Volume #2-2019 | February 2019
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Cabinet for Health & Family Services
Office of Inspector General
Division of Health Care

Long Term Care Provider Newsletter
February 2019
The Inspector General would like to announce that Jackie Aitkin is the new Director of the Division of Health Care, effective immediately. Jackie has been with the Office of Inspector General since 2001 and has served as Assistant Director for the Division of Health Care since 2011. Jackie’s background and understanding of the process will help ensure continuity as we move forward. We will continue to provide updates on legislative issues and changes to the new long term survey process, and address topics of interest requested by you. Please welcome Jackie to her new position.
MDS October 2019 Changes

On 07/31/2018, CMS published a Final Rule to implement a new Medicare case-mix classification system, the Patient Driven Payment Model (PDPM). The new changes will be implemented 10/01/2019 for Medicare SNF stays.

What do I need to know?

  • The changes will affect the MDS and RAI Manual in addition to Medicare reimbursement.

  • As part of the new PDPM system, the current 14-day, 30-day, 60-day, and 90-day, PPS assessments will be eliminated beginning 10/01/2019 for Medicare residents. Once implemented, facilities will only be required to complete the existing 5-day and the PPS Discharge Assessments. An Interim Payment Assessment (IPA) will be available to complete as needed.

  • The above mentioned changes to assessments relates to assessments for Medicare; there are no changes to the required Omnibus Budget Reconciliation Act of 1987 (OBRA '87) assessments for all residents.

  • The new payment model for Medicare reimbursement will use data from Section GG, Functional Abilities and Goals, rather than Section G data to calculate a functional score, which is similar to an activities of daily living (ADL) calculation.

  • Over the next few years, CMS will continue to make changes to the MDS 3.0 and the PDPM by removing MDS 3.0 items that are not necessary to classify residents under the new PDPM model. State agencies are still evaluating all the MDS changes and any impact on Medicaid reimbursement.

  • Currently, CMS states it will no longer support current RUG classification systems beyond 09/30/2020 for all Medicaid residents. Several states have submitted questions to CMS related to necessary data needed for various payment methodologies. Further clarification is expected from CMS soon.

Useful Resources:

Coming soon to a location near you!
Annual RAI Provider Training to be held before the 10/01/2019 implementation date. 
Details to be announced…
National Site Visit Contractors

CMS has implemented a site visit verification process using a National Site Visit Contractor (NSVC). The site visit verification process is a screening mechanism to prevent questionable providers and suppliers from enrolling in the Medicare program.

The NSVC will conduct site visits for all providers and suppliers except for the Durable Medical Equipment (DMEPOS) which will continue to be conducted by the National Supplier Clearinghouse. The NSVC will verify enrollment related information during the site visit and collect specific information based on pre-defined checklists. Failure to cooperate with the inspector(s) could result in the denial or revocation of your Medicare enrollment number.

MSM Security Services, LLC was awarded the national site visit contract. MSM and its subcontractors, Computer Evidence Specialists, LLC (CES) and Health Integrity, LLC (HI) are authorized by CMS to conduct the provider and supplier site visits. Inspectors performing the site visits will be employees of MSM, CES, or HI and shall possess a photo ID and a letter of authorization issued and signed by CMS that the provider or supplier may review. Under no circumstances may their ID or this letter be copied or retained by the provider/supplier . If you have any questions, please contact MSM point of contact at (855) 220-1071.

This information is also available on the CMS website.
The KEEN-CDC Project
The K entucky E nduring E ducation & care N etwork for C ollaborative D ementia C are

The Need: Over 5 ½ million Americans suffer from Alzheimer disease today and this number is rapidly increasing. Total costs in 2016 for people aged ≥65years with AD and other dementias exceeded $259 billion nationally. The majority of healthcare expenditures related to dementia occur in the later stages of disease when patients are often living in the setting of Certified Nursing Facilities (CNFs). A substantial proportion of this economic burden arises from costs associated with an inability to provide adequate care for residents with dementia that could have been more effectively managed if adequate specialty training were available. The KEEN-CDC Project’s educational platform will educate on Certified Medicare Services (CMS) Long Term Care Requirements and provide a platform for delivery of care meeting these guidelines, training both CNF providers/administration as well as Office of Inspector General (OIG) internal staff/surveyors, and providing practical tools needed to address deficiencies in CNF dementia care.

