Issue: February 8, 2018

Published on February 8, 2018

Articles in this issue:

Congress Introduces Repeal of Medicare Therapy Caps

Author: Carl J. Pucci* Published in Finance & Reimbursement

A congressional bill to permanently repeal the Medicare Part B Outpatient Therapy Caps, retroactive to January 1, 2018, has been introduced. AHCA expects the therapy cap repeal to survive within the ultimate passage of the bill. Below is the AHCA Bulletin with more details: 

On Monday evening, Congressional leadership released a short-term plan to fund the federal government through March 23, 2018. The bill contains notable benefits for our profession, including a permanent repeal of the Medicare cap on therapy services and two years of funding for other Medicare extenders. The even better news is that there is no cut to our Part A Medicare to pay for this. The original proposal called for a $2 billion market basket cut but we succeeded in keeping that out of the bill.

What's in the Bill

The bill repeals Medicare Part B outpatient therapy caps retroactively to January 1, 2018. This is important in two ways. First, it means our residents will no longer have to worry if Medicare will pay for important therapy services. Second, it eliminates the largest recurring risk of skilled nursing facility (SNF) offsets since the doc fix. Since Congress will no longer have to pass annual or biannual patches to the therapy exceptions process, this dramatically reduces our risk of being cut every year.

Also included in the bill are some measures that will give regulatory relief concerning how therapy is tracked and reviewed. The legislation permanently restores the limited targeted post-pay medical review program established under the Medicare Access and CHIP Reauthorization Act (MACRA). The program lowers the medical review pool threshold for annual beneficiary covered charges from $3,700 for physical and speech and language therapy services combined or occupational therapy services to $3,000. It also limits annual funding for these reviews to $5 million annually. This eliminates the risk of previously problematic recovery audit contractors (RAC) reviews, prior-authorization and pre-pay reviews, as well as 100% review programs.

Part of the bill is paid for by creating a new designation of physical therapy and occupational therapy assistant services on Part B therapy claims and reducing payment for those services by 15% starting in 2022. The overall impact on SNFs would vary depending on the percentage of treatments furnished by therapy assistants. SNFs with no therapy assistants will not be affected. Most medium to large SNFs likely operate with between 25-50% of therapy furnished by therapy assistants, so we estimate the negative revenue impact for most of these SNFs starting CY 2022 would range from 2.9-5.9% of their Part B Medicare payments. We are currently conducting additional impact analyses and will provide updates as they become available.  
Without repeal of the therapy caps, revenue and quality of care could suffer significantly. We estimate, without repeal, that SNF Part B therapy revenues would decline more than $811 million per year (37% of total Part B payments). SNF Requirements of Participation require maintaining resident function at the highest practicable level. However, most long-term residents are on Medicaid or otherwise may have limited funds and cannot pay privately for therapy services. This could stress SNF nursing staffing further to address the functional needs of these residents if therapy is not an option. As a result, we believe the benefits of permanently repealing the therapy cap outweigh the therapy assistant pay-for.

Path to Passage

There is partisan disagreement over parts of the bill unrelated to our sector and the path to passage is slightly murky. The bill can pass with Republican support alone in the House, but the GOP will need Democratic support to break the 60-vote filibuster threshold in the Senate.

What we do know is that the House will likely vote on and pass the bill Tuesday evening. Republicans included a year-long extension of defense spending in the bill to garner the support of more conservative members of the party.

Senate Democrats want to see any defense spending extension matched with a non-defense extension. Republicans need at least nine Democratic Senators to vote for the legislation, and will need one more if Senator John McCain, currently undergoing cancer treatment in Arizona, cannot make it to D.C. Many expect the Senate to reject the House version, amend the bill to match defense and non-defense extensions, and send that version of the bill back to the House.

The deadline to extend federal government funding is this Thursday, February 8. House Democrats are scheduled to attend their annual party retreat starting Wednesday afternoon but may be forced to stay in Washington while the Senate reaches a deal.

We don't know with certainty what will happen with the continuing resolutions to fund the federal budget, but we do believe that the elimination of therapy caps should stay in whatever is ultimately passed. We will continue to keep you updated as the bill moves this week.


