LeadingAge PA—living our new name through advocacy!

Posted by rmcdaid on May 11th, 2012

Last week we put out the call for advocacy on the FY 12-13 budget, asking members to contact their legislators with a simple message—Nursing Facilities caring for residents on Medical Assistance (MA) cannot sustain further funding cuts,  and need the rate cut proposed in the Governor’s FY 12-13 budget restored.  This initial email campaign was the first in a series of advocacy ‘asks’ LeadingAge PA and its members will be making as the budget discussions move forward.    

Your efforts helped make nursing facility funding a priority when the Senate developed and passed their proposed spending plan this week (SB 1466), sending it on to the House for consideration by a bipartisan 38-9 vote.  MA funding for nursing facilities was partially restored in the Senate plan, providing us with a good start to our advocacy efforts—but there is more work to be done. 

Beginning Monday,  May 14^th, we’ll be calling on members and your staff, residents, and resident families to focus their attention on the PA House of Representatives and the Corbett Administration.  In this communication, we’ll be putting our name into action, with LeadingAge PA leading the start of real system change in Pennsylvania.  In this letter—which we need each and every member to send to their legislators and Governor Corbett—we’ll be sharing our plan to control MA program costs by using MA to fund care in Personal Care Homes and Assisted Living Residences, provide financial incentives for nursing facilities who take beds off line, and implement other efficiencies in Pennsylvania’s system of long-term services and supports (LTSS).  This will be in addition to the continued message to restore full funding for MA participating nursing facilities, since their continued underfunding compromises the care our residents receive and prevents our dedicated direct care staff from receiving the wages and benefits that they so richly deserve.  It also unfairly forces your staff and private pay residents to make up the difference between MA reimbursement and your cost of providing care—in essence ‘taxing’ those groups to make up for the MA shortfall, which totals more than $500 million in FY 11-12. 

While the LeadingAge PA staff will continue to work tirelessly to advocate on your behalf in Harrisburg, it is YOUR participation in advocacy that provides the key to our success. 

Remember, YOU are the experts, YOU have the voices that the Governor and Legislators need to hear, and if YOU don’t tell your story, no one will.  Together we will make a difference in the FY 12-13 budget, and in jump starting meaningful changes to Pennsylvania’s LTSS system. 

ObamaCare: Will it stay, or will it go? (Part II)

Posted by nluciano on March 30th, 2012

Earlier this week, we dissected the first two days of arguments in the legal challenge to the Affordable Care Act (ACA) before the U.S. Supreme Court.  Now that arguments have concluded, we can assess the final day of questioning, look at the next steps by the Court, and what it may mean for LeadingAge PA members.

The final day of questioning centered on two separate issues.

• Is the individual mandate severable from the rest of the act, or must the act be treated as a whole?   The statute does not contain a severability clause, which is common in legislative drafting.  This may be seen as instructive to the Court that the Congress viewed the individual mandate as being so integral to the act that without it the rest of the statute fails.  However, the Supreme Court has previously acted on its own to strike portions of a statute that it deems unconstitutional while allowing the remainder of the bill to stand.  The Justices were openly wrestling with the idea of how to allow the rest of the act to stand if the individual mandate was struck down.  Justice Scalia indicated that the Court would be putting itself in the position of Congress if it were to attempt to re-write the act without the mandate, saying “Once you’ve cut the guts out of it, who knows, who knows which of them [the other sections] were really desired by Congress on their own and which ones weren’t?”  Others, such as Justice Ginsburg, preferred to engage in a “salvage job” rather than a “wrecking operation”.  Justices Sotomayor and Kagan, indicated their preference to use a scalpel to simply remove offending provisions, pointing to parts of the act that are currently implemented and working. The issue was under such scrutiny that Chief Justice Roberts added 30 minutes of time to the session, prompting Solicitor General Verilli (the Obama administration’s advocate in the case) to respond sarcastically, “Lucky me.”
  • Obama Administration’s Argument- Individual mandate is severable from rest of the ACA except for the requirement that insurers not exclude individuals based on pre-existing conditions and the limitation on how insurers set rates.
  • Opponents’ Argument- The individual mandate is not severable from the ACA, and the entire act must be struck.
  • Court Appointed Amicus- The individual mandate is completely severable from the rest of the ACA.
• The final argument to be heard was whether the requirement that the fifty states accept the vast expansion of the Medicaid program under the act, or pull out of the program all-together, was a violation of the concept of federalism.  The argument from the states hinges on whether the requirement to accept expansion or withdraw entirely violates a Supreme Court precedent that the federal government cannot create preconditions of participation in a program that are “so coercive as to pass the point at which pressure turns into compulsion.”  This argument initially seemed to be an add-on—somewhat of an afterthought—as none of the lower courts, even those that found the ACA to be unconstitutional, afforded it much merit.  However, the Justices dealt with this matter with as much intensity as the previous arguments.  Justice Kagan was forceful in questioning the attorney representing the states, interrupting him after only 10 seconds, remarking that the provision amounted to the federal government providing the states with “a boatload of Federal money for you to take and spend on poor people’s healthcare. It doesn’t sound coercive to me, I have to tell you.”  Seconding Kagan’s sentiments, Justice Ginsburg added “we have never had, in the history of this country or the court, any federal program struck down because it was so good that it becomes coercive to be in it.” 
  • Obama Administration’s Argument- Expansion does not violate federalism, as the states have the option to participate in the Medicaid program.
  • Opponents’ Argument- Expansion of Medicaid program as fashioned under the act violates doctrine of federalism as being coercive.

