Publication of the Maine Health Care Associationjanuary 16, 2009

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MHCA E-News

Publication of the Maine Health Care AssociationJanuary 16, 2009

317 State Street, Augusta, ME 04330 Tel: 207-623-1146 Fax: 207-623-4080

Check the MHCA website()for past issues of the E-News, as well as complete listings of education programs and committee meetings. To view items on the MEMBERS ONLY page: User ID:mehcambrsand Password:care4me(all lower case).

In This Issue:

• Work Continues on Two Budgets at State House
• Economic Recovery Package Moving Ahead in Congress
• Salmonella Outbreak – Check Your Peanut Butter Supplies
• MHCA Welcomes New Member
• One Bulb at a Time – January 22nd Session in Augusta is Cancelled
• Activity Coordinator Certification Course Offered in March
• Education Feature of the Week: Ethical Challenges for the Geriatric Social Worker
• Survey Tips: New Advanced Beneficiary Notice (ABN) Medicare Survey Protocols Issued January 9, 2009
• Rescheduled Advancing Excellence Campaign Satisfaction Webinar Dates Announced
• New CMS Surety Bond Requirement for DME
• AHCA/NCAL Quality Symposium – February 5-6, 2009
• Notice of State Rulemaking
• Upcoming EducationPrograms
• MHCA CommitteeMeetings

Work Continues on Two Budgets at State House

Richard A. Erb, President/CEO()

The Health & Human Services Committee and Appropriations Committee took turns this week analyzing the proposed supplemental budget, designed to close an $800 million hole in the 2008-09 budget. The major impact for nursing homes and residential care facilities is the switch to mandatory monthly MaineCare billing before the end of this fiscal year. According to the Department of Health & Human Services, this change was already scheduled for 2010 when the new MIHMS claims management system will replace the much-maligned MECMS program. By moving the policy change up to this year, DHHS plans to actually take the June 2009 payment and “push” it into early July. The result is a savings to the 2008-09 budget (on paper only) of approximately $7 million. Under Maine’s cash accounting system, expenses are booked in whatever year the actual transaction takes place. Work will continue on the Supplemental Budget into next week. A vote is expected to be taken as soon as possible.

The Governor’s Office has also provided our first look at the proposed biennial budget that will take effect on July 1, 2009. Because committees have been preoccupied with the supplemental budget, there has been little consideration given to this document yet. MHCA is waiting for further explanation from DHHS, but it appears that most human services items are flat funded for the next two years. In many cases, cuts were avoided because the State is assuming that the federal government will be providing relief to state Medicaid programs through an economic stimulus program. If those funds fail to materialize, the Governor’s Office has said that a second budget will be released that includes up to $98 million in new cuts.

Of immediate concern to MHCA is a DHHS proposal to reduce funding for elderly residential care services by approximately $2 million in Fiscal Year 2009-10 and $8 million in FY 2010-11. The budget document states that this will be through decreased usage. However, our discussions with the Office of Elder Services indicate that they do not believe the newly proposed PNMI eligibility standards would achieve these savings. We are following up with appropriate officials to get a better explanation of this item.

Economic Recovery Package Moving Ahead in Congress

Nadine L. Grosso, Director of Communications ()

On the heels of the release of $350 billion in so-called financial bailout funds yesterday, Speaker of the House Pelosi also unveiled theleadership’s economic recovery billwhich contains $87 million in enhanced federal Medicaid funding for states, $2 billion for health information technology, $600 million for training primary care practitioners, as well as doubling support for nursing programs and nurse scholarships, nurse faculty loans and advanced nursing and an extension of the moratorium on certain Medicaid regulations until October 1, 2009. Additionally, a one year delay in 3% of the tax withholding of Medicare receipts scheduled to take into effect 2011 has been included in the bill.Committees of jurisdiction have signaled they will mark up as early as January 21, with floor action quickly thereafter. The State of Maine is watching the process closely, having made some state budget decisions based on the possibility of significant federal financial assistance. For more information, contact Cynthia Morton.

