CMS Update, New Member Tools Featured at Washington Health Policy Forum

The annual LeadingAge PEAK Leadership Summit and Lobby Day were held in Washington, DC earlier this month. Although snow-induced closures of many federal offices reduced Lobby Day activities, the conference provided many great educational sessions and opportunities for delving into policy issues. While the speaker from the Centers for Medicare and Medicaid Services (CMS) was the centerpiece of the Health Policy Forum, the session began with an announcement about a set of new and exciting member tools developed by LeadingAge National.

LeadingAge has launched a suite of products designed to give members a quick and in-depth understanding of regulatory issues. The Regulatory Round Up is a suite of three products designed to provide LeadingAge members an exclusive, all-in-one resource for valuable information about federal regulatory initiatives and developments. It covers nursing home, HUD housing, and home and community-based services (HCBS) issues. Each Round Up includes an introduction that explains how to use the product as well as contact information for LeadingAge Public Policy staff for each content area and will be updated quarterly. The tool features include:

• Quick reference icons in each individual entry that provide an easy way to determine the purview of the initiative (e.g., regulatory, quality, or payment);
• A short, high-level summary providing basic information about each entry;
• Sources of additional information gathering together in one place resources relating to the particular initiative;
• Important dates and deadlines that provide the reader with a visual representation of important milestones in the evolution of the initiative as well as upcoming deadlines for compliance.

LeadingAge staff provided a federal legislative update on recent developments. The recently enacted Bipartisan Budget Act of 2018 resulted in several positives for long term care, including:

• a moratorium on civil monetary penalties (CMPs) for deficiencies related to new Requirements of Participation;
• the repeal of therapy caps;
• the extension of the Medicare home health rural add-on;
• the CHRONIC Care Act, which expands telehealth and enacts an Independence at Home demo; and
• a 2.4 percent inflation adjustment to Skilled Nursing Facility (SNF) Medicare Part A rates for October 2019.

While LeadingAge continues to advocate for legislation addressing observation stays that would require all hospital days to count toward the Medicare 3-day stay, policy staff is cautiously optimistic that Congress will not take up any large-scale changes to Medicare and Medicaid this year. Other advocacy priorities for the association include urging Congress to address financing long term care services in a unified way and a nursing home survey bill that would:

• establish surveyor training standards;
• require joint training for surveyors and NH staff;
• allow states to do demo programs to do alternative approaches; and
• provide flexibility to CMS in imposing survey deficiency remedies that include aide training program suspension, which is currently legislatively mandated in certain instances.

A representative from the CMS Division of NH Quality and Oversight (formerly the Survey and Certification Group) described the agency’s “patients over paperwork” initiative as a top priority. In response to stakeholder input, CMS is examining several areas of potential regulatory relief:

• Notification to the Ombudsman every time there is transfer or discharge;
• Abuse reporting requirements, especially the need to report everything within two hours;
• Documentation and other requirements regarding antipsychotic medications.

CMS has been examining the new survey process that started in November 2017 and has observed that it is taking longer, that survey teams are larger, and that there is a steep learning curve, especially in those states in which surveyors did not utilize laptop computers previously. The average number of deficiencies has not changed noticeably. Emergency preparedness surveys are being incorporated into health or life safety survey, not done as stand-alone survey. CMS may issue clarifications to previously-issued generator guidance because it has generated many questions.

In their efforts to increase transparency and consistency, CMS is moving surveyor training to an online, on-demand system that anyone will be able to review, along with videos of the software used by surveyors. Website visitors will be able to see screens of how samples are selected and the info surveyors see and use as they are performing inspections. CMS has also developed a tool for assessing CMPs that should help standardize how CMPs are determined and yield similar remedies under similar circumstances in all geographic areas.

Payroll-based journal staffing data is likely to become the basis of the 5-Star staffing rating soon, although no firm date for the transition has been announced. After that transition occurs, CMS intends to eventually get rid of form 671. Finally, although there remains no timeline for replacing the RUG-IV system with RCS-1 as the basis for case mix adjustments of SNF Medicare Part A rates, it will almost certainly not occur this year.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841