The ACA has had its day in court, and now the waiting begins.  The Justices will next meet in seclusion and determine on which side of the arguments they fall, with five Justices needing to agree in order to issue a majority opinion.  The job of writing the opinion will be assigned to a Justice in the majority by the most senior Justice within that majority.  In a case as momentous as this, the most senior Justice in the majority will often take the assignment themself.  Once the opinion is drafted, it will be circulated between the Justices, and those agreeing with the ultimate decision and the legal analysis will sign on.  If a Justice agrees with the outcome, but not the judicial analysis, they will write their own concurring opinion.  The Court has until June 30, 2012, to publish the outcome in this case, and we will not be able to identify the ramifications of the Court’s decision on members until they render it.  However, many believe that a good number of the provisions of the Affordable Care Act (ACA) relating to reimbursement under the Medicare program will be revisited by Congress, or by CMS via regulation, even should the Court strike down the ACA.  This makes it essential that members continue to work to improve their performance on key quality measures and benchmark their quality, cost, and hospital readmission rates against other post-acute care providers in their markets in preparation for the changes which are likely ahead. 

ObamaCare: Will it stay, or will it go?

Posted by nluciano on March 29th, 2012

Seldom does the most anonymous–and least understood–branch of our federal government take center stage in our nation’s consciousness, but that is where we find ourselves this week as the fate of the Patient Protection and Affordable Care Act (ACA), President Obama’s signature domestic policy achievement, is being questioned before the Supreme Court.  Not since Bush v. Gore in 2000 has such attention been focused on the nine members of the Court, with every legal commentator and reporter parsing through their every comment and reaction attempting to identify which Justice is willing to accept “Obamacare” as a permissible use of the federal government’s power to regulate interstate commerce, or strike it down as an impermissible mandate compelling an individual to contract for a service that they may otherwise not have wanted.   The ramifications are as significant as the issues are complex. 

Oral arguments were heard by the Court this week, with the Court taking the rare step of allotting three days and a total of 6 hours of arguments to the case—by comparison, since World War II only one case, Brown v. Board of Education, received more than 4 hours before the Court.  Below is a brief sketch of the arguments this week:  

• Monday, March 26, 2012: The Court entertained arguments of whether the treatment of the ACA’s penalty provision for not purchasing insurance was a tax.  The importance of this question is that a statute from 1867, known as the Anti-Injunction Act, prohibits the Court from hearing tax disputes before the tax has been paid.  If the penalty was deemed a tax consistent with the Anti-Injunction Act, the Court would have to refrain from issuing an opinion as the dispute would not be “ripe”.  From all indications, the members of the Court seemed satisfied that the Anti-Injunction Act would not preclude the Court from acting, as questioning seemed to drift toward the next day’s topic—the individual mandate.
  • Obama Administration’s argument- Provision not a tax. 
  • Opponent’s argument- Provision not a tax.
  • Court appointed amicus- Argued provision is a tax.  (While both named parties were in agreement on the issue, the Court felt the issue needed to be addressed and therefore appointed a third party to argue the point.)
• Tuesday, March 27, 2012: The Court heard arguments as to whether the “individual mandate” was a permissible use of Congress’s power to regulate interstate commerce.   The questioning from Justices Scalia, Kennedy and Alito was pointed and blunt.  Each probed the Solicitor General on whether any limit on the power Congress has to regulate commerce exists.  To this line of questioning Justice Breyer remarked that any limit on the Congressional power will be given in the statute.  Most observers shared the opinion that Chief Justice Roberts will be the swing vote on this issue, as his line of questioning did not give the appearance of any pre-conceived position. 
  • Obama Administration’s argument- Individual mandate is an acceptable means of regulating interstate commerce.
  • Opponent’s argument- Individual mandate is a federal compulsion to affirmatively engage in commerce not otherwise sought, and therefore beyond the authority afforded Congress.

