Archive October 2023

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Have you registered your Resident Assessment Team for the RAC-CT® certification workshop?

MHCA is offering the AAPACN Resident Assessment Coordinator - Certified (RAC-CT®) workshop virtually in December. This certification has become the Gold-Standard of assessment training for nursing homes and skilled nursing facilities. Taking place over Zoom, you can avoid travel time and expenses while bolstering your skill set. 

When: December 6, 7, and 8, 2023, 8:00am-5:00pm
Where: Zoom Virtual Platform
Instructor: Andrea Otis-Higgins, MBA, RN, MLNHA, RAC-MT, CHC
Expect to increase your knowledge of clinical assessments and care planning, completion of the MDS, regulations surrounding the RAI/MDS process, managing PDPM, and so much more. For details, including workshop pricing, you may click here. MHCA is an AAPACN Training Partner so the registration link connects to AAPACN's website. If you purchase an AAPACN membership, you'll qualify for their member rates (best value for your investment).
Don't miss out on this opportunity! The RAC-CT certification is the most widely recognized and respected MDS 3.0 certification available in the long-term care profession.  The deadline to register is end of business day on November 15, 2023.

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2024 Medicare Part A & Part B Premiums and Deductibles

The Centers for Medicare & Medicaid Services (CMS) has unveiled the premium, deductible, and coinsurance details for the Medicare Part A and Part B programs for the year 2024.
Medicare Part A encompasses coverage for inpatient hospitals, skilled nursing facilities, hospice care, inpatient rehabilitation, and select home health services. Nearly 99 percent of Medicare beneficiaries are exempt from a Part A premium, provided they have accrued a minimum of 40 quarters of Medicare-covered employment, as determined by the Social Security Administration.
  • For beneficiaries receiving care in skilled nursing facilities, the daily coinsurance rate for days 21 through 100 of extended care services within a benefit period will rise to $204.00 in 2024, up from $200.00 in 2023.
Medicare Part B, on the other hand, provides coverage for physicians' services, outpatient hospital services, specific home health services, durable medical equipment, and certain other medical and health services that aren't covered by Medicare Part A. Each year, the rates for Medicare Part B premiums, deductibles, and coinsurance are calculated in accordance with the provisions of the Social Security Act.
  • The standard monthly premium for Medicare Part B enrollees will be $174.70 for the year 2024, marking an increase of $9.80 from the $164.90 seen in 2023.
  • As for the annual deductible applicable to all Medicare Part B beneficiaries, it will amount to $240 in 2024, reflecting a $14 increase from the previous annual deductible of $226 in 2023.
Since 2007, the monthly premium for Part B beneficiaries has been determined based on their income level. Further details regarding the 2024 premiums based on income levels can be found in the CMS fact sheet.
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Submit Your Comments to CMS on Minimum Staffing Rule by November 6th

Yesterday, Maine Health Care Association submitted a letter to CMS in opposition to the staffing mandate in partnership with the following organizations:
  • Maine Hospital Association
  • Maine Medical Association
  • Maine Osteopathic Association
  • LeadingAge Maine & New Hampshire
  • Maine Council on Aging
You can review the letter here.

As a reminder, if you have not submitted your comments, please do so through the ACHA/NCAL Portal. To access the online portal, click here.

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.

We ask all MHCA members to please submit comments to CMS by the November 6th deadline.
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Reminder to Submit Nursing Facility ECA Application

As authorized by P.L. 2023, Ch. 412, Part NNNNN, DHHS will reimburse nursing facilities who qualify for an Extraordinary Circumstance Allowance (ECA). These payments will be dispersed in State Fiscal Year 2024.

To receive a payment under this initiative, eligible NFs must apply via an online form. Applicants must complete and submit the online form by October 27, 2023, to be considered. MHCA is working with the Department to get an extension on this deadline. Details will be sent out very soon. 

Facilities can preview the application here.

Before proceeding with an application, please read the guidance pertaining to eligibility requirements, the payment methodology, and allowable use of these funds. For those who may qualify, requests for payment amounts and other related questions can be directed to the Department at or you may contact the Maine Health Care Association directly.

