1.5% Increase to Cover Losses and Increased Costs Is an Insult

Saying that government should stop paying for good intentions and start paying for better performance, Governor Tim Pawlenty on January 22, 2007 unveiled his FY 2008-09 budget proposal that includes key investments in K-12 and higher education, renewable energy, health care reform, tax relief and other areas.  The $34.4 billion balanced budget is 9.3% more than the previous two-year budget cycle and is funded through the growth in state revenue, not tax increases.  In the budget category of greatest interest to us, Health & Human Services, the Governor proposes a 15.6% increase in spending from the current FY 06-07 biennium to the next FY 08-09 biennium.  It is an understatement to say how disappointed we are with the blatant disregard this budget shows for the need for serious investments in long-term care.

The following are “key lowlights” from the budget—as more details emerge we will be providing you with additional information:

HUMAN SERVICES
1.  Medical Assistance payment rates for continuing care providers are proposed to be increased by 2% each year of the biennium, effective 10/1/07 and 7/1/08; HOWEVER a portion of this increase for nursing facilities will be tied to performance measures.  This means all of the waivers and certain grants for people who are elderly and disabled will have a 2% increase applied to their rates; nursing facility rates would increase 1.5% effective 10/1/07 and 1.5% on 10/1/08.  Nursing facility rates would also be increased by an average of 0.5% per year based on a facility’s performance.  The total “value” of this long-term care payment adjustment is $92 million for the biennium; however, nursing facilities would receive only about $20 million of that increase.

2.  Effective 7/1/07, the Governor recommends requiring individual care plans to support the use of Elderly Waiver (EW) funds for assisted living and providing consumers who are considering moving to assisted living settings with information about in-home service options.  This proposal produces a small savings in the Medical Assistance budget as it will tighten EW payment levels and provide “program and fiscal accountability.”  This proposal has multiple components, from a study to examine private pay consumer use of assisted living, to creation of an assisted living website as a part of the MinnesotaHelp.Info site.  The goal appears to divert private pay and EW consumers from assisted living by offering other at-home services.

3.  The Governor recommends expanding the scope of the Nursing Home Report Card assessment to include an additional 11 nursing homes in the state who are currently not covered under current statute.  The four state veterans’ nursing homes and seven private nursing homes that are not Medical Assistance certified would be added to this program.  There is a small funding request to pay for the cost of adding these nursing facilities and to provide additional funding for the current shortfall in maintaining the consumer satisfaction survey for the current nursing facilities.

4.  The Governor recommends establishing the Minnesota Health Insurance Exchange (MnHIE) as a way for Minnesotans to enroll in health insurance coverage through the individual market, Minnesota Comprehensive Health Association, or MinnesotaCare.  The intention is to assist employers unable to offer affordable health insurance to provide a variety of options for coverage.

5.  $45 million is invested in a variety of programs to improve mental health service delivery and infrastructure—a follow-up to the recommendations of the Mental Health Commission of 2005.

HEALTH
1.  Loan forgiveness programs, including the program for nurses who practice in nursing facilities and nurses who commit to teach in their profession, would be increased and consolidated under the Governors’ budget.  The controversial aspect of this request is the use of Health Care Assess Funds rather than General funds for this expansion.

2.  The Governor recommends a Health Care Access Fund appropriation of $18.5 million for the biennium for investments in health information technology to improve patient safety, interconnect clinicians and health care communities, and strengthen public health.

3.  The Compliance Division within the Department of Health has included a funding request of $822,000 for the biennium to:  eliminate the current backlog in background check appeals to increase the available workforce; improve consumer information by making information on home care providers and their contracted services available on the web; and by funding a workgroup to review and make recommendations regarding the state’s future home care regulatory needs and a means to fund them.

4.  The Governor recommends a State Government Special Revenue Fund appropriation of $268,000 for the biennium AND a corresponding increase in the Housing With Services Fee to maintain current services and provide improved consumer information.  The registration fee increase from $35 to $155 will support the registration process and make baseline consumer information available.

General budget information, press releases and graphs, as well as links to specific budget pages, can be viewed online at the Department of Finance website:  http://www.finance.state.mn.us/.  The Department of Human Services (DHS) budget pages can be found in volume two from this link:  http://www.budget.state.mn.us/budget/operating/200809/gov/index.shtml.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Cold Weather Predicted – The Show Goes On

This is just a reminder that I will be heading north next week for the winter round of regional meetings.  These meetings will feature conversations with your local Ombudsmen on their policies and procedures.  We will also have an up-to-the-minute update from the Capitol, where our lobbyists, Patti Cullen and Jon Lips, will convey our response to the Governor’s budget proposal as the legislative session kicks into gear.  And we will review how the Assisted Living Law Legislation is being implemented, as well as respond to other issues you bring to the meetings.