There is one more day, and two arguments left for the Court to address.  Wednesday, the Court will look at whether the individual mandate clause at issue today can be removed from the ACA, or whether the act must be treated as a whole.  Also, the Court will examine whether the additional funding mandates placed on the states through the Medicaid program violates the constructs of federalism.  Stay posted…

LeadingAge PA Calls on PA to Overhaul Senior Care System

Posted by hgeist on January 20th, 2012

On January 19, LeadingAge PA  called on state government officials to overhaul how the delivery of senior care services is provided in Pennsylvania as part of the next budget process.

Despite being one of the grayest states in the nation, Pennsylvania’s senior care funding is spread out across several agencies, including the Pennsylvania Department of Public Welfare, Pennsylvania Department of Transportation, Pennsylvania Department Aging, Pennsylvania Tobacco Settlement Fund, Pennsylvania Office of Long-Term Living, Pennsylvania Lottery, and the Center for Medicare and Medicaid Services.

“It’s virtually impossible for seniors to work through the labyrinth of bureaucratic line items,” said LeadingAge PA President Ron Barth. “When they can find the programs they need, there are often times waiting lists or enrollment caps because the funding in that particular agency silo is maxed out.  For many families, they simply throw up their hands in frustration.”

Pennsylvania also bases funding for many of the programs on outdated 20^th century care models. For example, more than $3 billion is set aside for nursing home care, but personal care and assisted living are not funded.  

“In fact, we should eliminate the term ‘nursing home’ because they are no longer places where people stay for years,” Barth said. “They’ve become temporary settings for rehabilitation or end-of-life care. The vast majority of the residents will transfer from theinstitutional setting to the community, whether their own home, a personal care home or an assisted living residence, but funding isn’t following them to these settings. Pennsylvania must create a funding system that is centralized andsimple for seniors to use in order to meet their needs in the 21^st century.”

Satisfaction surveys help organizations collect data that measure quality; identify areas of improvement…

Posted by rbarth on November 21st, 2011

These are difficult times.  Not-for-profit senior care providers have to continuously be aggressive in ensuring their competiveness in a tough market.  Good, solid metrics are essential in improving services and marketability, including finding attractive matches for possible collaboration with other health care and service providers.  One of these key metrics is the level of satisfaction of residents, resident families, and staff.

Satisfaction surveys help organizations collect data that measure quality; identify areas of improvement; identify performance indicators and key drivers of satisfaction; and provide employee/resident comments and feedback.

Most top flight organizations already do these types of surveys.  Many other organizations would like to do well-done professional satisfaction surveys, but find the cost prohibitive.

To help all of our members to be able to do this in a professional manner, LeadingAge PA has partnered with Holleran, a national research firm out of Lancaster, PA, to develop a very affordable, yet professionally driven consumer and staff satisfaction survey. 

Members currently taking advantage of this program are enthused.  Fran Kuhns, former LeadingAge PA Board Chair and CEO of WRC Senior Services headquartered in Brookville, says, “WRC Senior Services was very pleased with Holleran’s LeadingAge PA satisfaction survey product. We were able to complete a comprehensive and scientific survey of our customers and employees within a very reasonable budget. We had a better response rate than when we completed our surveys in-house! The reports were very easy to read and understand and gave us great benchmarking data as well.  I want to encourage more LeadingAge PA members to use this service and product”.

Current LeadingAge PA Board Member, Pat Savage, CEO of Allegheny Lutheran Social Ministries (ALSM) which serves eight counties throughout West Central PA, says, “ALSM has used both the Holleran staff satisfaction survey as well as the resident satisfaction survey product provided by LeadingAge PA.  The surveys are comprehensive and address the areas for which we seek feedback. The process and the final product have more than met our needs and provide us with a better baseline to develop a plan of action to address those areas that are not meeting our standard. We appreciated the ease of use of the surveys and the professionalism and positive attitude of Holleran consultants. Thanks to LeadingAge PA for yet another needed product that met our needs in quality and affordability.”

Actual cost for conducting a survey will vary depending on the size of the sample and other varying factors, but I am certain that members will be surprised at how affordable this can be.  Every LeadingAge PA member, regardless of size, will now have access to a key metric previously only available to larger organizations.