The Program: The KEEN-CDC program will entail quarterly live tele-medicine based programs covering a range of topics over the next three years (2019-2021). These live programs will be archived into a 6 year enduring web-based educational resource focused on Certified Nursing Facilities advanced healthcare providers in KY. This program will be completely free of charge, provide continuing medical education credits, and is directly modeled after our existing, enduring materials program ( http://www.cecentral.com/dementia) that has been: widely received, trained over 2,000 individuals globally, and posted on the National Institute on Aging Alzheimer Disease Education and Referral Website.

Topics to Be Covered in the KEEN-CDC Program Series include:

  • Diagnosis and treatment of cognitive decline,
  • Management of behavioral and psychiatric disturbances,
  • Pain, nutrition, sleep disturbance,
  • Physical disability, daily care provision, elder abuse, and
  • End-of-life/palliative care issues for residents with dementia.

First Program in the KEEN-CDC Series:

“Overview of Dementia & CMS Long Term Care Requirements of Participation”

Greg Jicha, MD, PhD
University of Kentucky Sanders-Brown Center on Aging

Michelle Mitchell, RN, BSN
KY Office of Inspector General

Tuesday, March 5, 2019
3:00 – 4:30 pm ET/2:00 – 3:30 pm CT

To register, go to www.cecentral.com/live/13060

For the brochure, please click here. For the flyer, please click here.

Free Workshop - SAVE THE DATE!
Reducing Readmissions:
"Go to the Hospital or Stay Here?"
A Decision Guide

Readmissions are a fact of health care for the aged and chronically ill. However, CMS has identified that many transfers to the hospital are unnecessary and can potentially cause more harm than good for the resident. CMS is now imposing penalties on nursing homes for excess readmissions.

Timely education of residents and families about the care that can be provided in the facility early in the admission process and reinforced throughout the stay is a key component in reducing urgent transfers. To assist facilities in providing written information, Dr. Ruth Tappen and an interdisciplinary team at Florida Atlantic University produced a CMS Region IV and State of Kentucky approved Decision Guide, “Go to the Hospital or Stay Here?” ( www.decisionguide.org). The Guide provides facts and objective points for residents and families to consider when faced with a change in condition and possible readmission. The Guide has been piloted among select Skilled Nursing Facilities across eight states and now is being disseminated to all SNFs throughout CMS Region IV.

Several thousand Medicare-certified Skilled Nursing Facilities are being offered the unique opportunity to enhance their education to staff, residents and family on the options for going to the hospital or staying at the facility for care. Beginning in January there will be educational sessions offered in multiple locations across each state in Region IV. The dates for Kentucky will be April 10 th in Louisville and April 11 th at Kentucky Dam Village (Gilbertsville). During the session, participants will be provided with an overview of the Decision Guide content, learning videos and techniques to introduce the information to staff, residents and family. Best practices on how to hardwire “The Guide” into your organization’s admission process as well as highlights from the pilot project will be discussed.

Attached are the details for registering for this no-cost workshop. CEUs will be provided for nurses and administrators. Target audiences for the sessions should be any staff who provide education to residents and families during the admission process, as well as affiliate partners who support quality improvement such as QIOs, the State Survey Agency, Ombudsmen and LTC Professional Organizations.

The Guide was a perfect complement for our readmission reduction efforts. It validated everything we go over with our residents and families, but now we have “The Guide” to leave behind during the admission discussion.” - NC Pilot Facility.

Looking forward to seeing you there! 

Patient-Driven Payment Model

Effective October 1, 2019, CMS will be using a new case-mix model for Medicare, the Patient-Driven Payment Model, which focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment.

CMS has set up a website of resources available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM.html . As we prepare for this change, additional training opportunities will be made available later this year.
MDS 3.0 Data Specifications - V3.00.0

A new version (V3.00.0) of the MDS 3.0 Data Specifications was posted. This version is scheduled to become effective October 1, 2019. Note that there are many significant changes, including the removal of eight item sets (NS, NSD, NO, NOD, SS, SSD, SO, SOD), the addition of two new item sets (IPA and OSA), and item additions in Sections A, GG, I, J, O and Z. These specs accommodate the utilization of the PDPM grouper, which also begins on October 1, 2019.

