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Archive April 2024

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5-Star Revisions Reminder

As a reminder, effective with the April 2024 refresh, CMS will freeze four of the Quality Measures (QMs) used in the Five-Star Quality Rating System. The four QMs impacted by recent changes to the Minimum Data Set (MDS) are:
  • Percentage of Residents Who Made Improvements in Function (short stay)
  • Percentage of Residents Whose Need for Help with Activities of Daily Living Has Increased (long-stay)
  • Percentage of Residents Whose Ability to Move Independently Worsened (long stay)
  • Percentage of High-Risk Residents with Pressure Ulcers (long stay)
Starting in April 2024, CMS will freeze (hold constant) these four measures on Nursing Home Care Compare.

In October 2024, CMS will replace the short-stay functional improvement measure with the new cross-setting function measure that is used in the SNF Quality Reporting Program (QRP). The remaining three measures will continue to be frozen until January 2025 while the data for the equivalent measures are collected. In April 2024, CMS will also update the staffing level case-mix adjustment methodology and freeze three staffing level measures until July 2024:
  • Adjusted RN Staffing (Hours per Resident per Day)
  • Adjusted Total Nurse Staffing (Hours per Resident per Day)
  • Adjusted Total Nurse Staffing on weekends (Hours per Resident per Day)
Staffing turnover measures will not be affected by the changes described above, and therefore continue to be updated in April 2024.

In addition, beginning in April 2024, to incentivize providers to submit accurate staffing data, CMS will revise the staffing rating methodology so providers that fail to submit staffing data or submit erroneous data receive the lowest score possible for corresponding staffing turnover measures.
For more information, see The Five-Star User’s Guide 2024 Changes are identified in red, italicized text.
 
Staff Contact: mcarland@mehca.org

New DLC License Application/ Reapplication Forms

The Division of Licensing and Certification  (“DLC”) has updated the application facilities need to complete and submit for both initial license as well as renewal of existing license.
 
There are now separate applications for Nursing home ONLY facilities and those facilities that are both SNF/NF and residential (aka “Multi-Level” facilities).   No longer will Multi-Levels complete the Nursing Home application.  
 
Also for the first time, all application materials—the completed application and the additional documents necessary—will be accepted by email, not hard copy.  The email address to which these documents must be sent is on the attached applications: DLRS.MedFacilities@Maine.gov .
 
Payment of licensing fees, however, must still be made via check or money order, and thus must still be made via mail or delivery to: DHHS/Div of Licensing & Certification, State House Station #11, Augusta, ME 04333-0011.
 
The new applications reflect the requirements of State Regulations (10-144 Ch 110); clarify some sections that needed clarifying; require email addresses for all persons named in the application; and require full contact information for management companies, if the facility is managed by an entity other than its owner.   

The new applications also require the submission, every renewal period, of copies of documents such as, but not limited to:
  • leases, if the building(s) and/or land are leased rather than owned;
  • surety bonds to protect residents’ property;
  • transfer agreements with hospitals;
  • signed written agreements for qualified professional services; and
  • the most recent water test if the facility is using a private water supply.   
 
Please be advised that all applications submitted to DLC after today’s date must be one of these two new application forms, must include all required documents, and must be emailed. 
 
Additionally, only completed applications will be processed. Those that do not have a response for each question that is applicable to the submitting facility, or do not include the required documents,  will be returned to the facility for completion.   Please do not use abbreviations unless those are defined previously in the application.
 
Completed applications, all required additional documents, and payment must be received at least 20 days prior to the expiration of the facility’s existing license.
 
Please also remember that no application can be processed until DLC has the required payment.   
 
If you have any questions, please email Lynn Hadyniak, JD, DLC Associate Director of Medical Facilities Unit,  at Lynn.Hadyniak@Maine.gov .
 
Staff Contact: mcarland@mehca.org

MHCA Leads in Requesting $1 Million in Workforce Funding

In partnership with the Hanley Center for Health Leadership & Education, formerly known as the Maine Medical Education Trust (MMET), MHCA led in submitting a $1 million Congressional Directed Spending request (also known as "earmark") for CNA workforce expansion in Maine. 

This is a competitive application process, so we look forward to hearing whether this request is funded in the coming months. 

Application Objectives:
- Increase the number of CNAs in Maine to meet the growing demand for long term care services.
- Develop a sustainable model for recruiting and training CNAs to ensure a skilled and compassionate workforce.
 
