OHCA District II & Miami Valley Long Term Care Association

1. OHCA District II &Miami Valley Long Term Care Association February 2019 Kenneth Daily, LNHA kenn@qissurvey.com

2. District Update • CEUs for today’s program is 2 hours • Certificate of attendance at table

3. Upcoming Programs • March (2 hours) • A Changing Landscape: Regulatory Impact on Medication Management • Erin M. Foti, PharmD, BCGP, Director of Consulting Services, Remedi SeniorCare • April (3 hours) • Ohio State Budget 2020-2021 - Kenn Daily, LNHA • PDPM: Transitioning into New Payment Model without Compromising Quality of Care, sponsored by: • May (2 hours) • Medicare PPS, Value-based Purchasing, Bundled Care

4. Annual Golf Outing August 22nd at Pipestone Golf Club • Brochures will be to sent to all members and supporting vendors in March • Supports the MVLTCA scholarship funds • Educational Foundation of OHCA

5. April 29th to May 2nd • Facilities will be receiving their coupons this week • Golf outing - Monday 29th • Sessions - Program • Monday thru Thursday • Columbus Convention Center • District II sponsoring golf outing and early riser CEU program breakfast

6. EFOHCA Scholarships • Reminder that there are only three days left to apply for an 2019 EFOHCA Scholarship. • This year, EFOHCA will be awarding more than $160,000 to 60 individuals • Recipients will either a $2,000, $4,000 or $8,000 educational scholarship. • There is an additional $15,000 in certification scholarships which will cover 50% of the cost of the certification not to exceed $1,500 in any one scholarship. • The deadline to apply is Friday March 1.

7. Social Media • MVLTCA has launched a LinkedIn group site • Start a conversation • Post a job

8. Ohio Department of Medicaid

9. Medicaid Quality Indicators ODM announced recently that all facilities will be receiving at least 2 of the 7 quality points. There were data problems removing Hospice patients from long/short term antipsychotic indicator. The 7 measures are: • *Pressure Sores (long term) • *Pressure Sores (short-term) • *Antipsychotic (long term) • *Antipsychotics (short term) • *Unplanned Weight Loss (replaced potentially preventable hospital admission measure ) • *Staff Retention • Preferences for Everyday Living Inventory (PELI) *The 40th percentile will be used uniformly for the pressure ulcers, antipsychotics, weight loss, and staff retention measures.

10. ODM Exception Review • Department of Medicaid (ODM) notified Associations that exception reviews will not re-commence this week as previously anticipated but probably early March. • Reviews will cover the quarters up to ending December 31, 2018, but the telephone and email notices to each SNF will identify the quarter. • The results of exception reviews since the department activated the project for calendar year 2018. • 26 of 133 buildings reviewed (19.5%) ended up with reduced case-mix scores, with the average reduction being 0.1752 (approximately 6.3%). • This lowered the 26 centers’ direct care rates about $6.75 on average, which cut Medicaid spending by roughly $1.75 million for the year.

11. PDPM & Implications for Medicaid Rate Methodologies • Effective October 1, 2019 CMS will stop supporting the current RUGs for Medicare Part A Prospective Payment System • CMS will provide states one-year (September 2020) to devise new state payment system (non-RUGs) • Problem is that PDPM is for short-term payment vs. Medicaid is long term • PDPM is huge shift but it is only a temporary fix as payments are expected to morph into a single unified post-acute care payment system (U-PAC) as outlined in the IMPACT ACT.

13. PDPMSNF PPS Payment Model Research Provider-specific impact analysis file, which details the estimated impact of the PDPM model discussed in the FY 2019 SNF PPS NPRM on Medicare Part A payments to each SNF The provider and resident data is for fiscal year 2017 and represents estimated payments under PDPM, assuming no changes in provider behavior or resident case-mix. • SNF PDPM Provider Specific Impact Analysis

14. Ohio Department of Health

15. Legionella ODH posted at the EIDC Notifications: Prevent Legionnaires Disease training for healthcare facilitiesLegionnaires' disease (LD) is a form of pneumonia with around a 10% mortality rate. The disease is caused by an aerosol-transmitted bacterium in both potable and non-potable water sources. The state of Ohio led the country last year with 930 reported cases of Legionnaires' Disease. There is an increased need to educate healthcare facilities on improving LD prevention and response.

16. Legionella • CMS in June published S&C 17-30-Hospitals/CAHs/NHs REVISED 06.09.2017 • Facility Requirements to Prevent Legionella Infections: Facilities must develop and adhere to policies and procedures that inhibit microbial growth in building water systems that reduce the risk of growth and spread of legionella and other opportunistic pathogens in water. • Facility must have a comprehensive policy • Facility must complete a facility risk assessment

17. ODH Legionella F880 • Surveyors should be looking for: • Facility policy and procedures and water management program • The facility risk assessment • Evidence that the policy is being followed(facility on-going measures being followed) • Testing protocols • Staff awareness and steps to be taken should Legionella be identified.

18. Carbon Monoxide Monitoring • Enforcement began 1/1/19 to install carbon monoxide monitoring devices • If the facility has no fossil fuel fired appliances there is no requirement for installation of CO monitoring devices. • Existing nursing facilities may use devices that are either battery operated or hardwired. • According to licensure rule 3701-17-25 the devices must be placed on the ceiling within the maximum distance recommended by the manufacturer at each fuel fired appliance such as furnaces, water heaters, stoves, dryers, etc. • CO monitoring devices must either meet UL standard 2034 (alarm) or UL standard 2075 (detector).