These meetings will mark my one-year anniversary with the Association.  There are many of you that I have not seen since last August, so I look forward to this chance to connect with you.  Click here for the list of Region Meeting dates and locations, and click here for the meeting agenda.  Mark your calendars and be sure to attend a winter region's meeting near you.  Remember, you can always attend the meeting in a different region from the one you work in, if the timing or location is more convenient for you.  I'm eager to see you during this set of region meetings!

Phil Manz
952.851.2484
pmanz@careproviders.org

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Some Sections of the Department of Revenue Still Not Updated with Current Information

At least four members have called since we first alerted you that the Department of Revenue’s website is not current.  The communications division oversees the design and production of all public tax forms and publications, and manages the department website, so perhaps a call to Rebecca Christenson, the director, at 651-556-6450 will help get the site updated.  We realize you have a number of month-end projects to complete.

If you own rental property and rent living space to other persons, you or your managing agent must issue a CRP (Certificate of Rent Paid) to those persons if:  property tax was payable in 2006 on the property, or you were not required to pay property tax, but you made payments in lieu of property taxes.  You can find the information you need at:  http://www.taxes.state.mn.us/instructions/crp_ldin_06.pdf.  This section is up-to-date.

However, please be aware that other sections of the Minnesota Department of Revenue’s website are not up-to-date with respect to the latest year's information on the Certificate of Rent Paid.  The Minnesota Department of Revenue was not aware of this issue until contacted by Care Providers of Minnesota staff on Thursday morning, January 18.  We will continue to watch for any updates on the Department of Revenue website and communicate those to you as soon as we are aware of them.

Phil Manz
952.851.2484
pmanz@careproviders.org

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Background Information Helpful to Understand Biennial Budget

With the Governor’s biennial budget released this week, there are many familiar terms used that may be unfamiliar to members.  So, the following are the more commonly used terms, along with a brief definition for each.

General Fund
The General Fund is the major source of funding for education, health care and human services and other major functions of state government.  Most of the money in this fund is not earmarked for specific purposes.  It is the largest fund in the state treasury, into which receipts from most major taxes are deposited.

Budget Reserve or Reserve
State law establishes a Budget Reserve separate from the Cash Flow Account.  The reserve is like a savings account and serves as a hedge against an unforeseen economic downturn.  Reserve funds may be spent in the event expenditures are forecasted to exceed revenues, but only after consultation with the Legislative Advisory Commission.

Appropriation
Authorization by the Legislature to spend money from the state treasury for purposes established in law.  Appropriation language typically states:  “$XXX are appropriated to a state agency for a certain purpose.”  The Minnesota Constitution prohibits payment of money out of the treasury unless authorized by an appropriation.

Statutory (or standing) Appropriation
An appropriation made in statute authorizing the ongoing payment out of the treasury for a program.  In contrast to direct appropriations, statutory appropriations need not be renewed every biennium for funding to continue.

Direct Appropriation
An appropriation for a specific amount of money, for use only during a specific time period.  Appropriations are usually for a single year of the biennium; however, legislation occasionally makes single-year appropriations available either year of the biennium.

Omnibus Bill or Act
A collection of separate bills or appropriations in a single, large bill or act.

Biennium
Minnesota has a two-year (biennial) budget period.  The Legislature appropriates the major portion of the biennial budget in the odd-numbered year session, and makes adjustments as needed during the even-numbered years.  For example, the 2008-09 biennium is scheduled to begin at 12:01 a.m. July 1, 2007 and end at midnight June 30, 2009.

Forecast
Each year in November and February, the Department of Finance is required to project state revenues and expenditures based on current law.  This prediction is the forecast upon which the governor and Legislature base their budget proposals.  Within the forecast process, the Department of Revenue is required to forecast revenues to be received by school districts, counties and towns.  The Finance Department is also required to submit a debt capacity forecast at the same times as the revenue and expenditure forecast.