Program Components:
1.    Adult Educator Component: Training will be provided to nursing facility educators to enhance their skills in teaching adults from diverse backgrounds, including those from disadvantaged communities, ensuring effective dissemination of knowledge and best practices.
2.    Workforce Development: The funds from this earmark will be allocated to nursing facilities to pay for the costs associated with training CNAs, incentivizing them to further invest in building our workforce.
·       Many nursing facilities already train CNAs and other professionals. The infrastructure foundation already exists. However, the current issue is that it is significantly underfunded by the Medicaid program, thus not meeting its full potential. This earmark funding will make a major impact in expanding the pipeline of these training systems. 
3.    Supportive Services for Students: Financial assistance will be provided to CNA students to cover the expenses of study materials, uniforms, and other necessary supplies.
4.    "Earn While You Learn" Model: Students will have the opportunity to earn competitive wages while undergoing CNA training, making the program more accessible and attractive to prospective candidates.
 
Staff contact: bhawkins@mehca.org

Now Available: AHCA/NCAL Summaries of CMS Minimum Staffing and Medicaid Final Rules

Members now have access to detailed summaries of the three final rules released by CMS earlier this week. 

The Minimum Staffing final rule includes an overall standard of 3.48 nursing hours per patient day, which includes 0.55 hours per resident day (HPRD) for RNs and 2.45 CNA HPRD. There is a requirement for an RN in every building 24 hours a day, seven days a week. Specific details on these requirements, implementation timeframes, facility assessment requirements, waiver options, hardship exemptions, and enforcement are available in the member-only summary. Please note that a member log in is required to view this resource.  

The AHCA/NCAL webinar recording focused on this final rule is also available exclusively for members. On the webinar, President and CEO Mark Parkinson and team walk through the key requirements and time frames in the final rule, as well as next steps. The webinar registration page offers tips to access the webinar. Please email educate@ahca.org for additional assistance.

The Ensuring Access to Medicaid Services final rule supports ongoing initiatives to enhance health care accessibility and quality. It focuses on improving Home and Community-Based Services and enhancing transparency and public accountability. It also introduces additional data reporting and monitoring across Medicaid's fee-for-service and managed care systems. More information about this rule can be found here.

The Medicaid Managed Care final rule marks a substantial update in the framework governing Medicaid and the Children’s Health Insurance Program managed care plans. The rule introduces enhancements aimed at improving care access, quality, and outcomes, with implications for long term and post-acute care (LTPAC) providers. More information about this rule can be found here. 

Additional resources and materials will be shared as they become available.

Staff contact: bhawkins@mehca.org

MaineCare Provider Enrollment Progress Update

Gainwell continues to reduce the time it takes to complete their steps within the MaineCare enrollment process. Gainwell completed 559 enrollment cases in March and the average turnaround time for case completion was approximately 20 days. Case inventory was 578 at the end of March and the average system age of a case in inventory dropped to approximately 16.4 days old.

Additionally, to improve MaineCare enrollment, the Office of MaineCare Services (OMS) and Gainwell:
  • Completed three system and process enhancements related to provider enrollment referenced in prior updates were implemented and put into production during March.
  • Continue to assess and research further system enhancements, such as automating facility licensure.
During the Enrollment Listening Session held on January 17, 2024, providers made suggestions to improve the enrollment case processing time. MaineCare appreciates these suggestions, and we are reviewing and discussing all of them. We have updated the responses in this Provider Enrollment Suggestions document as we work through them. See the Provider Enrollment Presentation Follow-Up and Progress Update notice from February 13, 2024 for more information.

Staff contact: awesthoff@mehca.org

Nursing Facility Rate Reform Update

The Office of Maine Care Services is developing a new rate model to be implemented for Nursing Facilities, Section 67 Providers, in January 2025. As part of this process, stakeholder feedback was collected on the new proposed rate model. The comment deadline was April 23rd as was previously noted in MHCA e-news articles. MHCA and BerryDunn submitted detailed comments on the proposed new rate model and met with DHHS to share feedback. 

Interested stakeholders are encouraged to review the recently updated as of April 19, 2024, NF rate model Q&A document that provides some additional clarifying information. More details to come.

Questions on this process should be directed to Dwayne Parsons, MaineCare’s Acting Manager of Rate Setting.  

Staff contact: awesthoff@mehca.org

Do you need help understanding regulations related to Psychosocial Harm?

In the last few years, a growing number of facilities have received immediate jeopardy citations for psychosocial harm. Does your team understand the regulatory requirements? Do you have the systems in place to ensure the health and well-being of your residents?
 
We can help! On May 22 & 23, 2024, MHCA will be offering a two-part webinar series - Psychosocial Harm: Assessment, Process, Practice & Survey - from 1:00 pm to 2:30pm.

For details, click here to access the event page on our website

Staff contact: bhawkins@mehca.org

Center of Excellence for Behavioral Health in Nursing Facilities- Free training!