AHCA/NCAL are continuing to pursue Medicaid prompt pay and accountability, access to capital, job creation, and health information technology assistance. Now more than ever, it is critical that you tell Congress you support the inclusion of these proposals, which will help long term care in this time of economic strain. To send your letter, please click here.

Salmonella Outbreak – Check Your Peanut Butter Supplies

Tammy Rolfe, Director of Quality Improvement and Regulatory Affairs ()

Maine DHHS Licensing and Survey Staff today notified MHCA of a Salmonella outbreak and urged the association to publicize that facilities should check peanut butter supplies and follow the recall information listed below. We understand that 5 individuals in Maine have been sickened with the outbreak, but are not aware of any specific nursing home or assisted living residents or staff involved in the outbreak.

Nationally 410 individuals have been sickened. The Federal CDC is collaborating with public health officials in many states and the United States Food and Drug Administration (FDA) to investigate a multistate outbreak of human infections due to Salmonella serotype Typhimurium. DHHS referred to the link: for more information on the outbreak. You can be fairly certain that Surveyors will check your facility’s action regarding the recall during survey and licensing inspections. Additionally, any suspected salmonella outbreaks would be reported the Maine CDC at 1-800-821-5821 as a notifiable condition.

On January 10, 2009, King Nut Companies, a distributor of peanut butter manufactured by Peanut Corporation of America, issued a voluntary recall of peanut butter distributed under the King Nut label. In addition, King Nut Companies also issued a voluntary recall of Parnell’s Pride peanut butter distributed by King Nut, which is produced by the same manufacturer. The recalled products have lot codes beginning with “8”. No other King Nut products are included in this voluntary recall.More information about this recall can be found on the FDA website at –

MHCA Welcomes New Member

Richard A. Erb, President/CEO()

The Association would like to welcome Barbara Steller as a new member. Barbara Steller has recently retired but would still like to stay involved in the long-term care industry.

Barbara Steller

P.O. Box 75

Stillwater, Maine 04489

Phone: 207-827-3662

E-mail:

One Bulb at a Time – January 22nd Session in Augusta is Cancelled

Karen Michaud, Director of Education ()

This article is to inform you that the Augusta session of One Bulb at a Time which was planned for January 22, 2009 at MHCA has been cancelled due to lack of enrollment. If you were planning to attend, I apologize for any inconvenience this may have caused you. There are still three other options for participating in this course:

• February 5, 2009 @ Madigan Estates in Houlton, Maine
• February 19, 2009 @ Dirigo Pines in Orono, Maine
• March 5, 2009 @ Holiday Inn, West in Portland, Maine

If you are looking for alternatives educational programs to register for, please refer to our Education Quarterly Publication for January to March, 2009. If you have any questions, don't hesitate to contact Maine Health Care Association.

Activity Coordinator Certification Course Offered in March

Karen Michaud, Director of Education ()

The 200-hour Activity Coordinator Certification course approved by the State of Maine is being offered through the Adult Education Department in Augusta this March. The content of this course is designed to prepare individuals to plan, develop, organize, and direct therapeutic and leisure activity programs in long-term care and other health care settings, which are intended to meet the psychosocial, spiritual, physical and intellectual needs of residents.

This session is being offered at Cony High School every Monday and Wednesday from 4-9:00 PM for 10 weeks beginning on March 2, 2009. The instructor is Meredith Eldridge. For more information, use this link to access the catalog:

Education Feature of the Week: Ethical Challenges for the Geriatric Social Worker: Mastering a Sound Decision Making Process

Karen Michaud, Director of Education ()

Please forward this information on to your Social Workers. This workshop is intended for Licensed Social Workers and Conditionally Licensed Social Workers in Maine who provide services to individuals living in a Long Term Care setting. It was developed in response to a mandated requirement for licensed social workers in Maine to complete 4-6 CEU's in Social Work Ethics. Social Workers working in other settings would also benefit from this workshop.