Fiscal Year
The 12-month period on which the state’s budget is based; it runs from July 1 to June 30.  School district fiscal years are the same as the state fiscal year.  County and city fiscal years are the same as the calendar year.  The federal fiscal year runs from Oct. 1 to Sept. 30.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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First One Scheduled for January 31 Hearing

The grass-roots message sent to members from the Long-Term Care Imperative on Friday, January 19, talked about the advocacy plans for this session.  Included in this message was information on facility-specific legislation:

“This year, in addition to the legislation introduced on behalf of the Long-Term Care Imperative, we expect that there will be an unprecedented number of facility- or region-specific rate exception bills introduced by members of MHHA and Care Providers of Minnesota.  We believe this will only help us to build the momentum for support of older adult services.  We will lead the charge, wrap media exposure around all of our efforts, provide you and your staff with advocacy tools, address your boards and leadership teams, build coalitions of support with other potential partners in advocacy, and work tirelessly on your behalf with key legislators; however, "ground zero" is going to be local and it will take all of us pitching in to be successful.  Collectively we can elevate the importance of older adult services and succeed in making long-term care a priority.”

The first of the facility-specific proposals introduced this session, HF 55 (Sviggum, R-Kenyon) is scheduled for a House committee hearing on January 31.  This bill provides that all nursing facility payment rates would be increased to the geographic group III median rate.  As of Monday, January 22, the following facility-specific (or group-specific) bills have been introduced:

Bill Numbers	Authors	Description
HF 55   SF139	Rep. Steve Sviggum Nornes; Erickson; Simpson; Wollschlager; McNamara; Demmer Sen. Steve Murphy	Move all NFs up to the median of the group III rate
SF 55 HF 192	Sen. Steve Dille Rep. Dean Urdahl; Shimanski; Hosch	Meeker County facility into group II
SF 143	Sen. Tom Saxhaug Rosen; Senjem; Kubly; Skoe	PERA payment into NF rates
HF 173   SF 178	Rep.Sondra Erickson Eastlund; Anderson, B Sen.Betsy Wergin	Move NF rates from Wright, Mille Lacs, Isanti and Chisago counties to the median group III rate

If you want to review the specifics for any of the above bills, go to www.leg.state.mn.us, click on “Bill Search” then type in the bill number.  As in the past, members wishing to introduce facility-specific bills can ask for technical assistance and/or related data from Association staff.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Bills Would Return Inflation to the Budget Forecast

Two measures modifying the state's budget forecasting and budget preparation process were approved by members of the Senate Finance Committee on Tuesday, January 16.  Both measures, carried by Finance Committee Chair Senator Richard Cohen (DFL-St. Paul), were forwarded to the full Senate.

S.F. 25 requires the regular budget forecasts to include the impact of inflation on expenditures.  S.F. 11 is a more comprehensive package of proposals.  It includes the inflation requirement, a requirement that a cash flow forecast be delivered to the Legislature two weeks after the budget forecast, a one-year continuing appropriation at base levels if any of the major budget bills is not enacted before the new fiscal year begins, and provisions requiring the budget to be reported according to generally accepted government accounting principles.

Paul Anton, chief economist at the Wilder Foundation, was the lead testifier in support of SF 11.  Mr. Anton, who serves on the state’s Council of Economic Advisors, said including inflation in the forecast is “honest budgetary practice.”  Critics suggest that accounting for inflation in expenditures amounts to putting government on autopilot, he said, but these critics ignore the fact that the Legislature retains authority to adjust funding levels for programs.

Several years ago, legislators removed inflation from the expenditure “side” of the economic forecasts but kept an inflator on the revenue “side” of the forecast.  Anton also said that the forecast is a very large view of the state budget and does not attempt to forecast growth levels for specific programs.  “Just because inflation in a general area is at a certain level does not mean that every program within the area is at that level,” Anton said.  Additional benefits of including inflation in the forecast are that it adds urgency to calls to address structural financial issues, Anton said, such as the extreme fluctuation of the state's revenues and the need to increase the state's reserve fund.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Conflicting Reports Emerge on Progress and Solutions

On January 11, the Senate Health and Human Services Budget Division, chaired by Senator Berglin (DFL-Mpls), held a hearing on the Minnesota Veterans Home Budget and the progress of the Minneapolis Veteran’s Home resulting from two negative survey inspections.  The budget overview focused on the resources to the Veterans Homes Board, which is used for services at all of the state’s veterans homes.  Much of the hearing was spent on conflicting perspectives about the quality of care provided to the veterans at the Minneapolis facility, and whether or not the facility is on the “right” compliance path.

