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Community Provider News

12/07/18 – Kaiser Health News – More than Half of California Nursing Homes Balk at Stricter Staffing Rules

By Barbara Feder Ostrov

More than half of California’s nursing homes are asking to be exempted from new state regulations that would require them to spend more time directly caring for their patients.

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9/4/18 – Kaiser Health News – Creating Rituals to Honor the Dead at Long-Term-Care Facilities

By Judith Graham

One by one, their names were recited as family members clutched one another’s hands and silently wept.

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05/09/18 – CHCS – ThedaCare: Leveraging Community Paramedics to Bridge Persistent Gaps in Care

Brian Randall is a paramedic in northeastern Wisconsin, but when he goes out on a call he does not careen down the street in an ambulance, sirens blaring and lights flashing. Instead, Randall, who meets with people with complex medical and social needs in their homes, drives a Suburban and is more likely to be carrying a weighted lap blanket or blood pressure cuff than a stretcher. He is one of two community paramedics from Gold Cross Ambulance Service who work in partnership with ThedaCare, a large nonprofit health care system in Wisconsin, to bridge existing gaps in chronic disease management for patients struggling to manage their health.

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04/26/18 – CHCS – Providing Home- and Community-Based Nutrition Services to Low-Income Older Adults: Promising Health Plan Practices

By Stephanie Gibbs

State Medicaid agencies and Medicaid health plans increasingly recognize the importance of social support services, including nutritious food, as part of a holistic approach to addressing the needs of low-income older adults and enabling them to live independently. Medicaid health plans are especially well-positioned to identify nutrition-related needs for this population and address them through partnerships with community-based organizations.

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04/03/18 – Kaiser Family Foundation – Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2008 Through 2016

By Charlene Harrington, Helen Carrillo, Rachel Garfield, MaryBeth Musumeci, and Ellen Squires

Nursing facilities are one part of the long-term care delivery system that also includes home and community based services, but their relatively high cost has led them to be the focus of much attention from policymakers. Medicaid plays a major role in financing nursing facility care in the United States, and policy proposals to limit federal financing for Medicaid may lead to cuts in eligibility or scope of coverage for long-term care services. In addition, regulations effective November 2016 aimed to address longstanding challenges in quality and safety in nursing facilities. As the demand for long term care continues to increase and policy proposals and regulations unfold, the characteristics, capacity, and care quality of facilities remain subjects of concern among consumers and policy makers.

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Click here to view supplemental tables


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02/14/18 – McKnight’s – Skilled Nursing Providers Would Lose Out Under Trump’s Revised Payment System

By Kimberly Marselas

A plan to lump together payments to all post-acute providers would be a budget cut dressed up as reform, providers said after reviewing the Department of Health and Human Services budget proposal.

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12/19/17 – NAHC - NAHC Opposes Cuts to Medicare Home Health Payment Rates and Spending

Congress is considering severe cuts to Medicare home health payment rates and spending that could total $4-$6 billion over the next ten years. What’s more, lawmakers are considering phasing out the rural add-on over the next three to five years.

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12/4/17 – NAHC – The Time for Private Duty Home Care Accreditation is Now

It is an exciting time in private duty home care services, with expanding business opportunities yielding the possibility of rapid growth. However, growth in the industry has led to calls for more oversight and regulation and more and more states are considering legislation to make accreditation for private duty home care agencies mandatory.

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11/27/17 – McKnight’s – Tomorrow’s the Day: Providers Prepare for Phase 2 Deadline

By Emily Mongan

Despite efforts from provider groups and lawmakers to delay Phase 2 of the Centers for Medicare & Medicaid Services' Requirements of Participation, the new survey process is expected to take effect Tuesday.

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11/16/17 – McKnight’s – Changes to Medicare Telehealth Coverage May Benefit LTC

By Emily Wein

While arguably late to the telehealth game, long term care and post-acute care providers are now key players in telehealth as its benefits become more and more apparent for their patients and business models. Recent changes in federal law may provide some additional support and momentum for the continued and increased use of telehealth within this industry.