Date/Location:February 10, 2009 – Hilton Garden Inn (Freeport)

June 19, 2009 – Senator Inn & Spa (Augusta)

Time:8:00 AM Registration

8:30 AM – 4:00 PM Educational Program

Program Description: Social workers serving residents living in a long term care facility face multifaceted ethical challenges and decisions on a daily basis. Complex issues such as resident rights, family dynamics, care at the end of life, intimacy between consulting residents, caregiver stress, resident abuse, neglect and exploitation, and similar circumstances present ethical challenges that demand careful consideration and a sound decision making process. Through the use of case studies, video clips, lecture, discussion and group work, participants will learn to utilize the NASW Code of Ethics and other resources to develop an ethical framework for addressing dilemmas in long term care. Case studies and instructional videos will cover topics such as living in a long term care facility from the resident's perspective, ethics of nursing home placement, safety vs. autonomy, self-determination and paternalism, creating a home in a nursing home, self-neglect, elder abuse, ethical issues at the end of life, decision making capacity, refusal of treatment, and more. Case studies and video clips will offer a framework for identifying, defining, discussing and resolving complex issues that will help to enhance the quality of life for residents in Maine's long term care facilities.

For more detailed information, please refer to MHCA's Education Quarterly publication for January through March, 2008.

There are 3 options to register for this program:

1. Send a completed Registration/Invoice form by mail, along with your payment, to: Maine Health Care Association - 317 State Street, Augusta, ME 04330, or
2. Fax your completed Registration/Invoice form to Maine Health Care Association at 623-4080, or
3. Visit the Professional Development section of our website ( and complete a registration form online

Please Note: registrations submitted online or via fax must include payment information to be accepted.

If you have any questions, please don't hesitate to contact MHCA at 623-1146.

Survey Tips: New Advanced Beneficiary Notice (ABN) Medicare Survey Protocols Issued January 9, 2009

Tammy Rolfe, Director of Quality Improvement and Regulatory Affairs ()

MHCA was notified this week by CMS that there are new Advanced Beneficiary Medicare Survey Protocols effective January 9, 2009. Maine NF/SNF surveyors began using the attached protocols this week. The attached S&C letter reviews a Skilled Nursing Facility (SNF) provider’s obligations to issue Medicare beneficiary liability notices, a Medicare beneficiary’s rights related to standard claim and expedited appeals; and the surveyor’s responsibility to determine compliance with Medicare notice and billing requirements for determinations of non-coverage. The SNF provider must inform the beneficiary of potential liability for payment for non-covered services when limitation of liability applies. The SNF must provide a written notice to the Medicare beneficiary explaining his/her right to file an expedited appeal upon termination of all Medicare covered services. Appendix P of the SOM, Survey Protocol for Long Term Care Facilities, Part VII has been deleted. The information in this memo will be moved to Sub-Task 5C and a new section on Liability Notices and Beneficiary Appeal Rights was be created. This memo does not apply to beneficiaries with Medicare Advantage. Facilities will want to ensure Medicare team members, social workers and business office staff have the correct ABN forms and a copy of the S&C letters. Below are linkstothe ABN formsmentionedmentioned in the S&C letter.

Rescheduled Advancing Excellence Campaign Satisfaction Webinar Dates Announced

Tammy Rolfe, Director of Quality Improvement and Regulatory Affairs ()

The Advancing Excellence Campaign has rescheduled the Satisfaction Webinar. The webinar will now be held in two parts - on February 3, 2009 at 3:00 pm ET and on February 26, 2009 at 3:00 pm ET. You are invited to register and participate in both.

The Topic:

Measuring Satisfaction and Integrating the Results in Your Quality Improvement Program. Learn the value of finding out what your residents and staff think and how to use that information to make their lives even better!

Faculty:

Mary Tellis-Nayak, Consumers and Nursing Home Staff

When:

Part 1: February 3rd, 2008, 3:00 - 4:15 p.m. (Call-in begins at 2:45 p.m. E.T.)