I encourage every LeadingAge PA member, to seriously investigate this opportunity.  For more information on this program, please contact Jocelyn Martin at Holleran at jmartin@holleranconsult.com or 866-736-0474.

CLASS Act in trouble…

Posted by rbarth on November 4th, 2011

It was good seeing so many LeadingAge PA members at the LeadingAge national conference in D.C.  As many of you have heard either through attending the conference or through email communications, the CLASS Act is in trouble.  HHS is having trouble finding a credible, actuarially sound way to make this successful.  The basic problem is that everyone can sign up, but not all need to.  Younger, healthier individuals can opt out leaving the program with a top heavy number of older, less healthy beneficiaries.  Either premiums would have to be excessively high (which would result in more people opting out) or there would have to be some sort of underwriting to have different premiums based on age and health (which is problematic under the current law).

The basic idea behind CLASS is a good one.  People need to take some personal responsibility to plan for future needs for services when they age.  Right now, the vast majority of people either think Medicare will take care of everything, or are willing to let Medicaid be their backup plan.  The good news about CLASS is even if it is eventually repealed or at least not implemented, it has put the issue of how to fund senior services on the front burner.  Congress and the Executive Branch cannot credibly get rid of CLASS without talking about an alternative.

LeadingAge National and LeadingAge PA will be there with ideas when these discussions happen.

Negotiations yield positives for MA participating NFs

Posted by rmcdaid on August 5th, 2011

We’re officially in the ‘Dog Days’ of summer.  Its vacation time for many, and while it might seem that there’s not much happening in Harrisburg, that couldn’t be farther from the truth.  As the FY 11-12 budget was being finalized in late June, the Department of Public Welfare (DPW) and the Associations representing Medicaid participating nursing facilities (NFs) were in negotiations (with yours truly and LeadingAge PA playing a prominent role in the deliberations, as always) on a number of issues impacting MA participating NFs.  The discussions yielded a number of positives for MA participating NFs.  In exchange, we collectively agreed not to oppose an extension of the Budget Adjustment Factor through June 30, 2013 and allow DPW some additional time (until June 30, 2012) to develop and publish a final regulation on ‘Participation Review’ (aka, Bed expansion and/or exception requests) . 

In exchange, we got the following:

1. DPW’s commitment to update MA rates for the ‘missing quarter’ of claims from July-September 2010, which were still being paid at the April 2009 levels until the recent catch up. 
2. DPW’s commitment to offer the same payment and recovery schedule when the final FY 10-11 rate adjustments are completed as they allowed when adjusting the FY 09-10 rates. 
3. DPW’s commitment to send a letter to MA participating NF providers on Hospital Bed Hold Payments, since the revisions to the payment policy (e.g., facilities w/ <85% occupancy will no longer receive Bed Hold Payments) are in effect but the funds have yet to be ‘recouped’ from those facilities who don’t meet the 85% threshold.
4. DPW’s commitment to separate out the funding for NF MA rates into a separate line item so we can again more easily track the money appropriated for NF rates in the budget.
5. DPW’s commitment to share the actual days of care with the Associations on a periodic basis as the fiscal year progresses.
6. DPW’s commitment to engage in additional dialogue around the proposed regulations on Participation Review (e.g. , Bed Need/Exception requests) before moving forward with publication as final.
7. DPW’s commitment to begin dialogue with the NF Associations on a potential re-tooling of the BAF and/or re-design of the Case Mix system since the projected BAF of .88595 for July 1, 2011 and .86825 for October 1, 2011 further demonstrate the increasing inadequacy and volatility of the current rate setting system. 

These discussions will begin in August and September, and LeadingAge PA will be keeping members posted along the way.  Please send your comments or thoughts to russ@leadingagepa.org.

Government – An Unreliable Business Partner

Posted by rbarth on August 2nd, 2011

There is no question that the U.S. deficit is a huge problem. For the past several weeks we have been witnessing the twists and turns and the political gamesmanship where both sides seem to be more interested in placing the blame on the other or positioning themselves for the next election rather that seriously dealing with what almost all concede is a crisis.

And who ultimately is always left holding the bag? It is those who have relied on the government as a business partner. Although not directly related to the debt ceiling ruckus, this past Friday, senior care providers certified for Medicare were told that they would receive an 11.1% reduction in reimbursement on October 1. Just like that!! No reduction in requirements for providers, no change in eligibility…government solves the problem by simply reducing reimbursement while assuming – in fact requiring – that its partners will continue to do more with less. Wouldn’t it be great if you could treat your business partners the same way? Let’s see what happens if a provider goes to its utility company or food vendor or medical supply vendor and in essence says “there must be a mandatory 11.1% reduction in what you’re charging me. No, we’re not going to cut consumption, in fact we may require even better service, but we can’t afford to pay you your cost. Just do more with less.” Think that would work?

