Signature Celebrates National Day of Prayer

In 1775 the Continental Congress asked the colonies to pray for wisdom in forming the nation. President Harry Truman declared an annual day of prayer and President Ronald Reagan set it for the first Thursday in May delivered the benediction.
So on May 2nd, the 62^nd National Day of Prayer in America,
Signature Healthcare facilities celebrated the day with a simultaneous webcast
of the home office celebration with its 76 facilities in Kentucky, Indiana,
Florida, Tennessee, Maryland and Georgia. Along with religious representation including B’Hai, Buddhism, Christianity, Islam, Judaism, Native American, Quaker, Roman Catholicism, Sikhism and Unitarian,  it was a beautiful day to reflect on the religious freedoms that we have here in the United States, and to gain knowledge of the different faiths that celebrate their  beliefs alongside one another.

Signature residents and stakeholders from our local Louisville facilities also joined political leaders from the State and Federal legislatures, and City and County Government, as they shared insight as to the integration and relationship of government and faith today.

The exhilaration and at the same time the serenity that was omnipresent was a true reflection of the prayers offered and the conjoined reading by our CEO -      E. Joseph Steier, III and our Vice President of Spirituality, Dianne Timmering overflowed with expressions of gratitude and joy clearly in the hearts of us all as we gathered to celebrate our National Day of Prayer, and how fortunate we all were to be a part of this blessed day.
Enjoy the photos and God Bless!

“Doc Fix”-There’s a lot going on at Capitol Hill this week, including leaders of the Senate Finance Committee meetings on possible changes to the Medicare physician payment system.

• Under the current Sustainable  Growth Rate system, Congress has acted each year for about a decade to  prevent cuts to physician pay. The next cut, of 25%, would take effect  Jan. 1, 2014.
• CMS is looking to cut spending  elsewhere too – and looking again to LTC providers. The Congressional  Budget Office recently said that freezing physicians’ pay for 10 years  would cost about $100 billion less than the agency previously announced – giving a flicker of hope that a permanent “doc fix” can be hammered out.

Congress has previously opted to adjust Medicare physician payments with a yearly short-term “doc fix” rather than pursuing long-term reforms and remember- Part B outpatient therapy is a non-physician service reimbursed under the Physician Fee Schedule, and subject to SGR policy.

Legislation:

S. 878; H.R. 1844)- re-introduction of the Arbitration Fairness
Act in the 113th Congress. The bill would bar the use of mandatory pre-dispute arbitration agreements, including the use of these agreements in long-term care facility admission contracts.

HR1853 Congress has introduced a new version of the Medicaid Accountability Act of 2013 which has some variations of the 2012 version with some key points for LTC

• The provider tax is back “in” as reimbursable
• Intergovernmental Transfers are still  eliminated
• There is also a new section of Risk Adjustment
  methodology which requires HHS Secy to update this 2x per year
• HHS must work with MedPAC and  MacPAC to asses risk adjustments
• Mandatory Medical Loss Ratio reporting for  MCO’s to the state
• Also section on how payments go to states, not  directly to providers, for Title 18 payments
• http://www.govtrack.us/congress/bills/113/hr1853/text

HR45 – Repeal PPACA-Rep. Michelle Bachman (former GOP Candidate for
President) filed the bill to repeal the Patient Protection and Affordable Care
Act -Expect this to move through Committees and possibly House – but small
chance of passing in Senate. http://www.govtrack.us/congress/bills/113/hr45/text

HR1406 -Working Families Flexibility Act of 2013 Bill
would amend the Fair Labor Standards Act of 1938 to provide compensatory time for employees in the private sector –passed last week in House Committee on Education and Workforce – unlikely to pass in the Senate http://www.govtrack.us/congress/bills/113/hr1406/text

Lots of discussion now about S744 -bipartisan Senate immigration bill that has potential to increase the LTC workforce by allowing out of status immigrant workers to apply for visas addressing shortage of healthcare workers/staffing, recruitment and retention issues

• Although unknown at this time what the House schedule is for hearing the bill or  what their strategy might be, -hopeful that the bill will proceed  favorably as it has large bi-partisan Senate support http://www.govtrack.us/congress/bills/113/s744/text

Federal:

Lot of discussion now about S744 -bipartisan Senate immigration bill that has potential to increase the LTC workforce by allowing out of status immigrant workers to apply for visas addressing shortage of healthcare workers/staffing, recruitment and retention issues

• Although unknown at this time what the House schedule is for
  hearing the bill or what their strategy might be, -hopeful that the bill will
  proceed favorably as it has large bi-partisan Senate support

Acting Admin for CMS-MarilynTavenner was approved by vote today in Senate Finance
Committee and is expected to be confirmed by full Senate vote -She would be the first confirmed administrator for CMS since 2006
States:

Florida

Budget:

• Health Budget Conference Committee resolved our funding where the House offered to withdraw its $45.6 million cut and agree to the Senate position
• Senate fully funds expenditure estimates for nursing homes, including our inflation
• Negotiations still going on but all looks good…..

