Archive September 2023

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A Successful Coffee and Conversation with Senator King

Last Tuesday, September 26, Senator King joined MHCA members and friends to discuss the state of long term care in Maine. Generously hosted at the Avita of Stroudwater, the event aimed to foster an open dialogue about the challenges and opportunities associated with our industry. A highlight was the Senator sharing his concerns about CMS's proposed unfunded staffing mandate and committing to writing to CMS about his significant reservations. 

Thank you to all who contributed to the event. Building strong relationships with our elected officials will help ensure long term care is not overlooked. 

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2023 Excellence in Long Term Care Honorees Announced

This year's Excellence in Long Term Care celebration received over 50 nominations, and 14 were selected by a panel of judges as 2023's honorees. Maine is fortunate to have such a long list of dedicated caregivers. Thank you to all who participated in the nomination process. We look forward to recognizing the honorees at the Maple Hill Farm Bed & Breakfast Inn & Conference Center on November 9 from 10:30 AM to 1 PM.

•Tim Peaslee, CNA, Maine Veterans' Home Scarborough
•Stella Cain, Direct Support Professional, OHI
•June Phelps, PSS (Personal Support Specialist), Maine Home Care
•Kathryn Desrosiers, MDS Coordinator, Durgin Pines
•Kathy Russo-Farr, CNA, Scarborough Terrace
•Olivia Maxwell, Clinical Nurse Advisor, Alzheimer's Care Center- MaineGeneral Rehab and Long Term Care
•Michael Roy, CNA, Piper Shores
•Boon Moors, PSS (Personal Support Specialist), Clover Health Care
•Dennis Contreras, Nurse Manager, Springbrook Center
•Kerry Ratigan, Social Worker, Cove's Edge
•Jim LeBlanc, Cook, Maine Veterans' Home Scarborough
•Sandra Lucas, Director of Spiritual Care and Mission Integration, St. Andre Health Care
•Lisa Lindary, Life Enrichment Coordinator, Scarborough Terrace
•Lewis Stubbs, Director of Food and Nutrition, Dirigo Pines

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CMS wants to know if you do NOT have internet for your Residents.

Does your center have wireless internet access for your residents? 
CMS wants to know it you DO NOT
 On September 25, 2023, CMS released QSO 23-23-NHs  Civil Money Penalty Reinvestment Program Revisions.     As part of QSO 23-23-NHs The Center for Medicare and Medicaid Services is assessing the need for internet in nursing homes.   Once they assess the number of facilities without this capability and the reasons for the lack of access, they will determine if CMP funds can be used for a project to help address these issues.
Nursing Homes which do NOT have broadband wireless internet access for residents are requested to complete this form  and submit to CMS at no later than December, 22, 2023

For more information about the Civil Money Penalty Reinvestment Program Click here.

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The AHCA/NCAL 2023 #GetVaccinated Provider Toolkit is Now Available

As we gear up for cold and flu season, the importance of vaccination has never been more evident. Especially now that the federal government approved a new, updated COVID vaccine.
We know ensuring the health and well-being of residents and staff in long term care remains your top priority. That’s why we are excited to announce AHCA/NCAL’s 2023 #GetVaccinated Provider Toolkit – a comprehensive set of resources designed to equip providers with the tools and information needed to promote and facilitate annual vaccinations among residents and staff this fall and winter.
The 2023 #GetVaccinated Toolkit includes:
  • A checklist for providers with suggested best practices in order to prepare for fall vaccination season;
  • Poster graphics to raise awareness about the importance of getting vaccinated;
  • Social media posts and graphics;
  • Template letters to residents and family members; and
  • In-depth resources for providers about recommended vaccines for residents and staff, documenting vaccines, frequently asked questions, and more.
Why use the #GetVaccinated Toolkit?
  • Streamline Implementation: The toolkit provides ready to use materials, saving you time and effort in creating your vaccination campaign.
  • Consistency: Ensure that your message to residents and staff remains clear and consistent across all channels – posters, social media and letters.
  • Understand Requirements: With the end of the Public Health Emergency, make sure you understand changing regulations and policies, including documenting and billing.
  • Protect Lives: Vaccination is a powerful tool in preventing vulnerable populations from getting seriously ill and hospitalized from the flu, RSV and COVID-19.
Please take advantage of these resources located at and incorporate them into your fall vaccination campaign. If you have any questions about the resources or fall vaccinations, please contact
Together, we can make a significant impact on the health and safety of those who work and reside in long term care. 
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CMS Updates Nursing Home Care Compare Staffing and Quality Measures

