Figuring Out the Budget Pages is No Easy Task
By Patti Cullen
New Payment System Proposal for Nursing Facilities Under Development

Members have begun to ask questions about the proposal in the Governor’s budget relating to the 2% nursing facility increases tied to the new payment system.  The proposal in the budget does not give a very good indication about how increases would be given:

“Proposal. Effective October 1, 2005, all medical assistance Nursing Facilities (NF) would receive a two percent increase over their rates in effect on June 30, 2005.  This rate increase will be flexible funding to better enable the nursing facilities to transition to the new reimbursement system.  This proposal would phase in the new NF payment system over four years, beginning 10-1-06.  To transition to the new reimbursement system, effective 7-1-05, the automatic medical assistance rate adjustments for operating and property costs for NFs under contract through the alternative payment system (APS) will be incorporated into the new reimbursement system.  For the first two biennia, (FY 2006-07 and FY 2008-09) most of these funds will be redirected for NFs to transition to the new reimbursement system and to increase staffing levels.”

So, the Association staff has asked a series of questions to try to figure out the intent behind the budget page, especially since the legislation needed to implement the budget page is “in process”.  This is what is known to date:

1. The new nursing facility payment system is set for a four year phase-in, beginning with 10 percent of their rates under the new system starting October 1, 2006.  Year two would have 40 percent of the rate under the new system; year three 70 percent under the new system; and year four 100 percent under the new system.

2. With the proposal to start the new system on October 1, 2006, it means the reporting year-end for the first year would be September 30, 2005.  (We noted at a recent Department of Human Services meeting that facilities are already halfway into this reporting year without any knowledge of how they should be spending under the new system.  It is likely that their original proposal will now include either a complete hold harmless or shadow rates the first year as a result.)

3. The original proposal for the budget page was an assumption that there would be a partial hold harmless initially—no facility would have rates reduced more than $3.00 per day below reported costs on their blended rate.  This concept is being re-thought.

4. The fiscal note shows a “re-direction” of about $16 million from the forecasted increase for APS facilities for the next two biennium budget cycles.  (The forecasted increase for fiscal year 2007 was 1.79%.)  For a portion of the first year of the next biennium, effective October 1, 2005, nursing facilities would receive a 2% increase (flexible funding).  The effective date was moved from the “usual” July 1 implementation date to October 1 to “better fit” the money allotted and to ensure that DHS staff would be able to get the new rates calculated in a timely fashion.

5. Even though Association representatives are in the midst of negotiations with DHS on the structure of the new payment system, the Governor’s budget proposal will speed up the activity, since the budget page means a faster timeline and more detailed legislation passing this session.  The Long-Term Care Imperative’s position is to continue to work with stakeholders on new system development; however, significant new funds will be needed to fully implement a system that would be “acceptable” to the majority of our members.  We have not determined yet how much new investment would be needed to give facilities a “fighting chance” to survive and even thrive under a system with target rates and quality incentives.

6. Several assumptions were build into the forecast for the new payment system—several nursing facilities will close; and there would be a balance between facilities receiving increases due to higher quality scores and facilities receiving decreases due to costs over the target rate and lower quality scores. 

7. The budget working papers envision rate adjustments effective 10/1/07 tied to increases in staffing levels.  Facilities would apply for new funds every year to cover their annual progress toward meeting the new staffing standards.  The vision is that the staffing standard would increase by increments on a quarterly basis, with funding increases annually every October and a mechanism to “enforce” how the new funds were used.

As you can see, there are many, many unanswered questions—from where the targets are set to how specialized facilities will be defined and paid to forecasting questions.  The good news is that we have a long session ahead of us and opportunities to help fashion a proposal that meets the global goals of efficiency and quality.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Governor’s Commission on Sex Offender Policy Report Released
By Patti Cullen
Several of the recommendations would affect long-term care

The announcement of the Governor's policy agenda for the 2005 legislative session coincided with the receipt of the Final Report of the Governor's Commission on Sex Offender Policy.  (See related article on Governor’s Sex Offender Plan.)  In September of last year, Governor Pawlenty named the 12-member panel to closely examine the state's practices in sentencing, treatment, tracking and supervising sex offenders.  (Link to the Final Report of Governor's Commission on Sex Offender Policy).  During the past five months, the Commission convened 14 hearings, held 3 off-site seminars and heard from 50 expert witnesses, including staff from the Association.  Their report includes 30 recommendations in six distinct topic areas.  Here are the recommendations that would have the most impact on long term care providers:

• Establishing a layered, three-pronged approach to ensuring the timely disclosure of sex offender registry information.  So as to ensure that health care facilities have all information that is relevant to admission, transfer and abuse prevention decisions, at an early point in the admission process, modify Minnesota law so as to:
  
  
  • Codify the current Department of Corrections’ policy – which requires a supervising agent to notify a health care facility if he or she knows that a supervised offender is receiving in-patient care – into statute; thereby making this best practice binding upon all state and local corrections agents. 
  • Require local law enforcement agencies to disclose a registrant’s status to the administration of a health care facility, if law enforcement officials are aware that a Level I, Level II or Level III offender is receiving in-patient care.  In the Commission’s view, there are no circumstances where this information would not be relevant and useful to abuse prevention plans, and therefore should be disclosed by law enforcement if they are in a position to do so. 
  • Add to the existing requirements of the Predatory Offender Registry statute a requirement obliging registered offenders to disclose to the administration of any health care facility, upon admittance, his or her status as a registering predatory offender – and punishing the failure to disclose with a felony penalty.
    
    
• Modifying Minnesota law so as to prohibit the holding of Level III community notification meetings in a health care facility.  Anticipating the future case where a Level III offender is receiving long-term care at a particular site, the Commission believes that it is not appropriate to conduct such a meeting at the facility.  Community members and others should be notified at a nearby site in the community.
  