Mark Parkinson
President & CEO


Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

Medicaid Update - January 2018

Author: Carl J. Pucci

Dear Medicaid Provider,

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the January 2018 Medicaid Update. Please find the full current issue as a PDF (Portable Document Format) file available to be downloaded at:   


Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

Managed Long Term Care Webinar

Author: Amanda Vandenburgh

Understanding BPCI Advanced for Skilled Nursing Facilities

This webinar will provide attendees with an overview of BPCI (Bundled Payments of Care Improvement Advanced). The attendees will have an understanding of the following:

For the flyer containing the registration link, Click Here

Leadership in Person Centered Care: The Oasis Curriculum Train-the-Trainer Program


Leadership in Person Centered Care is a 2-day Train-the-Trainer program for nursing home and assisted living leadership teams to implement the Oasis curriculum in their organizations.  This program will provide in-depth training on the philosophy of Oasis, the four training modules, Oasis for families, the interactive exercises and videos that accompany the curriculum, and strategies for training staff and implementation of the program. The Oasis teams who attend this training will be prepared to provide 8-10 hours of Oasis training across all disciplines in their organization.

Who Should Attend

The Program is designed for Oasis teams, including Administrator, Director of Nursing, Social Workers, Nurse Educators from Skilled Nursing Facilities and Assisted Living Facilities. Applicants MUST be employed in one of the following Counties of New York: Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk.

Location, Time & Dates

Cold Spring Hills Center for Nursing & Rehab
378 Syosset-Woodbury Rd.
Woodbury, NY 11797

Time: 9:00 am – 4:00 pm

Session 1:  Thursday, March 1, 2018

Session 2:  Friday, March 2, 2018

Program Fees

Selected Facilities will be required to submit a minimal program fee of $50 for up to three participants prior to enrollment into the course. The remaining cost of this program is being funded through a grant from the New York State Department of Health & Department of Labor Health Workforce Retraining Initiative (HWRI).

Attached is the brochure and application.  Applications must be received prior to Tuesday, February 20, 2018.

FQC Contact:

Amanda Vandenburgh
Program Assistant
518-462-4800, Ext. 21

2018 Nursing Scholarship Program Accepting Applications


Once again we are pleased to announce the Foundation for Quality Care Nursing Scholarship Program. The Foundation for Quality Care, the research and education affiliate of the New York State Health Facilities Association (NYSHFA), will administer the Ruth E. Stafford and James D. Durante Nursing Scholarship Program for 2018. This Scholarship Fund Program has been established to provide financial support to incumbent employees of NYSHFA/NYSCAL member facilities who are also nursing students pursuing careers in long term care. The Durante/Stafford Scholarships will now be awarded to students/nurses in three categories:

Skilled Nursing

Category I:  Students pursuing licenses as a practical nurse or registered nurse.  Two scholarships for $2,000 each are available for the Category I Scholarship.

Category II:  Registered nurses pursuing advanced degrees in nursing (Bachelors, Masters, Doctorate, Nurse Practitioner, Clinical Specialist).  Two scholarships for $2,000 each are available for the Category II Scholarship.

Assisted Living

Students pursuing licenses as a practical nurse or registered nurse.  One scholarship for $2,000 is available.

The winners will be selected by NYSHFA’s Nurse Leadership Advisory Committee and awarded their Scholarship at the Annual Nurse Leadership Conference on May 3, 2018 in Verona, New York.

Scholarship Criteria and Submission Information:

Attached are the Scholarship Brochure, Application and Recommendation forms. At the time of application, and when the scholarships are awarded, applicants must be employed by a long term care facility that is a member in good standing of the New York State Health Facilities Association/New York State Center for AssistedLiving. Applicants must be applying to or enrolled in / accepted to an accredited school of nursing program for the 2018-2019 academic year.

Applications are due by February 28, 2018.

If you have questions regarding this program, please contact Nancy Leveille or Joanne O'Connor at the Foundation for Quality Care.


Nancy Leveille, RN, MS
Executive Director
518-462-4800 x20

Joanne O'Connor
Communications & Business Development Coordinator
518-462-4800 ext. 23

Last Chance to Register! Webinar -The Next Phase of the ROP: Antibiotic Stewardship in LTC Facilities 101


NYSHFA/NYSCAL will host a Webinar on Thursday, February 15th entitled "The Next Phase of the ROP: Antibiotic Stewardship in LTC Facilities 101".

