Agency For Health Care Administration Regulatory Update Training

Agency For Health Care Administration Regulatory Update Training September 2004 / January 2005 Presenters: Polly Weaver, Chief of Field Operations Molly Mc. Kinstry, Chief of Long Term Care Services Susan Acker, Ph. D. , Director of Nursing Services Agency for Health Care Administration-Division of Health Quality Assurance Agency for Health Care Administration

Hurricane Season 2004 Agency for Health Care Administration

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 Agency for Health Care Administration

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 Agency for Health Care Administration

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 Agency for Health Care Administration

Emergency Resources • First Contact: Local Emergency Management http: //www. floridadisaster. org/County_EM/county_list. htm# • Florida Emergency Information Line 800 -342 -3557 • Emergency Support Function – 8 850 -410 -1822 800 -320 -0519 (request ESF-8) Agency for Health Care Administration

Regulatory Update • Regulatory Changes • AHCA Information Regarding Trends • Regulatory Statistics Agency for Health Care Administration

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

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

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 Agency for Health Care Administration

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 • Water’s Edge Extended Care, Palm City Agency for Health Care Administration

Nursing Home Gold Seal Renewing Gold Seal Recipients: • Harbour’s 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 Agency for Health Care Administration

Report to the Legislature May 2004 – Status Report Nursing Home and Assisted Living Facility: Adverse Incidents & Notices of Intent Filed http: //www. fdhc. state. fl. us/Publications/index. shtml Also see Semi-Annual Report on Nursing Homes Report to the Legislature December 30, 2004 Agency for Health Care Administration

Adverse Incidents Reported to AHCA Agency for Health Care Administration

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 Agency for Health Care Administration

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 Agency for Health Care Administration

Adverse Incident Outcomes Agency for Health Care Administration

Nursing Home NOIs Agency for Health Care Administration

Characteristics of Reported Litigation Agency for Health Care Administration

Notices of Intent Past 3 -Years 548 Nursing Homes Reporting NOIs May 2001 - May 2004 Agency for Health Care Administration

Notices of Intent Past Year 339 Nursing Homes Reporting NOIs May 2003 - May 2004 Agency for Health Care Administration

Nursing Home Complaints Filed in Clerk of Court Complaint Service Dates June 2002 - April 2004 Agency for Health Care Administration

Nursing Home Complaints Filed in Clerk of Court By AHCA Receipt Date June 2002 - April 2004 Agency for Health Care Administration

Number of Nursing Homes on The Watch List Agency for Health Care Administration

Nursing Home Deficiencies Agency for Health Care Administration

Nursing Home Deficiencies for Failure to Have Sufficient Staff to Meet Resident Needs Agency for Health Care Administration

All Nursing Home Staffing Deficiencies Agency for Health Care Administration

Grant Proposal Requests Use 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 Agency for Health Care Administration

Federal Guidance • Federal Regulations 42 CFR 488. 442(g) and Section 7534 B 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 Agency for Health Care Administration

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 Agency for Health Care Administration

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 Should Be Relatively Short-term Projects Agency for Health Care Administration

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 Agency for Health Care Administration

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 Agency for Health Care Administration

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 Agency for Health Care Administration

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 Agency for Health Care Administration

Grant Information & Proposal Submission Bureau of Long Term Care Services Barbara Dombrowski Phone: (850) 922 -0048 E-mail: dombrowb@fdhc. state. fl. us Agency for Health Care Administration

Top 10 Nursing Home Deficiencies Agency for Health Care Administration

Top 10 Nursing Home Deficiencies Agency for Health Care Administration

Top 10 Nursing Home Complaint Allegations Agency for Health Care Administration

AHCA Resources Long Term Care Unit (850) 488 -5861 Bureau of Long Term Care (850) 414 -9707 Bureau of Field Operations (850) 414 -9796 Health Standards and Quality Unit (850) 922 -9138 AHCA Website: www. fdhc. state. fl. us New Format AHCA Facilities and Agencies Directory Website: www. floridahealthstat. com/qs/owa/facilitylocator. facllocator Federal Link to Survey Guidance: www. cms. hhs. gov/medicaid/survey-cert/siqhome. asp Agency for Health Care Administration