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Archive December 2024

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New education opportunity - PDPM for MaineCare!

Transitioning to PDPM for MaineCare: Ensuring Compliance, Quality, and Sustainability
January 30, 2025 from 1:00 - 3:00 PM
*Virtual Training - registration will close on January 29th @ 12:00 PM
With the conclusion of the OSA for MaineCare residents, Maine has announced the transition from RUGs to PDPM as part of its new payment model. Successful implementation and ongoing compliance will depend heavily on the accurate coding of the MDS.
As the healthcare industry faces an unprecedented volume of Medicare claim audits, this program is designed to support your transition to the MaineCare system while equipping you with the tools to defend effectively in audit situations.
For more details and to register for this training, click here to visit the event page on our website.

Eye Drop Recall

Alcon Laboratories Initiates Voluntary Nationwide Recall of Systane Lubricant Eye Drops Ultra PF, Single Vials On-the-Go (Lot 10101), Due to Potential Fungal Contamination

Alcon Laboratories has announced a voluntary nationwide recall of one (1) lot of Systane Lubricant Eye Drops Ultra PF, Single Vials On-the-Go, 25 count (Lot 10101) due to the potential for fungal contamination. Contaminated ophthalmic products can pose a risk of eye infections, which may threaten vision and, in extremely rare cases, be life-threatening in immunocompromised individuals. To date, no adverse events associated with this recall have been reported.

Product Information:
  • Usage: Temporary relief of burning and irritation due to dry eye symptoms.
  • Packaging: 25 sterile, single-use LDPE plastic vials of preservative-free solution, enclosed in a green and pink cardboard carton featuring “Systane” and “ULTRA PF” brand names and labeled with “25 vials.”
  • Identification Details:
    • Lot Number: 10101
    • Expiration Date: 2025/09
    • NDC: 0065-1432-06
    • UPC: 300651432060
  • Distribution: Nationwide to retail and online outlets.
Consumers are encouraged to verify their product to determine if it is part of the recalled lot. For further details and reporting instructions, refer to this release.
 
Staff contact: mcarland@mehca.org

Updated Medicare Beneficiary Non-Coverage Notice Forms Effective January 1, 2025

The Centers for Medicare and Medicaid Services (CMS) have updated certain Medicare beneficiary non-coverage notice forms, applicable to both Medicare Fee-for-Service and Medicare Advantage beneficiaries. These updates will take effect on January 1, 2025.

Fee-for-Service Medicare Providers:
Skilled Nursing Facilities (SNFs) must issue a Notice of Medicare Non-Coverage (NOMNC) to beneficiaries when Medicare-covered services are ending. The NOMNC informs beneficiaries of their right to request an expedited determination from their Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).

A Detailed Explanation of Non-Coverage (DENC) is provided only if the beneficiary requests an expedited determination. The DENC outlines the specific reasons why covered services are ending.

Medicare Advantage Plans:
The updated NOMNC reflects new regulations granting enrollees additional fast-track appeal rights. These rights apply when enrollees make an untimely request to appeal to the BFCC-QIO or wish to appeal after services have ended on or before the planned termination date (refer to CMS-4205-F, p. 30827).

Additionally, DENC instructions now require Medicare Advantage (MA) plans to include a new element. If the enrollee has previously received a favorable BFCC-QIO appeal decision during the current care episode, MA plans must explain specific changes in the enrollee’s condition that justify the decision to terminate services.

Additional Resources:
For the updated forms and instructions, visit the “Downloads” section of the CMS Fee-for-Service & Medicare Advantage NOMNC/DENC webpage. Questions about the NOMNC and DENC can be submitted via the provided CMS contact options.
 
Staff contact: mcarland@mehca.org
 

Welcome New Member!

Join us in welcoming the following new member:
 
Michael Tobiasen, RN Consultant, RAC-CT, MAT Healthcare and MDS Consulting LLC, 46 Givens Lane, Fishkill, NY 12524 T. 845.214.5233 F. 845.625.6772. E. matconsultservices@gmail.com. Remote MDS completion and QAPI plan development and consulting services.
 
Staff contact: dchicoine@mehca.org

Sign On Letter Invitation: Encourage COLA Increases for Providers

The Essential Care & Support Workforce Partnership is circulating a letter for signatories asking the legislature to immediately take action to direct the state to implement the annual cost-of-living adjustment for MaineCare services as required by 22 M.R.S.A §3173-J and §7402.
 