The chair and vice-chair of the Minnesota Veterans Homes Board, along with a dozen board members and top management at the Minneapolis Home (and several veterans in uniform), discussed the changes they have made to date since the November 2006 Department of Health survey resulting in 34 citations.  One of the reasons for this particular hearing was the fact that the Minneapolis Veterans Home had a prior negative survey—in September of 2005—and the Board came to the legislature to request additional funds to add more staff, which was supposed to be the “solution” to their quality problems.  In response, $4 million in additional resources were given last legislative session, with certain restrictions tied to the use of those funds.  Most of the funds were to be used to hire staff; and the Board was to work with the nursing union on how to improve staffing.  Board staff and management from the home both testified about the improvements in staffing that have been made, and the various quality improvement processes that have been implemented.  In addition, the new management team has only been in place for the past few months.

Committee members asked many questions about the survey process, specific steps taken, and whether the violations were “repeat” and/or cross tags.  Senator Berglin was specifically concerned that the number of registered nurses vacancies at the Minneapolis facility seemed high, given the additional resources provided for that purpose.

Countering the testimony from the Board was the testimony from the Minnesota Nurses Association, and several RNs that are long-time employees of the Minneapolis Veterans Home.  Not only were the RNs at the home responsible for calling in the Department of Health initially due to concerns over the quality of care being provided, but they continue to fight the staffing decisions of the Board and management team.  They requested additional legislative oversight to be sure that any additional funds are used to hire staff, specifically additional RNs in senior positions.  They summarized their concerns by stating that the quality problems at the Minneapolis Veterans Home are the results of a nurse staffing crisis that exists not only there, but throughout the state.

Subsequent hearings will be held on the budget for the veterans facilities in the next few months, as well as another overall progress report before the Senate Veterans Committee.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Efforts Under Discussion Intended to Avoid Budget Uncertainty

Several legislators have introduced bills that would avoid a partial state government shutdown, like the one that occurred July 2005.  The House Governmental Operations Committee held a hearing on many of these proposals on January 18, and passed one of the proposals on to the House Finance Committee.  HF 7 (Loeffler, DFL-Minneapolis) would continue baseline appropriations set in the previous fiscal year for one year IF an appropriations bill is not passed by the Legislature before adjournment.  Addressing continuing appropriations when there is a legislative impasse was one of the more popular issues identified in a survey last year.

The bill author, Rep. Diane Loeffler, noted in her bill presentation that several other states have similar laws allowing for continuing appropriations.  Opposition to the proposals came from several Republican legislators on the committee, who preferred setting earlier time limits for budget action, “forcing” legislators to get their jobs done.  In July 2005, when the Legislature and Governor did not agree on a budget prior to adjournment of the regular session in May or during the special session called for in June, there was a great deal of anxiety about which human services payments needed to be continued, and what authority the Governor has to continue payments without an approved budget.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Visit our Legislative webpage for this week's bill introductions!

Each week during the 2007 legislative session, we will post a list of Bill Introductions on the “Find It Here / Legislative / 2007 Session Bill Tracking” section of the Association’s website.

Please contact Jon Lips or Patti Cullen any time if you have questions about proposed legislation or just want to know the general "buzz" at the Capitol.

Jonathan Lips
952.851.2480
jlips@careproviders.org

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Flu Spreads from Local to Regional

Influenza activity increased to regional during week three of 2007, yet it remains mild in the long-term care setting (there have been 40 possible outbreaks in Minnesota Schools during the week).  The 65 influenza isolates that have been tested by the MDH Public Health Lab were all well matched to the current vaccine strain.  Click here:  http://www.health.state.mn.us/divs/idepc/diseases/flu/stats/index.html  to see how we are doing so far this year in comparison to the previous two flu seasons.

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org

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Automatic and Manual Exceptions to Therapy Caps Continue Through 2007

Section 1833(g)(5) of the Social Security Act provided that, for services rendered during calendar year 2006, fiscal intermediaries and carriers could, in certain circumstances, grant an exception to the therapy cap when requested by the individual enrolled under the Part B benefit (or by a person acting on behalf of that individual).