Legislation:

• HB1159/SB1482 – Certificate of Need creating an exemption from a limit
  on new nursing beds for certain communities, including The Villages retirement
  community in central Florida
• SB1482 passed out of Committee last week – now on to full Senate vote
• companion House bill HB 1159 was amended in the House HHS Committee on Thursday to include mutually-agreeable provisions.
• Still working with legislators to ensure the final legislation considered on the floor is one that maintains a fair process reflective of current CON law
• SB1384 –Fairness in NH Litigation – clarifies
  guidance in due process in determining whether evidence exists that would
  warrant a claim for punitive damages.
• passed favorably out of the Senate Health Policy Committee
• on to full Senate floor for a final vote
• House measure, required for the proposal to go to the governor, also appears to be advancing

Several of the regulatory bills that will go into a “study” :

• HB 9 /SB 110 would allow ARNPS and physicians assistants to
  initiate involuntary examinations under the Baker Act

Maryland: session has ended

Budget:

• Maryland’s approved FY14 budget includes a 1.5 % rate increase
• marks the first rate increase not associated with an increase in the quality
  assessment
• The approved Supplemental Budget of the Governor includes $1.5 million ($3 million with simple federal match) to help mitigate the federal cut in bad-debt co-pays

Legislation:

• The Labor and Employment- Workplace Violence Prevention Program was withdrawn
• Nursing Homes and Assisted Living Facilities- Sex Offenders, was also withdrawn
• Department of Health and Mental Hygiene- Health Care Facilities- Abuser Registry was amended to a study group after it was determined that more work with the Department and Office of Health Care Quality was needed before this bill was passed.

Tennessee: session has ended

Legislation:

• SB222 – signed into Law; Bill places limitations on findings of punitive damages based on the finder of facts by a special verdict http://www.capitol.tn.gov/Bills/108/Bill/SB0222.pdf
• SB56 – has been sent to the Governor w/amendments; Bill codifies that a defendant will only be severally liable for the percentage of damages for which fault is attributed to such defendant by the trier of fact, and no defendant will be held jointly liable for any damages
• http://www.capitol.tn.gov/Bills/108/Bill/SB0056.pdf
  

Indiana:Two weeks left to the legislative session

Budget:

• HB 1001, before a conference committee this week- the
  biennial budget -The amended Senate
  version of the budget extends the health facility quality assessment fee
  through June 30, 2017
• There was no mention of managed care in this amended version.

Legislation:

• HB1034 – has passed in House and Senate -Bill allows a physical therapist to evaluate and treat a patient without a referral for up to 24 days and requires a physical therapist to obtain a referral from the patient’s provider if further treatment by the physical therapist is needed.

http://www.in.gov/legislative/bills/2013/EH/EH1034.2.html

Signature Florida team meets with Senator Denise Grimsley to discuss long term care issues

Signature HealthCARE Florida Stakeholders attended a Lobby Day in Tallahassee on April 17, meeting with many legislators and discussing very important issues that long term care providers are facing in Florida right now that must be decided upon before session ends on May 5.

We met with 11 state legislators and several legislative staff, discussing three major issues surrounding long term care:

• The state budget, which includes the Senate budget proposal for level funding for long term care; and the House budget, which proposes cuts to providers of approximately 2%
• SB1482 – A  bill that would allow certain Florida nursing homes to bypass the Certificate of Need process
• SB1384 – A bill that would require judges to hold evidentiary hearings before determining whether claims for punitive damages can move forward

As a highlight of our day, Rep. Joe Gibbons (D-Hallandale Beach), unexpectedly gave the team a great honor by recognizing the team on the floor of the House of Representatives!

For several stakeholders, this was their very first time in Tallahassee. The trip ratifies the experience of being able to meet with their legislators one-on-one, sharing concerns that we have for the needs of our residents and stakeholders, and truly putting forth grassroots advocacy at its best.

