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Archive June 2024

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Update on Rate Letters for Nursing Homes and PNMI-Cs

MaineCare will increase reimbursement rates for certain services under Sections 67 NFs and 97, Appendix C, RCFs effective July 1, 2024, through a Cost-of-Living Adjustment (COLA), in alignment with MRS Title 22, 3173-J (referred to as ‘Rate Reform Statute’). The COLA is equal to an increase of 4.91% above the currently established rate(s), which is based on the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index for nursing homes and adult day care services as required under Maine P.L. 2017, ch. 460 (see 22 MRSA §1708, sub-§3, ¶F for NFs).

Additionally, the rate adjustments for RCFs also include updates to use fixed costs from the latest audited cost reports.

MaineCare continues to provide an add-on rate, as needed, per the requirement under 22 M.R.S. §7402 to enable providers to cover labor costs for essential support workers of at least 125% of the minimum wage. This add-on has been recalculated to account for the new increased direct care rates. Since the direct care rate increase from the COLA also contributes to ensuring that the rate meets the 22 M.R.S. §7402 requirements, providers require a proportionally lower amount from the add-on, and will see a slight reduction in the add-on amount, accordingly.

The NF and RCF rate letters will be available soon. Please watch for a follow up message to confirm the exact date.

Nursing Facility Specialty Rates
The Department is also updating the interim prospective rates for Specialty NF’s effective July 1, 2024, based on the most recent as filed cost reports. These rate letters will be available for viewing on the secure Health PAS online portal by July 1, 2024.

For questions on rate letters, please contact Rate Setting directly by emailing Dwayne Parsons at: Dwayne.A.Parsons@maine.gov

Staff contact: awesthoff@mehca.org

American Hospital Association Voices Support In Overturning Federal Staffing Mandate

Skilled Nursing News (6/26, Siddiqi) reports, "The American Hospital Association (AHA) is lending its voice to the fight against the minimum staffing mandate, and joining hands with nursing home organizations as well as a coalition of lawmakers to overturn the federal government’s rule." In a letter sent to lawmakers Monday, "AHA boosted the bipartisan bid to halt the staffing mandate through the Congressional Review Act (CRA)."

Officials with "the American Health Care Association (AHCA) praised AHA’s backing of legislative efforts to defeat the staffing mandate." AHCA Government Relations Senior Vice President Clif Porter said, "This mandate will not only worsen the workforce crisis for nursing homes, but it will also cause a negative ripple effect on the entire health care system as nursing homes are forced to limit admissions or close their doors altogether." Porter added, "We appreciate AHA’s support and will keep at the fight to overturn this unrealistic and out-of-touch mandate." 

Staff contact: bhawkins@mehca.org

Medical Record Scam: Watch out for Phishing

CMS identified phishing scams for medical records. This may include scammers faxing you fraudulent medical records requests to get you to send patient records in response; see example (PDF).
When you review any requests, look for signs of a scam, including:
  • Directing you to send records to an unfamiliar fax number or address
  • Referencing Medicare.gov or @Medicare (.gov)
  • Indicating they need records to “update insurance accordingly” 
A scam request may include:
  • Poor grammar, misspellings, or strange wording
  • Incorrect phone numbers
  • Skewed or outdated logos
  • Graphics that are cut and pasted
If you think you got a fraudulent or questionable request, work with your Medical Review Contractor to confirm if it’s real. Submit medical documentation through the Electronic Submission of Medical Documentation (esMD) system or CMS medical review contractor secure internet portals, when available. 
 
Staff contact: mcarland@mehca.org
 

AHCA Updates Antipsychotic Medication Toolkit

Antipsychotic medications remain an area of high focus for State Agencies, CMS, and ongoing quality measures in the Five-Star Quality Rating program as well as the recently implemented Schizophrenia Audits.
 
Therefore, the AHCA Clinical and Regulatory Team has refreshed the Antipsychotic Medication Management Toolkit. This toolkit includes a variety of evidenced-based tools which may be used by members for their quality improvement efforts. In addition to the main toolkit, there are three Fact Sheets and a separate case study for staff education.
 