On January 1, 2006, Medicare implemented financial limitations on covered therapy services (therapy caps); however, the 2006 Deficit Reduction Act provided for exceptions to this dollar limitation when the provision of additional therapy services is determined to be medically necessary.  This exceptions process has been extended by recent legislation (the Tax Relief and Health Care Act of 2006) for one year (calendar year 2007).  Remember that a therapy cap exception may be made when a beneficiary requires continued skilled therapy (in other words, therapy beyond the amount payable under the therapy cap) to achieve their prior functional status or maximum expected functional status within a reasonable amount of time.  Documentation supporting the medical necessity of those therapy services must be kept on file by the provider.

Additionally, you should note that, in 2006, Exception Processes fell into two categories:  Automatic, and Manual.  Beginning January 1, 2007, there is no manual process for exceptions, and all services that require exceptions to caps will be processed using the automatic process.

You can find more information about the outpatient therapy cap exception process for 2007 by going to CR 5478.  CR5478 is actually issued in 3 separate transmittals, one for each manual being revised.  The attachments to each of the transmittals include the updates to the Medicare Claims Processing Manual, Chapter 5 (Part B Outpatient Rehabilitation and CORF/OPT Services), section 10.2 (The Financial Limitation) for 2007; the Program Integrity Manual, Chapter 3 (Verifying Potential Errors and Taking Corrective Actions), Section 3.4.1.1.1 (Exception From the Uniform Dollar Limitation (“Therapy Cap”)), and the Medicare Benefit Policy Manual, chapter 15 (Covered Medical and Other Health Services), Section 220.3C (Documentation Requirements for Therapy Services – Evaluation/Re-Evaluation and Plan of Care).  You are encouraged to be familiar with these important manual sections.  You can find these transmittals on the CMS web site at:

• The Medicare Claims Processing Manual transmittal – http://www.cms.hhs.gov/transmittals/downloads/R1145CP.pdf;
• The Medicare Benefit Policy Manual transmittal – http://www.cms.hhs.gov/transmittals/downloads/R63BP.pdf and
• The Medicare Program Integrity Manual transmittal – http://www.cms.hhs.gov/transmittals/downloads/R181PI.pdf.

Patti Cullen
952.851.2487
pcullen@careproviders.org

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Formal Adoption Expected at January 30, 2007 Board Meeting

The National Center for Assisted Living Executive Committee, including our own Howie Groff of Tealwood Care Centers, met in early January to develop priority areas for 2007.  They are:

1. Preparing for and responding to the rapidly evolving national political environment
2. Membership expansion
3. Supporting state affiliates (as requested) as they expand their assisted living member services
4. Obtaining an accurate understanding of consumer wants relative to their long-term care needs
5. Expanding our support of member facilities in the context of workforce development/enhancement

These areas will be under review at a NCAL Board Meeting next week.  In addition to Howie Groff, Care Providers of Minnesota will be represented on the Board of Directors of NCAL by Jim Birchem of ElderCare of Minnesota, and Faun Spencer of Steven’s Residence.  Please contact them if you have thoughts on what NCAL’s priorities for 2007should be.

Phil Manz
952.851.2484
pmanz@careproviders.org

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Information Available at Home Health Quality Improvement Website

On Jan. 11, the Centers for Medicare & Medicaid Services announced the start of a national initiative to help home health agencies improve patient care and reduce hospitalizations.  The Home Health Quality Improvement National Campaign is a grassroots collaborative quality improvement effort among home health agencies, health care leaders and Quality Improvement Organizations (QIOs), according to the campaign website.  The goal of the campaign is for home care patients to remain in their home settings, resulting in fewer avoidable hospitalizations.

"Currently, more than one in four home health patients episodes result in a hospitalization," according to Barry Straub, director and chief clinical officer of CMS's Office of Clinical Standards and Quality, who spoke at the Jan. 11 summit to kick off the campaign, held at CMS headquarters in Baltimore.  "That's what this campaign is going to address," he said.  More information about the campaign and how to sign up can be found at www.homehealthquality.org.

Phil Manz
952.851.2484
pmanz@careproviders.org

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What do our clients want?

My InnerView recently published the results of assisted living and skilled nursing resident satisfaction surveys conducted in 2005 and 2006 outlining the top five factors that influence residents’ recommendation to others in assisted living and skilled nursing facilities.  Here is what is important to our clients:

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org

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Are You Getting the Most from Your Data?

Many Nursing Home and Housing with Services providers conduct ongoing staff surveys.  Management can learn a lot about how to improve morale and services from such surveys.

