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U.S. Rep. Ann Kirkpatrick (D-AZ)
U.S. Rep. Ann Kirkpatrick (D-AZ)

MIDWEST

Appeals process finalized

IOWA — The state recently finalized new regulations pertaining to how nursing homes appeal citations and fines, drawing sharp criticism from a former public official.

Under the new system, independent reviewers will hear the first stage of an appeal. Formerly, this stage of an appeal often was heard by an administrative law judge associated with the state's inspections department. Some argued that these judges could not be objective in cases that hinged on the department's own reports.

The new system also may have eliminated the state's ability to appeal decisions made by the new independent reviewers, even though nursing facilities will be able to appeal. 

Dean Lerner, the former director of the inspections department, has spoken out forcefully against the finalized regulations, saying they hand too much power to nursing homes while hamstringing state inspectors. 

Lerner voiced his concerns during a September meeting of the legislature's Administrative Rules Review Committee, according to local reports. However, the committee chairwoman, Rep. Dawn Pettengill (R-Mount Auburn), pointed out that the legislature unanimously passed the law that led to the regulations and said Lerner's objections were coming too late.

Lerner said he was not aware of the bill when lawmakers were considering it.

NORTHEAST

Dental care lacking

CONNECTICUT — More than 50% of residents at long-term care facilities have untreated tooth decay, according to the state's Department of Public Health.

The DPH recently performed dental exams on 845 seniors, half at LTC facilities. The findings were released on the heels of a New York Times story about poor dental care at facilities nationwide.

The Southwestern Connecticut Agency on Aging, a nonprofit, has provided grants to help some organizations provide dental care to seniors. The agency's grant manager, Pat Knebel, told local reporters that poor dental care has been linked to diabetes and heart disease. It also has been tied to pneumonia, the Times noted.

Medicaid waivers advocated 

MAINE — Susan Wehry, M.D., Vermont's commissioner of disabilities, aging and independent living, spoke at the first of three roundtable events sponsored by the Maine Council on Aging last month.

She said Maine could adopt a program similar to Vermont's Medicaid waiver system, which offers tiered funding across the spectrum of long-term care. Wehry said nursing home occupancy in Vermont has decreased and home care has increased, according to local reports. 

Alarm over duals program 

RHODE ISLAND — Virginia M. Burke, president of the Rhode Island Health Care Association, warned in a Providence Journal op-ed that a dual-eligible initiative likely will be a fiasco.

Under Phase I of the Integrated Care Initiative, scheduled for a November kickoff, a health plan would take over management of Medicaid-only long-term care services in the state. For every person enrolled, the health plan would receive a monthly amount intended to cover the individual's care plus administrative costs.

Because the health plan would not take over the Medicare services these people also receive, Phase I is likely to be an ineffective “halfway step” in the program, Burke argued. Without being able to integrate Medicare and Medicaid services, the health plan cannot reasonably hope to cut costs while improving quality of care, she wrote. She also pointed out that the contracted health plan, Neighborhood Health Plan of Rhode Island, has no experience managing the long-stay nursing home population.

Burke has called on Gov. Lincoln Chafee (D) to exclude nursing home residents from the dual-eligible program until it can incorporate both Medicare and Medicaid, which would be in 2015 at the earliest.

PLAINS/MOUNTAINS

Flood recovery underway

COLORADO — Long-term care facilities are recovering after devastating September floods forced some facilities to evacuate and created dire conditions at others.

Torrential rain led to massive floods that hit a region known as the Front Range of the Rockies. Boulder was hit especially hard, but Fort Collins, Denver and Colorado Springs were among the other highly populated areas affected. Thousands of people were listed as missing in the days after the floods struck in early September, and there were eight confirmed fatalities as of press time.

The disaster prompted operators nationwide to review emergency response procedures.

LeadingAge President and CEO Larry Minnix posted a message on the provider association's website, sharing the story of one affected facility. Frasier Meadows, a continuing care retirement community in Boulder, lost primary and generator power and moved all residents and staff to upper floors to escape flooded ground-floor areas. It has engaged a remediation company to begin restoring the badly damaged facility.

SOUTHEAST

Class action status withheld

FLORIDA — A federal judge recently denied class action status in a case pertaining to children in nursing homes.

