Title: Survival Guide for Long-Term Care Providers Update Since SB 1202 Presentation by the Agency for Health Care Administration September/October 2002
1Survival Guide for Long-Term Care
ProvidersUpdate Since SB 1202Presentation by
the Agency for Health Care AdministrationSeptembe
r/October 2002
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
2Updates Recent Activities
- SB 1202 Questions Answers Adverse Incidents
- Liability Claims and Insurance
- 2002 Legislative Changes
- Nursing Home Staffing
- Alzheimers Training
- Gold Seal Program
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
3New Slides
- Blue Background
- Underlined Text
- Added to Presentation
- Not in Handout
- Post on AHCA Web Site
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
4SB 1202 Emphasis on Adverse Incidents
- Asked Quality of Care Monitors
- Definition of Adverse Incidents
- Questions and Answers Published
- February 2002
- May 2002
-
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
5Adverse Incident Definition
- Florida Statutes 400.147(5)
- (a) An event over which facility personnel could
exercise control and which is associated in whole
or in part with the facility's intervention,
rather than the condition for which such
intervention occurred, and which results in one
of the following
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
6Adverse Incident Definition
- Florida Statutes 400.147(5)(a) continued
- 1. Death
- 2. Brain or spinal damage
- 3. Permanent disfigurement
- 4. Fracture or dislocation of bones or joints
- 5. A limitation of neurological, physical, or
sensory function - 6. Any condition that required medical attention
to which the resident has not given his or her
informed consent, including failure to honor
advanced directives or - 7. Any condition that required the transfer of
the resident, within or outside the facility, to
a unit providing a more acute level of care due
to the adverse incident, rather than the
resident's condition prior to the adverse
incident
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
7Adverse Incident Definition
- Florida Statutes 400.147(5)
- (b) Abuse, neglect, or exploitation as defined in
s.415.102 - (c) Abuse, neglect and harm as defined in s.
39.01 - (d) Resident elopement or
- (e) An event that is reported to law enforcement.
- (Note Always defined as adverse incident
regardless of facility control. See Chart 5
Adverse Incident Reporting.)
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
8Adverse Incident Definition
- Q What is the Agencys position on reporting
skin tears, bruises or fractures of unknown
origin, in terms of adverse incident reporting?
Is the same interpretation applied in hospitals? - A If it meets the definition of an adverse
incident pursuant to section 400.147 for nursing
homes or 400.423 for assisted living facilities
it must be reported. There are some differences
in the definitions of adverse incidents for
hospitals versus nursing homes and assisted
living facilities, but each entity is expected to
operate in compliance with their respective
regulations.
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
9Adverse Incident - Elopement
- Q - How is elopement defined for the purposes
of adverse incident reporting? - A - Elopement is when a resident leaves the
facility without following facility policies and
procedures for signing out.
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
10Adverse Incidents Baker Act
- Q Baker Act referrals and risk management
reporting requirements Does a facility have to
report a call for law enforcement transportation
as an adverse incident?
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
11Adverse Incidents Baker Act
- A Events reported to law enforcement for
investigation are considered adverse incidents
pursuant to sections 400.147(5)(e), F.S. - A call to law enforcement for something other
than investigation, e.g. transportation only,
would not alone meet the definition of an adverse
incident. - However, a Baker Act situation must be reviewed
independently to determine if it meets one of the
definitions of an adverse incident.
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
12Adverse Incident Reporting
- Q If, prior to the required report date,
facility staff determine that an incident does
not meet the definition of an adverse incident as
specified in statute, is a report to the Agency
still required?
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
13Adverse Incident Reporting
- A Only those incidents that meet the definition
of an Adverse Incident must be reported to the
Agency. - If the facility is able to determine that the
incident does not meet the definition, prior to
the required report date, then a report is not
required. - However, if the facility has not yet determined
if the incident meets the adverse incident
definition the incident must be reported on the
1-Day report. - After the facility investigation is complete and
if it is determined that the incident does not
meet the definition of an adverse incident, then
the facility staff may report on the 15-Day
report that the incident was determined not to be
an adverse incident.
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
14Adverse Incident Report
- Q What should a facility provide in the adverse
incident report? - A - All the questions on the Adverse Incident
Report forms should be answered. The description
of the incident should include answers to basic
questions like Who, What, Where, When, Why,
allows AHCA reviewers to determine appropriate
action. - Â
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
15Adverse Incident Confidentiality
- Q Are a facilitys risk management and quality
assurance records protected from public
disclosure once they are sent to the Agency, such
as with a plan of correction? - A All documents received by the agency are
considered public records unless there is a
specific public record exemption in law. Only
the adverse incident reports themselves are
protected from public record. Any documents
submitted with a plan of correction are not
protected from public disclosure, however,
resident unique identifying information remains
protected and redacted from documents prior to
the release of the records.
