2.  Education Credits  Previously:  National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) Administrators  CPE – Pa. State Board of Accountancy  RN – Pa. State Board of Nursing  New:  Personal Care (through state of Pa.)  RC/AL – Assisted Living Residence Administrators through NCERS  Dietary – Certifying Board for Dietary Managers  Looking to obtain - American Nurses Credentialing Center (ANCC) Credits for RNs with special certifications Membership Update

3.  PACAH Awards – Back by popular demand!  The following awards will be announced at the fall conference:  Administrator or CEO of the Year  CFO or Fiscal Director of the Year  Innovation Award  Business Member of the Year Award  Friend of PACAH Award  Nominations will open next month, continue through August 1 st.  Award winners selected by Executive Board  PLEASE PARTICIPATE! Membership Update

4.  New Member Referral Program– Refer your friends and colleagues!  Facility Members  Refer a facility = iPad Mini OR one full conference registration  Refer a new business member = $50 gift card  Business Members  Refer a new facility = one free vendor show registration  New business member = free full page color ad  Most of our new members come from current member referrals – you were already doing it, now get rewarded for it! Membership Update

5.  Regional Meetings  Life Safety Training  Webinar Series  Membership Calls Membership Update

6.  Governor Blue Lined appropriations bill at the end of December, long-term care line item was appropriated then but school funding, human services funding, and other funding was vetoed in part  Allowed budget bill to become law in March without signing, vetoed fiscal code  Major disagreements about revenue sufficiency, pension reform, education funding  Governor will also allow fiscal code bill to become law by not signing; will allow funds to school districts, earmarks Budget Update

8. Highlights Plans to raise the state income tax rate A tax on natural gas extraction Increasing education funding Restoring county human services line items cut by the previous administration There was also a proposed increase of the state's minimum wage from $7.25 an hour to $10.15. For the first time in years the IGT (Intergovernmental Transfer) was noted in the budget book Nursing facility rates were proposed at a one percent increase - $17 million Budget Update

9. Long-Term Care (6.4 Billion OLTL budget) Nursing facility rates – 1% increase = $17 million Long-term care line item itself was increased slightly, by approximately 7% ($4.1 Billion) Home and Community Based Services line item was increased by 23% For the first time in years the IGT (Intergovernmental Transfer) was noted in the budget book Included proposal for Home and Community based loans Also, received Federal Grant for $91 Million “money follows the person” grant to move individuals into HCBS services Budget Update

10. Other Issues: Assessment? BAF? Rates? Budget Update

11. Has been approved by CMS New Agreements Actual Numbers Removal of prohibition on returning funds Language noting that if there is a disallowance, it comes from the nursing home Other issues: This is not to be accounted as a “loan” to the state; this is a payment There can be a disallowance in future years for any reason Timeline is still to “IGT” on June 3, 2016 Budget Update

12. Introduced April 22, 2015 by Representative Killion (Del. Co.) Would eliminate the county share 10% non-federal portion of Medicaid costs counties are required to pay $18.5 million Passed Pa. House unanimously In Senate Health and Welfare Committee – needs to be scheduled for a vote Budget Update

13. MLTSS  Stands for Managed Long-term Services and Supports  In Pa. now called "Community Health Choices” or “CHC”  New initiative that will use managed care organizations to coordinate physical health care and long-term services and supports (LTSS) for older persons, persons with physical disabilities, and Pennsylvanians who are dually eligible for Medicare and Medicaid (dual eligible). COMMUNITY HEALTH CHOICES

14. What does that mean? Population served: Individuals with Medicaid-only coverage who receive or need LTSS Individuals with full Medicare and Medicaid coverage (dually eligible) All Nursing Facility Eligible individuals will be included in CHC Financial eligibility: OIM will continue to administer the Medicaid financial eligibility process through the County Assistance Offices Independent Enrollment Entity: Assist in filling out application Schedule CE screening MCO Choice Counseling Clinical Eligibility – done by a conflict free entity Community Health Choices

17. The Southwest zone (SW) includes Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland Counties. The Southeast zone (SE) includes Bucks, Chester, Delaware, Montgomery and Philadelphia Counties. The Lehigh/Capital zone (L/C) includes Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York Counties. The Northwest zone (NW) includes Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango and Warren Counties. The Northeast zone (NE) includes Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne and Wyoming Counties.

18. Community Health Choices The Southwest zone (SW) includes Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland Counties. The Southeast zone (SE) includes Bucks, Chester, Delaware, Montgomery and Philadelphia Counties. The Lehigh/Capital zone (L/C) includes Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York Counties. The Northwest zone (NW) includes Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango and Warren Counties. The Northeast zone (NE) includes Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne and Wyoming Counties.

