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F E B R U A R Y / M A R C H 2 0 0 9
A G E N C Y F O R H E A L T H C A R E A D M I N I S T R A T I O N
Nursing Home Joint Training
Nursing Home Guides & Information
Federal Nursing Home Compare – 5 Star Ranking
Florida Nursing Home Guide
Comparison Chart (Handout) Time Frame
Violations Considered (Deficiencies)
Weight of Violations (Algorithms)
Star Rankings
Frequency of Updates
Inspection Reports Posted on the AHCA Web Site: ahca.myflorida.com/Consumer_Resources/index.shtml
Florida Nursing Home Quality Assessment
Authorized During January 2009 Special Session
Allows Florida Medicaid to Draw Federal Funds to Offset Cuts in Medicaid Budget
All Nursing Homes Pay Assessment Except:
Nursing Homes on the Campus of a Continuing Care Retirement Community (CCRC)
Hospital Based Skilled Nursing Units (SNUs)
Nursing Homes with 45 Beds or Less
Assessments Effective April 1, 2009
First Report Period May 1, 2009 – Deadline May 15th
Nursing Home Quality Assessment Rates
Per Day Assessment Rates Will Be Once Each Year
Rates will Differ for Large Versus Small Medicaid Providers
Large is 52,000 Annual Medicaid Days
Rates May Not Exceed 5.5% of Total Aggregate Net Patient Revenue
Report Monthly the Number of Non-Medicare Part A Days
Monthly Assessment = Number of Non-Medicare Days X Rate
Federal Approval Required from the Center for Medicare and Medicaid Services (CMS)
Modifications Must Be Made if Required by CMS
Nursing Home Quality Assessment Rates
Assessment Must Be Paid by the 15th of the Following Month
AHCA May Deduct from Medicaid Funds Owed or Fine $1,000 Per Day Late
Assessment Can Be Claimed in Medicaid Cost Reports with a Pass Through Reimbursement (full repayment)
Assessment Fee Amounts Cannot Be Passed on to Private Pay Residents
AHCA Developing the Method of Collecting Monthly Data and Fees
Emergency Status System Update
Provider, Affiliate, and Partner Accounts Available Nursing Home Enrollment 94%
Verify Your ESS Users & Access the System Update ESS Information:
Contacts, Numbers and Emails Utilities and Generator
ESS Activation: Email Users with Instructions Census and Bed Availability Impact if Affected
ESS Transportation Tab
Select the Add tab
Transportation Type
Select the Transport Type
Transportation Details
Transportation Updated
Emergency Status System Assistance
AHCA Emergency Resources: ahca.myflorida.com/MCHQ/Emergency_Activities/index.shtml
Emergency Status System Web Site: ess.myflorida.com
AHCA Long Term Care Unit: (850) 488-5861
AHCA Celerate
AHCA’s Version of “Accelerate Florida”
Focus on Opportunities to Simplify Processes & Information
Applications and Forms
Recognize Regulatory Requirements
Eliminate Duplication
Feedback Requested: [email protected]
New AHCA Web Site
Preview AHCA Web Site
Health Inspection Results: Florida Nursing Home Guide versus CMS Nursing Home Compare
Both web sites contain helpful information about nursing homes and can be used together with other information (such as a visit to the nursing home and information from your health care provider) to make informed choices when seeking nursing home care. The primary differences between the Health Inspection Stars
on the two web sites are described below:
Florida Nursing Home Guide Federal Nursing Home Compare Star Rankings Stars are based upon violations identified
during an inspection. “Health Inspections” Stars based upon certain violations identified during an inspection, staffing information, and quality measure information.
Time Frame Last 30 months of violations for all recertification and complaints inspections
Last 3 recertification surveys (which occur every 6-15 months) Last 3 years of complaints
Violations Considered
All federal nursing home deficiencies: “F” tags - Health and Services and “K” tags - Fire/Life Safety Non-certified nursing homes (5): “N” tags - State Licensure “K” tags - Fire/Life Safety
Certain federal nursing home deficiencies: “F” tags - Health and Services (“K” tags - Fire/Life Safety are excluded)
Weight of Violations
Violations are given points based on severity and scope (see chart) Certain critical violations receive additional points, See attached state algorithm All inspections are equal weight
Violations are given points based on severity and scope (see chart) “Substandard quality of care” violations additional points, See attached federal algorithm Most recent recertification inspections carry heavier weight: Most recent - 1/2 weight (50%) Second most recent - 1/3 weight (33.3%) Third most recent - 1/6 weight (16.7%)
Star Assignment Stars are allocated based upon a comparison with other nursing homes in the inspection region (11 geographic areas in Florida). Ranking across 100%: 5 Stars: Top 20% 4 Stars: 21% - 40% 3 Stars: 41% - 60% 2 Stars: 61% - 80% 1 Stars: Bottom 20%
Health Inspections Stars are allocated based upon a comparison with other nursing homes in the state. Ranking across 100%: 5 Stars: Top 10% 4 to 2 Stars: Middle 70% spread among 2 to 4 stars in 23.33% segments 1 Stars: Bottom 20%
Web Site Updates Quarterly Monthly
Florida’s Algorithm
Scoring and Ranking Algorithm
Severity
Immediate Jeopardy to Resident Health or Safety J=32 K=45 L=60
Actual Harm that is not Immediate Jeopardy G=16 H=22 I=28
No Actual Harm with Potential for more than
Minimal Harm D=5 E=8 F=11
No Actual Harm with Potential for Minimal Harm A=0 B=1 C=3
Isolated Pattern Widespread Scope
CMS Algorithm
Survey Deficiency Score: Weights for Different Types of Deficiencies
Severity Scope
Isolated Pattern Widespread
Immediate jeopardy to resident health or safety
J 50 points (75 points)
K 100 points (125 points)
L 150 points (175 points)
Actual harm that is not immediate jeopardy
G 20 points
H 35 points (40 points)
I 45 points (50 points)
No actual harm with potential for more than min. harm that is not IJ
D 4 points
E 8 points
F 16 points (20 points)
No actual harm with potential for min. harm
A 0 point
B 0 points
C 0 points