Nursing Home Joint Training Handbook - Agency for Health Care

178 Pages·2014·5.22 MB·English

Florida’s Agency for Health Care Administration
2014 Joint Training
for Skilled Nursing Facilities
Tuesday, February 4, 2014 – Orlando
Thursday, February 6, 2014 – Tampa
Monday, February 24, 2014 – Davie/Ft. Lauderdale
Thursday, February 27, 2014 – Tallahassee
Approved for 6 hours of continuing education – FHCA Provider Number 50-720:
Florida Board of Nursing Home Administrators
Florida Board of Nursing
Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling
Florida Board of Occupational Therapy
Florida Board of Speech-Language Pathology & Audiology
FHCA does not have NAB approval for this program

Event Overview

The 2014 Joint Training for skilled nursing facilities is a forum for the Agency for Health Care Administration and
leading long term care experts to brief providers, advocates and state surveyors on regulatory compliance with
enforcement provisions explained. This training will highlight the implementation of managed care, critical
compliance topics and problematic care areas with guidance for quality outcomes. The Life Safety section will
address recent physical plant citations across Florida and how to avoid negative survey outcomes.
Schedule of Events
7:30 a.m. Registration
8:30 a.m. Welcome and Introductions
8:45 to 9:45 a.m. Medicaid Managed Care LTC Program Update for Skilled Nursing Facilities
Beth Kidder, AHCA

Beth Kidder will provide an update on the Statewide Medicaid Managed Care
Long-term Care program implementation and discuss how Florida will ensure
the managed care system for long term care provides quality services to individuals
with long term care needs.
9:45 to 10:00 a.m. Break
10:00 a.m. to 12:00 p.m. Top 10 Deficiencies and Hot Topics - Including Life Safety Citations, F 309,
Transfer/Discharge and Resident Rights
Polly Weaver and Eddie Alday, AHCA
The Florida State Survey Director will discuss the major areas of deficiencies.
Concerns with transfer and discharge decision-making, residents’ rights and other
issues in the determination of levels of care and placements will be addressed. Life
Safety enforcement will also be a topic of discussion, with opportunities for Q & A.

