CLINICAL OPERATIONS February 16, 2017

Minutes

I. Call to Order

II. Introductions

III. Approve Minutes Minutes approved as written

IV. Agenda Additions Discuss SCIO audit tool from the last meeting.

V. Executive Director’s Report All members encouraged to attend Annual State Legislative Day. Important to register so legislators know if they have constituents present. Barry explained process. The relationships are just as important as the discussion of the issues. Members will meet at the Capitol at 10:30am. NAHC March on Washington, in March, contact Barry if you are attending. OASIS answers workshop and ICD-10 workshops coming up with Sparkle Sparks from OASIS Answers. Last time 40 members attended. Let the education committee know if this is no longer a necessary workshop.

VI. Announcements/Reports: A. Regulatory Update 1. NGS – Christine Weir The NGS POEAG meeting was held on 2/15/17. NGS has continued to update their website and members are encouraged to look at the site. They specifically mentioned a CERT denial finder and new U-Tube videos explaining NGS Connex. NGS announced that a company called Advance Med will now be making request for CERT records. Some of the reasons for CERT denials this past review were related to homebound status, skilled services, medical necessity and face-to-face missing. NGS encouraged agencies to call the CERT office if they are having difficulty getting information from physicians. The CERT error rate for J6 is down to 16%. This is a dramatic improvement and is down from 50%. The overall goal is to be <10.5%. Round 2 of probe and educate started on 1/19/17. They have requested 2900 records. They started in Michigan with a goal

1 of helping to educate providers prior to PCR beginning. The probe and educate group has updated the language in the ADR request. They have revised their tips and created a probe and educate mailbox for education requests. They are committed to a plan to be more proactive in round 2 regarding education. There will be a virtual conference on April 13th and agencies are encouraged to sign up. The next meeting will be in June.

2. MILARA – Amy Parkinson Explained the purpose of the liaison meetings. Discussed some scores, surveys on their data base. MILARA notes that data looked better but could not explain the time frames or where the data pulls from. Bill Dombi, from NAHC, and Barry Cargill have composed a letter requesting the parameters that go into the data. Only non-accredited agencies are represented in the data. New surveyor attended the MILARA meeting. Members encouraged reporting any difficulty with survey to Rick Brummette. Can also do this through MHHA. Barry also discussed recipical arrangement with other states. Larry Howath states Michigan would not be a hold up, however all other states have been resisting except Wisconsin. This is some legislation related to Certified Nurse Aides. Michigan doesn’t have a statute, so we follow Federal Guidelines. We have to watch this closely as nursing homes would like a statute that would place the SUFs at an advantage .

3. BCBSM Ed gave report. Invitation from BCBS to schedule a liaison meeting. With the exception of SCIO most issues are getting resolved. Members are encouraged to contact their rep. Concerns with SCIO continue. They are aggressive and seem to only follow Medicare standards when it is convenient. SCIO contract through 2018. BCBS does not require a new F to F with payor changes. One member had an entire record denied because the physician’s signature had a typed date as opposed to handwritten.

4. Regulatory – Elizabeth Barkley COPs and Emergency Preparedness. Non- Emergency Preparedness is covered in the new COPs. NAHC would like the program delayed until 2018. Barry asked members if MHHA should support the delay. Members would support and comments made regarding lack of interpretive guidelines to prepare. There was a request for MHHA to do a COPs workshop bringing in Arlene Maxime. Amy Parkinson encouraged members to pull their PEPPER Reports.

5. Education Committee – Cindy Thelen Lots of teleconferences coming up. Reschedule HIS workshop as a teleconference in May. Working on Annual Conference Registration, it will be available shortly. Topics for leadership, NGA, MILARA, VBP, QAPI, workmans comp. integrated health, pain management, HIPPA and many more. Bill Dombi will be presenting again this year. Many Hospice and Palliative Care sessions. MHHA is having a ICD-10 class, not good attendance, will offer member rate to coding companies,

2 that have members as clients. Discussion regarding how many agencies are out sourcing their coding, about 50% of agencies present indicated that they did, which is making MHHA’s coding class unnecessary.

B. MPRO Working on their educational programs. Focus will be on re-admission and there was not a lot of Home Care Companies involved. Discussed concerns with navigators and coaches and then not recommending home care. Key concepts are med management and patient involvement. Katie Brown would like member’s participation. Contact Barry if interested in being involved in Pre Claim Review.

VII. Sub-Committee/Task Force Reports: A. IV Therapy/Infection Prevention – Debbie Opalewski reported that the group is open to new items. Looking at a guide on IV’s that are safe to give in a home setting. B. Psych Home Care - inactive C. Rehab Subcommittee – No report

VIII. New Business A. Thermometer - There has been a bit of controversy about types regarding accuracy. B. Scales – How many agencies are buying scales? Some agencies buy for the patients that do not have them. Some agencies are buying for their staff. Use stainless steel and cleansing with alcohol.

IX. Sharing Segment A. Survey Report One Joint Commission survey, with use of new evaluation tool, using the safety matrix, very focused on risk to the patients. Interesting finding related to hand sanitizer, must wait for sanitizer to dry. Wound wash, aide care plan and care plan updates and missed visits. One had a state surveyor. 4 surveyors for 4 days and then brought a 5th surveyor respectful and thorough – 485’s intervention. Concerned that survey was a month ago with no report. G tags mostly, too many checked boxes and not enough narrative. Documentation did not support 485.

X. Adjournment

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