Continuing our efforts to build relationships with our legislators, we invited them to come to our facilities once they are back in their hometown districts following session. We hope they will come and meet with our residents and stakeholders, with the goal of enhancing the relationships we are building in order to amplify our grassroots voices. As we know, ‘all politics are local politics.’

Kudos to the Signature Florida team!

• The proposed budget has $81billion in Medicare cuts to LTC providers over 10
  years
• This comes via an adjustment of payments to SNF’s and also maintains provisions for reductions in hospital readmissions as an incentive which is estimated to be equal to $500 million in deficit reduction by 2018
• Budget leaves out a “blended rate” for federal matching dollars and reduce states’ ability to use Medicaid provider taxes
• labs, pharmaceuticals and Medicare Advantage stakeholders would be hit with billions
  in new cuts
• The budget does however protect Medicaid from cuts for LTC with policy changes to amount to $22.1 billion in savings
• Budget proposes to limit Medicaid reimbursement of durable medical equipment based on Medicare rates
• As expected proposes to permanently repeal the Medicare physician payment formula and replace it with a value-based system

Kaiser Health analysis of the Presidents Budget

No doubt, much to be worked on in coming months between Dems and Republicans

Congressman Yoho defeated long time Congressman Cliff Stearns in November, 2012 for the District Congressional seat and covers Alachua, Union, Gilchrist, Bradford, Marion, Clay, Suwannee, Dixie, Lafayette, Columbia, Levy, Madison and Hamilton Counties.

He is dedicated to preserving Medicare and Social Security
and hopes to be influential in long term solvency for these programs for
America’s seniors.

We will be arranging facility visits for him in the very near future at our Orange Park and Gainesville facilities, so Congressman Yoho can meet with our residents and stakeholders and get to know who we are and how we serve the community!

Open House with US Congressman Ted Yoho

Legislative
Update 3-25-13

FEDERAL:

Budget:

Washington will be a bit quieter this week following the House and Senate having passed budgets and it looks like taxes, spending and the national debt will be addressed later this
year.

• President Obama is expected to release his own
  fiscal 2014 budget in early April
• The Senate budget calls for nearly $1 trillion in
  tax increases over 10 years and tries to reduce the deficit without making
  big changes in Medicare and other safety-net programs.
• The House GOP budget calls for eliminating the
  deficit in 10 years without raising taxes, while making major cuts in the
  growth of Medicare.
• Appearances are that the President is indicating a
  willingness to support bigger changes in Medicare and other entitlement
  programs than the Democratic budget called for, but only as part of
  broader deficit-reduction deal with Republicans that includes tax
  increases.

Therapy:

CMS provided the final guidance on Manual Medical Review (MMR) for therapy claims
above $3,700.

• The Medicare Administrative Contractors (MACs) will conduct prepayment review until March 31, 2013.
• Beginning April 1, 2013, Recovery Audit Contractors (RACs) will conduct prepayment review for all claims processed on or after April 1, 2013 as part of a
  “demonstration” for the following states:  Florida, California, Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North Carolina and Missouri.
• Post payment review will be conducted by the RAC in the other states.  The 10
  days seems to only apply to the prepayment review.

Long Term Care Commission:

In accordance with the Affordable Care Act, the Federal 15 member LTC panel has now been completed and begins task of 5 year study how to address the rapidly aging population that will require LTC…. The commission has been charged with brainstorming solutions to a variety of LTC issues. By law, the commission has six months to produce its suggestions.

• Henry  Claypool – VO for policy at American Association of People with
  Disabilities and advisor to HHS Secy – Sebelius
• Julian Harris, MD – Director of Massachusetts Office of Medicaid
• Carol Raphael – Vice chair of AARP and Board chair of NY Ehealth Collaborative ,
  former Pres/CEO of Visiting Nurse Service of NY
• Judith  Y. Brachman, national co-chair of Jewish Federations of North America’s
  Aging and Family Caregiving Committee and former director of the Ohio
  Department of Aging
• Stephen Guillard of Chatham, Mass., a health care executive
• Grace-Marie  Turner, president of the Galen Institute
• Bruce  D. Greenstein, secretary of the Louisiana Department of Health and
  Hospitals
• Neil  L. Pruitt, Jr., chair and CEO of the UHS-Pruitt Corporation and board  member of the American Health Care Association
• Mark  Washofski, a former member of the Treasury Department under President
  George W. Bush
• Javaid  Anwar, physician and former chair of Nevada’s Committee on Access to
  Health Care.
• Laphonza  Butler, president of the United Long-Term Care Workers Union
• Judy  Feder, professor of public policy at the Georgetown Public Policy
  Institute
• Bruce  Allen Chernof, president and CEO of The SCAN Foundation
• Judith  Stein, founder and executive director of the Center for Medicare Advocacy,  Inc.
• George  Vrandenburg, president of the Vrandenburg Foundation and founder of US  against Alzheimer’s