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Statement on Tragedies Unfolding in Lewiston

The Maine Health Care Association continues to monitor the tragedy in the greater Lewiston & Auburn area as the search for the person of interest in the Lewiston mass shooting continues. We extend our deepest sympathies to the family and friends of the 18 individuals who were killed and the 13 people who were injured in this senseless act of violence.

Several of our facilities remain in lockdown. We continue to keep the staff and residents of those homes in our thoughts. We also thank all of the law enforcement agencies, first responders, and hospital staff who are involved in this tragedy.

The state has resources available for those looking for mental health assistance. The Maine Crisis Line (MCL) can be reached at 1-888-568-1112 (Voice) or 711 (Maine Relay) and is the state’s crisis telephone response service for individuals or families experiencing a behavioral health crisis or having thoughts of suicide and/or self-harm. Also, StrengthenME is available for all frontline and healthcare workers. They can be contacted 24/7 for support at 1-800-769-9819.

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CMS Issues Corrections to FY24 SNF PPS Final Rule Impacting Rates

Please review:  Providers should verify with MDS and billing software vendors that updates have been applied before submitting October 2023 claims.

The Centers for Medicare & Medicaid Services (CMS) issued a Correction Notice that applies to the Fiscal Year (FY) 2024 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule published on August 7. Although the resulting changes represent only pennies per day, the corrections impact nearly all PDPM urban and rural component rate tables and the rural wage index table. 

Additionally, three corrections were made to the FY24 PDPM ICD-10 mappings file. The effective date for these corrections is retroactive to dates of service beginning October 1, 2023. Provider front office and MDS staff should review the changes and confirm with your software vendors that the updates have been applied prior to submitting Medicare Part A claims, or other payer claims using PDPM payment methodologies, for dates of service on or after October 1, 2023.
Wage Index and Rate Corrections Background
CMS has identified a technical error in the calculation of the final FY24 SNF PPS wage indexes resulting from a cost report calculation of one rural hospital in North Carolina and requiring the Agency to recalculate multiple updated tables posted in the Correction Notice to maintain budget neutrality requirements. 
  • Page 68488: The unadjusted SNF PPS Federal per diem rates provided on page 53209 in Tables 3 and 4 of the Final Rule; 
  • Pages 68488 and 68489: The case-mix adjusted SNF PPS rates provided on pages 53210 through 53211 in Tables 5 and 6 of the Final Rule; 
  • Pages 68489 and 68490: The rate computation examples in Tables 8, 9 and 10 on pages 53215 through 53216 of the Final Rule; and 
  • Pages 68490 and 68491: The impact analysis provided in Table 30 on pages 53333 through 53334 of the Final Rule.
PDPM ICD-10 Mappings Corrections Background
CMS corrected the following three errors in the FY 2024 PDPM ICD–10 code mappings file that are effective for dates of service on or after October 1, 2023: 
  1. CMS corrected errors in the clinical category assignment of 332 codes ranging from C00.0 through C49.6 to reinstate the prior year's assignments from the FY23 SNF PPS final rule, as the Agency proposed no changes in clinical categories in this code range in the FY24 SNF PPS proposed rule nor finalized them in the FY24 SNF PPS final rule.
  2. CMS is correcting errors in the clinical category assignments of D75.84, F43.81, F43.89, G90.A, and K76.82 to reflect the changes finalized in the FY 2024 SNF PPS final rule (88 FR 53220 through 53221).
  3. The SLP-Comorbidity table in the FY24 PDPM ICD–10 code mappings file displays a list of ICD–10 codes associated with comorbidities included in the Speech-Language Pathology (SLP) component under PDPM. In the Correction Notice CMS notes the removal of the following new ICD–10 codes effective October 1, 2023, that were erroneously added, noting the addition of any ICD–10 code to the SLP comorbidity list would amount to a change in policy that would first need to undergo notice and comment rulemaking: G20.A1, G20.A2, G20.B1, G20.B2, G20.C, G11.6, G23.3, G31.80, G31.86, G37.81, G40.C01, G40.C09, G40.C11, G40.C19, G90.B, G93.42, G93.43, G93.44.
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Recent Study: Why Some Employees Prefer Working for a Provider over a Staffing Agency

Becker's Hospital Review article titled, Why nurses prefer staffing agencies — beyond the paycheck, discusses why some workers enjoy staffing agencies and why others prefer working for a healthcare provider. The article and related study provide useful insight into what could help make healthcare providers stand out as attractive employers.  

