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HHS Makes Changes to COVID-19 Provider Relief Fund Requirements<p>The Department of Health and Human Services (HHS) has made changes to the reporting requirements and expanded the types of providers who could apply for COVID-19 Provider Relief Funds (PRFs), according to an update from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). </p><p>The association said the keys from the announcement include&#58;&#160;</p><ul style="list-style-type&#58;disc;"><li>HHS is returning to its previous definition of lost revenue, a decrease from 2019 revenue, rather than using the Sept. 19 version that would have capped funds to a facility's 2019 net revenue.&#160;</li><li>HHS has created new flexibility around reporting at the parent and subsidiary level.&#160;</li><li>HHS now is allowing private-pay assisted living communities to apply for Phase 3 awards.&#160;</li></ul><p>In its press release, HHS said, “In response to concerns raised, HHS is amending the reporting instructions to increase flexibility around how providers can apply PRF money toward lost revenue attributable to coronavirus.&quot;</p><p>The agency said after reimbursing health care-related expenses attributable to coronavirus that were unreimbursed by other sources, providers may use remaining PRF funds to cover any lost revenue, “measured as a negative change in year-over-year actual revenue from patient care related sources.&quot;&#160;</p><p>All Phase 3 applicants have until 11&#58;59 p.m. (ET) on Nov. 6 to submit their applications for payment consideration, AHCA/NCAL said. <br></p><ul style="list-style-type&#58;disc;"><li>Read the&#160;<a href="https&#58;//">HHS Press Release</a>.</li><li>Download the&#160;<a href="https&#58;//">policy memorandum</a>&#160;on the reporting requirement decision.</li><li>Download the&#160;<a href="https&#58;//">amended reporting requirements guidance</a>.</li></ul><p>For updates and to learn more about the Provider Relief Program, visit&#58;&#160;<a href="https&#58;//"></a>.&#160; </p><p>​</p>2020-10-23T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/mask_2.jpg" style="BORDER&#58;0px solid;" />COVID-19Patrick Connole​HHS says it is amending the reporting instructions to increase flexibility around how providers can apply PRF money toward lost revenue attributable to the coronavirus.
Provider Groups Urge Congress to Extend Relief From Medicare Sequester Cuts Into 2021<p>The American Health Care Association, American Hospital Association, American Medical Association, and National Association for Homecare and Hospice wrote congressional leaders on Oct. 21 urging them to extend the congressionally enacted moratorium on the application of the Medicare sequester cuts into 2021 and through the duration of the public health emergency (PHE) caused by the COVID-19 pandemic. </p><p>In total, these organizations provide health care to more than 62 million Medicare patients, and the persistently high COVID-19 rates across the country are stressing the health care system, they said. </p><p>The letter to House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Mitch McConnell (R-Ky.) urges extension of the relief from the 2 percent sequester cut enacted in the CARES Act that afforded critical relief during the pandemic to all providers who participate in the Medicare program through the end of 2020.</p><p>“Physicians, nurses, hospitals, health systems, long term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and hospices have been hit hard by the pandemic, incurring significant expenses to treat the sick, but experiencing historic financial losses due to the decrease in inpatient and outpatient services,” the letter said.</p><p>Relief from the 2 percent sequester cut by way of the CARES Act afforded critical relief during the PHE to all providers who participate in the Medicare program through the end of 2020, it continued. </p><p>“Clearly Congress recognized the importance of this relief for the duration of the PHE. Given that the PHE is certain to continue into 2021, it is a safe assumption that America’s health care providers will continue to face the overwhelming financial challenges and pressures<br>associated with higher overhead costs due to personal protective equipment and other safeguards, lost revenue due to delayed elective procedures and/or forgone routine visits, and hazard pay to staff.”</p><p>The organizations said they are grateful that Congress has provided a much-needed reprieve from the Medicare sequestration since May. Without future sequestration relief, however, America’s health care safety net could be at risk of collapse, they said.<br></p>2020-10-22T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/mask_4.jpg" style="BORDER&#58;0px solid;" />PolicyPatrick ConnoleGiven that the public health emergency is certain to continue, it is safe to assume that America’s health care providers will continue to face the overwhelming financial challenges associated with higher overhead costs, the groups said.