Effective Nov. 28, 2017, all Medicare and Medicaid-certified nursing homes must have an antibiotic stewardship program that includes antibiotic-use protocols and a system to monitor antibiotic use as part of their infection prevention and control program. The antibiotic stewardship program is a section of the Phase 2 Requirements of Participation. Surveyors will assess compliance under F-tag 881 during the Infection Control Facility Task as a part of the new survey process. In 2015 The CDC’s Core Elements of Antibiotic Stewardship for Nursing Homes was born, utilizing the recommendations of the CDC Core Elements of the Hospital Antibiotic Stewardship Program. These recommendations are the standard for what an Antibiotic Stewardship Program should look like. This presentation will examine the 7 elements that are contained in the standard and review what needs to be done to satisfy the requirements.

Click here for more details. 

NYCACHCA 2018 Annual Conference


The 2018 NYCACHCA Annual Conference is being held March 11-14th at Villa Roma Resort in Callicoon, NY. With programs for Administrators, CFOs and Clinicians, this 4-day conference has something for everyone! Click here for additional details and registration information.

15th Annual Social Service & Activities Conference


Join NYSHFA/NYSCAL for the 15th Annual Social Service & Activities Conference. The conference is being held March 22-23rd at the Saratoga Holiday Inn. The program is approved for 10 contact hours for Social Workers and Activity Directors. This year's Hot topics include: Behavioral Health; eMOLST; Communication; Holistic Wellness and many more.  Click here for additional details and registration options. 

Audio Conference - An Integrated Care Model: The Role of Behavioral Health Services in LTC


On Thursday March 22nd, NYSHFA/NYSCAL will host an audio confernece entitled "An Integrated Care Model: The Role of Behavioral Health Services in LTC". The role of long term care facilities in addressing resident’s health care needs continues to evolve at a rapid pace. One area where more is being expected involves identifying and responding to residents who are at risk of developing, or exhibiting behavioral or emotional needs. The broad term behavioral health covers a wide range of clinical issues including, but not limited to, trauma informed care, dementia care, depression, behavior management, pharmacological management, and optimizing the care of the chronically mentally ill. The evolution in the role of LTC facilities is being driven in part by research, which has established that mental health care is a key component in achieving quality care outcomes. Whether the care is focused on short term rehabilitation, medical compliance, palliative care, or decreasing re-hospitalization rates, the resident’s psychological state and wellbeing will affect every aspect of care. This presentation will focus on a variety of behavioral health issues faced by facilities, address key compliance issues, and describe strategies to optimize behavioral health care.

Click here for additional details. 

Audio Conference - Discharge to Community: Safe Transitions to Reduce Hospitalizations


On Thursday, March 29th, NYSHFA/NYSCAL will host an audio conference entitled "Discharge to Community: Safe Transitions to Reduce Hospitalizations". Discharge to community claims-based quality measure creates a challenge to the status quo to change the current process to resident centered planning from the day of admission to the skilled nursing facility and more importantly the discharge planning process. Discharge planning is an interdisciplinary team approach to not only transitioning to the next level of care, but to the next level of care with a solid discharge plan to reduce hospitalizations and emergency department utilization. Understanding what led up to the person’s hospitalization and including this in the discharge planning is an important element in safe transitioning to the appropriate level of care. This program explores various evaluations, and ideas to understanding barriers for transitions as well as community resources and alternate resources for care levels such as Assisted Living available to transition safely. Click here for more details. 


Audio Conference - Cyber Security & CMS Nursing Home Recommendations


On Wednesday, April 25th NYSHFA/NYSCAL will host an audio conference entitled "Cyber Security & CMS Nursing Home Recommendations". On January 13, 2017 the Survey & Certification Group released recommendations to providers regarding cyber security. A review of cyber security policies and procedures is recommended by the agency as part of the “All Hazards Approach to Emergency Preparedness”. In this session we will detail best practices to help keep your facilities safe from cybercrime incidents. We will be taking a deep dive into topics such as: Disruptions to patient care, including missing information, potential compromise of Protected Health Information & Personally Identifiable Information  and loss of electronic health records. Click here for more details.