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|October 4, 2018
WEBINAR FREE TO FAHA H&S MEMBERS PROVIDES TRAINING ON THE SMMC CONTRACT NEW REQUIREMENTS
Medicaid New SMMC Five-Year Contract Begins January 1, 2019
Please join us for the training webinar October 4 at 2:00pm free to FAHA H&S members. This webinar will explain the new credentialing and recredentialing requirements for nursing homes contracted with the health plans for the Medicaid LTC population.
In anticipation of tomorrow’s webinar, below are follow-up articles specific to the antipsychotic percentage requirements and reduction programs.
THE AGENCY REQUIREMENTS ON THE HEALTH PLANS AND HOW THEY AFFECT THE NURSING FACILITY PROVIDERS
Two of the Agency goals are reducing antipsychotics and implementing value-based contracting. These goals are clearly written into the new contract and were part of the rebidding process requiring the health plans to implement. These requirements include possible fines if not implemented and monitored.
Why this is potentially problematic to the nursing facility is how this requirement is implemented. For example, a new requirement of re-credentialing will include reviewing the nursing facility providers quality star ratings and antipsychotic percentage. The below is directly from the new contract between the Agency and the health plans:
Within the new contract, there is an eighteen-page section explaining the sanctions/liquidated damages and fines that will be applied if the requirements of the contract are not met. There are 100 specific items to be sanctioned or fined by the Agency ranging from $500 per day to $25,000 per occurrence based on the severity of the offense. These damages will not be passed through to the provider but, the health plans will be diligent in their requirements to ensure they are not fined. Below is a fine for not meeting credentialing requirements:
Value based purchasing is another goal of the Agency to implement through the SMMC contract. Value based purchasing was a repeated theme throughout the rebidding process and is linked to various goals of the Agency. The Agency is requiring the health plans to implement value-based purchasing contracts within their provider network. There are specific contract volume requirements for each year of the five (5) year contract. Most of these will be physician-based contracts but, there are specific measures such as, potentially preventable admissions(PPA) and readmission(PPR) and potentially preventable emergency department visits (PPV) that will affect nursing facility providers.
If you have questions, please contact Dana McHugh via email or by calling her at (850) 339-2909.
Reducing the Use of Antipsychotics in Nursing Homes
Paul Katz, MD
RIPPED FROM THE HEADLINES
ACO Announcements Add to Existing Skilled Nursing Pressures Value-based arrangements generate much of their savings by shifting spending away from the post-acute setting, according to recent government announcements. That ups the already-high pressure on skilled nursing facilities to lower patient length of stay while maintaining quality of care. Read more...
Health plan updates
Important: Medicare Compliance FDR Attestation. All contracted providers for Medicare (Parts C and/or D) or Medicaid must complete an annual Medicare Compliance Attestation by December 31st of each year.
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