AHCA, NCAL Gold Quality Award Achievers Talk Strategy, Sacrifice<blockquote><h4><span class="ms-rteThemeForeColor-6-4 ms-rteFontSize-2">National Quality Awards Ceremony </span></h4><h4><span class="ms-rteThemeForeColor-6-4 ms-rteFontSize-2"><strong>Don’t miss the Live National Quality Awards Ceremony, which begins at 2&#58;00 p.m. ET Thursday, Oct. 22, in the General Session and Special Events Theater in conjunction with AHCA/NCAL’s 70th Virtual Convention &amp; Expo. </strong></span></h4><h4><span class="ms-rteThemeForeColor-6-4 ms-rteFontSize-2"><strong>All 719 Bronze, 147 Silver, and 4 Gold recipients will be honored. Attendees are invited to join in the chat function to share congratulatory messages and shout out to other 2020 recipients. </strong></span></h4><h4><span class="ms-rteThemeForeColor-6-4"><strong class="ms-rteFontSize-2"> Registration for the convention closes Friday, Oct. 23. Not signed up?</strong><span class="ms-rteFontSize-2"> </span><a href="https&#58;//"><strong class="ms-rteThemeForeColor-6-4 ms-rteFontSize-2">Register now.</strong></a> </span></h4></blockquote><p></p> <style> p.MsoNormal, li.MsoNormal, div.MsoNormal { margin:0in; font-size:11.0pt; font-family:"Calibri",sans-serif; } a:link, span.MsoHyperlink { color:#0563C1; text-decoration:underline; } span.MsoHyperlinkFollowed { color:#954F72; text-decoration:underline; } .MsoChpDefault { font-size:11.0pt; font-family:"Calibri",sans-serif; } .MsoPapDefault { margin-bottom:8.0pt; line-height:107%; } div.WordSection1 { } </style> <p>A quartet of providers has received the preeminent Gold National Quality Award designation from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) for 2020 and is being honored for their achievement during the association’s annual convention that runs on a virtual basis through the month of October.</p><p>Jane Martin, RN, director of nursing, Treutlen Health and Rehabilitation, Soperton, Ga., says for her 50-bed facility in rural Georgia the latest attempt to achieve Gold started five years back when the organization earned Bronze from AHCA/NCAL, then Silver in 2017.</p><p>“That is when we decided to go for the Gold,” she says. “We [earned] a site visit last year and then this year got the Gold award.”</p><p>Going for the top honor and going for the Bronze or Silver are worlds apart, Martin notes. “The Gold is so much different, and you really need to dedicate time to it.” This work includes copious writing down to report quality-based outcomes for residents, since getting positive results is what the award process is all about, she says.</p><p>“Probably the most difficult things is collecting the data. Everything has a different measurement time frame, so I really rely on LTC Trend Tracker [from AHCA/NCAL], NursingHome Compare…You need to know all of these data today on a regular basis.”</p><p>Once all the hard work resulted in the Gold, Martin says sharing the good news, in a COVID-sensitive manner, was a great feeling for staff and residents alike.</p><p>“We were in a huge open area when we told them, and it was a lot of yelling through masks,” she says. “It was kind of sad that we could not hug or have family there, but we did our best.”</p><p>As for what she would tell fellow providers about the award program, Martin says facilities should do it; even though it is not easy, it is well worth it. “We all learned so much through the process, and there were so many little things along the way, it has changed the way we live and work here.”</p><p>Kristin Thrun, administrator, Burgess Square Healthcare and Rehab Centre, Westmont, Ill., says her nursing home got into the quality award world because back in 2012 when accountable care organizations and other value-based care entities emerged in her area, it became imperative for her facility to set itself apart.</p><p>“The focus became even more pronounced on overall performance outcomes and quality measures, and becoming part of the AHCA award process helped us to do this in a systematic way,” she says.</p><p>After receiving some local awards for their work with residents, the facility earned Bronze from AHCA/NCAL in 2017 and then eyed going for Gold after that. </p><p>“I think the biggest challenge is continuing to push forward in terms of meeting the criteria and putting our programs in place and sustaining them despite the external challenges brought on by things like changes in payment models [person-directed payment model] and keeping pace with those,” Thrun says.