• Adding to the existing requirements of the Predatory Offender Registry statute, an additional requirement obliging these offenders to disclose to the administration of any health care facility, upon admittance, his or her status as a registered predatory offender.
  
• Modifying Minnesota law so as to make clear that any registered predatory offender who does not disclose his or her status upon admission to a health care facility, and is subject to transfer or discharge when this fact is later discovered, may not rely upon the anti-discharge protections of state law to remain in the facility.  One possible reading of Minnesota Statutes § 144A.135 is that it permits predatory offenders to receive a 30-day notice and to remain in health care settings, pending an appeal of their transfer or discharge, even when the health care facility could not adequately account for added security risk of such patients.  Facilities should not be obliged to take a “wait and hope for the best” strategy when it comes to non-disclosing predatory offenders.
  
• Modifying Minnesota law so as to make clear that details of a patient’s criminal history that are public information are not given a different and higher classification as confidential medical data when included in the patient’s health care records.  The classification and permitted uses of criminal history data should be uniform across settings and agencies – and should not particularly disadvantage health care providers.
  
• Developing partnerships to provide medical care in a secure setting to those with a criminal history of sex offenses.  State government has an interest in developing the infrastructure of willing providers that can deliver health care – at varying levels of security – to those with a criminal history.
  
• Supporting the development of secure health care settings by having the state assist in the site selection process.  In order to overcome local controversies as to the placement of such facilities, state participation in the site development process may be necessary.

For the next few weeks, legislative committees will be hearing presentations on the Commission recommendations from Eric Lipman, State Sex Offender Policy Coordinator, and other interested stakeholder groups.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Governor Pawlenty Outlines Reform Plan for Sex Offenders
Aspects of the plan will affect health care providers, if enacted.

Governor Tim Pawlenty on January 31, 2005, announced a series of comprehensive reforms designed to increase public safety and lock-up sex offenders for longer periods of time.  The plan includes more than $100 million in funding for enhanced sentences, supervision and treatment of sex offenders and additional money for 850 more prison beds.

At a press conference announcing the release of both the final report from the Governor’s Commission on Sex Offender Policy and the administration’s sex offender plan, Governor Pawlenty stated:  "Sex offenders are the worst of the worst.  My preference is to allow the voters of Minnesota a chance to re-establish the death penalty to deal with sex offenders who kill their victims.  The legislature has prevented that, but we are taking steps to deal with sex offenders with strong measures that include longer prison terms and intensive supervision.  My plan will lock-up sex offenders for significantly longer than current law and will provide for indefinite incarceration for the most violent.  It will also greatly strengthen tracking, monitoring and supervision of sex offenders who complete their sentences."

The Governor's proposal incorporates elements of work done by the Governor's Commission on Sex Offender Policy, the Minnesota Sentencing Guidelines Commission, and the Legislative Auditor.  (See related article on the specific recommendations from the Governor’s Commission, many of which are highlighted below.)

Governor Pawlenty's reform package touches upon six important areas of sex offender management: (1) Sentencing; (2) Assessment and Treatment; (3) Civil Commitment; (4) Community Supervision; (5) Abuse Prevention; and, (6) Implementing Best Practices.

Highlights of Pawlenty's proposal include:

• Blending recent sentencing proposals (from the Minnesota Sentencing Guidelines Commission and the Governor's Commission on Sex Offender Policy) into a single plan that locks up the most dangerous sex offenders indefinitely.
• Life without release for heinous sex crimes.
• Indeterminate life sentences for forcible rape and repeat sex offenders.
• Enhanced sentencing guidelines that increase the presumptive prison terms for all categories of sex offenses.
• Adding new resources and expertise to civilly commit sex offenders who remain dangerous.
• Mandating that local law enforcement or corrections agents inform health care facilities and their residents if a registered offender or offender on supervision is receiving in-patient care.
• Establishing felony penalties for registered sex offenders who do not disclose their status as a registered sex offender when receiving in-patient health care.
• Developing new computerized criminal data capabilities to be able, in real time, to verify the sex offender registration status of new admissions to health care facilities.  (Note that both staff from the Governor’s office and Department of Health Commissioner Mandernach have contacted the Association to request that we work with them on the development of this database, should the legislature adopt this aspect of the Governor’s proposal.)
• Strengthening background check standards for persons licensed to work with vulnerable adults and children.
• Enhancing our abilities to track and monitor sex offenders no longer in prison.
• Establishing a Sex Offender Policy Board to ensure Minnesota's development of statewide sex offender supervision and treatment standards and implementation of the best sex offender management practices.

In spite of the projected budget shortfall for the next biennium, the sex offender proposal from the Governor recommends increased spending of nearly $100 million in general revenue funds for this current biennium ($17 million) and for the 2006-2007 biennium ($78 million).  In addition, there is are bonding recommendations to expand programs at Faribault Correctional facility, Stillwater, St. Peter, and construction of a Forensic Nursing Facility totaling $122 million.  Here are a few of the budget initiatives tied to the administration’s plan to deal with sex offenders: 

• Eighteen new Intensive Supervised Release Agents, and additional Bureau of Criminal Apprehension agents, to closely monitor sex offenders who are in the community.
• Adding hearing officers to swiftly punish, and hold accountable, offenders who violate conditions of their supervised release.
• New technology to better track offenders using Global Positioning Satellite technology.
• More than $5.5 million for enhanced sex offender treatment programs for offenders in prison or being supervised in the community
• Providing grants to counties for pre-sentence assessments of sex offenders.
• Development of housing options for sex offenders to allow for maximum surveillance and supervision.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Legislative Leaders Respond to Questions on the Budget
By Patti Cullen
Agreement on taxes and spending seems quite far away!