The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) is excited to announce the 2024 series of the Behavioral Health Action Network. This series of six-monthly virtual one-hour sessions will kick off in May 2024. We are inviting facilities across the United States to join us for these interactive sessions where participants will:
  • Learn from nationally recognized subject matter experts.
  • Network with their peers in an interactive learning environment. 
  • Learn about tools for sustainable implementation of best practices. 
  • Connect with COE-NF behavioral health specialists willing to provide ongoing support as facilities implement best practices.
The series is designed to meet the needs of leadership and interdisciplinary staff members and facilitate better resident outcomes.
  • Leadership – Facility assessment and staff education. 
  • Nurses and Certified Nursing Assistants – Screening for behavioral health and substance use disorders, resident assessment, care planning, communication, and de-escalation skills.
  • Support Staff – Understanding of behavioral health and substance use disorders, communication, and de-escalation skills.
We recommend creating an interdisciplinary team to attend this series. We'll include information on which staff to prioritize for each session after you register for the series. 
Topics include:
  • Understanding behavioral health regulations
  • Mental health basics
  • Screening for behavioral health and substance use
  • Effective communication skills
  • Individualized assessment and resident-centered care planning
  • De-escalating aggressive behavior and crisis 
For more information and links to register, check out: Behavioral Health Action Network - COE-NF (nursinghomebehavioralhealth.org)
 
Staff contact: mcarland@mehca.org
 

SNF Provider Preview Reports – Now Available

The Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on Care Compare and Provider Data Catalog (PDC) during the July 2024 refresh.

The data contained within the Preview Reports are based on quality assessment data submitted by SNFs from Quarter 4, 2022 through Quarter 3, 2023. Additionally, the Centers for Disease Control and Prevention (CDC) measures reflect data from Quarter 4, 2022 through Quarter 1, 2023 for the Influenza Vaccination Coverage Among Healthcare Personnel measure, and Quarter 3, 2023 for the COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) measure. The data for the claims-based measures will display data from Quarter 4, 2020 through Quarter 3, 2022 for this refresh, and for the SNF Healthcare-Associated Infections (HAI) measure, from Quarter 4, 2021 through Quarter 3, 2022.
Providers have until May 15, 2024 to review their performance data. Only updates/corrections to the underlying assessment data before the final data submission deadline will be reflected in the publicly reported data on Care Compare. If a provider updates assessment data after the final data submission deadline, the updated data will only be reflected in the Facility-Level Quality Measure (QM) report and Patient-Level QM report. Updates submitted after the final data submission deadline will not be reflected in the Provider Preview Reports or on the Care Compare website. However, providers can request Centers for Medicare & Medicaid Services (CMS) review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate.

For questions related to accessing your facility’s provider preview report, please reach out to the iQIES Service Center by email at iqies@cms.hhs.gov or call 1-800-339-9313. For questions about SNF Quality Reporting Program (QRP) Public Reporting, please email SNFQRPPRQuestions@cms.hhs.gov.
 
Staff contact: mcarland@mehca.org

State Lawmakers Pass a Budget

Working through last night into the early morning hours today, the Maine legislature passed a budget that funnels hundreds of millions into schools, nursing homes, affordable housing, and storm-battered communities.
 
After significant back and forth between the Senate and the House with numerous amendments, the supplemental budget passed just after 5:00 AM.
 
The Supplemental Budget (LD 2214) includes important investments in Maine’s nursing homes. The bill provides $26 million of general fund appropriation with $45 million in federal match for nursing home rate reform efforts that would total approximately $72 million. This is in addition to the $10 million (all funds) that was already proposed for increased funding for rate reform.
 
The bill creates a Nursing Facility Rate Transition Fund to assist with rate reform efforts scheduled to be implemented in January 2025. As soon as practicable, $15 million from this fund coupled with $15 million from the previously approved $29 million in the Biennial Budget will be distributed to nursing facilities as a one-time payment. This combined $30 million is a bridge payment until new rates take effect in 2025.
 
Angela Westhoff, President & CEO comments, “MHCA is grateful to the many legislators who advocated for long term care funding and we will continue to work collaboratively with lawmakers to address the ongoing needs of long term care providers and the older adults we serve. Rate reform for residential care facilities is next on our advocacy agenda.” 
 
The budget also includes $76 million in affordable/ emergency housing, $50 million for storm damage, $20 million for mental health services, and nearly $12 million for one-time funds to support childcare providers, among other initiatives. Governor Mills has signaled that she will sign the bill into law.
  
Staff contact: awesthoff@mehca.org
 
 
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