12:00 to 1:15 p.m. Lunch
1:15 to 3:15 p.m. Successful Practice Guidelines for Quality Outcomes
Deborah Afasano, Avante Group, Inc.
Successful clinical care practices will be highlighted within the framework of a
facility’s Quality Assurance and Performance Improvement (QAPI) and the
partnership with Advancing Excellence.
3:15 to 3:30 p.m. Break
3:30 to 4:30 p.m. Survey Enforcement and Civil Money Penalties
Polly Weaver and Kimberly Smoak, AHCA
Florida has one of the highest CMP collections in the nation, linked to costly
immediate jeopardy citations. This session will discuss the importance of regulatory
compliance in critical areas of enforcement.
*6 total contact hours can be earned
Target Audience February 4, 2014
Radisson Resort
Orlando-Celebration
Nursing home administrators, nurse leaders, charge nurses, social workers,
2900 Parkway Boulevard
therapists, activity directors, consultants, ARNPs, Physician Assistants, Medical
Kissimmee, FL 34747
Directors and dietary staff. Additional stakeholder audiences include state surveyors.
[phone]
Room rate: $99
Cut-off: January 15
Faculty:
Parking is complimentary
Polly Weaver has over 25 years of regulatory experience and has served as the Chief of February 6, 2014
Field Operations for the Division of Health Quality Assurance, Agency for Health Care Embassy Suites Hotel
Administration (Agency) since 1995. Her responsibilities include management of the eight USF/Busch Gardens
field offices located throughout Florida, which are responsible for the certification, survey 3705 Spectrum Boulevard
functions and enforcement activities of the health care facilities licensed by the Agency. In Tampa, FL 33612
addition, she oversees the staff training and quality assurance program as well as complaint [phone]
administration activities. Room rate: $129 single
$139 double
Eddie Alday has been with the Agency for Health Care Administration since Cut-off: January 17
December 2012. Currently, he is a Government Analyst II with the Survey & Certification
Parking is complimentary
Support Branch located in the Division of Health Quality Assurance. He is responsible for
preparing and monitoring the Medicare and Medicaid Services and CLIA budgets for Field
Operations. He also provides oversight, instruction and development of quality assurance
February 24, 2014
activities for the Life Safety Survey Program.
Signature Grand
6900 State Road 84
Deborah Afasano, BSN, CDONA, HCRM, ELNEC is Vice President of Clinical
Davie, FL 33317
Services for Avante Group, Inc. She is an end-of-life trainer through ELNEC, MDS 3.0 resident
[phone] (directions
assessment coordinator through AANAC and a licensed health care risk manager. Her diverse
only)
nursing background spans 30-plus years in acute and long term care settings. Ms. Afasano
also serves as Chair of the FHCA Quality Foundation Senior Clinicians Council. Parking is complimentary
Hotel reservations can be
Beth Kidder is the Assistant Deputy Secretary for Medicaid Operations at the Agency for made at the Holiday Inn
Health Care Administration. She oversees Medicaid policy development and quality located at 2540 Davie
initiatives. She has 15 years of experience working for state Medicaid programs, beginning in Road, Davie, FL 33317 by
North Carolina, and including 11 years with Florida Medicaid. Ms. Kidder holds a calling [phone].
Bachelor’s Degree from the University of Florida and a Master of Public Policy Degree from
Room Rate: 15% Discount
Duke University.
on published room rates
when you mention
Kimberly Smoak, QDDP, MSH has been with the Agency for Health Care
Signature Grand Event
Administration (Agency) for over 18 years. Currently, she is the Manager of the Survey &
Certification Support Branch located in the Division of Health Quality Assurance (Division).
As the Manager of the Survey & Certification Support Branch, she is responsible for February 27, 2014
monitoring quality improvement/quality assurance indicators for the Division, training of Tallahassee Automobile
survey staff and other Division staff, data management and support functions. She develops
Museum
and implements strategies to improve consistency among the field offices and the program
6800 Mahan Drive
units as those functions relate to the Survey and Certification functions of the Agency under
Tallahassee, FL 32308
contract with the federal Centers for Medicare and Medicaid Services (CMS), in addition to
[phone] (directions
monitoring state requirements and timeframes. She provides technical assistance regarding
only)
programmatic issues and assists in interpreting rules, policies and standards.
Parking is complimentary
If you need suggestions
on hotel accomodations,
contact FHCA at
[phone].
Florida’s Agency for Health Care Administration

2014 Joint Training for Skilled Nursing Facilities

Program Objectives:
After completion of this program, the attendee will be able to:
describe the most up-to-date Medicaid Managed Care implementation processes for
long term care;
recognize the methods through which Florida’s Medicaid Program will ensure quality
services to individuals with long term care needs;
identify the major areas of deficiencies, including transfer and discharge, resident rights
and life safety, and methods for compliance;
outline best-practices for developing a QAPI plan integrated into all care and service
areas of an organization;
identify strategies to influence safe transitions of care, advanced care planning and
reduced re-hospitalizations; and
summarize methods for successful regulatory compliance to avoid costly immediate
jeopardy citations and penalties.

Presenter Bios:

Beth Kidder is the Assistant Deputy Secretary for Medicaid Operations at the Agency for Health
Care Administration. She oversees Medicaid policy development and quality initiatives. She has
15 years of experience working for state Medicaid programs, beginning in North Carolina and
including 12 years with Florida Medicaid. Beth holds a Bachelor’s Degree from the University of
Florida and a Master of Public Policy Degree from Duke University.

