Agency For Health Care Administration Regulatory Update Training September 2004 January 2005

1
Agency For Health Care AdministrationRegulatory
Update Training September 2004 / January 2005

• Presenters
• Polly Weaver, Chief of Field Operations
• Molly McKinstry, Chief of Long Term Care
  Services
• Susan Acker, Ph.D., Director of Nursing
  Services
• Agency for Health Care Administration-Division
  of Health Quality Assurance

2
Hurricane Season 2004

3
Emergency Plans

• Check Current Plans to Ensure They Are Up-to-date
• Consider Lessons Learned From Recent Experience
• Check Vendors to Ensure They Will Honor
  Agreements Supplies, Transportation, Receiving
  Facilities
• Consider Secondary Evacuation Plan/location If
  Initial Is Affected
• Ensure Appropriate Receiving Facility
• Prior to Evacuation, Reach Agreement on Supplies
  and Resources and Who Will Provide

4
Emergency Preparedness

• Test Emergency Generators
• Check Supply of Drinking Water If Contractor Is
  Used Ensure Service Provider Is Able to Meet
  Needs
• Check Non-perishable Food Supplies Assure
  Regulatory Minimums Are Met
• Review Loss of Power Plans

5
Evacuation

• Notify AHCA Of Evacuation
• Staffing and Other Basic Requirements to Meet
  Resident Needs Are Not Waived
• Ensure Resident Information Follows the Resident
• When Returning Residents to a Facility After
  Damage, Obtain AHCA Approval First

6
Emergency Resources

• First Contact Local Emergency Management
  http//www.floridadisaster.org/County_EM/county_li
  st.htm
• Florida Emergency Information Line
• 800-342-3557
• Emergency Support Function 8
• 850-410-1822
• 800-320-0519 (request ESF-8)

7
Regulatory Update

• Regulatory Changes
• AHCA Information Regarding Trends
• Regulatory Statistics

8
2004 Legislative Changes

• Inactive License for a Portion of Facility
• Rule Must First be Established
• Allows a Contiguous Portion of Nursing Home Beds
  to Become Inactive for 12 Months, Renewable
  Annually
• Retains Ability for Entire Facility to be
  Inactive for up to 18 Months
• Established Requirements for Request and Approval
• Staffing
• CNA Increase to 2.9 Delayed from May 1, 2004 to
  July 1, 2005
• Certificate of Need
• Allows Development of New Nursing Home Beds in
  Limited Circumstances An Exception to the CON
  Moratorium
• Rural Counties in Limited Circumstances
• Counties Without a Nursing Home Where a Nursing
  Home Closed Since July 2001

9
2004 Legislative Changes

• Nursing Homes
• CNA In-service Hours
• Requires In-Services Hours as a Condition of CNA
  Certification Rather Than Nursing Home Employment
• Refers the In-Service Requirements of S.
  464.203(7), F.S.
• Remains 18 Hours Annually
• DON Signature on Care Plans
• Allows Another RN to Sign Resident Care Plans for
  DON
• RN Must Have Institutional Responsibilities in
  Writing
• RN Cannot be a Temporary Staff Person
• Gold Seal
• State and Federal Nursing Homes are Deemed
  Financially Stable and Not Required to Submit
  Financial Statements

10
Nursing Home Gold Seal

• Thirteen Homes Received the Award in November,
  2004
• Performance Criteria Include
• Financial Soundness and Stability
• High Quality of Care Ranking Among Other Nursing
  Homes in Their Region
• Excellent Record With the State Long-term Care
  Ombudsman Program
• No Conditional Licenses nor Nursing Home Watch
  List Appearances in the Past 30 Months
• Evidence of Community Involvement
• Stable Workforce

11
Gold Seal Awards

• New Gold Seal Recipients
• Baldomero Lopez Memorial Veterans Nursing Home,
  Land O Lakes
• Bay Village of Sarasota, Sarasota
• Life Care Center of Hilliard, Hilliard
• Mayflower Healthcare Center, Winter Park
• Miami Jewish Home Hospital for the Aged, Miami
• Ponce Plaza Nursing and Rehabilitation, Miami
• Sunnyside Nursing Home, Sarasota
• Waters Edge Extended Care, Palm City

12
Nursing Home Gold Seal

• Renewing Gold Seal Recipients
• Harbours Edge, Delray Beach
• John Knox Village Medical Center, Tampa
• The Pavilion for Health Care, Penney Farms
• River Garden Hebrew Home for the Aged,
  Jacksonville
• Village on the Green, Longwood

13
Report to the LegislatureMay 2004 Status Report

• Nursing Home and Assisted Living Facility
  Adverse Incidents Notices of Intent Filed
• http//www.fdhc.state.fl.us/Publications/index.sht
  ml
• Also see Semi-Annual Report on Nursing Homes
  Report to the Legislature December 30, 2004

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Adverse Incidents Reported to AHCA
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Adverse Incident Analysis