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
16Adverse Incident Confidentiality
- Adverse Incident Reports (1-Day and 15-Day) are
Exempt from Public Disclosure - The 5-Day Report of the Status of an Abuse,
Neglect or Exploitation Not Specifically Exempt
from Public Disclosure - Accept the 15-Day Report by the 5th Day to Meet
Federal 5-Day Requirement
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
17Adverse Incidents
- Role of Risk Management Process
- Identification of Incidents
- Affect Compliance with Regulations
- Role of Quality-of-Care Monitor
- Risk Management Program
- Adverse Incident Identification
- Role in the Survey Process
- Regulatory Compliance Related to Occurrences
- Current Non-Compliance Except Egregious
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
18AHCA Annual Adverse Incident Report
- 13,772 Adverse Incident reports processed
- 4,613 determined by facilities to be adverse
incidents - 3,145 Nursing homes
- 1,468 Assisted living facilities
Assisted Living Facilities 97 inspections
completed 23 inspections with deficiencies (24)
Nursing Homes 445 inspections completed 72
inspections with deficiencies (16)
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
19Adverse Incidents Outcomes
- Nursing Homes
- 1,505 Event Required Transfer
- 1,030 Fracture or Dislocation
- 879 Abuse (Ch 415)
- 383 Elopement
- 318 Event Reported to
- Law Enforcement
- 27 Death
- 21 No Consent
- 13 Functional Limitation
- 3 Brain or Spinal Damage
- 2 Disfigurement
Assisted Living Facilities 926 Event
Required Transfer 510 Fracture or
Dislocation 261 Event Reported to Law
Enforcement 214 Elopement 133 Abuse (Ch
415) 40 Death 11 No Consent
1 Disfigurement
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
20Practitioner Review
- Medical Quality Assurance Investigates
Practitioners for Violations of Practice Acts - Review All Adverse Incident Reports
- Practitioners Being Investigated Receive a Copy
of the Adverse Incident Report - Other Staff Names are Removed
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
21Staff Disciplinary Actions
- Referred for Investigation
- 567 Total Referred Out of 13,772 Reports
- 410 Certified Nursing Assistants
- 149 Licensed Nurses
- 3 Nursing Home Administrators
- 3 Pharmacists
- 2 Physical Therapist
- Average 5 of Referred Result in Prosecution
- 361 Investigations Completed
- 50 Found Probable Cause
- 95 Dismissed
- Ten Emergency Actions Against Practitioners
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
22Liability Claims Reported to AHCA
- 1,123 Liability Claims Reported
- - 1,050 Nursing Homes
- - 73 Assisted Living Facilities
- 33 Claims are for incident dates or residency
dates since May 2001 - 1090 (97) of liability claims reported for
incidents or residency dates prior to May 2001,
and extend as far back as 1990
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
23Nursing Home Liability Claims Received by Month
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
24Top Reasons for Claims Reported
- Assisted Living
- 13 Other
- 13 Fracture
- 12 Death
- 10 Transfer Involved
- 4 Abuse
- Nursing Homes
- 260 Other
- 159 Death
- 133 Fracture
- 89 Abuse
- 75 Transfer Involved
- Other for Nursing Homes Pressure Sores, Illness
(Pneumonia, UTI), Falls, Weight Loss
(non-terminal residents), Restraints, Unnecessary
Medications
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
25Liability Insurance Requirement
- Insurance required for Nursing Homes and ALFs
- Recent changes for nursing homes now require
General and Professional Liability Insurance - No Minimum coverage Amounts are Required
- No Licenses have been Denied or Revoked to Date
for Failure to have Insurance since January 1,
2002 - The Risk Retention Group is working on a product
to be available in September primarily ALFs - 6 million advance to the Risk Retention Group
for capitalization of the fund
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
26Nursing Home Bed Occupancy
272002 Legislative Changes AHCA Semi-annual Report
- First report due December 30, 2002
- Data reported on a monthly basis
- Number of Notices of Intent to Litigate received
- Number of complaints filed with the Clerk of the
Court - Incident dates (or residency dates)
- Regulatory history including
- Deficiencies cited Nursing Home Guide
information - Nursing Home Watch List
- Federal CMS Quality Information Project
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
282002 Legislative Changes
- Continuing Care Retirement Community (CCRC)
residents are not considered new admissions for
the purposes of the moratorium on new admissions
required for insufficient staffing - SB 1246
amends 651.118 (13) - (CCRC must meet staffing ratios)
- Medicaid Lease Bonds for Leased Nursing Homes
- - Exempts certain municipal bond leases from
the lease bond requirement - - Allows payment to a Medicaid overpayment fund
in lieu of posting the Lease Bond - Increase in Medicaid reimbursement to assist with
cost of liability insurance
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
29Staffing Information
- Since January 1, 2002
- 138 facilities cited for one of the following
staffing citations - 109 citations for failure to meet the minimum
staffing standards in the statute (N063) - 11 Class IV, balance Class III
- Look at multiple periods
- 49 citations for failure to have sufficient staff
to meet resident needs (F353) - 14 citations for failure to self-impose a
moratorium if staffing ratio is not met for 2
consecutive days (N069) mandatory Class II