19. CO Monitoring • Facilities must a install CO monitoring or alarm devices centrally located on each floor of a facility • Devices must be installed in every heating/ventilation/air conditioning (HVAC) zone of the building. An HVAC zone is the area served by a specific HVAC fuel fired appliance. • In addition, the Ohio Fire Code requires an additional CO detector or alarm installed at the location of the first air vent or discharge from each fuel-fired furnace (this is normally found at the nearest room or area served by the furnace). • Licensure does not define battery life, testing, or frequency. All inspection, testing and maintenance of the CO devices must be completed based on manufacturer guidelines and instructions. It is recommended that when the devices are installed to write date of installation on battery/ device.

20. CO Response Policy • Need to update facility policy in the event of an alarm CO alarm is alarming (CO levels that could make residents and staff ill ) and should include: • Follow the facility’s Fire Evacuation Policy • Response is normally: R-A-C-E • R – Remove residents in immediate harm’s way • A – Alarm by initiating the nearest fire alarm pull station to initiate • C – contain normally is closing windows and doors, however in the situation where it is a carbon monoxide alarm staff should open all windows to add additional ventilation such as fans and fresh air to dilute the concentrations of carbon monoxide. • E- Evacuate the smoke compartment where the CO Alarm is sounding as directed by the fire department the entire facility. • When the fire department contacts the facility to verify the alarm notification the facility staff member should inform the fire department of the CO Alarm

21. Ohio Budget 2020-2021 • Expected to be released by March 15th (though Governor DeWine has stated it will be out by March 8th. • Interesting that over year budget is both the most important funding and public policy legislation every two years in Ohio. • Long term care profession will, as in prior years, be a focus of the budget debate

22. Budget Messages • We support the full continuum of care for Ohio’s seniors and people with disabilities. All parts of the continuum are important and should be funded appropriately. We support expanding PASSPORT and the Assisted Living Waiver programs. • The Governor’s budget emphasizes the need to care for vulnerable populations, including one of the most vulnerable – 50,000+ skilled facility residents who rely on Medicaid for quality care. These Ohioans need care they cannot receive at home or a less intensive setting. • In recent years which is perpetuated by the Governor’s budget, skilled nursing facility reimbursement rates have not kept up with inflation. This jeopardizes providers ability to maintain needed staffing levels and in turn, negatively affects the quality of care.

23. Managed Care • Kasich Administration's proposal to expand managed care to long-term services and supports (MLTSS) in the rural areas of the state not in MyCare Ohio was the #1 issue last budget • Hearings are focusing on several issues including removing SNF payment from statute • ODM is not planning to move back to fee-for-service but will be more thoughtful as managed care expands • MLTSS is not expected to be included in budget which means expansion not likely this year • Right now ODM is waiting for CMS decision on extending MyCare three years to December 2022. ODM is not expected to withdraw extension request • ODM did announce last week that they plan to have managed care providers rebid this year

24. SNF Regulatory • Public policy issues related to survey • Before starting a ‘new’ cycle, ODH would have close prior cycle. • Triaging of complaints to limit ‘rushing out’. Currently ODH is over run by complaints and data shows: • 2 day 17% • 10 day 72% • 30 day+ 11% • Establish new licensing standards for changes of ownership, including such things as surety bonds, proof of financial viability, quality assurance and risk management plans, background checks, and liability insurance coverage. • Require transparency and timeliness for IDR process including a written rational • Require joint surveyor/provider training

25. SNF Reimbursement • Ensure support of the current statute providing for market basket adjustment of SNF rates starting July 1, 2019. (This is from prior budget) • Update and correct statutes on rate calculation for newly constructed SNFs (tax component) and to improve accuracy for changes of ownership. • Require provisional eligibility if Medicaid application not processed timely per federal standards resident would be approved • Revise quality incentive for SNFs that meet specified care coordination requirements and report related measures to ODM.

26. Intellectual and Developmental Disabilities • Support ICF/IID rate formula enacted in HB 24 (132nd GA), effective July 1, 2018. • Support/enhance DODD efforts to improve rates for waiver providers and wages for direct support professionals, add market basket provision.

27. Home & Community-Based Services • Support the increase in Assisted Living Waiver rate with the top tier being $96 • Include market basket increase provision for future increases • Provide 5% increase for nursing and aide services by waiver providers (including PASSPORT) and state plan home health.

28. Ohio Senate Bill 24 Establish the Alzheimer's Disease and Related Dementias Task Force • Sponsored by Senators Wilson and Yuko and locally co-sponsored by Senator Hackett • Creates an Alzheimer’s Disease and Related Dementias Task Force, which would be charged with reporting on 28 different points specified in the legislation including: • Trends in the state's Alzheimer's disease and related dementias populations and service needs, including type, cost, and availability of services • Existing resources, services, and capacity relating to the care of individuals diagnosed with Alzheimer's disease or related dementias • Policies and strategies that address Alzheimer's disease and related dementias including service delivery, research and legal concerns.

29. Senator Bob Hackett (R-London) • Senate District 10 • Counties: Clark, Greene, Madison • Will chair the Finance Health & Medicaid Subcommittee

30. Grassroots Lobbying • Anybody can talk to their legislators or elected officials • You are the expert; tell your story! • Legislators are just people • Talk positively about things your facility is contributing to the community • Feel free to discuss issues you are experiencing as a provider • Explain the impact of positive/negative legislation on the residents and/or staff.

31. Initial Meeting with Your Legislators • Your part in the overall effort is to personally share your story and to educate • Legislators need a barometer on constituent thoughts and opinions, • Listening to constituents is an essential part of their job

32. Tour Of Facility • At some point show your legislators some of the realities of resident care and compliance with changing standards. • If there is a regulation that you have particular difficulty meeting due to its application at your facility e.g. storage of linen carts or cross contamination, show the legislator the real life roadblocks to compliance. • Point out a variety of levels of care required by the residents and discuss the varied costs associated with this care