ICD-10 codes have arrived! And more in long term care news

In this week’s long term care newsletter, we explore several letters from legislators to the Centers for Medicare and Medicaid Services (CMS), a Kaiser Health poll on end-of-life care, behavioral alternatives to antipsychotic medications for dementia treatment, and more. Read a copy of the newsletter below, and sign up at the bottom of this page to have it delivered to your inbox every week!


As of today, Medicare Prospective Payment System (PPS) payments for nursing homes will increase by an average of 1.2% as per the final rule issued on July 30th of this year. CMS projects a $430 million increase in payments to SNFs in fiscal year 2016 compared to fiscal year 2015. That said, changes in facilities’ Core Based Statistical Area (CBSA) Wage Index and other labor-related statistics will cause payment increases in some areas and decreases in others.

Mental health legislation is progressing in the Senate. Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander and Sen. Patty Murray’s bill to reauthorize suicide prevention and mental health awareness programs passed the HELP committee yesterday.

Over 100 members of Congress signed a letter to the Office of Management and Budget (OMB) and the Department of Health and Human Services (HHS), in which they asked the departments to delay finalizing Stage 3 of the Meaningful Use rules for electronic health records. Reps. Renee Ellmers, Tom Price, and David Scott are leading the effort against what they call arbitrary deadlines dependent on unproven technology.

The representatives ask OMB and HHS to “work to refocus the program to better serve patients and the providers who care for them.” Sen. Lamar Alexander has also requested a delay and is prepared to use legislation to achieve one if necessary.Read more here, and read the letter here.

34 Democratic senators, led by Sen. Al Franken, signed a letter asking CMS to prohibit nursing facilities from including binding pre-dispute arbitration clauses in admission contracts. The letter states, “All too often, only after a resident has suffered an injury or death, do families truly understand the impact of the arbitration agreement they have already signed.” The senators say CMS efforts to increase resident and family awareness of arbitration clauses are “well-intentioned” but do not adequately protect their rights. Read the letter here.

A Kaiser Health Tracking Poll finds that 81% of respondents support Medicare and private insurance coverage of end-of-life planning. 90% think doctors should talk to their patients about end-of-life care, but only 17% have had such discussions with their doctors. Read more.

An HHS report released yesterday finds that Medicare paid SNFs far more for therapy than the therapy actually cost over a ten-year period, as a rising number of SNFs billed for higher levels of therapy than necessary. In some cases, SNFs billed for therapy that was never provided.  This is leading some, the report’s authors among them, to urge CMS to reform the SNF payment system to prevent improper payments and facilitate care that is “better aligned with beneficiaries’ care needs.” Read more.

According to a federal audit released this week, Medicare reimbursed ambulance services for $30 million worth of questionable rides. In some cases, there are no records that the patients received any medical care before, during, or after the ambulance ride. Some ambulance services were paid for an average of 100 miles per ride – in urban centers, where the average ride is 10 miles. Philadelphia, Los Angeles, New York, and Houston are home to the largest numbers of suspicious rides. Read more.

As more negative side effects of antipsychotic medications become apparent and CMS calls for a reduction in their use, doctors and nursing homes can introduce more behavioral interventions to treat dementia. This article by Dr. Eleanor Barbera outlines the behavioral services used in place of antipsychotics in several countries and the VA. She calls for Medicare and Medicaid to reimburse behavioral health training for LTC facility staff, a move that several provider associations also support. Dr. Barbera points out the irony in being able to be reimbursed for counseling a resident who is upset by how a staff member treated him or her, but not for training the staff member in how to treat the resident better in the future.

New Jersey

Patients at New Jersey hospitals are less likely to contract a variety of hospital-acquired conditions, from infections to bedsores, thanks to an ACA-funded program that began in the state in 2011. Partnership for Patients, which has programs in several states, trains hospital personnel to protect patients from hospital-specific conditions. One of the most important improvements seen in New Jersey hospitals is the 7.7% reduction in readmission rates. Read more.


The Minnesota Department of Human Services compiled a question and answer document for concerns related to the value-based reimbursement program. The document covers questions related to everything from collective bargaining to cost reporting, rate setting, and health insurance. Download it here.

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