Federal News

VA Offering Free Webinars on Serving Veterans

 The VA’s Office of Community Care has started a free monthly webinar series that focus on providers that deliver care through the Veterans Choice Program (VCP) and Patient-Centered Community Care (PC3) networks, VCP Provider Agreements, and traditional community care.  The webinars are held every third and fourth Thursday of each month from 12:00-2:00 p.m.

The webinars scheduled for the third Thursday provide an overview of community care networks and programs. The next webinar is scheduled for January 17, 2019, and will provide an overview of Community Care programs and policies, focuses on how to file clean claims, and goes into other topics such as eligibility, referral, top rejection reasons and other provider issues.  

The webinars scheduled for the fourth Thursday are on health care-related topics, e.g. VA’s Opioid Safety Initiative, Traumatic Stress Disorder (PTSD), and military sexual trauma. The next webinar is scheduled for January 31, 2019, on “Tele-mental Health in the VA.” 

To access the webinars, participants must register via VHA TRAIN website.


HUD:  Providers Will Need to Rely on Reserves for Renewals During Shutdown

The federal government shutdown has struck the U.S. House and Urban Development Department (HUD) faster than expected. HUD did not renew 650 rental assistance contracts up for renewal in December, and there are an additional 500 contracts up for renewal in January that will not be renewed.

In a January 4 memo, HUD clearly stated its inability to renew the January contracts. However, we recently learned that 650 contracts that were up for renewal in December were not renewed prior to the shutdown that began on December 22. HUD sent notices on January 9 sent to owners and agents for these 1150 expired December and January contracts. 

Of the 650 contracts that expired in December, 224 of them are connected to Section 202 Housing for the Elderly communities' Project Rental Assistance Contracts. HUD said 92 percent of these 224 Section 202 communities have at least $3000 per unit in their reserve accounts. Reasoning that the average annual subsidy for a Section 202 unit is $7000, HUD believes these communities will be “fine for several months” by relying on their reserves. 

Section 202 owners with contracts expiring in January take note: you too are expected to rely on reserves as well during the shutdown. 

For additional information, including how to know whether you will be paid during the shutdown, please

read: Verifying Available Funds; Accessing Project Reserves. 

Take Action: Tell Congress to Fund HUD, End Shutdown. 

Questions or Concerns?  Please contact [email protected] and [email protected].


CMS Proposes Changes to Medicare Advantage Risk Adjustment for 2020

As a matter of background, in order to mitigate against the risk of only the healthiest Medicare beneficiaries being targeted to participate in the MA program, federal payments to MA plans are adjusted to reflect how sick their members are. The sicker a member is, the higher the payment to the member’s MA plan is supposed to be. 

Under the current risk adjustment model, the member’s level of sickness or “risk score” is determined in large part by identifying certain health conditions the member has that are included in the model, i.e., “payment conditions.” The proposed risk adjustment model in the Advance Notice would make a further adjustment as the number of payment conditions the member has increases, up to a maximum of 10 conditions. In addition, what constitutes payment conditions in the proposed model would expand to include categories for mental health, substance use disorder, and chronic kidney disease. 

As an alternative to the proposed model described above, the Advance Notice presents another payment condition count for public comment. This alternative model supplements the proposed model mentioned above by adding categories for pressure ulcers and dementia as payment conditions. CMS intends to phase-in implementation of one version of these new risk adjustment models beginning with 2020 payments, which payments are proposed to be a 50/50 blend of the current model and the new model. The 21st Century Cures Act requires full implementation of the new risk adjustment model by 2022.

The Advance Notice also includes a proposal to phase-in a change how CMS calculates an MA member’s risk score. For 2020, CMS proposes that half of the risk score be calculated using diagnoses from encounter data (i.e., treatment information from a clinician), Risk Adjustment Processing System (“RAPS”) inpatient diagnoses, and fee-for-service (“FFS”) diagnoses, and that half of the risk score will be calculated with diagnoses from RAPS and FFS diagnoses. This proposal would result in increased importance of encounter data to establish a member’s risk score. 

