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August 9, 2018


Medicaid New Five-Year Contract Begins January 1, 2019

Please review previous articles on our ongoing analysis of the upcoming new Statewide Medicaid Managed Care contract effective January 1, 2019. This week is focused on recredentialing requirements for nursing homes. This is critical in order to preserve your health plan contracts.

At the recent annual LeadingAge Florida conference, I was fortunate to have the opportunity to present updates on the SMMC Medicaid LTC contract during the nursing home roundtable session. During this session, I relayed to the group some highlights of the upcoming Medicaid contract requirements. We focused on the expectations the Agency (AHCA) has for the program and how the health plans are required to meet those expectations. One of the ACHA focal points is “recredentialing requirements of the nursing homes.” During this recredentialing process, the health plans are required to review the nursing home’s star rating and their anti-psych percentage versus the state average. If the nursing home’s anti-psych percentage is higher than the state average, this could result in non-renewal of credentialing. Non-renewal of credentialing would likely trigger the health plan to terminate the nursing home’s contract.

As of today, 35% of the LeadingAge Florida members do not meet the requirement of being at or better than the state average of 14.7%. Thus, these members are at risk to have their contracts terminated by the health plans. There have been improvements since the previous reporting period where 43% of the membership were above the then state average of 15%.

In preparation of the new standards and specifically related to the re-credentialing requirements, we will provide training in the fall on best practices for lowering anti-psych percentages. FAHA H&S Medical Directors Ken Brummel-Smith, MD, and Paul Katz, MD, will provide insight and the latest documented successes in reducing antipsychotics. This training will include tools such as policies and procedures and example corrective action plans. These tools are important because, they are tools the health plans understand and utilize in their business activities. The health plans are likely to request your policy and procedures and your corrective action plan to bring the percentage into compliance.

Additional trainings related to requirements of the SMMC contract will be announced soon for fall dates.

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
FAHA H&S Medical Director
Professor and Chair, Department of Geriatrics, College of Medicine, Florida State University

The past several years has witnessed a dramatic reduction in the inappropriate use of antipsychotics in nursing home residents. The prevalence of antipsychotic use in the fourth quarter of 2017 was just under 15% compared to a prevalence in 2011 of 24%!1 This decline has been fueled by several factors, most importantly a concerted effort by CMS to disseminate best practice guidelines while at the same time incorporating the use of antipsychotics into the quality measurement system.

A systematic review of interventions to reduce inappropriate prescribing of antipsychotic medication identified a few potentially effective approaches (see table below).2 The impact of a given intervention was dependent on several factors, most importantly staff engagement, staff availability and integration of the family into the care plan.

Table 1: Interventions to Decrease the Use of Antipsychotics in Nursing Homes2

• Distribution of educational materials
• Educational meetings
• Audit and feedback
• Local opinion leaders
• Reassignment/redefining of staff roles
• Change in physical structure, facilities and equipment
• Presence and organization of quality monitoring mechanisms

A recent report of antipsychotic use in Australia offers additional insights. This initiative, referred to as the HALT study, sought to reduce the use of antipsychotic medication in the nursing home through two key interventions3:

1) Education/training of health care staff and 2) creation of a de-prescribing protocol. In this study the education intervention involved a 3-day workshop where “nurse champions” reviewed concepts around dementia, behavioral and psychological symptoms of dementia (BPSD) and person centered non-pharmacologic treatments. Upon return to their respective facilities, the nurse champions trained additional staff in the concepts and techniques recently acquired.

Deprescribing was facilitated by the creation of an “individualized” deprescribing protocol by a pharmacist which stipulated dose reductions of specific medications over a two (2) week period. Physicians could restart antipsychotic medication if deemed appropriate as well as prescribe the use of short acting benzodiazepine as needed. At twelve (12) month follow-up, antipsychotic use declined by 81.7 percent without a concomitant change in BPSD or other adverse outcomes such as falls or hospitalizations.

While the type of intervention employed to reduce the use of antipsychotics is clearly important, it is often not sufficient to guarantee success. Priorities must be aligned between those delivering care at the bedside with those individuals making decisions at the administrative level. Reducing antipsychotics requires a concerted team effort. The focus must not merely be that of regulatory adherence but rather on enhancing the safety and quality of life for each affected resident.


  1. www.nhqualitycampaign.org/files/AP_package_20180416.pdf, Accessed August 3, 2018.
  2. Coon JT, Abbott R, Rogers M et.al. Interventions to reduce inappropriate prescribing of antipsychotic medication in people with dementia resident in care home: A systematic review. J Am Med Dir Assoc 2014;15: 706-708.
  3. Brodaty H, Aerts L, Harrison F et al. Antipsychotic deprescription for older adults in long term care: The HALT study. J Am Med Dir Assoc. 2018;19: 592-600.


‘Post-Hospital Syndrome’ Blamed for Readmissions. Many hospitals likely would get terrible reviews on a hotel rating site like TripAdvisor. The noise, harsh lights, disrupted sleep, unpalatable food, and other negatives that can come with a hospital stay are not only unpleasant, they may be sending some patients home in a state that resembles post-traumatic stress disorder. Read more...

Health plan updates

CIGNA provides webinar training for provider portal CignaforHCP.com. This guide explains how to access their provider portal and all the capabilities within the portal. Read more...


UnitedHealthcare Community Plan Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates. Page 29 of the August 2018 UHC network bulletin addresses the Medicaid updates. Read more...

Copyright 2018 — Publication of FAHA H&S
Chair: Brian Robare
President/CEO: Steve Bahmer
Principal/Editor: Dana McHugh

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