Leaders from the House and Senate caucuses met on January 27, 2005 for a business-sponsored event.  Moderator and former Finance Commissioner, Pam Wheelock, asked the panel a series of questions regarding Governor Pawlenty’s budget proposals and the overall direction of the Legislature this year.  House Speaker Steve Sviggum (R-Kenyon), told the audience the current legislature would “all be better off” if “cooperation and balance” were used as guidelines for action.  House Minority Leader Matt Entenza (DFL-St. Paul), responded the “my way or the highway” approach to passing legislation needed to change.  He encouraged passage of a bonding bill in the House by early February; the Senate passed their bonding bill earlier this week.  (Since the bonding bill is historically known as the “bring home the pork” bill, desired by many legislators looking to develop campaign materials, it is likely that the Governor and House have different political motivations tied to negotiating the more difficult biennial budget that may delay their action on a bonding bill.)

Regarding transportation, Senate Minority Leader Dick Day (R-Owatonna), voiced his support for a gas tax increase, describing it as a “user tax” that should have been raised before now.  When asked his position on light rail, Senator Day responded that “light rail should have gone from Woodbury to Wayzata to take some cars off the highway;” he then intimated that new funding ideas would be released soon.  Senate Tax Committee Chair Larry Pogemiller (DFL-Minneapolis), sitting in for Senate Majority Leader Dean Johnson (DFL-Willmar),  added that he hopes the House will be flexible with funding for Central Corridor, a proposed light rail traveling down University Avenue between the Twin Cities; the project received over $5 million in the Senate bonding bill this year, but was not included in Governor Pawlenty’s proposal.  Senator Pogemiller added he too agreed with a gas tax increase but believed strongly the Governor would not sign such an increase.  He described the proposal by Governor Pawlenty and the Minnesota Chamber to place a voter referendum on the 2006 ballot to approve a gas tax increase as “silly.”

When asked for their opinions on a new casino in Minnesota to help balance the budget, the panelists took more noticeable party lines, with Representative Entenza and Senator Pogemiller describing the casino debate as “a diversion from issues of the state” and that “gaming is not the magic bullet to solve problems.”  Both Senator Day and Speaker Sviggum spoke in favor of a new casino, with Senator Day stating that gaming revenues should “not balance the budget.”  Speaker Sviggum added any gaming revenues “should be dedicated to education” and not specific projects.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Minimum Wage Bill Again Moving through Senate
By Jonathan Lips
The perennial workers rights issue has surfaced again at the Capitol.

Last week, the Senate Jobs, Energy, and Community Development Committee passed Senate File 3, a bill to raise the state’s minimum wage from it’s federally mandated level of $5.15 to $7.00 by July 2006.

Committee Chair and bill author Senator Ellen Anderson (DFL-St. Paul), has carried the bill in the past, telling other Senators on Wednesday that Minnesota is now behind 15 other states in an effort to raise its minimum wage.

In response, Senator Michele Bachmann (R-Stillwater), suggested eliminating the minimum wage all-together as a way to employ more people in Minnesota.  “If we allow businesses to be prosperous and build capital,” she said, “they will give their employees more than we can imagine.”  Her colleague, Senator Carrie Ruud (R-Breezy Point), offered an amendment recognizing tips earned by restaurant and other service employees as wages.  The amendment failed, and the bill passed on a party-line vote.  It was moved straight to the Senate floor.

A House companion was introduced January 6 (Rukavina, DFL-Virginia), and it is awaiting a hearing in the House Commerce Committee.

Jonathan Lips
952.851.2480
jlips@careproviders.org

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Commerce Department Releases Report on LTC Insurance
By Patti Cullen
Prices Stabilizing; No Significant Increases in Enrollment Expected

The Department of Commerce, on January 31, 2005, released its report on long-term care insurance.  After sharp increases of 10 to 40 percent for long-term care insurance policies, prices seem to be stabilizing, Department of Commerce Commissioner Glenn Wilson said.  "We think the industry has adjusted to the major factors -- far fewer lapsed policies than in the past and lower interest rates -- that were hurting the insurance industry," he said.

Over the past two years, rates rose for about half of the 113,000 Minnesotans who own long-term care insurance policies, "after almost no increases in the previous 15 or 20 years," he said.  The policies cover costs of nursing home, home health and other long-term care.  His department approved rate increases for 14 of 50 firms that sell policies in Minnesota, and several other requests are pending.

Commissioner Wilson said the rate increases were justified because company profits plunged with a sharp drop in interest rates, and because the rate at which policyholders let their policies lapse dropped from about 15 percent a year in the past, to 1 to 3 percent now.  (Policies that lapse mean the company won't have to ever pay benefits on those policies.) 

According to the report:  We believe that rate increases will be less frequent in the future (unless there are unanticipated changes in utilization), because long term interest rates are unlikely to decrease significantly from current historically low levels.  Also, lapse rates can’t go below zero, so they can’t decrease very significantly from current levels.  At this point, there is no indication that per-person utilization of long-term care services will increase or decrease significantly in the near future.  Sales of new policies appear to have hit a plateau in Minnesota.

According to the detailed state reports, enrollment climbed from about 69,000 people at the end of 1999 to 112,000 at the end of 2002, but only gained another 1,000 in 2003.  Recently, rates appear to have increased faster than wages, making the policies less attractive.  The market may have reached an equilibrium point, where sales do not outpace lapses significantly, and the percent of the senior population with coverage remains stable.

The report on long-term care insurance increases, and a revised 23-page pamphlet on long-term care insurance are available on the Department’s website.

Long Term Care Insurance      January 31, 2005
"What you need to Know" about long term care insurance to make an informed choice about purchasing.  This is a printable (PDF) version of the long term care topics.  Click here.