In the January 2007 newsletter of My InnerView, they recommend four important steps to follow once you have compiled the results of your staff surveys:

1. Promptly post the results
2. Department managers should hold staff meetings to talk about the results
3. Lead multidisciplinary team meetings to discuss the results and implementation of potential improvements/solutions
4. Pilot tests of proposed solutions and resurvey to determine effectiveness

The article provides many more hints and suggestions for how to use the survey data to improve the work-life at each facility…for the good of staff and residents.  Click here http://www.myinnerview.com/enews_article.php?articlepage=enewsC3_1.php to read the entire My InnerView article.

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org

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Minnesota effective date is April 15, 2007

Medications comprise an integral part of the care provided to residents in nursing homes.  These medications are beneficial in curing, treating, and managing, or preventing disease and/or symptoms.  It is the responsibility of the interdisciplinary team, in collaboration with the prescriber, to evaluate and manage medication regimens.

This educational program is designed in response to the CMS Transmittal 22 issued 12/15/06 that contains Revised Surveyors Guidance and Investigative Protocols Related to Unnecessary Medications and Pharmacy Services.

Attendees will receive information to educate appropriate facility staff about implementation of the clinical content included in this protocol.  Attendees will learn how to incorporate this new protocol into the facility’s ongoing continuous quality improvement program.

This program will provide a shared learning opportunity for long-term care providers and surveyors and promote positive working relationships through communication regarding unnecessary medications.

Learning Objectives:

• Describe the intent of the regulation
• Explain the various medication management considerations described in the Guidance
• Utilize the components of the investigative protocols
• Identify compliance with the regulations
• Appropriately categorize the severity of noncompliance

Presenters:
Todd A. Johnson, Pharm.D., CEO, Consultant Pharmacists, Inc., and Assistant Professor, College of Pharmacy, University of Minnesota
Bonnie Wendt, Nurse Specialist, Minnesota Department of Health

Additional Resources:
View the video at:  http://www.cms.internetstreaming.com/. (Log in or register, then click on "Archived Webcasts," and click on "Nursing Home Journal Volume IV Unnecessary Medications," dated December 15, 2006.)
Download Transmittal 22 (click on "Show only items containing the following word" and enter R22SOMA in the box on the site) dated December 15, 2006 at:  http://www.cms.hhs.gov/Transmittals/2006Trans/list.asp?listpage=56.

Who Should Attend:

• Administrators
• Directors of Nursing
• Nursing staff
• Medical Directors
• Pharmacists
• Prescribers including MD’s, DO’s, NP’s, PA’s, CNS’s
• Trainers
• Other interested staff

Accommodations:
Information on local overnight accommodations for training locations will be sent with confirmation emails.

Continuing Education Credits:
The training has been designed to meet the continuing education criteria for the Minnesota Board of Nursing, the Minnesota Board of Examiners for Nursing Home Administrators and the Minnesota Board of Pharmacy.

Training Stakeholders Work Group:
Care Providers of Minnesota, ElderCare Rights Alliance, Empira, Minnesota Alzheimer’s Association, Minnesota Board of Examiners for Nursing Home Administrators, Minnesota Board of Pharmacy, Minnesota Department of Health, Minnesota Directors of Nursing Administration, Minnesota Health & Housing Alliance, Minnesota Pharmacists Association, Stratis Health and The Office of Ombudsman for Older Minnesotans.

Schedule:
Check-in and continental breakfast    8:30 am to 9:00 am
Program                                             9:00 am to 3:30 pm

Cost:  $115 per person.
Fee includes training materials, refreshments at breaks, and lunch.  There is free parking available at all locations.

Registration:
Registration is limited and is on a first-received basis.  Payment must accompany registration—invoicing is not an option.  Minnesota Health and Housing Alliance will handle all registrations.  You may register online at www.mhha.com, fax 651-645-0002, or mail to:

Minnesota Health & Housing Alliance
Education Services
Attn: Beth Gabrysiak
2550 University Avenue West, Suite 350S
Saint Paul, Minnesota  55114-1900

Dates & Locations:

Wednesday, January 31 –
Fergus Falls
Bigwood Event Center
921 Western Avenue
Phone:  (218) 739-2211

Thursday, February 1 –
St. Cloud
Radisson Suite Hotel
404 West St. Germain
Phone:  (320) 654-1661

Wednesday, February 21 –
Redwood Falls
Jackpot Junction Convention Center
39375 County Highway 24 (Morton)
Phone:  (800) 946-2274