Deborah Afasano, BSN, RNC,CDONA, HCRM, is a certified Director of Nurses, a certified end-
of-life ELNEC trainer and a health care risk manager on faculty for the USF Health Care Risk
Management Program. Her diverse nursing background spans over 30 years in acute and LTC
settings. Debbie is currently the VP of Clinical Services for the Avante Group with skilled nursing
and assisted living facilities in three states. She is a former governor appointee to the Florida
Center for Nursing, and the founding and current chair of the FHCA Senior Clinicians’ Council.
Debbie is the 2011 recipient of the NADONA Spirit of Nursing Presidents Award and an
inductee into the Sigma Theta Tau National Honor Society.

Eddie Alday has been with the Agency for Health Care Administration since December 2012
where he currently serves as Government Analyst II with the Survey & Certification Support
Branch located in the Division of Health Quality Assurance. His responsibilities include
preparing and monitoring the Medicare & Medicaid Services and CLIA budgets for Field
Operations. He also provides oversight, instruction and development of quality assurance
activities for the Life Safety Survey Program. Eddie holds a Master Certification for Code
Enforcement from the University of Georgia, Associates Businesses Management from
Vincennes’s University, attended classes for Construction Management at Clayton University
and Valdosta State College and received his Fire Inspector I certification from the Florida State
Fire College. Previously, he served 24 years as a US Army Engineer and has worked the past
12 years as a Building Official, Planning and Zoning Administrator, Building Inspector for
Commercial and Residential, Third Party Construction Consultant and Contractor.
Kimberly Smoak has been with the Agency for Health Care Administration for over 18 years.
Currently, she is the Manager of the Survey & Certification Support Branch located in the
Division of Health Quality Assurance. She is responsible for monitoring quality
improvement/quality assurance indicators for the Division, training of survey staff and other
Division staff, data management and support functions. She develops and implements
strategies to improve consistency among the field offices and the program units as those
functions relate to the Survey and Certification functions of the Agency under contract with the
Federal Centers for Medicare and Medicaid Services (CMS), in addition to monitoring state
requirements and timeframes. She provides technical assistance regarding programmatic
issues and assists in interpreting rules, policies and standards.

Polly Weaver has over 25 years of regulatory experience and, since 1995, has served as the
Chief of Field Operations for the Division of Health Quality Assurance, Agency for Health Care
Administration. Her responsibilities include management of the eight Agency for Health Care
Administration field offices located throughout Florida, overseeing the staff training and quality
assurance program, as well as complaint administration activities.

Shevaun Harris is the Bureau Chief for Medicaid Services at the Agency for Health Care
Administration. She has over 10 years of experience in the health and human services field,
working with children and adults with HIV/AIDS, chronic conditions and behavioral health
issues. She has worked at the Agency for Health Care Administration since 2005 and has held
several progressively responsible positions. In her current role with the Agency, Shevaun is
responsible for managing a staff of over 65 employees and responsible for the development,
coordination and implementation of Medicaid program policies and procedures (with the
exception of pharmacy services) and is responsible for the administration of the program’s
medical authorization functions. She received her Bachelor’s degree in Psychology and a
Master’s degree in Social Work from Florida State University and most recently earned another
Master’s degree in Business Administration from Quinnipiac University.

Presentations and Descriptions:

8:45 to 9:45 a.m. Medicaid Managed Care LTC Program Update for Skilled
Nursing Facilities
Beth Kidder, AHCA (Orlando and Tallahassee) or Shevaun Harris
(Tampa and Davie)

Description: AHCA representatives will provide an update on the Statewide
Medicaid Managed Care Long-term Care program implementation
and discuss how Florida will ensure the managed care system for
long term care provides quality services to individuals with long
term care needs.
10:00 a.m. to 12:00 p.m. Top 10 Deficiencies and Hot Topics - Including Life Safety
Citations, F 309, Transfer/Discharge and Resident Rights
Polly Weaver and Eddie Alday, AHCA

Description: The Florida State Survey Director will discuss the major areas of
deficiencies. Concerns with transfer and discharge decision-
making and residents’ rights and other issues in the determination
of levels of care and placements will be addressed. Life Safety
enforcement will also be a topic of discussion, with opportunities
for questions and answers.