Report: LTC in Minnesota      January 31, 2005
This report on long term care insurance was prepared in 2005 at the request of Commissioner Glenn Wilson by Commerce Department staff.  It contains historical and legislative information.  Click here.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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DHS Offers Overview of Governor’s Budget
By Jonathan Lips
Commissioners take the hot seat in legislative committees

This week the halls of the Capitol are filled with state agency staff, called to testify about aspects of the Governor’s budget.  At this stage in the game, legislators are working to understand what the Governor has proposed, and it is customary for commissioners and other staff from the various departments to appear before finance committees to explain, sometimes page by page, what the administration is requesting.

As reported in a separate article, Commissioner of Human Services, Kevin Goodno, took his turn this week before the Senate Health and Human Services Budget Division.  Among those who joined Goodno was Loren Colman, Assistant Commissioner for Continuing Care.  Here are a few highlights from that portion of the hearing.

• Commissioner Colman described the proposal to increase rates for nursing facilities by 2%, with the dollars provided on a flexible basis to support a transition to the new payment system currently under development.  Senator Julie Rosen (R-Fairmont) asked how the Department intends to measure quality, and Colman explained that a stakeholder group is meeting to develop the criteria.
  
• Committee Chair Linda Berglin (DFL-Mpls) asked rhetorically about the “missing page” in the Governor’s budget – the one that would have provided a cost of living increase for disabled care and eldercare staff in the waiver service areas.  She reminded the committee of the 1% cut to these programs in the last budget and called the lack of new funding a “disturbing omission.”  Discussion followed among Colman and members of the committee about how to balance the needs of facilities and community-based providers.
  
• Senator Paul Koering (R-Fort Ripley), a republican who is known for openly questioning certain aspects of the Governor’s proposals, asserted that nursing facilities in his district are having difficulty retaining their staff and that they need to be able to pay better wages.

The next step in the overall budgeting process is for the legislature to begin developing its own proposals.  As soon as the February budget forecast is released, we will see the majority and minority caucuses in both the House and Senate coming forward with the outlines of their budgetary solutions.  Depending on how the forecast looks, the Governor may also tweak certain aspects of his proposal.

Jonathan Lips
952.851.2480
jlips@careproviders.org

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House and Senate Committees Busy With Budget Reviews
By Patti Cullen
Legislators Quick to Criticize Governor’s Choices

Finance and budget committees in the House and Senate have been spending their committee meeting time this week getting agency overviews of the Governor’s budget proposals.  Although the budget proposal for the next biennium is a 5.8% increase in spending over this biennium, there are plenty of critics, especially with the large program reductions in certain health and human services programs.  Of particular concern, expressed in several hearings, are the “downsizing” of the rate of growth of some “welfare health care” groups such as the working adults without children being removed from the MinnesotaCare program.

Department of Human Services Commissioner Kevin Goodno was on the “hot seat” in front of the Senate Health and Human Services Budget Division on January 31, 2005.  Division Chair Senator Linda Berglin (DFL-Mpls) asked many pointed questions about the health care access fund and inflationary assumptions used.  The most critical exchange occurred over the Department of Human Services’ request for 71 new staff positions (FTEs) at a time when there were major reductions and caps on programs for vulnerable populations.  Commissioner Goodno justified the request for new FTEs—most being requested for compliance reasons such as addressing backloads in client appeals, licensing reviews and program integrity. 

Over the next few weeks, before the release of the updated budget forecast, the “money” committees will be learning more about the administration proposals and waiting to see the proposed legislation that would implement these proposals.  Decisions on which of the administration proposals will be ultimately adopted are months away, as counter proposals are developed by the House and Senate.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Audit of Survey Process Will Be Unveiled February 10
By Jonathan Lips
Office of Legislative Auditor will explain its findings to a Senate health policy committee.

We have learned that the Office of the Legislative Auditor (OLA) will release its long awaited report on nursing facility surveys on Thursday, February 10.

Over several months, the OLA has examined whether state surveys are conducted consistently throughout the state and assessed the amount of flexibility the department has in conducting nursing home inspections.

OLA staff will present their findings to the Legislature during a noon meeting of the Senate Health and Family Security Committee.  Members who are looking for a good reason to visit the Captiol should give this one some serious thought.  Call Jon Lips or Patti Cullen if you plan to attend, and they can help you make arrangements.

Many legislators have expressed eagerness to see the report, and, whatever its findings are, the release of the document will mark the beginning of a renewed conversation with the Health Department and Legislature about the survey and certification process in our state.

The report will be available on-line, and if it is posted in time, we will provide a link to it through our February 10 newsletter.  Given our publication deadline for next week, our analysis of the report will likely follow separately.

Jonathan Lips
952.851.2480
jlips@careproviders.org

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Confirmed Flu Cases Double in January
By Pam Guyer
It’s Still Not Too Late to Get a Flu Shot!

Reports of influenza in the state have increased markedly recently, and have come from all regions of the state.  The flu season in Minnesota often peaks in March or even April.  About 20,000 doses of flu vaccine remain in the state.  

Influenza activity in the state has increased recently, from 65 culture-confirmed cases as of January 7 to 135 cases as of January 28.  The MDH Public Health Lab has reported on 135 culture-confirmed cases of influenza. 

• One isolate (1%) was identified as Influenza A-type pending
• 45 isolates (34%) were identified as B-Sichuan-like, which is well matched to the B-Shanghai strain that is covered in the current influenza vaccine
• 89 isolates (65%) have been identified as A-Wyoming-like (H3), which is well matched to the influenza A/Fujian (H3N2)-like component in the vaccine

For the week ending January 28, MDH received 16 reports of confirmed outbreaks and 2 reports of unconfirmed outbreaks in long-term care facilities.  A nursing home has an outbreak when it has 3 or more influenza-like illnesses in a single unit during a period of 48 to 72 hours or has one resident with a positive rapid test for flu. 

Earlier restrictions on who can get a flu shot have been lifted, so if you have residents or staff that still have not received a flu shot, it’s not too late!