deficiency - Note Averages reported generally meet the
required levels
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
30Report Staffing InformationNursing Homes
- AHCA collects semi-annual reporting of staff
ratios, turnover and stability - Next report
- - Will be sent to all facilities in September,
2002 - - Due October 20, 2002
- - Anticipate on-line submission of staffing
reports and monthly bed vacancy by October, 2002 - Centers for Medicare and Medicaid Services (CMS)
also posts staffing data on Nursing Home Compare - - From the CMS 671 form (provider completes
during annual survey)
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
31Nursing Home Information
- Know What Others See About Your Facility
- Reconcile Information IDR
- Online Federal and State
- Public File
- Public Information Office (850) 414-6044
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
32Alzheimers Disease Training
- Department of Elder Affairs Rule is finalized,
mailed to nursing homes in May - 58A-4.001(2),
F.A.C. - http//elderaffairs.state.fl.us/doea/mark.html
- (see Nursing Home Alzheimers Training)
- Nursing Home Training Provider Certification and
Curriculum Approval maintained by the Florida
Policy Exchange Center on Aging at USF at
www.fpeca.usf.edu - Recent Questions and Answers from the Department
of Elder Affairs Attached - Teaching Nursing Home CD-ROM Alzheimers
Training for LPNs Contact LTC Unit Richard
Kelly
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
33Legal Activity
- Conditional Licenses
- Fines for Deficiencies
- Late Fines
- Fine for Failure to Report Monthly Bed Vacancy
- Adhere to Timeframes
- Informal Hearing
- 40 Facilities Eligible for a 6-month Survey Cycle
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
34Other Legislative Updates
- Medicaid Up or Out
- Monitor Facilities with Lowest NH Guide Scores
- Improve or Terminate from Medicaid
- Funding Cut
- Consumer Satisfaction Survey
- Resident Interviews and Family Questionnaire
- Tool Survey Questions in Rule 59A-4
- Unable to Secure Contractor
- Funding Cut
- AHCA Still Required to Conduct Survey
- Gold Seal and Nursing Home Guide
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
35Gold Seal Award Recipients
- River Garden Hebrew Home for the Aged,
Jacksonville - The Pavilion for Health Care, Penney Farms
- John Knox Village Medical Center, Tampa
- Florida Presbyterian Homes, Lakeland
- Memorial Manor, Pembroke Pines
- Menorah Manor, St. Petersburg
-
-
- Presentation made by
- Lt. Governor Brogan on
- July 24, 2002
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
36Gold Seal Criteria
- Facility Must Be Licensed For 30 Months
- Â Quality of Care Standards
- Consider Past 30 Months
- Top 25 In Quality of Care Rank
- (LTC Unit Contact Richard Kelly)
- No Conditional Licenses
- No Class I or II Deficiencies
- Â Free of Bankruptcy Proceedings For Past 30
Months (Including Parent Company)
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
37Gold Seal Financial Criteria
- Meet a Combination of Financial Thresholds over
Past Three Years - Positive Current Ratio of At Least One
- current assets (due in 1 year) greater than
current liabilities (cash equivalent within 1
year) - Positive Tangible Net Worth
- (total assets exceed total liabilities)
- Time Interest Earned Ratio of At Least 115
- (profit margin is at least 15 of the interest
expense)
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
38Gold Seal Financial Criteria
- Note candidates must submit audited financial
statements and a one-year set of pro-forma
financial statements and meet two of three
thresholds on the pro-forma and - Two of three financial thresholds for two of the
three most recent years (one of which must be the
most recent year), or - All three thresholds for the most recent year
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
39Gold Seal Criteria
- Staff Stability
- Turnover Rate of Not More Than 85
- A Stability Rate of At Least 50
- Evidence of Efforts To Maintain Stable Workforce
- Outstanding Ombudsman Complaint History
- Â
- Evidence of Family And Community Involvement
- Â
- Targeted In-Service Training Programs
- See Statute 400.235 and rule 59A-4 for Specific
Requirements
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
40Gold Seal Process
- Applications received (minimum of five)
- Staff review for regulatory then financial
criteria - Ombudsman review
- Initial Panel review and site visit selection
- Site visits conducted
- Final Panel review, site visit reports, facility
presentations, and decision regarding
recommendation to Governor - Final decision by Governor
- Gold Seal Awards presented
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
41Current Gold Seal Reviews
- Meeting July 26 in Tampa
- Four Facilities Recommended
- Governors Decision
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
42 Gold Seal Benefits
- Facility Marketing
- Agencys NH Guide Web-site and in the Next
Hard-copy Publication - Public Inquiries Legislative
- Future Benefits
- Nursing Home Licenses
- Gold Seal Facility Best Practices
- Request an Extended Survey Cycle
Agency for Health Care AdministrationDivision of
Managed Care Health Quality
43Resources
- AHCA Web Site www.fdhc.state.fl.us
- AHCA Annual Report on Adverse Incidents
- Gold Seal Applications
- Licensure Applications and Forms
- Nursing Home Guide
- Nursing Home Watch Lists
- Florida Health Stats Locate Facilities/Providers
- Long-Term Care Unit (850) 488-5861
Agency for Health Care AdministrationDivision of
Managed Care Health Quality