MedPAC Report:

MedPAC came out last week with recommendations –MedPAC ‘s new recommendations proposing revising the skilled nursing facility Prospective Payment System (PPS) for 2014 include an additional cut of at least 4% to providers.

Legislation:

S 569/HR1179:  introduced to amend title XVIII of the Social
Security Act to count a period of receipt of outpatient observation services in
a hospital toward satisfying the 3-day inpatient hospital requirement for
coverage of skilled nursing facility services – hope to see this gain traction!!

STATE:

Florida:

Riddled with scandal, Florida Lt. Governor Jennifer Carroll resigned from office. Under
state law, Gov. Rick Scott must appoint a new lieutenant governor, but indicated that he would not name a replacement until after legislative session.

• Despite Governor Rick Scott’s support, Florida seemed
  unlikely to expand Medicaid following rejections by the state House and
  Senate this month.
• Republicans are trying to come up with a plan for the
  uninsured, something they believe would be better than expanding Medicaid.
• New estimates show that the expansion and other
  parts of the law would cost the state about $5.2 billion over 10 years.
• For long  term care providers key question is the application of the 2% percent cut  to the RUG categories

Georgia:

• The House passed the 2014 budget- the House version of the
  budget eliminates the 0.74% Medicaid provider reimbursement cut for our
  industry.
• House Judiciary Committee passed  SB 158, which  addresses Physician-Orders for life-sustaining treatments and fixes the  discrepancy of two physicians having to sign and instead only one  physician and another person.

Pennsylvania:

• SB 625 introduced and would require nursing homes to report turnover and
  staffing levels to the health department.
• SB  626 introduced and would require the homes to spend a minimum amount of
  their Medicaid resident care per-diem rate.

Kentucky:

• HB217  (formerly HB1)-After last summer’s workshops on this bill, it has been
  revised and signed into law and includes language to amend KRS 218A.202 to allow hospitals and long-term-care  facilities to have KASPER accounts and goes on to state regarding prescribing of controlled  substances:   “ For administration in a hospital or long-term-care  facility if the hospital or long-term-care facility with an institutional  account, or a practitioner in those hospitals or facilities here no  institutional account exists, queries the electronic monitoring system established in Section 3 of this Act for all available data on the patient
  or resident for the twelve (12) month period immediately preceding the  query within twelve (12) hours of the patient’s or resident’s admission  and places a copy of the query in the patient’s or resident’s medical  records during the duration of the patient’s stay at the facility”
  http://www.lrc.state.ky.us/record/13rs/HB217/bill.doc

Tennessee:

• As Gov. Bill Haslam weighs whether to expand TennCare, the General Assembly’s
  Fiscal Review Committee, a nonpartisan office set up to assess the costs  and benefits of proposed legislation, says expanding TennCare would inject  more than $418 million into the state’s budget in 2013-2014 and $1 billion  more in the next budget year.
• The money would cover the cost of offering TennCare  to 161,900 more Tennesseans.

Indiana: (Welcome to our Signature family!)

• The biennial budget bill has introduced language concerning managed care and we should know more in coming weeks about implementation date and the possible interim study committees concerns of how it will impact long term care.

Legislation:

HB 1034, the physical therapy services without a referral bill had an amendment put forth and adopted by clarifying how many days a patient can see a physical therapist without a referral.

HB 1182, the Physician Order for Scope of Treatment form (POST), establishes a process for the execution of a POST form by an individual or the individual’s representative and the individual’s treating physician to indicate treatment the individual would like to have or have withheld underspecified circumstances. HB 1182 passed in Committee with an 8-2 vote.

HB 1319, titled Health Benefit Exchange Provisions and authored by Representative Lehman, pertains to how the health benefit exchange will be implemented in accordance with the Federal Affordable Care Act in Indiana- the bill has not yet received a hearing date.