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09/14/2017 – McKnight’s – New Bill Seeks to Bolster LTC Workforce with Grants, Awards Program

By Emily Mongan

Legislation introduced in the House last week will aim to shore up the nation's long-term care workforce with increased investment in training and a focus on caregivers in rural areas.

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Click here to view the bill


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08/16/2017 – The Commonwealth Fund - An Emerging Approach to Payment Reform: All-Payer Global Budgets for Large Safety-Net Hospital Systems

By Joshua M. Sharfstein, Sule Gerovich, Elizabeth Moriarty, and David C. Chin

Many communities in the United States experience high rates of premature illness and death. In 2015, the nation’s life expectancy dropped for the first time since 1993.  Expanding access to primary care, behavioral health services, and other social services can improve health outcomes and moderate rising costs. However, finding sustainable sources of funding for clinical transformation has been challenging. One major reason is that the safety-net health care systems still depend on fee-for-service reimbursement for hospital services. When health systems can stay afloat only by keeping inpatient beds filled, major investments in prevention can sink the ship.

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08/08/2017 – The Commonwealth Fund - Patients Are Not Given Quality-of-Care Data About Skilled Nursing Facilities When Discharged from Hospitals

Most hospital patients who require care from a nursing facility following their discharge receive no information about the quality of available facilities, according to interviews with patients and medical staff. With hospitals now held partly responsible for their patients’ care after discharge, Medicare will likely need to amend or clarify its rules to encourage hospitals to recommend higher-quality facilities to their patients.

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Click here to view the report


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07/13/2017 – The United States Department of Justice - National Health Care Fraud Takedown Results in Charges Against Over 412 Individuals Responsible for $1.3 Billion in Fraud Losses

Largest Health Care Fraud Enforcement Action in Department of Justice History

Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists. 

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07/13/2017 – All Gov - Assistant Secretary for Aging: Who Is Lance Robertson?

On June 19, 2017, President Donald Trump nominated Lance A. Robertson of Oklahoma to be the next chief of the Administration for Community Living, an office in the Department of Health and Human Services that is responsible for home and community-based services and programs related to aging. Since 2007, Robertson has been director of Aging Services at the Oklahoma Department of Human Services. If confirmed by the Senate, Robertson would succeed Kathy Greenlee, who had served since 2009.

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07/11/2017 – Kaiser Family Foundation - Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 Through 2015

By Charlene Harrington, Helen Carrillo, and Rachel Garfield

Nursing facilities are one part of the long-term care delivery system that also includes home and community based services, but their relatively high cost has led them to be the focus of much attention from policymakers. Medicaid plays a major role in financing nursing facility care in the United States, and recent policy proposals to limit federal financing for Medicaid may lead to cuts in eligibility or scope of coverage for long-term care services. In addition, new regulations, effective November 2016, aim to address longstanding challenges in quality and safety in nursing facilities. As the demand for long term care continues to increase and new policy proposals and regulations unfold, the characteristics, capacity, and care quality of facilities remain subjects of concern among consumers and policy makers.

Read More

Click here to view the supplemental tables


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06/14/2017 – AARP Public Policy Institute – Long-Term Services and Supports State Scorecard 2017 Edition

By Susan C. Reinhard, Jean Accius, Ari Houser, Kathleen Ujvari, Julia Alexis, and Wendy Fox-Grage

The Long-Term Services and Supports (LTSS) State Scorecard—a compilation of state data and analysis—finds that progress toward better support for our rapidly increasing populations that are aging and living with disabilities is slow and uneven, with great variation among states. Still, states made significant improvements in supporting family caregivers, providing more home- and community-based services, and reducing burdensome care transitions from one care setting or provider to another.