The Centers for Medicare & Medicaid Services (CMS) has issued QSO-23-21-NH, which pertains to forthcoming changes scheduled for April 2024 within the Nursing Home Care Compare Staffing and Quality Measures.
These adjustments are designed to align with previously announced changes to the Minimum Data Set (MDS) that are set to take effect on October 1, 2023. These modifications encompass shifts in the staffing level case-mix adjustment approach, transitioning from RUG-IV to PDPM. Moreover, CMS has announced its intention to eliminate the CMS-672 form (Resident Census and Conditions of Residents).
Additional modifications include:
Adjusting Turnover Scoring in the Absence of PBJ Data
As of  April 2024, CMS will amend the staffing rating methodology for providers that either fail to submit staffing data or provide inaccurate data. In such cases, they will receive the lowest achievable score for the relevant staff turnover metrics. The turnover measures rely on PBJ data over six consecutive quarters. Currently, nursing homes failing to submit data for staff turnover have their turnover metrics excluded from the staffing rating calculation. No alterations have been made to the consequences of missing PBJ data on the calculation of hours per resident day measures or the automatic downgrade to one-star if the most recent quarter's PBJ data is absent.
Freezing Staffing Ratings from April to June 2024 for PDPM Case-Mix Adjustment Transition
Beginning in April 2024, CMS will temporarily freeze (i.e., maintain at a constant level) staffing measures and ratings for a three-month period. This freeze is in response to the transition from RUG-IV to PDPM case-mix adjustment, prompted by the elimination of MDS Section G on October 1, 2023. The specific methodology utilizing PDPM will be disclosed in July 2024, and it will include revisions to staffing rating thresholds to uphold the same distribution of staffing points and ratings.
Freezing Four of the Fifteen Quality Measures in Five-Star
Starting in April 2024, CMS will implement a freeze on four out of the fifteen Quality Measures within the Five-Star rating system. This action is attributed to the MDS transition, which occurred on October 1, 2023, shifting from Section G to GG. The affected measures are as follows:
  • Percentage of Residents Who Demonstrated Improvements in Function (short stay).
  • Percent of Residents Whose Need for Assistance with Activities of Daily Living Has Increased (long stay).
  • Percentage of Residents Whose Independent Mobility Declined (long stay).
  • Percentage of High-Risk Residents with Pressure Ulcers (long stay).
CMS will replace the short-stay functionality measure with the new functionality measures from the Quality Reporting Program (QRP) in October 2024. The other three measures will remain frozen till January 2025. During the freeze, the measures will continue to count towards Five-Star quality ratings at the rate when the freeze takes effect.  
Updating CMS forms 671 and 672 
CMS has attributed the elimination of the CMS-672 form to alterations in the Minimum Data Set (MDS) framework. This decision is based on the fact that the necessary information to complete the form will no longer be accessible following the removal of Section G from the MDS. The implementation of these changes will be phased in over several weeks, in accordance with the guidelines provided in QSO 23-21-NH.
Effective September 29, 2023:
  • Facilities will no longer be obligated to fill out fields F79-F145 on the CMS-672 form.
  • Surveyors will no longer be required to complete certain sections of the form starting from this date.
Effective October 22, 2023:
The CMS-672 form will be entirely discontinued. As well as, data related to census, medication error rates, and ombudsman information will be transferred to the CMS-671 form.
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Statement on the CMS Unfunded Staffing Ratio Mandate

The CMS-proposed staffing mandate is not the answer to the ongoing nursing home labor shortage and will only exacerbate this workforce crisis. The mandate could push nursing homes operating on already tight budgets into closing, ultimately reducing access to care. The state has already experienced a decline in access to long term care, with 17 facilities either closing or converting to a lower level of care since the beginning of 2020. This is primarily due to underfunding and the persisting staffing shortage. While nursing homes are eager to hire more staff, the fundamental issue lies in the insufficient pool of available workers. An unfunded mandate will not help nursing homes hire more staff and will likely lead to further closures. Maine’s population is the oldest in the country and is getting older. A policy like this will only further limit access to long term care, resulting in older adults and their families having to wait longer and search farther for the nursing home care they need.

This proposed rule comes at an incredibly difficult time. Nursing homes were grappling with a severe workforce shortage even before the onset of the COVID-19 pandemic, and it has only gotten worse. Across the country, the long term care sector still needs approximately 150,000 more workers to simply return staffing levels to pre-pandemic figures. Over 500 nursing homes nationwide have closed since 2020, often due to an absence of qualified staff to hire. Astonishingly, CMS estimates this proposed staffing rule would cost $4 billion annually, or roughly $300,000 per facility, but does not provide any funding to meet these steep costs. These issues are especially pertinent in rural states like Maine, where meeting the specific requirement of having a registered nurse (RN) on-site 24/7 is a formidable challenge. In fact, two-thirds of nursing homes in Maine would not be able to meet this requirement.  

The proposed rule also disregards the hard work of many nursing home care providers, such as LPNs, Directors of Nursing, and activities staff, who play pivotal roles in resident care but are not factored into the staffing ratio. Moreover, the mandate's stringent penalties and limited flexibility in addressing temporary staffing shortages reveal a lack of understanding of the operational realities of nursing homes. 

Our homes provide quality care and want more staff. This rule, however, will ultimately cause more harm than good. Instead, we call on CMS to collaborate with nursing facilities on creating policies that will help us resolve this workforce crisis.