</p><p>An example she gives is the challenge it was to make the systemic change on medication reconciliation when a resident moved from the hospital to the nursing home. “We worked with the hospital to change the process and reduce errors tied to these transitions of care and created a pharmacy position that just does admission reviews for new patients coming in,” she says. </p><p>The third achieving group says its journey to Gold began 18 years ago, according to Gail Cushing, RN, executive director, Applewood Center, Winchester, N.H.</p><p>“It has been a long journey for sure, but we continued to forge on throughout the time, but it did not prevent us from getting to where we wanted to go,” she says.</p><p>The greatest thing about the Gold process, Cushing says, is that it gave Applewood Center and its staff new skill sets to be able to adapt to new demands. “We can take new problems and adapt very quickly. An example is with COVID-19; I have said handling the pandemic was made more manageable because we went through a dress rehearsal with the Gold awards.”</p><p>For her, the award application has taught her and her people to communicate better, get feedback, educate, teach, and fix pitfalls. One example is that during the pandemic, her staff came up with a way to clean their goggles when there was no water source in an area where people were working.</p><p>“The whole Gold process is a concept really that provides a facility&#160;with new means to achieve success, and the more you practice, the better you become and the more ingrained it all becomes,” Cushing says.</p><p>Katie Frederick, administrator, Heritage of Bel-Air, Norfolk, Neb., started out talking about the end game of achieving Gold, which was the joy she, her 160-strong staff, and residents felt at accomplishing so much. Even though the pandemic has made a true celebration difficult, she says the pride all in the community feel about making Gold is real.</p><p>For her, making changes to be more efficient and better at evaluating results and outcomes is the lasting impact going through the award process will have. </p><p>“Evaluating and learning is what this has all been about. And, really getting better at communicating, listening to each other, and putting ideas into practice. That has all worked for us,” Frederick says.</p><p>Looking ahead to 2021, AHCA/NCAL said the deadline to submit an Intent to Apply for a 2021 National Quality Award is Nov. 12 by 8 p.m. (ET). For more information, visit the Quality Award <a href="https&#58;//">website</a>.</p>2020-10-21T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0220_News2.jpg" style="BORDER&#58;0px solid;" />Quality AwardsPatrick ConnoleAll Quality Award recipients are being honored Oct. 22 at the association’s 70th Virtual Convention & Expo going on this month and live on Thursday the 22nd.
AHCA, NCAL Say Even with COVID Restrictions, Residents Have Right to Vote<p>​As Election Day nears, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said residents of long term care (LTC) facilities have a right to have their voices heard, even if the communities in which they live are operating with COVID-19 restrictions.</p><p>“With the election less than a month away and a pandemic that uniquely targets the LTC population still rampant, providers have an opportunity to play a larger role in helping residents exercise their right to vote in 2020,” AHCA/NCAL said.</p><p>“As the prevalence of COVID-19 continues to require targeted restrictions and precautions for indoor visiting, previous strategies to facilitate voting for residents, such as making facilities polling places on Election Day, have likely shifted to reduce the risk to residents and staff. Nonetheless, our seniors and other residents have a right to make their voice heard, and providers should make every effort to assist them in doing so.”</p><p>To learn more, go to <a href="https&#58;//">https&#58;//</a>.</p><p>In other developments, the Centers for Disease Control and Prevention (CDC) is releasing a new pathway through its National Healthcare Safety Network (NHSN) LTCF COVID-19 Module that will allow providers to report the results of their Point of Care (POC) COVID-19 testing. <a href="https&#58;//">Read More.</a><br></p>2020-10-21T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/senior_man_nurse.jpg" style="BORDER&#58;0px solid;" />ManagementPatrick ConnoleLTC residents have a right to have their voices heard, even if the facilities in which they live are operating with COVID-19 restrictions.