More information is needed to determine whether a “systemic problem” is leading disabled children to be unnecessarily confined to Florida nursing homes when they could live in community-based settings, the judge ruled. He left open the possibility of class certification at a later date, if evidence of a systemic issue emerges. 

Filed last year, this is one of two lawsuits over the state's handling of pediatric nursing home residents. The other was filed this year by the U.S. Department of Justice.

Long-term care operators and associations, including the Florida Health Care Association, have said children are being appropriately placed and well cared for in the state's facilities. 

Pesticide use lawsuit

GEORGIA — A pest control company faces charges of improperly using a pesticide in nursing homes and engaging in a cover-up, which could result in prison time and stiff fines, according to the U.S. Department of Justice.

Bio-Tech Management Inc. provided improper services to Georgia nursing homes between 2005 and 2009, the indictment states. The company allegedly used Termidor, a pesticide, indoors more often than twice a year, contrary to instructions on the label. Murray instructed workers to alter reports after the Georgia Department of Agriculture began an investigation, according to the charges.

Bio-Tech and owner Steven Murray face one count of conspiracy, 10 counts each of unlawful use of a pesticide and making false statements, and 20 counts of falsifying records. They face 10 counts of mail fraud, for allegedly billing these facilities through the U.S. mail.

Each count of mail fraud and falsifying records carries a maximum penalty of 20 years in prison and a $250,000 fine, according to the DOJ. Each false statement charge carries a maximum five-year prison sentence and a $250,000 fine.

SOUTHWEST

ARIZONA — U.S. Rep. Ann Kirkpatrick (D-AZ) has put forward a bill that would allow government funding for veteran nursing homes built on Native American tribal land. 

The measure was spurred by the so-far unsuccessful effort in Arizona to build a VA nursing home on the Navajo Nation, according to local reports. The project is ineligible for a 65% construction reimbursement and per diem grants, which are available for VA homes outside reservations.

“Native Americans have a greater proportion of veterans than the general U.S. population,” Kirkpatrick noted. “Yet when these veterans return home, they may lack access to the facilities and care they need.”

The bill has bipartisan support in the House and has been praised by state legislators in Arizona. State Rep. Albert Hale (D-District 7), a former president of the Navajo Nation, noted that many Native Americans currently have to travel long distances to access facilities or to see loved ones.

The Navajo Nation and the Inter Tribal Council of Arizona also support the legislation.

WEST

Deal averts Medi-Cal cuts

CALIFORNIA — Skilled nursing facilities may be spared a 10% reduction in Medi-Cal reimbursements thanks to a bill that unanimously passed both houses of the legislature.

The rate cut was approved two years ago but was not enforced due to a legal challenge. The state spared certain rural SNFs from the cuts earlier this year. Urban facilities were still facing the reductions, and some said they would close as a result.

A bill co-authored by Sens. Ed. Hernandez (D-Los Angeles) and Darrell Steinberg (D-Sacramento) would lift the current Medi-Cal rate freeze and reverse the 10% cut. 

The bill, SB 239, also would extend a “hospital quality assurance fee” through 2016. The tax on hospitals triggers federal dollars that the state can use to issue grants back to hospitals. It also creates an infusion for the general fund. 

Gov. Jerry Brown (D) is expected to sign the measure.

“Hospitals are winning, the state is winning and we're taking care of this Medi-Cal rate cut issue,” said Jan Emerson-Shea, vice president of communications for the California Hospital Association.

However, it's up to the federal government whether California SNFs must pay back a portion of the Medicaid money they received when the rate cuts had been approved but were not implemented.

Holiday will pay vets

OREGON — Holiday Retirement recently settled a marketing practices case with the Oregon Department of Justice, agreeing to pay restitution to about 160 veterans.

The state DOJ alleged that Holiday unlawfully promoted benefits to veterans, including deferred rent. These victims became residents at Holiday's 14 Oregon facilities before discovering that the promised benefits would not be forthcoming, according to the charges.

The case also involved Robert E. Elhard Jr. The DOJ says he was not upfront about his business relationship with Holiday and presented himself as a financial adviser to veterans. He allegedly convinced them to divest themselves of assets to qualify for VA benefits.

Under a separate settlement, Elhard will no longer be able to provide financial services to veterans in Oregon, the DOJ announced.

Holiday will pay the affected veterans — more than $3,500 in some cases — and the company donated $50,000 to the Oregon Veterans' Home, according to the DOJ.