19. Implementation - timeframe: March 1 st – CHC RFP Released May 2 nd – Deadline for submission of proposals July 2016 – CHC MCOs notified of selection (all regions) July 2016 – rate schedules released January 1, 2017 – Implementation in the Southwest January 1, 2018 – Implementation in the Southeast January 1, 2019 – Implementation in the Northwest, Lehigh-Capital and Northeast regions COMMUNITY HEALTH CHOICES

20. Who are the MCOs? Aetna Better Health* AmeriHealth Caritas Cigna-Health Spring Gateway Health Plan* Geisinger Health Plan* HealthPartners Plans Magellan Complete Care* Molina Healthcare* Pa. Health and Wellness, a Centene Company* United Healthcare* UPMC HealthPlan* Wellcare Health Plans* COMMUNITY HEALTH CHOICES

21. What does this mean for my facility: All nursing facility residents and those deemed nursing facility eligible who are Medicaid recipients will be covered by CHC MCOs will be responsible for developing a provider network Current residents will not be forced to leave a facility just because that facility is not in a network. New nursing facility eligible consumers will only be able to receive services from providers in their plan of choice’s network I am a willing MA provider, will I be guaranteed to be “in network”? There is a continuity of care period for 6 months after implementation where all willing providers must be in network. How will plans determine who is “in network”?

22. Nursing Facility Rates:  Rates will be negotiated between the provider and MCO  Rate schedules are to be released in July  Will there be a rate floor?  Will the county homes continue to be carved out of the rate system? In the RFP there is a separate place for a rate schedule for county homes and private homes  What will happen to supplemental payments like the NH Assessment and IGT: These payments will continue, payments will be allocated by MCOs according to requirements implemented by DHS. COMMUNITY HEALTH CHOICES

23. OTHER GENERAL IMPLEMENTATION CONCERNS FOR NURSING FACILITIES:  Timely Billing and payment, minimization of payment delays  Authorization and enrollment concerns, pre-authorization uniformity and retroactive payment consideration  Small facilities that feel as though they may be “cut-out” in a managed care environment  Funding Floor – restrictions on drastic cuts to rates  Resident wants vs. needs when it comes to placement  Safe and orderly discharge options – who is responsible  Credentialing standards  Coordination with licensure standards  Continuity of Care period  Excess administrative and paperwork requirements  Adequate discharge and HCBS options  The exclusion of ALs and PCs  As acuity trends , rates should as well

24. WHAT CAN I DO TO PREPARE? THIS IS HAPPENING!  Read the RFP, listen to the webinars, BECOME EDUCATED!  Network with the MCOs bidding on your region, DEVELOP RELATIONSHIPS  PREPARE TO DEMONSTRATE VALUE: be able to articulate data/outcomes; quality of care; align value with MCO goals  Work to improve quality indicators  Shorter stays are more attractive (reduce readmissions, ER visits, etc.,)  Make your facility an attractive one in a managed care environment  Look at increasing alternative services (short-term rehabilitation, specialty units, etc.)  BE PREPARED for shorter stays, census decrease

25. MEDICARE NETWORK CHANGES Highmark PAC Network Standards:  Highmark will be utilizing quality data (star rating) as well as data from Navihealth to determine which SNFs have successful patient outcomes and are delivering the highest quality of care  Cut 10 facilities from network in January – more to be announced in July, cut January 2017  “We no longer a need to include low quality providers”

26. MEDICARE NETWORK CHANGES Metrics :  LOS Variance 20% (Navihealth live safe tool)  Discharge Variance 20% (Navihealth live safe tool)  Discharge to community 5%  Overall star rating 5%  Quality star rating 5%  Cost per episode 10% - measures cost of claims paid per discharge  Risk adjustment readmit 10% - all information submitted to AHCA to determine how likely a readmission within 30 days of the acute discharge  30 day SNF readmission rate 15% - non-risk adjusted  60 day readmission rate 10%

27. MEDICARE NETWORK CHANGES Top 3 Opportunities for improvement (according to Highmark):  Length of stay  Patient function at discharge  60 day readmit rate GET A COPY OF YOUR SCORECARD! Additional Information on the scorecard or to receive a copy:  Lillian Sweeney – lsweeney@navihealth.us; Renee Riccelli rriccelli@navihealth.us

28. SEQUESTRATION ISSUES Highmark Sequestration reductions  Some facilities received contract amendments  Webinar held two weeks ago with K&L Gates to discuss legal options  Will be keeping membership apprised

29. DOH/LICENSING/ INCREASED SURVEYS Nursing Home Quality Task Force to look at need for updating regulations (last updated in 1999), other issues surrounding nursing home quality. Findings to be out this summer Auditor General reviewing DOH’s oversight of nursing homes Lawsuit filed by Attorney General last summer against various nursing homes alleging inadequate care Community Legal Services questioned number of “unfounded” complaints DOH now accepting anonymous complaints

30. kandrisano@pacounties.orgkandrisano@pacounties.org (717) 526-1010 Education is more important now than ever… Conferences, webinars, regional meetings. You can no longer afford to miss learning about the changes and what you need to do to keep up with them.