What is the answer for providers? We know that many providers, especially in very rural or very urban areas,  serve fewer clients who can pay privately and currently must rely on government funding. So in the short term the answer is working with LeadingAge PA and LeadingAge (national) to continue our advocacy efforts to get legislators and policy makers to be more familiar with your organizations and show them how impractical these types of cuts are. But in the long term, the answer must be to strategically shift the way services are provided in order to be less reliant on payment from a very unreliable business partner – government.

Value First Group Purchasing Now Available to LeadingAge PA Members

Posted by mmarchi on July 28th, 2011

Pennsylvania’s senior care providers have a new option for purchasing supplies and services through an innovative group purchasing organization called Value First, Inc., which is owned by LeadingAge PA along with 25 similar state associations and LeadingAge, our national association.

“Having access to contracts for goods and services negotiated on their behalf by Value First gives our members the ability to stretch their resources and, in turn, better serve older adults in Pennsylvania,” said Ron Barth, CEO LeadingAge PA.

“Aging services is a broad arena, ranging from assisted living to adult day health care to long-term care for the frailest elderly. Value First will help providers who strive for efficiency while providing high quality care in times when healthcare costs are a national concern,” Ron Barth added.

LeadingAge PA is an affiliate of LeadingAge, which represents 5,400 not-for-profit organizations dedicated to expanding the world of possibilities for aging. LeadingAge PA alone has membership of over 350 aging services providers.

“This is an innovative business model that not only makes buying easy and affordable for older adult services providers of all sizes, it helps strengthen the shareholder associations, which advance policies, promote quality services and conduct research that supports, enables and empowers people to live fully as they age,” said Value First President Steve Nielsen, St. Paul, Minn. Value First is managed by shareholder Aging Services of Minnesota, an association similar to LeadingAge PA.

Value First, Inc. is expected to manage $100 million in sales in its first year. Its contracts are being negotiated by MedAssets, Inc., (NASDAQ: MDAS) a national leader in healthcare group purchasing based in Atlanta, Ga.

LeadingAge PA members were sent a packet of information from Value First that included a letter explaining the Value First program as well as some forms that you were asked to sign and return solidifying your participation in the Value First program. If you have not returned these signed documents, please do so. If you have any questions concerning participation or these forms feel free to contact Mario Marchi at 717-790-3952 or e-mail to mario@panpha.org.

Assessing your Readiness for Version 5010

Posted by IWoody on July 19th, 2011

 By, Iara Woody, Sr. Finance & Health Policy Associate – Advocacy, LeadingAge

 In preparing for Version 5010, facilities should be working with their vendors on their plans, conducting tests, evaluating partners who will be affected and making sure everyone is ready. It is less about making the technical fixes and more about checking in with key people, doing a test and making sure everything is ready. 

Below is a checklist provided by CMS to help facilities prepare for the January 1, 2012 compliance date:

• Current transaction versions must be upgraded to Version 5010 and D.0. Medicare has performed a side by side comparison of the current 4010A1 and 5010 base formats. The side by sides do not include errata changes and do not replace the TR3s. To purchase TR3s and access Technical QuestionsX12 please go to www.x12.org or for NCPDP D.0 go to www.ncpdp.org.
• Software must be modified to produce and exchange the new formats (e.g. trading partners must be able to read incoming 277CA transactions sent from Medicare).
• Review business processes to ensure changes are not necessary to capture additional data elements not previously required (e.g. impact of patient registration, billing, and claim reconciliation).
• Contact your vendor and/or clearinghouse to ensure products and processes are updated (e.g. license includes regulation updates, and will the upgrade include acknowledgement transactions 277A & 999).
• Trading Partners should contact their local Medicare-Fee-For-Service contractor (MAC) for specific testing schedules. See www.cms.gov/ElectronicBillingEDITrans/  under downloads, to find a MFFS contractor in your state, or find your operational MAC on this list. For details on testing requirements see the 5010 National Call presentation on Provider Outreach and Education – Transition Year Activities.
• Do not wait to begin testing with your MAC because the MACs will not be able to accommodate large volumes of trading partners seeking production status all at once. Be sure to start testing Version 5010 and D.0 as early as possible in 2011. Be prepared.

To download readiness checklists from CMS and a resource card with helpful web links go to www.cms.gov/Versions5010andD0/40_Educational_Resources.asp#TopOfPage .