The symptoms of influenza, which tend to come on suddenly, can include a sore throat, coughing, fever, headache, muscle aches and fatigue.  People who become severely ill with influenza-like symptoms should see a physician.

During flu season, it is important for everyone, shots or no, to do their part to avoid spreading influenza by following these guidelines:

• Do your best to stay healthy. Get plenty of rest, moderate exercise, and eat right.
• Stay home from school or work if you have a respiratory infection.  Avoid exposing yourself to others who are sick with flu-like illness.
• Cover your nose and mouth with a tissue whenever you cough or sneeze, then throw the tissue away.  If you don’t have a tissue, cough or sneeze into your sleeve.
• Wash your hands often with soap and water, or with an alcohol based, waterless hand sanitizer.
• Clean surfaces you touch frequently, such as doorknobs, water faucets, refrigerator handles and telephones.

Pam Guyer
952.851.2485
pguyer@careproviders.org

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ALJ to Hear Debate Over Communicable Disease Rules
By Jonathan Lips
As sometimes happens in administrative law, Health Department will be required to justify rule changes to an administrative law judge

The Department of Health (MDH) has scheduled an administrative hearing on the proposed amendments to the communicable disease reporting rules.

In keeping with our state administrative law, the Department published the proposed rules last month and reported that there would not be a public hearing to discuss them unless 25 or more individuals requested one.  According to a source within the department, a sufficient number of requests came in thanks to a letter writing campaign by the Citizens Council on Health Care, a lobbying organization that focuses its work on data privacy issues.  The CCHC is concerned generally about government’s surveillance powers.

The result is that a hearing will be held before an administrative law judge (ALJ) on Monday, February 14, beginning at 9:00 am in the Chesley Room at the Minnesota Department of Health (717 Delaware Street SE) and the public is welcome to attend.  After the hearing, there is a comment period (most likely 5 or 10 days) where MDH can respond in writing to what was presented.  After the comment period, the judge has 30 days to review everything and give her recommendation.

Click here for more information, including a link to the text of the proposed rule, along with a summary of the changes and an explanation of the history and rationale behind the changes.

Jonathan Lips
952.851.2480
jlips@careproviders.org

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DHS Requests Partnership Proposals for Rebalancing Long Term Care
By Jonathan Lips
Full RFP available through DHS website

For members’ information, the Minnesota Department of Human Services (DHS) posted the following notice in the January 31 state register.  The Department has been, and will continue to be, in contact with Association staff about this work, and may seek to involve long term care providers in the planning process in some way.

The Minnesota Department of Human Services is soliciting proposals for state fiscal year 2006 (July 1, 2005, to June 30, 2006) from qualified applicants to increase the capacity of local long-term care resources to support older people in the community.

As directed by Minnesota Statutes 256B.0917, the goal of this initiative is to fund qualified Partnerships to implement the state’s long-term policy directions: (1) maximize people’s ability to meet their own long term care needs, (2) expand the capacity of community long-term care resources, (3) reduce reliance on the institutional model of long-term care, (4) align systems to support high quality and good outcomes, (5) support the informal network of families, friends and neighbors, and (6) ensure a stable, long-term care workforce.

Through this RFP, the State invites proposals to fund up to six collaborative ElderCare Development Partnerships comprised of counties, area agencies on aging and other organizations to expand the capacity of home and community-based services in the service area, bring about new economies through collaboration, coordination and service redesign, catalyze new service models that are better suited to today’s needs and resources, and to leverage new funding sources—including private pay.

The Partnerships will provide technical assistance (TA) to local providers to develop and implement service delivery models in line with the state’s long-term care policy directions.  Priority TA activities for the Partnerships include working with both public and private LTC service providers to collaboratively develop sustainable proposals for systems change.

Partnerships are encouraged to propose strategies shared by multiple counties or market areas in the project area.  An applicant conference for this initiative will be held on Monday, February 28, 2005 (1:30 pm to 3:00 pm) in Room 1-A, Department of Human Services Building, 444 Lafayette Road, St. Paul.  Pre-registration for this conference is requested: call 1-800-882-6262 by February 24, 2005, if you expect to attend.

The full text of the RFP, which includes requirements and all application forms, is available on the Internet by clicking here.  

It is also available by contacting: Hal Freshley, MN Department of Human Services, 444 Lafayette Road, St. Paul, MN 55155-3843  Phone: (800) 882-6262 / TTY: (800) 627-4529.  E-mail: hal.b.freshley@state.mn.us.

Jonathan Lips
952.851.2480
jlips@careproviders.org

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Senate Approves Nomination of Leavitt as HHS Secretary
By Patti Cullen
Confirmation confirmed in spite of concerns over Medicaid

By voice vote, the Senate on January 26, 2005, approved the nomination of Michael O. Leavitt as Secretary of the Department of Health and Human Services. Leavitt, previously administrator of the Environmental Protection Agency and former governor of Utah, replaces Tommy Thompson, who announced his resignation Dec. 3, 2004.  Leavitt's confirmation follows his unanimous approval on January 25 by the Senate Finance Committee.  As reported in earlier issues of Action, the Senate Finance Committee questioned Leavitt extensively at his confirmation hearings, about the status of the Medicaid program and concerns he would duplicate actions taken in Utah under his reign as governor.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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AHCA Electronic Town Hall Meeting Discusses Medicare Drug Benefit Program
By Jonathan Lips
The role of administrators highlighted

The American Health Care Association conducted a National Electronic Town Hall Meeting last week to allow members to hear from CMS about the new Medicare drug benefit program and what the role of nursing home administrators will be.  It was the most successful call-in effort that AHCA has ever conducted.  Folks joined in from more than 1,000 locations, and CMS estimated that more than 2,000 listened in to a review of the new rules governing the structure of the new Part D prescription drug program. 