1:15 to 3:15 p.m. Successful Practice Guidelines for Quality Outcomes
Deborah Afasano, Avante Group, Inc.

Description: Successful clinical care practices will be highlighted within the
framework of a facility’s Quality Assurance and Performance
Improvement (QAPI) and the partnership with Advancing
Excellence.

3:30 to 4:30 p.m. Survey Enforcement and Civil Money Penalties
Polly Weaver and Kimberly Smoak, AHCA

Description: Florida has one of the highest CMP collections in the nation,
linked to costly immediate jeopardy citations. This session will
discuss the importance of regulatory compliance in critical areas
of enforcement.
1/30/2014
TheStatewide Medicaid Managed
Care Program & Florida Nursing
Facilities
Beth Kidder / Shevaun Harris
Agency for Health Care Administration
Why are changes being made to
Florida’s Medicaid program?
• Because of the Statewide Medicaid Managed Care
(SMMC) program, the Agency is changing how a
majority of individuals receive most health care
services from Florida Medicaid.
Long‐term Care program
(implementation Aug. 2013 –
March 2014)
Statewide Medicaid 
Managed Care program
Managed Medical Assistance 
program 
(implementation May 2014 –
August 2014)
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The SMMC program does not/is not:
• The program does notlimit medically necessary
services.
• The program is notlinked to changes in the Medicare
program and does not change Medicare benefits or
choices.
• The program is notlinked to National Health Care
Reform, or the Affordable Care Act passed by the U.S.
Congress.
– It does not contain mandates for individuals to purchase insurance.
– It does not contain mandates for employers to purchase insurance.
– It does not expand Medicaid coverage or cost the state or federal
government any additional money.
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1/30/2014
General Eligibility and Enrollment
Information
• All Medicaid recipients will be enrolled in a managed care
plan unless specifically exempted under Chapter 409,
Florida Statutes
–Approximately 85% of Medicaid recipients will receive
their services through a managed care plan once the
SMMC program is implemented
–The majority of the remaining 15% of Medicaid
recipients who are exempted from enrollment are only
eligible for limited Medicaid benefits
• Each Medicaid recipient will have a choice of plans and
may select any available plan unless that plan is restricted
by contract to a specific population that does not include
the recipient.
4
Choice Counseling & Outreach
5
Choice Counseling
• Choice counseling is a service offered by the
Agency, through a contracted enrollment
broker, to assist recipients in understanding:
–managed care
–available plan choices
–plan differences
–the enrollment and plan change process.
• Counseling is unbiased and objective.
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2
1/30/2014
The Choice Counseling Cycle
Recipient determined
eligible for enrollment or
enters open enrollment
Newly eligible recipients Recipient receives
are allowed 90 days to communication
“trbye”c tohme ipnlagn l oocukte, db-eifnore informing him of choices
Enrollment or change is
processed during Recipient may enroll or
monthly processing and change via phone, online
becomes effective the or in person
following month
7
A Closer Look at the Choice
Counseling Cycle
• Newly Eligible Letters:
–Approximately 60 days prior to the plan begin date,
recipients will receive a letter and a packet of
information detailing their choice of plans and how to
choose a plan.
•Letter
•Brochure that provides plan information specific to
the recipient’s region
•Information on how to make a plan choice
•The plan to which they’ll be assigned if they don’t
make a choice.
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A Closer Look at the Choice
Counseling Cycle
• Reminder Letter: Reminds fully eligible recipients of their
need to make an enrollment choice by a specific cut-off date,
(this information was also included in the original letter).
• Confirmation Letter: Mailed after a voluntary plan choice
or change to confirm the recipient’s selection and to inform
of next steps and rights.
• Open Enrollment: Mailed 60 days prior to the recipient’s
plan enrollment anniversary date to remind them of the
right to change plans.
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