Mother-Daughter Team Makes Waves Team Makes Waves<p><img src="/Topics/Guest-Columns/PublishingImages/IMG_2217.jpg" alt="Kris Mastrangelo, Savannah James" class="ms-rtePosition-1" style="margin:5px 20px;width:295px;height:429px;" />Kris Mastrangelo, OTR/L, LNHA, MBA, chief executive officer and president of Harmony Healthcare International (HHI), shares her journey of over 20 years in the long term health care industry. </p><p><strong><em>Provider</em>: You have been quoted in the past saying, “I left what I thought was my dream job to start Harmony, and now this is the dream job." Why did you start Harmony? </strong></p><p><strong>Mastrangelo:</strong> Initially, I began Harmony in 2001 to lessen my travel for work as I was on the road every week, and I had two young daughters—Savannah 2 ½ and Carissa nine months old. However, within two years of starting the company, the client base grew beyond the New England area, and it became apparent that travel would always be a part of my job.</p><p>As the company grew, so did the family, adding two more daughters, Alexandra the Great in 2003 and Mia in 2007. In addition to the travel, I noted that the work I was completing for nursing homes across the country was necessary and relevant as a third-party, unrelated vendor [versus being a department within the organization] to provide the client with unbiased, objective analysis and systems implementation.</p><p>Systems require oversight and refinement, and often companies are too close to the situation to see the necessary change or opportunity. Consulting to different organizations was vastly different from being a VP [vice president] in one organization. Consulting brought a deeper understanding and awareness of different ways to solve the same problem or opportunity. </p><p><strong><span><strong><em>Provider</em></strong></span>: </strong><strong> </strong><strong>What did you see that was missing from the industry that Harmony could provide?</strong></p><p><strong>Mastrangelo:</strong> HHI connects the dots between care and:</p><ul><li><strong>C</strong>ompliance</li><li><strong>A</strong>uditing</li><li><strong>A</strong>nalysis</li><li><strong>R</strong>eimbursement</li><li><strong>R</strong>egulatory</li><li><strong>R</strong>ehabilitation</li><li><strong>E</strong>ducation </li><li><strong>E</strong>fficiency</li><li><strong>S</strong>urvey</li></ul><p>Back in 1998, the Medicare Part A reimbursement system transformed from a retrospective cost-based system to a prospective payment system (PPS). This was the first step in which the health care services rendered to the patient/resident directly impacted the rate of reimbursement.</p><p>Before 1998, clinicians virtually had zero fiscal responsibility. As an occupational therapist (OT), licensed nursing home administrator (LNHA), MBA, and, most importantly, the daughter of a mathematician/systems electrical engineer, I could translate the care [service delivery] into the numbers [reimbursement], a powerful combination back then. </p><p><strong><span><strong><em>Provider</em></strong></span>: What do you wish you knew as a young entrepreneur that you know today?</strong></p><p><strong>Mastrangelo: </strong>There is nothing that I wish I knew back then that I know today because every mistake is an educational experience on how not to do it next time. I am all about the journey. While I always have a sense of urgency to get the job done right, I know today that errors can make us better. </p><p>However, two concepts that do resonate:</p><ol><li>If it isn't broke, do not fix it. Andy Turner, Sun Health Group, used to say that to us all the time. Yes, it is crucial to refine and improve, but don't blow up a system for a minor change. </li><li>Prioritization is a skill set. Knowing what requires your attention first is how you need to manage every day. Because, as an entrepreneur, there is always something on the to-do list. </li></ol><p><strong><em>Provider</em>: How has your daughter becoming an entrepreneur in the health care industry changed your relationship? </strong></p><p><strong>Mastrangelo:</strong> Savannah and I have always had a very close relationship and having her begin her career in the health care industry has only strengthened our bond. When Savannah was away for college, we talked every day. And this has not changed. Our conversations are endless, and we jump from subject matter to subject matter with excitement and curiosity. She retains complex, voluminous amounts of information while being able to distill and synthesize the subject matter…. with apparent ease. This affords everyone the benefit of her creations and ideas.</p><p><strong><em>Provider</em>: Tuning in to your motherly intuition, is this the path you knew she would take, or did you imagine her in another field?</strong></p><p><strong>Mastrangelo:</strong> I always knew that Savannah would be an entrepreneur. I didn't expect her to do it so quickly and so gracefully. She was on the path to be an OT during her freshman year of college. Two things happened.</p><ul><li>She decided, “for fun," to take a computer class the summer of her Tufts University freshman year into her sophomore year, and she loved it.</li><li>The OT profession was discussing the need for doctorate degrees for the trade. Savannah attended a rigorous, academically intense high school and wanted to get into the workforce before graduating college.