• For The One Year Period May 15, 2003 Through May
  14, 2004, The Agency Received
• 3,175 Nursing Home Adverse Incidents
• 1,996 Assisted Living Facility Adverse Incidents
• 19,378 Total Reports Submitted - 5,171 Were
  Determined To Be Adverse Incidents After Final
  Facility Staff Review

16
Adverse Incident Analysis

• AHCA On Site Visits In Response To Adverse
  Incidents
• 84 On-Site Visits To Nursing Homes
• 48 On-Site Visits To Assisted Living Facilities
• Of These Surveys 3 Nursing Homes And 5 Assisted
  Living Facilities Were Cited For Class I and/or
  Class II Deficiencies 

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Adverse Incident Outcomes
18
Nursing Home NOIs
19
Characteristics of Reported Litigation
20
Notices of Intent Past 3-Years 548 Nursing
Homes Reporting NOIsMay 2001 - May 2004
21
Notices of Intent Past Year 339 Nursing Homes
Reporting NOIsMay 2003 - May 2004
22
Nursing Home Complaints Filed in Clerk of
CourtComplaint Service Dates June 2002 - April
2004
23
Nursing Home Complaints Filed in Clerk of
CourtBy AHCA Receipt Date June 2002 - April 2004
24
Number of Nursing Homes on The Watch List
25
Nursing Home Deficiencies
26
Nursing Home Deficiencies for Failure to Have
Sufficient Staff to Meet Resident Needs
27
All Nursing Home Staffing Deficiencies
28
Grant Proposal RequestsUse of Civil Money
Penalty (CMP) Funds

• CMPs Returned to Florida Based Upon Medicaid
  Participation of Sanctioned Nursing Homes
• Deposited in State Quality of Long Term Care
  Improvement Trust Fund
• Authorization to Spend 500,000 Annually
• Expenditures Must be Consistent with State and
  Federal Requirements

29
Federal Guidance

• Federal Regulations 42 CFR 488.442(g) and Section
  7534B of the State Operations Manual Direct
• Use of CMPs for Protection of Health or Property
  of Residents of Facilities That the State or the
  Centers for Medicare and Medicaid Services (CMS)
  Finds Deficient

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Federal Guidelines

• Prevention of Deficient Practice Through
  Educational Means by Development of Videos,
  Pamphlets, or Other Publications Providing Best
  Practices
• Development of Public Service Announcements on
  Issues Directly Related to Identified Deficient
  Areas
• Employment of Consultants to Provide Expert
  Training to Deficient Facilities
• Issuing Grants to Facilities for Projects Such As
  the Eden Alternative
• Other Projects That Directly Benefits Facility
  Residents

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Federal Limitations

• A Loan to a Facility Having Financial Difficulty
  Meeting Payroll or Paying Vendors is an
  Inappropriate Use of the Funds
• Funds Cannot Be Used to Bring a Facility Into
  Current Regulatory Compliance
• Projects Should Be Limited to Funding on Hand and
  Should Be Relatively Short-term Projects

32
Grant Proposals

• All Florida Nursing Homes May Apply
• Proposals Must be Innovative and
• Provide Well Conceived Vision/Plan with Detailed
  Explanation and Steps to Achieve Improvement
• Propose Achievable Goals
• Provide Education Plan for Residents/Staff
• Provide Detailed Implementation Plan
• Provide Budget of Expenditures

33
Grant Proposals

• All Florida Nursing Homes May Apply
• Proposals Must be Innovative and
• Provide Well Conceived Vision/Plan with Detailed
  Explanation and Steps to Achieve Improvement
• Propose Achievable Goals
• Provide Education Plan for Residents/Staff
• Provide Budget of Expenditures

34
Grant Process

• Initial Request for Interest and Proposals,
  Nursing Home Letter December 22, 2004
• Applications Will be Provided for Completion
• Proposals Will be Reviewed Within Available
  Funding
• Presentation May be Requested

35
Grant Participation

• Recipients of Grants Will Enter Into a Contract
  With the Agency
• Contracts Will Generally Be One Year No More
  Than Two Years
• Monitoring Will Be Developed Based Upon the
  Project
• Quarterly Reports
• Onsite Reviews

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Grant Information Proposal Submission

• Bureau of Long Term Care Services
• Barbara Dombrowski
• Phone [phone]
• E-mail dombrowb_at_fdhc.state.fl.us

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Top 10 Nursing Home Deficiencies
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Top 10 Nursing Home Deficiencies
39
Top 10 Nursing Home Complaint Allegations
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AHCA Resources
Long Term Care Unit [phone] Bureau of
Long Term Care [phone] Bureau of Field
Operations [phone] Health Standards and
Quality Unit [phone] AHCA Website
www.fdhc.state.fl.us New Format AHCA Facilities
and Agencies Directory Website
www.floridahealthstat.com/qs/owa/facilitylocator.f
acllocator Federal Link to Survey
Guidance www.cms.hhs.gov/medicaid/survey-cert/siq
home.asp