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06/07/2017 – The Commonwealth Fund - An Overview of Home-Based Primary Care: Learning from the Field

By Sarah Klein, Martha Hostetter, Douglas McCarthy

In the United States, some 2 million older adults are so sick, frail, or functionally limited they are effectively homebound; another 5 million have difficulty leaving home without help.1 Many suffer from multiple chronic health conditions such as heart failure, emphysema, and stroke, which may be compounded by psychiatric or cognitive disorders, including depression or dementia.2 These figures don’t include the millions of younger Americans suffering from catastrophic or disabling conditions like quadriplegia or ALS.3 “These are the people you don’t see in grocery stores and restaurants. Because they also don’t get to the doctor, they often end up in the emergency department and the hospital in crisis,” says Terri Hobbs, executive director of Housecall Providers, a Portland, Oregon–based nonprofit that brings primary, palliative, and hospice services to people at home.

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05/12/2017 – CHCS - Self-Direction of Home- and Community-Based Services: A Training Curriculum for Case Managers

Self-direction of home- and community-based services (HCBS) allows individuals to determine what mix of personal care services and supports works best for them within the parameters of their person-centered service plan. Many states implementing Medicaid managed long-term services and supports or other managed integrated care programs that provide HCBS are offering individuals the opportunity to self-direct their HCBS. Health plan case managers play a key role in implementing self-direction.

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05/10/2017 – Kaiser Family Foundation - Data Note: A Large Majority of Physicians Participate in Medicaid

By Julia Paradise

About 70% of all office-based physicians accept new Medicaid patients, including two-thirds of primary care physicians and close to three-quarters (72%) of specialists. The percentage of physicians accepting new Medicaid patients varies by state, ranging from 39% in New Jersey to 97% in Nebraska (Figure 1). Overall, about 85% of physicians accept new privately insured patients, but this rate also varies by state, ranging from 57% in the District of Columbia to 95% in Illinois. In one-quarter of states (14), more than 85% of physicians accept new Medicaid patients, including 10 states where at least 90% do. Physician participation in Medicaid is generally highest in the most rural states.

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04/06/2017 – Alzheimer’s Association - Toolkit for Medicare Coverage of Care Planning

Cognitive decline — including Alzheimer's disease and other dementias — can be difficult and time consuming to discuss with patients. Although in-depth care planning is beneficial for all, this type of service has not been covered under Medicare — until now.  The new G0505 Medicare code provides reimbursement for a clinical visit that results in a comprehensive care plan, allowing you to deliver services that can contribute to a higher quality of life for your patients. Clinicians who can be reimbursed under the code include: physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives.

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Click here to view the complete toolkit


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04/05/2017 – McKnight’s - More Targeted Medicare Claims Reviews Coming, Former Agency Examiner Says

By Emily Mongan

An evolving Medicare integrity program and improved data analytics will put providers on the receiving end of more targeted claims reviews, one industry expert warned on Tuesday.  That increased scrutiny means providers would be wise to beef up their documentation and ensure they're responding to additional development requests with timely, sufficient document packets, according to Jaclyn Warshauer, PT, national clinical director for Aegis Therapies. She spoke Tuesday during the American College of Health Care Administrators' annual convocation in St. Louis.

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03/21/2017 – Administration for Community Living - DRAFT Principles for a Person-Centered Approach to Serious or Advanced Illness

By Edwin Walker and Bob Williams

At ACL, we believe that every person should be able to make choices and to control their own decisions, regardless of their age, disability, or illness.  ACL, in consultation with stakeholders from the aging and disability communities, has drafted a set of principles to guide our work in this area, and to enhance existing programs and services related to serious or advanced illness for older adults and people with disabilities.  Now we need your feedback. We know there are a wide variety of deeply held perspectives on these issues, and we are committed to better understanding them.  We are seeking input from the people we serve—older adults, people with dementia, people with all types of disabilities, and the families and caregivers who often support them.  We also hope to hear from our partners in the aging and disability networks.  Please send your comments, by May 12, 2017, to AdvancedIllness@acl.hhs.gov. We will carefully consider all input as we finalize the principles, which we will share via ACL.gov when complete.    

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