</li></ul><h2><span class="ms-rteForeColor-10 ms-rteFontSize-3">Savannah James</span></h2><p>Developing a calculator to determine the reimbursement rates for patients in a long term health care facility may not be what a young mind dreams of creating when imagining the future. For Savannah James, daughter of Kris Mastrangelo, reimbursement, patient advocacy, and the complexities of ever-changing regulations have always been standard dinner table talk. The mother-daughter team is rare in the health care industry, let alone the technology field, with two generations mirroring one another's journey through entrepreneurship. <strong><br></strong></p><p><strong><em>Provider</em>: Please describe Hopforce.</strong></p><p><strong>James:</strong> Hopforce's mission is to optimize processes (via technology) in the health care industry. Our primary focus is the PDPM [patient-driven payment model] calculator, i.e.,, specifically designed for the long term health care industry and specific Medicaid Case-Mix States. In just a couple of clicks, the user can obtain the Medicare Part A or Medicaid Case-Mix reimbursement level by day and for the entire patient stay. </p><p>Simplicity in the calculator functionality is paramount; it was important that we make<span style="text-decoration:line-through;"> </span> (The PDPM Calculator), user-friendly for those who are less enthusiastic<span style="text-decoration:line-through;"> </span>about technology. More importantly, Hopforce provides accurate data, reliable results, that are readily and efficiently displayed despite the dense and often confusing, multifaceted regulations. There are approximately 60,000 potential combination of HIPPS [Health Insurance Prospective Payment System] Codes for every Medicare Part A patient. The opportunity for miscoding or missing an element of care can result in colossal mistakes that impact the facility and patient care.</p><p><strong></strong><strong><em>Provider</em>: What was the inspiration behind Hopforce?</strong></p><p><strong>James:</strong> I have a background in computer science, software development, and psychology. During my education, I became passionate about optimization and reducing human error. I grew up with a family engrossed in health care, so discussions about what worked and what didn't work in the industry were daily dialogue. The notion of removing the inefficiencies that exist in current processes that are ripe for human error and improving patient care truly spoke to me. </p><p><strong><em>Provider</em>: What has the feedback been like since you launched Hopforce?</strong></p><p><strong>James:</strong> The reaction has been outstanding! Users provide ongoing feedback and say it has “improved the lives of MDS coordinators, decreasing their stress and enhancing their jobs' efficiency." </p><p><strong><em>Provider</em>: Many startups are concerned about setbacks due to COVID19, quarantining, social distancing, and the restrictive nature of hospitals and long term health care facilities. How has this time helped or hurt Hopforce?</strong></p><p><strong>James:</strong> There has been a massive surge in usage due to COVID because no one knew how to code for this, let alone code correctly, to receive proper reimbursement and use a new payment model. It was rewarding to offer a level of ease and assistance in helping the long term care facilities generate the information they needed to activate the funds for the most vulnerable population. Using a haphazardly written spreadsheet that does not give accurate data paired with COVID is disastrous for the facility and the patient. </p><p><strong><em>Provider</em>: What are your aspirations for Hopforce as it grows? If you could describe the dream, barring any setbacks, what do you envision?</strong></p><p><strong>James:</strong> My biggest dream for Hopforce is expanding into other realms of health care that need optimization and improvement. I would like to be able to facilitate them while pioneering how to protect the data. Further down the line, I want to develop software to assist health care disparities toward women and people of color. </p><p><strong><em>Provider</em>: What is it like directly working with your mother? How has it changed your relationship?</strong></p><p><strong>James:</strong> I have always looked up to my mom. To be in the arena, side by side, it is exciting to run with her and watch her operate. She is a genius and inspiring to watch her problem-solve. I am excited to offer what I do well and be able to play in the same stratosphere, especially in tech, which is so male dominated. I do not think that you see too many mother-daughter duos in the health care and tech field. It's exciting to be pioneering this today in the climate of our country.</p><p>Kris Mastrangelo, OTR/L, LNHA, MBA, is chief executive officer and president of Harmony Healthcare International. She can be reached at <a href="" target="_blank"></a>. Her daughter, Savannah James, is founder of the PDPM calculator, Hopforce. Savannah James can be reached at <a href="" target="_blank"></a>.</p><p>​</p>Kris Mastrangelo shares lessons learned from her first years as an entrepreneur and what it’s like cultivating a professional relationship with her daughter.2020-10-01T04:00:00Z<img alt="" src="/Topics/Guest-Columns/PublishingImages/KrisSavannah.jpg" style="BORDER:0px solid;" />ManagementMastrangelo and James


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