Staff contact: mcarland@mehca.org

DHHS Partner Briefing on MaineCare Unwinding and CoverME.gov

A DHHS MaineCare Unwinding Partner Briefing Webinar will be held on Wednesday, June 26 from 10:00AM – 11:00AM.  You must register in advance for this webinar. Space is limited.

During this Zoom webinar, you will hear from the DHHS Office for Family Independence, Office of MaineCare Services, and Office of the Health Insurance Marketplace about:
  • The timeline and process for the last phase of eligibility reviews for people enrolled in MaineCare who benefited from continuous coverage during the COVID public health emergency, also known as the “unwinding” period
  • Analysis of the remaining “unwinding” population and why they are more likely than previous members to face disenrollment
  • How partners and providers can help to educate their communities who are likely still eligible about staying covered with MaineCare
  • For those members transitioning off MaineCare, how they can find affordable coverage through CoverME.gov
Register here to learn more and assist with sharing information and resources in your community.    

Staff contact: awesthoff@mehca.org

Mike McNeil Scholarship Applications Due August 9th

Now in its 18th year, Mike McNeil Scholarship Fund has awarded $78,250 to 128 students to help them pursue careers in long term care. Scholarship applications are now available online. Application deadline to apply is August 9, 2024.
The fund provides support to individuals pursuing careers in long term care. Applicants must be affiliated with an MHCA-member facility including nursing homes/ assisted living facility employees, their immediate family members, and/ or volunteers. Supporting documentation including school acceptance letter or current transcript, and written references can be sent to MHCA, 317 State Street, Augusta, ME 04330. Winners will be notified in writing by mid-October.

 Contact Lori Vigue or Angela Westhoff at MHCA at 207-623-1146 with any questions.

 Staff contact: awesthoff@mehca.org

From ME DHHS: Section 97, Private Non-Medical Institutions (PNMI) Appendix F: Rate Letters for Fiscal Year (FY) 2025, CR 125612

The Section 97, Appendix F, FY 2025 rate letters will be accessible on the secure Health PAS Online Portal by July 1, 2024. To view them, log into your Trading Partner Account and follow this pathway: File Exchange > Reports > Rate Setting Letters.  ? 
If you have questions about accessing the letters, please contact Provider Services at: 1-866-690-5585.

Staff contact: bhawkins@mehca.org

Reminder: New Federal Rules on Nondiscrimination in Health Care

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care. The purpose of the rule, entitled Nondiscrimination in Health Programs and Activities, is to restore protections against discrimination on the basis of race, color, national origin, sex, age, and disability. The rule also reduces language access barriers, expands physical and digital accessibility, and tackles bias in health technology. 
 
Specifically, the rule includes the following elements: 
 
  1. Holds HHS’ health programs and activities to the same nondiscrimination standards as recipients of Federal financial assistance. 
  2. For the first time, the Department will consider Medicare Part B payments as a form of Federal financial assistance for purposes of triggering civil rights laws enforced by the Department, ensuring that health care providers and suppliers receiving Part B funds are prohibited from discriminating on the basis of race, color, national origin, age, sex, and disability. 
  3. Requires covered health care providers, insurers, grantees, and others, to proactively inform people that language assistance services are available at no cost to patients. 
  4. Requires covered health care providers, insurers, grantees, and others to inform people that accessibility services are available to patients at no cost. 
  5. Clarifies that covered health programs and activities offered via telehealth must also be accessible to individuals with limited English proficiency, and individuals with disabilities. 
  6. Protects against discrimination by codifying that Section 1557’s prohibition against discrimination based on sex includes LGBTQI+ patients. 
  7. Respects federal protections for religious freedom and conscience and makes clear that recipients may simply rely on those protections or seek assurance of them from HHS. 
  8. Respects the clinical judgment of health care providers. 
  9. Protects patients from discriminatory health insurance benefit designs made by insurers. 
  10. Clarifies the application of Section 1557 nondiscrimination requirements to health insurance plans. 
 