"Nurses who work for staffing agencies are much more satisfied than their counterparts who serve hospitals, health systems, home healthcare providers and senior living facilities, according to an Oct. 18 report from MIT Sloan Management Review. Researchers identified 200 of the largest healthcare employers in the U.S., and calculated how highly nurses rate the organization and senior leadership on Glassdoor from the beginning of COVID-19 through June 2023 (view their ranking here). 

The five highest-ranked employers in the sample were staffing agencies, according to the report — and higher compensation only accounts for part of nurses' satisfaction. Researchers analyzed the free text on Glassdoor to determine how positively nurses spoke about 200 topics, and found that nurses spoke more highly of staffing agencies on issues other than pay. 

Overall, 75% of nurses' comments about staffing agencies were positive, compared with 23% of nurses' comments about health systems. 

Staffing agencies have other healthcare employers beat in problem resolution, the researchers found. Seventy-three percent of nurses said staffing agencies resolved problems efficiently, compared to 31% of nurses employed by hospitals and health systems. The difference was even greater when it came to resolving problems effectively — 55% of nurses say staffing agencies do this, compared to 9% of nurses at hospitals and health systems. 

Nurses also rated staffing agencies more highly on several measures related to honesty, according to the report. Three-quarters of nurses employed by staffing agencies spoke highly of their organizations' speed in replying to inquiries; less than one-quarter of nurses employed by hospitals and health systems praised their organization on timely replies. Staffing agencies scored 41 percentage points higher on transparency, 36 points higher on trust and 46 points higher on honesty than their hospital and health system counterparts. 

Although nurses employed by staffing agencies also ranked their compensation and work-related stress levels significantly better than nurses employed by hospitals and health systems, the latter took the lead in some metrics. Nurses prefer hospitals and health systems for health and retirement benefits, learning and development opportunities, and connection with colleagues: all "important aspects of organizational life," according to the report. 

"Healthcare systems can learn from staffing agencies, but they can also leverage their own distinctive advantages to attract and retain nurses," the report says. "Healthcare systems should invest in their comparative advantages and emphasize them when communicating their value proposition to potential and current employees."

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Maine Labor Law Updates

From a Maine Department of Labor press release, October 25, 2023:

The final round of laws enacted by the 131st Legislature become effective today. These laws include amendments to multiple labor laws - the Department would like employers and workers to be aware of the below:

Protections from Retaliation for Maine Workers:
There is now a uniform anti-retaliation statute for all of Chapter 7, which regulates employment practices such as wage and hour laws. The new statute makes it a civil violation for an employer to take action intended to prevent or penalize a person from exercising their employment rights.

This enables the Maine Department of Labor to assure workers that they can report potential labor law violations without fear of employer retaliation, which is often a deterrent that keeps people from advocating for their workplace rights.
Read the law:

Maine’s Equal Pay Law Amendment to Prohibit Pay Discrimination Based on Race:
An employer may not discriminate between employees in the same establishment on the basis of race by paying wages to any employee in any occupation in this State at a rate less than the rate at which the employer pays any employee of another race for comparable work on jobs that have comparable requirements relating to skill, effort and responsibility.
An employer may not prohibit an employee from disclosing the employee's own wages or from inquiring about or disclosing another employee's wages if the purpose of the disclosure or inquiry is to enforce the rights granted by this section.
Read the full law:

Severance Pay to Cover More Types of Employers and Include More Workers:
Originally adopted in 1979, Maine's statute regarding severance pay and notification only covered ‘industrial or commercial’ facilities, which were prevalent at the time but no longer employ as large a proportion of Maine's workforce.
The new amendment increases access to severance pay for Maine workers by expanding this provision to workplaces outside of the industrial and commercial sectors.
Read the law:

Timely Payment for Salaried Employees:
This amendment exempts members of the employer's family and salaried employees from the requirement that an employer pay in full at regular intervals all wages earned by an employee; removes the exemption for salaried employees from the requirements relating to the rate of pay and records regarding time worked; and adds S corporations and limited liability partnerships to the exemptions from the requirements relating to the rate of pay and records regarding time worked.
Read the law:

Parity in Tipping Laws for Restaurant Workers:
If an employer pays its employees the minimum hourly wage and does not take a tip credit, the employer may impose a tip pooling arrangement to include employees, such as dishwashers and cooks, who are not classified as service employees.
Read the law:

Prohibiting Noncompete Agreements in Veterinary Care:
The law prohibits an employer from requiring or permitting an employee who is a licensed veterinarian to enter into a noncompete agreement unless the employee has an ownership interest in the business and provides that a court may not enforce such a noncompete agreement entered into prior to the effective date of this legislation.
Read the law:

Other General Reminders:
Maine's Minimum Wage to Increase to $14.15 Per Hour in 2024 – More information:
Paid Family Medical Leave – The Maine Department of Labor will begin the rulemaking process for a Paid Family Medical Leave program in the spring of 2024. Benefits are scheduled to begin in 2026. To stay informed, visit
Child Labor Laws - The Department wants to work with employers and young job seekers to ensure students know their rights and are safe and healthy both in the workplace and in school. More information:
Earned Paid Leave - An employer that employs more than 10 employees in the usual and regular course of business for more than 120 days in any calendar year shall permit each employee to earn paid leave based on the employee’s base pay. An employee is entitled to earn one hour of paid leave from a single employer for every 40 hours worked, up to 40 hours in one year of employment. Accrual of leave begins at the start of employment, but the employer is not required to permit use of the leave before the employee has been employed by that employer for 120 days during a one-year period.
Time of Payment - Employees must be paid in full at least every 16 days. Employees must be notified of any decrease in wages or salary at least one day prior to the change.
Payment of Wages - Employees who leave a job must be paid in full on the next payday or within two weeks, whichever is earlier. This will also include all accrued Earned Paid Leave if established in company policy or in practice.
Unfair Agreement - Employers cannot require that an employee pay for losses such as broken merchandise, bad checks, or bills not paid by customers, nor for special uniforms and certain tools of the trade.
Rest Breaks - Most employees must be offered a 30 consecutive minute paid or unpaid rest break after 6 hours of work.
More information on these and other labor laws can be found here: You may also contact the Maine Department of Labor’s Bureau of Labor Standards at 207-623-7900 or  

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Salmonella Outbreak from Diced Onion Products Distributed in Long Term Care Settings

The Centers for Disease Prevention and Control (CDC) and the Food and Drug Administration (FDA) have jointly issued a food safety advisory concerning a Salmonella outbreak associated with the consumption of fresh diced onions. This outbreak has afflicted 73 individuals in 22 states and has been traced back to Gills Onions brand fresh diced onion products, which were distributed to long term care facilities.
Actions Recommended for Long Term Care Facilities:
  1. Conduct a thorough check of your facility's freezers and refrigerators to identify and discard any recalled onion products.
  2. Avoid serving any recalled Gills Onions products or dishes containing these recalled onion items.
  3. Employ rigorous cleaning and sanitization procedures for items and surfaces that may have come into contact with the recalled onion products.
Possible Symptoms of Salmonella:
  • Most individuals infected with Salmonella typically manifest symptoms such as diarrhea, fever, and abdominal cramps.
  • These symptoms generally appear within a window of 6 hours to 6 days after exposure to the bacteria.
  • In the majority of cases, recovery occurs without medical intervention within 4 to 7 days.
  • However, certain vulnerable populations, including children under 5 years of age, adults over 65 years of age, and individuals with compromised immune systems, may encounter more severe illnesses necessitating medical treatment or hospitalization.
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Revised COVID and RSV Vaccination information documents.

The CDC has recently made updates to the Vaccine Information sheets for both COVID and the RSV Vaccine. You can access the latest versions by clicking here. These information sheets are valuable for educating both residents and staff.
Additionally, Maine has introduced new RSV resources, including an informative infographic that could be beneficial for your residents, their families, and your staff. For more details on these resources and information regarding over 60 RSV vaccination options, please click here.
Furthermore, the NHSN has released an updated 2023 COVID-19/RESPIRATORY PATHOGENS VACCINATION PROTOCOL for Vaccination Modules designed specifically for Long-term Care facilities. You can find the RPV Protocol for LTC Residents for October 2023 here.
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