATION FORM

AHCA Seeks Sped-Up Timeline In Challenge Against Federal Staffing Mandate

McKnight’s Long-Term Care News (8/13, Marselas) reports AHCA, "LeadingAge and four other parties in a lawsuit challenging the federal nursing home staffing mandate have told the case’s judge they expect a decision to be reached on motions alone and proposed a schedule that could lead to a resolution as early as January." This "motion, filed Friday, reveals AHCA’s intention to seek summary judgment by mid-October." HHS, "along with Secretary Xavier Becerra," CMS, and "Administrator Chiquita Brooks-LaSure also have agreed to the proposed timeline, according to filings reviewed by McKnight’s Long-Term Care News Tuesday."

First facility assessment deadline leaves gaping questions about surveyor intent

After three months of preparation, skilled nursing providers across the country were required late last week to complete their first enhanced facility assessment.

The broader look at resident and staffing needs will be used to support the federal staffing mandate, which has more specific hourly staffing requirements that begin to come into play in 2026. READ MORE

Education Spotlight