In addition, a new version (V1.04.0) of the MDS 3.0 CAT Specifications was posted. This version is also scheduled to become effective October 1, 2019. The specification for CAT 12 (Nutritional Status) has been updated in accordance with the changes in V3.00.0 of the MDS 3.0 Data Specifications.

Both of these updates can be downloaded from the CMS MDS 3.0 Technical Information site.
MDS 3.0 Quality Measure Reports Available

MDS providers were notified by CMS on January 25th, that the reports in the 'MDS 3.0 Quality Measure Reports' category in the CASPER Reporting application would be unavailable while enhancements were being applied to the reports. These reports are now available and contain the following enhancements:
  • Calculation updates/changes to short stay pressure ulcer measure, long stay pressure ulcer measure, and the long stay weight loss measure
  • 'Hi-risk/Unstageable Pres Ulcer (L), N015.02' will display with 'Hi-risk Pres Ulcer (L), N015.01' measure results to see changes in calculations
  • A new legend is present to direct users to the SNF QRP Quality Measure CASPER reports to view results for the SNF QRP Pressure Ulcer (S) Measure
  • Updates made to columns/display for 508 compliance
If you have questions concerning this information, please contact the QTSO Help Desk at help@qtso.com or 1 (800) 339-9313.

The CASPER Reporting User's Guide For MDS Providers  has been updated to reflect these Quality Measure changes.  
Kentucky Annual Utilization Surveys

The Kentucky Annual Utilization Surveys were released on January 15, 2019. The required completion date is March 15, 2019. All licensed long term care facilities are required to report. These include Nursing Facility, Personal Care, Nursing Home, Alzheimer, Intermediate Care and ICF/IID beds. The reporting of this data is required by 902 KAR 20:008 and 900 KAR 5:020. 

Any request for an extension of the deadline must go through Elizabeth Tutt, Survey Administrator and Healthcare Data Analyst. You may contact her by email or by calling (502) 564-9592 x.3156.

CLICK HERE for the website for the survey completion. The facility license number is the login and facilities should create their own password the first time they log in each year.
Informal Appeal of Survey Findings

Every Long Term Care provider has the right to both an informal and formal appeal process following receipt of a completed Form CMS-2567. There are two informal appeal processes: Informal Dispute Resolution (IDR) and  Independent IDR (IIDR) .
Interested in Serving on an IDR Panel?
Kentucky requires one member of the IDR panel to be "a person currently engaged in the provision of Long Term Care services who has no affiliation with the provider disputing a deficiency." Typically, a Long Term Care Administrator is on each IDR panel. There is no payment or travel reimbursement for an Administrator serving on a panel. Administrators will be rotated. If a Long Term Care Administrator is interested in serving on a panel, a confidentiality statement must be signed prior to the participation in the first IDR panel.
Please complete the  Confidentiality Agreement  and submit via email , fax, or mail to:
Chrystal Daugherty, IDR/IIDR Coordinator
Office of Inspector General
116 Commerce Ave.
London, KY 40744

Fax: (606) 330-2054
Improve Quality Measures for Pressure Ulcers and Other Wounds and Earn FREE CE Credits for LTC Nurses, Social Workers, Dietitians/Nutritionists

Access the newest AMDA Clinical Practice Guideline on Pressure Ulcers and Other Wounds as part of the Kentucky initiative to prevent pressure ulcers! Staff can earn FREE CE/CPE hours by completing the exam for nurses, social workers, and dietitians/nutritionists. Other staff can earn a Certificate of Completion! 

Access the other FREE training resources at the password-protected website www.cpgltc.org
with the CMS Region IV Quality Improvement Initiative, a 6-state CMS CMP program. 