Given the increasing use of artificial intelligence (AI) in health programs and activities, the rule clarifies that nondiscrimination in health programs and activities continues to apply to the use of AI, clinical algorithms, predictive analytics, and other tools.  
 
Specifically, the rule: 
 
  1. Applies the nondiscrimination principles under Section 1557 to the use of patient care decision support tools in clinical care. 
  2. Requires those covered by the rule to take steps to identify and mitigate discrimination when they use AI and other forms of decision support tools for care. 
This rule applies to covered entities, which per HHS’ definition, includes any health program or activity receiving federal funds from HHS, any program or activity administered under Title I of the ACA, and health insurance marketplace participants.  
 
This means that nursing homes, ID/DD providers, and Medicare Advantage plans are subject to this Final Rule. 
 
A complete summary of the rule is available in the federal register. HHS also published a fact sheet outlining key elements of the rule. This rule will introduce new requirements for nursing homes and ID/DD providers. AHCA will share a more detailed summary in the coming weeks that outlines the regulatory impact on LTC providers and time frame for implementation. 
 
Questions? Contact regulatory@ahca.org?.  

Celebrating Caregivers: A Call for Videos for an Upcoming Conference hosted by LTCOP

Maine’s Long Term Care Ombudsman Program is preparing a conference for this September, and we are excited to share their plans for a special initiative to highlight the incredible impact caregivers have on the daily lives of residents.

A Special Request for Videos:
LTCOP is requesting providers submit short videos featuring residents expressing their gratitude and sharing stories about how caregivers have positively impacted their lives. These videos will serve as a heartfelt tribute to the hard work and dedication of caregivers, providing a powerful and uplifting experience for all attendees.
How to Participate
  1. Create a Video: We encourage providers to capture genuine moments where residents share their appreciation for their caregivers. Whether it's a simple "thank you" or a touching story, every message matters.
  2. Include Your Logo: To acknowledge your contribution, we will feature your organization’s logo during the conference. Please include your logo in the video or provide it separately when submitting.
  3. Submission Guidelines:
  • Deadline: Please submit your videos by August 15.
  • Format: Ensure the videos are in a standard format (e.g., MP4) for easy playback.
  • Length: Aim for 10 seconds to 3 minutes per video to keep them concise and impactful.
How to Submit Your Videos
Please send your video submissions to Nicole Marchesi at nmarchesi@maineombudsman.org and Ben Hawkins at bhawkins@mehca.org. If you have any questions or need assistance, feel free to reach out to Nicole or Ben.
Thank you for your support and participation!

Welcome New Members

Join us in welcoming the following new members:
 
Fusion Medical Staffing
18881 W Dodge Road, Omaha, NE 68022 Tel: (531) 200-3231
Contact: Mr. Brandon Schafer, Division Manager of Business Development
E. brandon.schafer@fusionmedstaff.com / www.fusionmedstaff.com/client
 
USI Insurance Services
3 Executive Park Drive, Suite 300, Bedford, NH 03110 Tel: (603) 801-3603
Contact: Ms. Wendy Matsis, Vice President, Senior Living & Healthcare Practice
E. wendy.matsis@usi.com / www.usi.com
 
Vantage Healthcare
45 Dan Road, Canton, MA 02021 Tel: (781) 424-9195
Contact: Mr. Chris Wasel, President, Strategy & Development
E. cwasel@vantagehcs.com / www.myvantagehcs.com
 
Vantage Healthcare provides on-site physician services at Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALFs) leading integrated care teams at each location. Its service offerings will expand in 2024 to include care for post-acute patients in Inpatient Rehab (IRFs) and Long-Term Acute Care (LTACHs) settings. Vantage Healthcare has a team of over 30 Physicians, with experience across the care continuum in acute care, skilled nursing, and senior care settings.
 
Staff contact: dchicoine@mehca.org
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