If you'd like to lend your support and add your organization to the letter, please see the letter here and complete this form no later than 5 PM on Monday, December 23, 2024.
 
Here's who has already signed on:
Employers of Essential Care & Support Workers:
Align Home Care  |  https://alignhomecareservices.com/  |  Cumberland County
Andwell Health Partners  |  www.andwell.org  |  Androscoggin County, Aroostook County, Franklin County, Kennebec County, Oxford County
Aroostook Mental Health Center  |  www.amhc.org  |  Aroostook County, Hancock County, Washington County
Breakwater Commons  |  https://breakwatercommons.com/  |  Knox County
Bridges Home Services/Spectrum Generations  |  www.spectrumgenerations.org  |  Statewide
Day One  |  www.day-one.org  |  Residential services are State wide, Outpatient services are within York, Cumberland, Oxford and Androscoggin counties
GMS  |  www.gmsme.org  |  Androscoggin County, Cumberland County, Franklin County, Hancock County, Kennebec County, Knox County, Lincoln County, Oxford County, Penobscot County, Piscataquis County, Sagadahoc County, Somerset County, Waldo County, York County
Happy Haven  |  https://happyhaven.llc/  |  Androscoggin County
Independence Advocates of Maine  |  www.iamsupports.org  |  Aroostook County, Hancock County, Knox County, Penobscot County, Piscataquis County, Waldo County, Washington County
Jmpb inc. Dba Assistance Plus  |  www.assistanceplus.com  |  Androscoggin County, Franklin County, Kennebec County, Knox County, Lincoln County, Oxford County, Penobscot County, Sagadahoc County, Somerset County, Waldo County
Milestone Recovery  |  www.milestone-recovery.org  |  Statewide
Penquis  |  www.penquis.org  |  Knox County, Penobscot County, Piscataquis County
SeniorsPlus  |  www.seniorsplus.org  |  Statewide
SKILLS, Inc.  |  www.skillsinc.net  |  Somerset, Kennebec, Penobscot
Spurwink  |  www.spurwink.org  |  Statewide
The Pines Senior Communities  |  www.thepinescommunity.org  |  York County
The Progress Center  |  www.progresscentermaine.org  |  Androscoggin County, Cumberland County, Oxford County
Wellspring  |  https://wellspringmaine.com/  |  Statewide, Penobscot County

Associations, Research Institutions, Advocates, and Others
3i Housing of Maine  |  www.3iHome.org  |  Statewide
Alliance for Addiction & Mental Health Services, Maine  |  https://thealliancemaine.org/  |  Statewide
Alzheimer's Association, Maine Chapter  |  www.alz.org  |  Statewide
Direct Care and Support Professional Advisory Council  |  https://www.mainedirectcarepros.org/  |  Statewide
LeadingAge ME NH  |  www.leadingagemenh.org  |  Statewide
Maine Association for Community Service Providers (MACSP)  |  www.meacsp.org  |  Statewide
Maine Association of Nonprofits  |  www.nonprofitmaine.org  |  Statewide
Maine Center for Economic Policy  |  www.mecep.org  |  Statewide
Maine Council on Aging  |  www.mainecouncilonaging.org  |  Statewide
Maine Health Care Association  |  www.mehca.org  |  Statewide
Maine Long Term Care Ombudsman Program  |  www.maineombudsman.org  |  Statewide
PHI  |  www.phinational.org  |  Statewide
 
 
 

MHCA Holiday Hours

In observance of the holidays and time with family, the MHCA Office will be closing at noon on Tuesday, December 24th and will re-open on Monday, December 30th. The office will also be closed on January 1st in observance of New Year’s Day.

Staff contact: awesthoff@mehca.org

Season’s Greetings Message from MHCA President/ CEO

As we celebrate this holiday season, MHCA wanted to take a few moments to extends our deep appreciation to each of you for your dedicated and compassionate care of older and disabled adults in Maine. You have made a profound difference in the lives of many residents and family members over the past year.

Reflecting on this past year, we are proud of the many accomplishments we have achieved together. From enhancing the Nursing Facility Rate Reform model, to providing high quality continuing education, and advocating for common sense policy change, we have tackled a lot together as a united membership. We will continue to strive for improvements in the long-term care environment, ensuring that you have the support and resources needed to provide the best possible care for your residents.

Wishing you and your loved ones a joyous holiday season and a prosperous New Year.