Monday, February 26 –
Brooklyn Center
Earle Brown Heritage Center
6155 Earle Brown Drive
Brooklyn Center
Phone:  (763) 569-6300, (800) 524-0239

Tuesday, February 27 –
Rochester
Ramada Hotel and Conference Center  Gold Hall
517 16th Street SW
Phone:  (507) 289-8866

Cheryl Smith
952.851.2488
csmith@careproviders.org

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Advocacy, Education and Knowledge Strongly Favored as Topics

Over the past month, 58 members completed a three question survey to evaluate our Regional Meetings, which occur at least four times a year.  Over 50% of the 58 respondents attend 3 or more Regional Meetings.  When asked to rank order the five components of Care Providers of Minnesota's mission statement—Advocacy, Education, Knowledge, Resources and Support—over 50% of the members ranked Advocacy, Education and Knowledge as the first or second most important topic to be covered at the Regional meetings.

In addition to numeric rankings, 31 respondents provided open-ended feedback about what topics or events would increase their attendance.  Topics mentioned ranged from encouraging more information on senior housing and assisted living to planning events that include staff from the Minnesota Department of Health.  Only one respondent capitalized some of their response:  “Legislative ACTION and grass roots involvement to DEMAND financial relief.”

The 2007 Regional Council and the 2007 Membership Enhancement and Effectiveness Committee will continue to work together to earn more comments like, “I think the topics are good.  They are usually very current and it has been nice that many of them pertain to both Assisted Living and Long-Term Care.”  If you have any additional comments please contact your regional manager, or call Phil Manz at 952-851-2484.

Phil Manz
952.851.2484
pmanz@careproviders.org

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Were You on the Line?

On January 22, 2007, The Minnesota Department of Health (MDH), Compliance Monitoring Division, held the second of four free conference calls to update nursing facility providers on the survey status of newly enacted federal survey guidelines.  The conference call covered post survey implementation of F248/F249 (Activities), the Psychosocial Outcome Severity Guidance, and the F520 (Quality Assessment and Assurance) guidelines.

The survey changes discussed during the conference call focused on those changes that were implemented in Minnesota on October 1, 2006.  Data discussed during the conference call was based on nursing home surveys conducted since November 4th, 2006.  None of the deficiencies issued during this period of time relating to the October 1 survey changes were cited at a scope and severity of Level F or higher (all were issued at an E or lower).

The following summarizes some of the information shared during the conference call:

Psychosocial Severity Outcomes – 21 F-Tags in three areas were issued under this new guidance:

• F164 – Privacy and Confidentiality – issued 5 times
• F241 – Dignity – issued 9 times
• F225 – Employment of staff with history of abuse – issued 7 times

F249 – Qualified Activities Professional – This deficiency was issued once during this time period.  However, based on the number of questions participants asked the presenters, following are the requirements for the Activities Director:

1. Is eligible for certification as a Therapeutic Recreation Specialist or as an Activities Professional by a recognized accrediting body on or after October 1, 1990; or
2. Has 2 years of experience in a social or recreational program within the last 5 years, 1 of which was full-time in a patient activities program in a health care setting; or
3. Is a qualified Occupational Therapist or Occupational Therapy Assistant

F248 – Activities

Four deficiencies were issued under this tag.  The deficiencies focused on two problem areas:

1. Failing to provide the activities as outlined in the care plan
2. Failing to provide individualized activity programming

F520 – Quality Assessment and Assurance Guidelines

Two deficiencies have been issued under F520 during the period discussed:

1. Failing to develop and implement action plans
2. Failing to conducting quarterly meetings

The next MDH statewide conference call focusing on new survey guidelines is scheduled for March 26, 2007 – NOTE:  rescheduled from the originally announced date of March 19, 2007 – please update your calendars.

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org

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Have you been cited?

Hospice Minnesota has contacted Care Providers of Minnesota in an effort to resolve a possible trend of increasing F-Tags being given to nursing homes in regards to the delivery of hospice care.

If your nursing facility has received either a federal deficiency or a state citation order in 2006 or 2007 based upon the interplay between your nursing facility and any hospice provider(s), please fax the deficiency as written on your 2567 form to the attention of Doug Beardsley – Care Providers of Minnesota (Fax: 952-854-6214).  We will work with Hospice Minnesota and the Minnesota Department of Health to determine what areas are problematic and help to minimize such deficiencies through education or other means.  Thank you for your assistance with this issue.

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org

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