  • 20 CE Exams with 1-3 contact hours – up to 42 total hours for LTC Nurses
  • 15 CE Exams with 1-3 contact hours – up to 29 NASW approved hours for LTC Social Work
  • 14 CE Exams with 1-3 contact hours – up to 20.5 hours for LTC Dietitians/Nutritionists from Becky Dorner Associates
  • CPG Implementation Series (Heart Failure, Pain Management, Urinary Incontinence) with accompanying training resources including narrated Power Points for nurses and nurse aides
  • 4-part Disease Awareness Video Series (COPD, Diabetes, Pain Management, Moderate Alzheimer’s)
  • Know-it-All™ Before You Call (for LTC staff) data collection tools for 70+ common health conditions
  • Know-it-All™ When You’re Called (for physicians and practitioners) data collection tools for 70+ common health conditions

LTC administrators receive facility-specific passwords and usernames. Please share with staff for access to FREE training materials at www.cpgltc.org. For facility username and password assistance, contact help@cpgltc.org
The next level of FREE Emergency Preparedness training conferences, EP 201, will be held on April 16-17 at the Crowne Plaza Hotel in Louisville, Kentucky. This conference is a “Deep Dive” into the elements of the CMS Final Rule on Evacuation, Transportation and Surge Planning. A preview of the new Electronic Hazard Identification mapping tool, created by Stantec, will be showcased at the conference. Learn how to conduct both Community and Tabletop Exercises. Bring your facility floor plans to create a Surge Plan specifically for your facility. Network with other facilities in your region.

All Leadership Teams such as Administrators, Assistant Administrators, Directors of Nursing, Maintenance/Plan/Facility Directors, Risk Managers and members of Safety/Emergency Preparedness Committees are invited to attend. There is no limit on the number of representatives from your facility who can attend.

Click here for a registration brochure. Please complete one registration form for each member attending the EP 201 conference and return by email to ltc2prep@louisville.edu or by fax to 502-852-5887.

This is the last of three EP 201 conferences to be offered, so don’t delay and register today!  

Questions? Contact Diana Jester at 502-852-3487 or diana.jester@louisville.edu.
A Message from Kentucky's QIN-QIO
OIG is pleased to provide information from the CMS funded QSource and atom Alliance, the Quality Innovation Network (QIN) - Quality Improvement Organizations (QIOs) for Kentucky. 
Click the link below to read a message from Kentucky's QIN-QIO:

Kentucky's Top 10 Citations
for Nursing Homes

Chrystal Daugherty
MDS Assessment/Coding Issues
 606-330-2030 x.283 or  e-mail  
Rhonda Littleton-Roe  
Transmission or Technical
502-564-7963 x.3300 or   e-mail
ePOC Accounts
Is your certified nursing facility signed up for ePOC? If so, be diligent about keeping your account and password up to date.  Click here  for the CMS security rules.

If your facility is not signed up, see the  Account Setup  instructions.

Not sure if your facility has any ePOC accounts or have other questions?
E-mail  ePOC.Support@ky.gov .
Have you notified your residents?

Click the link below to download and/or print the contact list for various agencies.

to find an Ombudsman

Which Enforcement Branch
is Serving You? 
To provide the highest level of service, the Division of Health Care operates through four regional offices. Knowing the appropriate Enforcement Branch to contact with questions and concerns will ensure you receive maximum service in minimum time. Review links below for detailed information.

CMS Survey and Certification memoranda, guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices.

Transfer/Discharge Hearing Appeals

Please submit your requests for transfer/discharge hearing appeals to Secretary Adam M. Meier, Cabinet for Health and Family Services, by emailing:

LTC Facility Self-Reported
Incidents & Complaints
New email addresses have been established for communications regarding LTC Facility Self-Reported Incidents and for use by residents and the general public to report possible violations of regulatory requirements.  Click Here  for the email addresses and additional contact information. 
ISTW: Integrated Surveyor Training Website

This CMS website provides training information to include the preceptor manual, the State Operations Manual and other documents. As always, the survey and certification process is a collaborative effort between CMS and providers. This website will allow providers the opportunity to take the same courses as surveyors.

Employment Opportunities  

To search and apply for positions within the Office of Inspector General, please visit the Kentucky Personnel Cabinet's web page by clicking below.

DHC Leadership Team:
Inspector General 

V acant
Deputy Inspector General 

Assistant Director
Assistant Director
Assistant Director 

 Pharmacy Consultant
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