CMS experts, Leslie Norwalk and Laurence Kocot joined AHCA Finance Policy Council Elise Smith and Legislative Counsel Nancy Taylor in outlining provisions of the new rules and answering questions.  The audio recording of the entire call is archived on the opening page of the AHCA website and available to members either as a streaming version or by downloading the content into either WMA or MP3 formats.  Association President Hal Daub moderated the call.

A written transcript should be available at the same location very soon.  Many questions still remain about these new procedures, and CMS still needs to issue more guidance, but the call was especially helpful in getting information to those who need it about the rules that were issued recently.  Anyone with specific questions can email them to PartD@ahca.org, and AHCA will ensure that they are forwarded to CMS for response.  This is a special email address that was set up since the call. 

Care Provider of Minnesota staff was able to ask what the top five things were that a nursing home administrator should be thinking about over the next few months.  CMS recommended that administrators: (1) Go to the CMS website and get familiar with the dates of activities; (2) find out which plans would be offering services in their region; (3) talk to your regional LTC pharmacy networks; (4) make a pharmacy selection with whom you want to do business (facilities can still contract with one pharmacy, if the pharmacy meets the CMS criteria and must be part of the network); and (5) Get prepared to help educate your patients so they can choose a plan.

Nursing home administrators will be asked to provide education to their patients so they choose the best plan for the patient, but will be prevented from actually signing them up. 

Care Providers of Minnesota staff is in the process of developing educational programs for members to allow them to understand their role in the transition process.

For members who missed the AHCA call, please note that on Monday, February 7, CMS will be hosting an “Open Door Forum” to clarify and discuss the regulations.  This will not be long term care specific, but may be of general interest to members.  They intend to allow some time for questions or comments.  Here are the details:  Monday, February 7, 12:00 PM to 3:00 PM (Central Standard Time).  To participate by phone, dial: 1-800-837-1935 and reference Conference ID: 3280007.  There is no need to RSVP.

Jonathan Lips
952.851.2480
jlips@careproviders.org

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Noridian Lists Admission Questions to Ask Medicare Beneficiaries
By Patti Cullen
Suggested Questions Determine Primary Payer Before Medicare

Noridian Administrative Services, Medicare Part A fiscal intermediary for Minnesota, frequently sees claims submitted to Medicare where Medicare should be the secondary, rather than primary payer.  They have recently re-issued their admission question chart to address this concern.  This chart lists questions that can be used to ask Medicare beneficiaries upon each inpatient and outpatient admission.  Use of the chart is not mandatory, however providers could use this chart as a guide to help identify other payers that may be primary to Medicare.  If you choose to use this questionnaire, please note that it was developed to be used in sequence.  Instructions are listed after the questions to facilitate transition between questions.  The instructions will direct them to the next appropriate question to determine Medicare Secondary Payer situations.  Click here to access this chart.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Top 10 Reasons for Claims Being Returned to Provider
By Patti Cullen
Claims rejected by Medicare fiscal intermediary

The following lists the top ten reason codes why Minnesota claims were Returned to Provider (RTP) for correction for October through December 2004 by Noridian Administrative Services.  When claims are RTP, the claim is considered unprocessable; when it is received with the correction a new receipt date is applied to the claim.  This changes when the claim will process for payment and the date of when interest would apply.  Please note that Noridian publishes these “Top 10” lists for provider education purposes, in hopes that billing staff would review and note changes that may need to occur with their billing systems. 

Minnesota:

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Skilled Nursing Facility Consolidated Billing Revised
By Patti Cullen
CMS MedLearns Article Can Serve as Reminder

On occasion we get inquiries from members about coverage of certain services by Medicare.  No surprise, with the sometimes confusing consolidated billing regulations, sometimes facilities are not aware of which services they will ultimately be financially liable to cover.  The most frequent question relates to services that are excluded from the skilled nursing facilities prospective payment, but ONLY if the services are rendered at an outpatient hospital.  The prospective payment system (PPS) payment responsibility grid, located on our website, is still accurate, but members need to look closely at where the services must be given in order to be excluded.  In addition, the Centers for Medicaid and Medicare Services (CMS) has just recently issued an informational article intended to remind affected providers that skilled nursing facilities (SNFs) must submit all Medicare claims for the services its residents receive, except for a short list of specifically excluded services.  The specific excluded services (including the codes) are listed in this article, click here.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Improving Mental Health Care in Nursing Homes
By Pam Guyer
Free On-line Education Program

The American Geriatrics Society (AGS) has posted a free on-line educational program entitled, Improving Mental Health Care in Nursing Homes.  The program was developed in coordination with an interdisciplinary panel of experts, including representatives of the American Health Care Association (AHCA), convened by the AGS and the American Association for Geriatric Psychiatry (AAGP).  The program is accessible now on the Internet and will continue through December 31, 2005.

AHCA reviewed, contributed to, and endorsed the Consensus Statement on Improving the Quality of Mental Health Care in America’s Nursing Homes:  Management of Depression and Behavioral Symptoms Associated with Dementia, that is the basis for this program.  The consensus paper identifies approaches that are found to be effective in addressing the needs of nursing home patients with depression and behavioral symptoms associated with dementia.  Other organizations involved in the consensus statement include the Alzheimer’s Association, AAGP, American Association of Homes and Services for the Aging, American College of Health Care Administrators, AGS, AHCA, American Medical Directors Association, American Psychiatric Association, American Psychological Association, American Society on Aging, American Society of Consultant Pharmacists, Gerontological Society of America, National Association of Directors of Nursing Administration in Long-Term Care, National Citizens’ Coalition for Nursing Home Reform, National Conference of Gerontological Nurse Practitioners. 

For details about the course, including content, instructors and access, click here.

