A weekly update of long-term care news and information for ASHS members. FRIDAY, NOVEMBER 08, 2013 HEADLINES
J&J pays out billions for promoting off-label use of Risperdal, other drugs Johnson & Johnson
settled with the Justice Department for more than $2.2 billion earlier this week. The settlement is the result of accusations that J&J marketed the drug Risperdal for off-label use, including the use of the drug for persons with dementia. The other drugs that J&J has been accused of inappropriately marketing are Natrecor and Invega, the latter another antipsychotic. Janssen Pharmaceuticals, the pharmaceutical subsidy of J&J, will plead guilty to a misdemeanor charge for inappropriate marketing of Risperdal, but J&J holds that it is innocent in regard to the civil charges. The settlement still has to be approved by federal court. ODM releases MyCare Ohio draft rules; consumer education docs The Ohio Department of Medicaid
(ODMfor the MyCare Ohio demonstration project for dual eligibles (the ICDS program). The rules provide more details on the administration of the program, including who is eligible, the appeals process, and covered services. For the most part, MyCare Ohio managed care organizations (MCOs) will be following the same rules as current Medicaid MCOs. In related news, ODM released MyCare Ohio "education documents" that are based upon the setting the eligible individual is located. These documents are part of an education and enrollment effort that ODM, in partnership with AGE and community providers, is currently in the process of implementing. The documents are available here: Draft payment reform initiative released The Office of Health Transformation (OHT) has moved its
attention from reforming long-term care services and supports, leaving that to the managed care companies in the form of MyCare Ohio, to payment reform for various other types of health care services. OHT recently those reform initiatives. The initiatives, part of the State Innovation Model grants, have the objective of generating better outcomes at lower cost. To do this, the state is focusing on different payment mechanism to reward value and better outcomes over utilization. The pay for performance models involve various collaborations between health care providers. This can occur via "patient centered medical homes" for consumers or episode-based payment to a group of providers for a specific health care incident. Most of the initiatives have limited direct impact on SNF services. The model that has the greatest potential to impact a SNF would be an episode-based payment for a hip or joint replacement. This model will be controlled by a "Principle Accountable Provider," which could be any type of provider that would be held accountable for the services provided and outcomes (most likely a hospital or primary care physician). The model is retrospective and retains the current fee-for-service structure. The coordinating providers with below average costs would receive incentive payments form above average cost coordinating providers. The payment reform initiatives will be rolled out over the next three to five years and will be eventually implemented State expects $118 million savings by streamlining LTCSS assessments The Kasich administration
has been working on reducing administrative costs via the streamlining and the elimination of redundant or unnecessary system processes. This summer, the Ohio Department of Medicaid held a retreat to evaluate system processes and determine areas for improvement. One area identified was the assessment process for long-term care services and supports. The new system will reduce process steps from 340 to 50 and decrease "decision points" from 60 to 10. It will also increase consumer involvement and allow for better data sharing between agencies and providers. The state anticipates saving over $118 million, mostly from nursing home diversions ($115 million). More information is Bill changing individual social worker requirements passes House The Ohio House passed H.B. 232,
a bill that makes changes to the State Counselor, Social Worker, and Marriage and Family Therapist Board and the individuals it licenses. The bill would, among other things, increase the requirements for an independent social worker. The bill now heads to the Senate. An analysis of the committee version of the bill i Academy accepting board nominations The Academy is currently accepting nominations for the Board of
Directors elections that will take place next month. Members in good standing can send them t The deadline to submit nominations is November KePRO to host webinar on QI programs Ohio KePRO is hosting a webinar that will present information
and updates on current quality initiatives in Ohio: The Quality Care Collaborative, the Advancing Excellence Campaign and the forth-comi Details of the new requirement for Ohio nursing homes to participate in quality improvement activities will also be provided. There will be time for questions and answers after the presentation. More information on the webinar scheduled for November 19 at 3 pm, including registration instructions CMS releases Part A coinsurance amounts CMS recently announced the inpatient hospital deductible and
the hospital and extended care services coinsurance amounts for services furnished in calendar year (CY) 2014 under Medicare's Hospital Insurance Program (Medicare Part A). For CY 2014, the inpatient hospital deductible will be $1,216. The daily coinsurance amounts for CY 2014 will be: $304 for the 61st through 90th day of hospitalization in a benefit period; $608 for lifetime reserve days; and $152 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period. The effective date is January 1, Federal Update. News and information from federal sources:
Final Rule CMS-1599-F: Discussion of the Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions. Tuesday, November 12, 2013 1:00pm – 2:00pm Eastern Time; Conference Call Only Participant Dial-In Number: 1-866-501-5502 CMS will host a Special Open Door Forum (ODF) call to allow hospitals, practitioners, and other interested parties to ask questions on the physician order and physician certification, inpatient hospital admission and medical review criteria that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) final rule (CMS-1599-F). Feedback and questions on the two midnight provision for admission and medical review can be sent t. Questions on Part B inpatient billing and the clarifications regarding the physician order and certification should be sent to the subject matter staff listed in the final rule. CMS also recently releas National Partnership to Improve Dementia Care in Nursing Homes — Register Now To Register: Visi Space may be limited, register early. Target Audience: Consumer and advocacy groups, nursing home providers, surveyor community, prescribers, professional associations, and other interested stakeholders CMS has developed a national partnership to improve the quality of care provided to individuals with dementia living in nursing homes. This partnership is focused on delivering health care that is person-centered, comprehensive, and interdisciplinary. By improving dementia care through the use of individualized, person- centered care approaches, CMS hopes to continue to reduce the use of unnecessary antipsychotic medications in nursing homes and eventually other care settings as well. The partnership promotes a systematic process to evaluate each person and identify approaches that are most likely to benefit that individual. While antipsychotic medications are the initial focus of the partnership, CMS recognizes that attention to other potentially harmful medications is also an important part of this initiative. During this MLN Connects Call, CMS subject matter experts will provide a brief overview of the progress that has been made so far during the implementation of this national partnership. Additional speakers will be presenting on the CMS Hand in Hand training series. A question and answer session will follow the presentation. Continuing education credit may be awarded for participation in certain MLN Connects Calls. Visit tweb page to The Centers for Medicare & Medicaid Services (CMS) issued a memorandum to all Part D sponsors and is available on the spotlight section of the hospice center web page at: CMS has announced the contract suppliers for the Round 1 Recompete of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. A list of Round 1 Recompete contract supplier locations for each product category and competitive bidding area is now available at This list is current as of October 31, 2013. Contract suppliers may add or change locations. Updates will be posted on the Medicare Supplier Directory website at in mid-December 2013. CMS is required by law to recompete contracts under the DMEPOS Competitive Bidding Program at least once every three years. The Round 1 Rebid contracts will expire on December 31, 2013, and the Round 1 Recompete contracts and prices are scheduled to go into effect on January 1, 2014. For more information, view t Copyright 2013 The Academy of Senior Health Sciences Inc., All Our mailing address is:
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