Part 2: February 26, 3:00 - 4:15 p.m. (Call-in begins at 2:45 p.m. E.T.)

Target Audience:

Directors of Nursing, Certified Nursing Assistants, Administrators, Family and Resident Councils

Where:

Bring a cup of coffee or soda to your nursing home's conference room. You can use a telephone line and follow along with handouts, or you can follow along on your computer.

Registration for Free at:

To register for Part 1 of the conference:

To register for part 2 of the conference:

The content for these teleconferences is different and we suggest that you listen to both. After you register, you will receive three separate numbers that you will need to access the call. These include the call-in number, the direct event pass code for the conference and your registration ID. Please keep these in a safe place until the day of the teleconference!

Handouts:

The Power Point presentation will be posted on by January 26, 2008 for Part 1 and February 20th for Part 2. You will be able to download the presentation and follow along with the speakers.. There will also be other information to download and read on Resident Satisfaction that you may find helpful.

Instructions On the Day of the Teleconference

Starting at 2:45 p.m. E.T., call the number given to you when you registered and enter the direct event pass code and your registration ID. You will be connected to the conference. To view the Power Point Presentation online, go to then click on "join conference," and sign-in as a participant with the Conference ID (2025089407 NO Dashes!), and enter your name.

CEUs are not provided for this webinar. Please contact Tammy Rolfe at or 623-1146 at the Maine LANE for assistance or additional information.

New CMS Surety Bond Requirement for DME

Tammy Rolfe, Director of Quality Improvement and Regulatory Affairs ()

On Monday, January 5, 2009 AHCA notified state affiliates that CMS finalized a rule that will require durable medical equipment, prosthetics, and orthotics providers to post $50,000 surety bonds as a condition of participating as a provider in the Medicare program. CMS declined to exempt nursing facilities as requested by AHCA, citing that there was no Congressional intent in the authorizing statute to exempt nursing facilities. CMS stated that the requirement is meant to provide some protection to the Medicare program from fraudulent payments. The final rule was published in the Jan. 2 Federal Register (74 Fed. Reg. 166).

New DMEPOS suppliers in the Medicare program will be required beginning May 4, 2009, to comply with the new rule. Existing suppliers will have until Oct. 2, 2009, to post the bond. CMS said the delayed implementation time frame for existing providers would allow suppliers to deal with financial concerns that could make obtaining a surety bond at an affordable rate difficult. CMS had considered raising the $50,000 bond requirement to as much as $65,000, but the final rule kept the requirement at the lower level. However, CMS said in the rule that some suppliers that “pose a significantly higher risk to the Medicare program” would be required to post higher bond amounts. The surety bond requirement was required by Congress in the Balanced Budget Act of 1997, and CMS first issued a proposed rule on the matter in January 1998 (63 Fed. Reg. 2926). A second proposed rule was issued in August 2007 (72 Fed. Reg. 42001) because too much time had passed since the 1998 proposal to issue a final rule.

AHCA commented on the August 2007 proposed rule, and asked that CMS waive the requirement for nursing facilities who are their own DMEPOS suppliers and who provide DMEPOS solely to their own residents. They argued that the impact of this requirement, when added to the demands of competitive bidding and the increasing cost of the many layered regulatory long term care environment, would be a wholly unnecessary burden to nursing facilities that obtain a supplier number and provide and bill for DMEPOS servicesdirectly. They requested the waiver for facilities that provide and bill for covered DMEPOS, in particular parenteral and enteral nutrition (PEN) therapy, to their own residents for three critical reasons:

First and foremost, nursing facilities have the authority to select the supplier of services for patients within the facility -- and have the ability to be their own supplier if that will optimize the potential for quality care.

Secondly, the problems that the proposed rule seeks to address appear historically to be those, as explained by CMS itself the preamble to the original proposed rule of January 20, 1998, associated with certain small independent businesses that are essentially or exclusively suppliers of DME and not with nursing facilities that have acquired a supplier number – and now an National Provider Identifier (NPI) -- and provide DMEPOS to their own residents.