The second part of CMS’s Advance Notice regarding MA capitation rates and final payment policies for 2020 has not yet been released. Comments on the risk adjustment methodology modifications proposed in the first part are due February 19, 2019, and can be submitted here. CMS will publish the final 2020 MA rate announcement on or before April 1, 2019.


CMS Safety Focus:  Reducing Harm in Nursing Homes 

The Centers for Medicare & Medicaid Services released a new report that provides six key steps nursing homes can focus on first to avoid preventable harm. The report also provides detailed suggestions through adverse event “change packages” related to medication, resident care, infections and abuse/neglect.  

The report, All Cause Harm Prevention in Nursing Homes, is presented as a change package and provides a wide range of strategies and actions that nursing homes can take to promote resident safety. The report includes a two-page appendix with six strategies SNFs can pursue to get started, including shoring up staffing, identifying gaps in care, and promoting multidisciplinary team work. A  January 24 webinar from the National Nursing Home Quality Improvement Campaign will provide more details on the report and its recommendations.  

The report comes out just as LeadingAge Iowa is preparing the final details for the 2019 Spring Conference set to launch next month.  Members can expect sessions related to topics addressed in this report such as infection control and resident safety as well as many others.



Federal Government Issues EHR Usage Report on Post-Acute Providers 

More home health agencies (HHAs) than skilled nursing facilities (SNFs) have adopted electronic health records (EHRs), according to the Office of the National Coordinator for Health Information Technology (ONC). The new report, Electronic Health Record Adoption and Interoperability among U.S. Skilled Nursing Facilities in 2017 , shared these and other key findings:  

  • More HHAs (78 percent) adopted EHRs than SNFs (66 percent) in 2017.
  • A majority of HHAs that have an EHR used it for both reconciling and recording medications, and are more likely to use these functions than SNFs.
  • Only 36 percent of HHAs and 18 percent of SNFs were able to integrate patient health information received from outside facilities.
  • Over half of HHAs and 41 percent of SNFs electronically send or receive health information. Only 18 percent of SNFs integrate patient health information electronically received from outside sources. Hospitals' interoperability is at a similar level. While a large proportion send and receive health information electronically, fewer have the capability to electronically find or integrate data from outside sources.
  • HHAs (32 percent) and SNFs (37 percent) most commonly used EHRs to exchange health information. Yet at least 43 percent of HHAs and 29 percent of SNFs used more than one method to exchange health information electronically. 
  • HHAs and SNFs that use three methods of exchange are more likely to have information electronically available. Settings that used multiple methods of electronic exchange were more likely to engage in the four interoperability domains—sending, receiving, finding, and integrating health information received from outside sources—and were more likely to have information electronically available at the point of care. Although using multiple methods makes information more available, it also may make data exchange more complex and costly. 
  • Nearly 40 percent of HHAs used telehealth technology to keep track of patients’ health between in-person visits.
  • HHAs need to use technology during in-home patient visits and to monitor patients between visits. Three-fourths of HHAs (72 percent) used mobile technology. Of those, 85 percent directly entered data into the EHR during patient visits.
  • About four in 10 HHAs (37 percent) used telehealth. Use of telehealth technology did not vary by HHA ownership status (private vs. not) or location (urban vs. rural). 


Policies that advance interoperability in post-acute care settings are critical to ensuring that HHAs and SNFs can meet future demand for services and address their patients' complex health needs. However, SNFs and HHAs are not eligible to participate in the Medicare and Medicaid Promoting Interoperability Programs. The brief outlined two important building blocks to advancing health information exchange: 

  • Implementing federal policies such as the IMPACT Act
  • Making interoperability standards for standardized patient assessment data available through resources such as the CMS Data Element Library  
If you would like more information about EHR, please check out the CAST EHR Selection Tools.
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