Pam Guyer
952.851.2485
pguyer@careproviders.org

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Caresource Specials through March 31
By Jennifer Eyrich
Feeding Assistant Training and Web Design Packages Both Discounted in February & March.

Caresource, a product partner of Care Providers of Minnesota, is offering two specials through the end of March for Association Members.

May I Help You?
Three Part Feeding Assistant Training on DVD or VHS

This is the video package you need for recruiting, orientation and in-service education of feeding assistants.  This is a video companion to AHCA’s book, Assisted Dining – The Role and Skills of Feeding Assistants.

Part 1: Getting Started (20 minutes)
Covers what a feeding assistant does; working with older adults; protecting residents’ rights; spotting and reporting changes; and preventing the spread of infection.

Part 2: Proper Feeding Techniques (18 minutes)
Covers preparing to serve the meal; serving the meal; cueing and other special help; and making mealtime a pleasant, social time.

Part 3: Problem Behavior and Emergencies (14 minutes)
What to do if a resident begins to choke; refuses to eat; falls; becomes agitated or abusive; or if there’s a fire or other emergency.

This video training set regularly costs $249, but is available for the discounted price of $199.  Be sure to mention code A-3 when ordering to receive the discount.  Training is available in VHS (item number FA01) or DVD (item number FA002).  If you order on DVD, you may add a quality, full function DVD player for only $30 more.

To order, click here, or call 800-448-5213.

Caresource is also offering a discount package on their Web Page Design Services through March 31.  Each web package includes: Consultation on your website strategy and goals; custom, professional designed graphics; editing and proofing all web content; photo scanning, enhancement, and compression; search engine registration; your home page, plus your choice of content elements such as About Us, Photo Guide, Calendar of Events, Newsletter, Employment Opportunities, Contact Us, Community Resources, Testimonials, Resident Council News, and Volunteer Opportunities.  With this service, you also have the ability to add 360 degree virtual tours, downloadable brochures & forms, video and audio streaming, and much more.

A Four Page web design/redesign package is $699 regular price, $599 for member, but discounted to $499 through March 31.  An eight page package is regularly $1,099, $899 for members, but just $799 during this promotion.

For more information (or to order), call 800-448-5213 or click here.

Jennifer Eyrich
952.851.2483
jeyrich@careproviders.org

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The Billing Institute Starts Next Week
By Jennifer Eyrich
Offered just once in 2005 - February 9 & 10.

Have you registered for The Billing Institute yet?  This very popular Core Course will be offered just once in 2005, so don’t miss out.  Over 150 Business Office Professionals have already attended this program, some of them with their Administrators in tow.

Why would you want to spend two days learning the intricacies of billing?  Well, what if you are leaving money on the table that you COULD be collecting – how much money would be reason enough to be at this event?  What if your business office could be more efficient – what would THAT do for your bottom line?  And how about the TOOLS you’ll take home – most of them in digital format, so you can use them immediately upon your return to the office?  If those aren’t reasons enough, here’s what we hear from folks who have attended:

“Finally, a course for me, with an instructor who understands what I do!”
“I am not the only one who thinks there HAS to be an easier way to do this!”
“Simplify, Streamline, Systematize – that’s what I must go home and do!”

This is truly a course that gets to the bottom of one of your primary business functions – BILLING.  In these days when money is tight, you need to think of this course as an investment, in your people, in your financial future and in your business.  We are confident that it is one investment on which you will experience an early and welcome return. 

The Billing Institute:
February 9 & 10
8:30 am - 4:30 pm (8:00 am Registration)
Care Providers of Minnesota, Room 114
7851 Metro Parkway
Bloomington, MN  55425

Cost: $225 Members / $275 Non-Member

Click here to register, or contact Jennifer Baker at 952-851-2494.

Jennifer Eyrich
952.851.2483
jeyrich@careproviders.org

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Survey Guidance Development
By Pam Guyer
Catheters and Incontinence Expected Last Half of 2005

The Centers for Medicare and Medicaid Services’ (CMS) November 12, 2004 release of new survey guidance for F tag 314, Pressure Ulcers, and related changes to F309, Quality of Care (See the November 2004 Regulatory Update) marked the beginning of a series of releases expected to span the next couple of years.

Currently, several sets of F tag guidance are being drafted or are at various stages of development process: initial drafting, stakeholder comment period and redrafting.  The process for each guidance set takes at least two years and includes initial week-long meetings of expert panels followed by drafting at CMS and the contractor, American Institutes for Research (AIR); revisions and meetings with the respective panel; release of the draft for key stakeholders’ comments; further revisions, which often necessitate additional panel meetings or conference calls; and release of the final document.  CMS plans to hold training sessions by satellite for each set of guidance, click here.  

The guidance on catheters and incontinence is going through the CMS clearance process that is required before release, and CMS expects to implement the final version in mid to late 2005.  Several sets of guidance have received stakeholders’ comments, and currently are being revised.  The expert panel developing the guidance for medical director and quality assurance regulations met in August to review stakeholder comments and CMS staff are currently editing the draft.  The activities and activity director guidance is undergoing revision after the panel met in January 2005, the third such meeting since CMS released the first draft in 2001.  It is not known at this time if CMS will need to seek additional stakeholder comment on the redraft.  The psychosocial outcomes panel reviewed stakeholder comments in October 2004 and the draft is currently being revised.  The stakeholder comment period for the unnecessary drugs and pharmacy services guidance ended in mid-January 2005.  CMS and AIR are reviewing the comments and preparing for panel meetings in April to review these comments.  Additional expert panels met recently to draft guidance, and CMS currently is preparing them for release to stakeholders for comment.  These sets include accidents and supervision guidance, which will be released for stakeholder comment in late January/early February and the pain and palliative care guidance for which the expert panel met in August 2004 to start the drafting stage.

Pam Guyer
952.851.2485
pguyer@careproviders.org

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Feeding Assistant Litigation May be Dismissed
By Jonathan Lips
Court asks government for a motion to dismiss; denies ACHA request to become a party to the case.