Warm regards,
Angela
Angela Cole Westhoff
President & CEO

Staff contact: awesthoff@mehca.org

Nursing Facility Rate Reform Implementation Key Updates

The Maine Health Care Association (MHCA) in partnership with BerryDunn provided a webinar training on the new Nursing Facility rate model and implementation updates on December 19. Tammy Brunetti and Lisa Trundy-Whitten gave an update on the final model that will be implemented as of January 1, 2025 and will be fully adopted in February 2025 when rulemaking is completed. The webinar slides and the recording are available here.

Some Highlights of the NF Model include:
  • Costs were updated with 2023 “as-filed” cost report data
  • Guardrails updated to allow for a more gradual transition to the new model, including a “hold harmless” provision in year 1, by component.
  • Contract staff add-on in Year 1 to temporarily increase assumption to 20% agency labor, to be reduced to 10% in Year 2.
  • Occupancy penalty removed from fixed costs.
  • Worker’s comp has been moved from fixed to routine.
  • Value-based payment program pool of $8.1 Million per year in Years 1, 2, and 3 and gradual withhold (no withhold in Year 1). Funds to come from the NF Transition Fund.
  • The NF Transition Fund was created (total of $72.8 Million) to enable a more gradual implementation over three year period.
It is important to note that the Department of Health and Human Services (DHHS) has put together a draft Nursing Home Guide for Billing PDPM Nursing Component and an Implementation FAQ document in response to some rate reform implementation questions MHCA submitted. Please note that these are draft documents. DHHS will publish a final copy in the near future and will send out notification via their e-messaging system. MHCA will flag that for members when it becomes available.

In addition, there have been several MDS 3.0 Trainings conducted by the Office of MaineCare Services. All of these handouts and training materials are located here.

As additional details on implementation, billing, and the Value Based Payment (VBP) program become available, we will be certain to share that information with the membership and partners and future education programs are being discussed.

Staff contact: awesthoff@mehca.org

Nominate Outstanding Direct Care Workers for National Recognition!

The Maine Health Care Association is thrilled to share an amazing opportunity to honor and celebrate the dedicated individuals who provide exceptional care in post-acute and long term care settings. Through the national initiative Celebrating America’s Care Force, the Ceca Foundation is recognizing and rewarding care workers who make a profound difference in the lives of patients, residents, and their families.

?? Nominate a caregiver or share their story today! Submissions are due by February 15, 2025.

About the Initiative

The Ceca Foundation, a 501(c)(3) charity, is collecting stories that showcase the remarkable impact of care workers across the country. Submissions can come from providers, employees, patients, residents, and family members and may be written testimonials or inspiring videos recorded through Ceca’s platform. These stories highlight the very best of our profession and the people who make it extraordinary.

Awards and Recognition

Selected nominees will not only gain national recognition but also have the chance to receive one of Ceca’s 2024 National Awards, which include $2,500 cash prizes.

How to Participate

The submission deadline is February 15, 2025. Here’s how you can participate:
  1. Nominate a caregiver by submitting a story about their impact.
  2. Share this opportunity with your team members, residents, and families.

Spread the Word

AHCA/NCAL and Ceca encourage members to share this opportunity widely. Use newsletters, social media, and workforce committees to promote the call for nominations. A toolkit with resources is available to help you spread the word.

Staff contact: bhawkins@mehca.org

No Intent to Apply? No Problem!

Missed the AHCA/NCAL Quality Award Intent to Apply? Don’t worry! There is still time to showcase your commitment to quality. While submitting an Intent to Apply is encouraged, it’s not required. This means you can continue with your application process and take the next step toward excellence. 
Resources to Help You Complete and Submit Your Application 
AHCA/NCAL provides a variety of tools and resources designed to guide you every step of the way and help make the application process as smooth and successful as possible.
 
The Criteria Series? 
Watch the Criteria Series, a collection of short, easy-to-follow videos that break down application questions and categories. These videos are tailored to help you navigate each level of the program: 
  Criteria Submission Templates? 
If you're submitting a Silver or Gold application, don't forget to use the Criteria Submission Templates. These templates can help you create an outstanding application. 
 
Portal?Navigation Support 
Need assistance with the application Portal? These step-by-step guides will help you navigate the process with ease: 
  ?Questions? 
?We’re here to help! If you have any questions or need support during the application process, please contact the Quality Award Program team at qualityaward@ahca.org. ?
 
 
Staff contact: mcarland@mehca.org
 
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