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Maine's Minimum Wage to Increase to $14.15 Per Hour in 2024

Pursuant to Maine law (Maine statute Title 26, chapter 7, section 664), effective January 1, 2024, the state minimum wage will increase from $13.80 to $14.15 per hour, based on data recently made available by the U.S. Department of Labor's Bureau of Labor Statistics. Maine law, amended by citizens referendum in 2016, requires annual adjustments to the minimum wage based on the cost-of-living index (CPI-W) for the Northeast Region. Between August 2022 and August 2023, there was a 2.4 percent increase in the CPI-W.

In addition to the minimum wage, the new "tip wage," or service employee minimum wage, in 2024 will be $7.08 per hour. This means that service employees must receive at least a direct cash wage of $7.08 per hour from the employer. The employer must be able to show that the employee receives at least the minimum wage of $14.15 per hour when the direct wage and tips are combined at the end of the week. 

The minimum salary threshold for exempting a worker from overtime pay is also based on the minimum wage. Starting January 1, 2024, the new minimum salary threshold is $816.35 per week, or $42,450.20 per year. This is only one of the factors used in determining whether a worker is exempt from overtime pay under federal or state law. An individual can earn more than the minimum salary threshold and still be eligible for overtime. The duties of each worker must be considered as part of this analysis.

The minimum wage and overtime law can be found here: . The Department also has more information available on its website at .

Per Section 7402. Essential support work reimbursement, "an amount equal to at least 125% of the minimum wage established in Title 26, section 664, subsection 1 for the labor portion of the reimbursement rate." In 2024, 125% of the minimum wage will be $17.69 (rounded). 

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MHCA offering virtual RAC-CT Certification in December!

The AAPACN Resident Assessment Coordinator—Certified (RAC-CT) credential is the most widely-recognized and respected MDS 3.0 certification available in the long-term care profession, and a mark of nurses who truly understand resident assessments.

Join us for this (3-day) RAC-CT Certification Workshop to increase your knowledge of clinical assessments and care planning, completion of the MDS, regulations surrounding the Resident Assessment Instrument (RAI) and MDS process, managing the PDPM, and more.
When:   December 6, 7 & 8, 2023, 8:00am-5:00pm
Where:   Virtual Workshop (Zoom)
Instructor:   Andrea Otis-Higgins, MBA, RN, MLNHA, RAC-MT, CHC

For details (including a printable flyer, rates, registration link, and more), click here to visit the event page on our website.  Don't miss out on this excellent opportunity for your MDS Coordinator.

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Welcome New Members!

Join us in welcoming the following new Associate Organizational members:

Accordion Healthcare Consulting, LLC: Contact: Adam Buccieri, COO, 3121 Firenze Court, Las Vegas, NV 89128 T. 702.806.4294 E. Provides healthcare organizations with onsite and remote assistance with compliance, reimbursement, regulatory, survey, auditing, analysis, education and training.
Skilled Cyber / Tools 4 Data, LLC: Contact: Mark Alexander, Marketing Manager, 176 Route 81, Unit 4A, Killingworth, CT 06419 T: 860.452.4413 E: W: At Skilled Cyber / Tools 4 Data, we understand the urgency and importance of safeguarding your healthcare facility from cyber threats. Our seasoned cybersecurity experts are board-level resources who bring extensive knowledge, experience, and strategic insights to the table. We perform free one-time Risk Assessments and Penetration Tests to provide baseline evaluations of your cyber protections.  We go further and offer recurring in-depth assessments and testing to guide decision-making, meet regulatory requirements and regularly check your defenses. We offer group-based consulting to independent facilities and individual consulting for larger organizations who want to achieve solid compliance for HIPAA and PCI regulations.
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MaineCare Provider Enrollment Update

On Friday, September 15th, the Office of MaineCare Service (OMS) provided an update on the status of provider enrollment case processing timeframes. MaineCare is experiencing a high volume of enrollment cases. In addition, their provider enrollment credentialling vendor, Gainwell Technologies, is experiencing staffing shortages. These challenges are causing provider enrollment cases to take much longer to process than normal, resulting in many pending enrollment cases. Currently, some enrollment cases are taking over 60 days to complete. 

OMS and Gainwell are working diligently to reduce both the number of pending cases and overall case processing time. OMS and Gainwell are investigating the root causes, Gainwell has added staff members, and they continue to evaluate staffing levels. Additionally, they are assessing whether technological upgrades could help automate certain enrollment processes in the mid to longer term. To support timely processing, providers are reminded they should update their enrollment information, such as new licenses, as soon as possible after receiving that update, and well before their license expires. 

If a provider is experiencing hardship as a result of these delays and their enrollment case has remained pending for more than 60 days after submission, they should contact their assigned Provider Relations Specialist. Waiting until your case has remained pending for at least 60 days will assist us in managing this ongoing backlog of cases. A list of the Provider Relations Specialists by service type and their contact information is located on the OMS website here: Provider Relations Specialists 
They understand that these challenges impact your day-to-day operations. They are working hard to implement solutions and to keep enrollment cases processing as quickly as possible. They will follow up regularly to provide status updates. 

MHCA has been in regular communication with Department on this issue and have asked for a timely resolution. 

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