The American Health Care Association (AHCA) has sent us this update on the feeding assistant litigation going on in the federal district court of Washington state.

The court has directed the U.S. Department of Health and Human Services (HHS) to file a motion to dismiss Resident Councils of Washington v. Thompson, the class action lawsuit filed by those opposing the final Nutrition and Hydration Assistant rule.

The court has specifically directed HHS to file a motion to dismiss the case based on subject matter jurisdiction, which means that the judge may believe that the consumer groups and individuals asking to revoke CMS' final Nutrition and Hydration rule do not have the ability to use the federal courts to pursue their claims.  It may also signal that these groups and individuals do not have what the court calls a case or a controversy - a requirement necessary for the case to proceed in federal court.  A case or controversy in this instance means that the complaining parties must show that:  (a) they suffered imminent or actual harm as a result of CMS' final rule; (b) the harm is directly traceable to CMS' final rule; and (c) the revocation of CMS' final rule would eliminate any further harm or injury.

At the same time the judge gave direction to HHS, he also denied AHCA's Motion to Intervene on the basis that CMS could adequately defend the case.  Despite this decision, AHCA's willingness to get involved in the case quickly, by asking to help defend CMS' final Nutrition and Hydration rule alongside the government, gives us the continued opportunity to provide information and feedback to HHS attorneys on this important matter.  Depending on how the litigation continues, AHCA may submit an amicus brief in the future. 

We will keep you posted of all new developments.

Jonathan Lips
952.851.2480
jlips@careproviders.org

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Ramsey Nursing Home Issues RFP for Market Analysis
By Patti Cullen
Pre-proposal conference set for February 14

Ramsey County is issuing a Request for Proposals (RFP) for a market analysis to determine if a list of potential service expansions at the Ramsey Nursing Home would both: 1) address unmet need(s) in the community, and 2) be financially feasible for Ramsey County.  There are 11 new services under consideration.  If interested in applying, the request for proposals and instructions for the preparation of a proposal can be found on the Ramsey County website, the RFP will be available beginning February 7.  If you do not have access to our website, you may call 651-266-8008 to have a copy mailed to you.  Please leave your name and address.

A pre-proposal conference will be held on February 14, 2005, at 10:00 AM at the Ramsey County Courthouse, 15 West Kellogg Blvd., St. Paul, MN, in Room 40B.  The purpose of this conference will be to review the RFP and address any questions you might have about it.  RFP DEADLINE: March 4, 2005.

Send or Deliver Proposals to:
Marsha Kurka
Ramsey County Manager’s Office
15 W. Kellogg Blvd., #250
St. Paul, MN  55102 

To request a copy of the Proposal: 
Phone:  651-266-8008
Fax: 651-266-8039
Email: Carol.Monroe@co.ramsey.mn.us

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Hospice Minnesota’s 2005 Annual Conference
April 14-15 in St. Cloud

Hospice Minnesota’s 2005 Annual Conference on April 14-15 in St. Cloud is an excellent opportunity to:

• learn from experts on a variety of hospice and palliative care topics and
• network with health care providers from across Minnesota.

Conference topics include:

• Hospice and Palliative Care Partnerships
• Improving Pain Management through Quality Improvement
• Homelessness and End-of-Life Perspectives
• Spirituality, Suffering, Depression and Personality Disorders
• Rituals at the End of Life
• An American Indian Perspective on Preparation for Crossing Over

Click here for a copy of the brochure or more information about the conference.

Fran Conklin
Hospice Minnesota...for care of the dying
1600 University Ave. W, Suite 301
St. Paul, MN  55104
(651) 659-0423
www.hospicemn.org

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Minnesota Nursing Homes Focus on Culture Change
Person centered care is about choices and autonomy—just like at home.

Bloomington, MN (January 25, 2005) – Culture change in the nursing home is a movement aimed at promoting transformational change in work practices, care practices, and the nursing home environment.  Culture change centers around making nursing homes into places where people can continue to fully live and grow as they transition into a phase of life where they need a higher level of care. 

In a national initiative supported by the federal Centers for Medicare & Medicaid Services (CMS) and implemented by Stratis Health, the Medicare Quality Improvement Organization (QIO) for Minnesota, five nursing homes have begun a journey to improve their resident’s living experience as part of a pilot project called, Improving Nursing Home Culture – Person Centered Care Pilot Project.

 “The Person-Centered Care Model and culture change allows flexibility in focusing on the desires, interests, and wishes of residents, ultimately changing the culture of today’s nursing homes,” said Patsy Riley, CEO of Stratis Health. “The model encourages facilities to create places where both workers and residents thrive.”

Ambassador Good Samaritan Center of New Hope, Benedictine Health Center of Duluth, Grandview Christian Home of Cambridge, Granite Falls Manor of Granite Falls, and The Lutheran Home of Belle Plaine, will join Stratis Health in working collaboratively over the next year on a series of training sessions and workshops facilitated by Stratis Health. The focus of the learning sessions is to orient the nursing home staff to the Person Centered Care Model and other resources available on culture change. The participating nursing homes will share successes and lessons learned as they implement changes related to culture change in their facilities.

The pilot project will build upon the quality improvement efforts that these five nursing homes have focused on as part of a larger group of 68 homes. The 68 homes have received support from Stratis Health related to the clinical topics of pain assessment and management and pressure ulcer prevention and treatment as part of the Nursing Home Quality Initiative, also supported by CMS.

Stratis Health is a non-profit independent quality improvement organization that collaborates with health care providers and consumers to improve health care.  The organization has worked with providers and consumers to improve care for more than 30 years of its existence.  Stratis Health focuses on collaborative improvement work with hospitals, clinics, health plans, nursing homes, and home health agencies.

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