No. 14 – Winter 2017
  In This Issue   Phase Two Beneficiary Forms Now Available in Spanish
The NY–RAH project is pleased to now offer the project beneficiary notification form and project opt-out form in Spanish. These forms are required as part of the Centers for Medicare & Medicaid Services (CMS) Initiative and have previously been available only in English.

Prior to the go-live date for Phase Two on November 1, 2016, CMS required all Group A and B facilities to distribute a beneficiary notification form to all eligible residents or family members about the project. The beneficiary notification form explains the project's goals, the treatment options for the six clinical conditions, and the data collection requirements.

All facilities participating in the CMS Initiative are also required to permit an otherwise eligible beneficiary to opt out of the project if he or she wishes to do so. The NY–RAH project management team (PMT) distributed an opt-out form template for each participating facility to customize and encouraged facilities to develop a workflow to distribute all required forms. To date, NY–RAH has received 19 completed opt-outs out of the thousands of eligible residents. If your facility has a need for the documents in any other language, please contact Megan Burns, Assistant Project Director, at 212-554-7243, and we will do our best to accommodate your request.
Phase Two Payment Reform Practitioner Billing Update
The NY–RAH PMT has heard from several Group A and B facilities and associated practitioners about billing issues that have arisen when submitting practitioner claims for the acute nursing facility care visit (G9685) and the nursing facility conference (G9686). Following a review of the rejected claims and discussions with CMS project officers, NY–RAH has identified the issues that are causing some concerns and would like to clarify the following:

Practitioner NPI
To be eligible to bill for G9685 and G9686, a practitioner must be vetted and approved by CMS. Vetting is done based on the individual practitioner's NPI number and the approval of practitioners is at the individual level, not the group level. Therefore, to bill using the project's new codes, an eligible practitioner must use his or her individual NPI number, not group NPI number, to bill.

TIN Associated with the Practitioner
The claim must also include a tax identification number (TIN) associated with the practitioner. While the TIN included on the claim can be that of either an individual or group, it must match what was submitted to the PMT for vetting. A list of all approved, pending, and removed practitioners and their associated information is distributed to each facility's Administrator and Medical Director at the beginning of each month for updating.

Location of the Practitioner Visit
An eligible practitioner is only able to bill using the new codes for visits that take place in certain approved facilities (those participating in the CMS Initiative). Therefore, the facility NPI number should also be on the claim form so those processing the claim can be assured that the visit is eligible for use of the new codes.

The PMT is regularly updating the Phase Two facility and practitioner FAQ documents based on the questions that come in, and we encourage facilities and practitioners reach out to either Ashley Hammarth, Director, Performance Improvement, at 212-540-5421, or Megan Burns at 212-554-7243, if there are any issues. A copy of any rejected claim can be faxed to 844-726-2720 and the NY–RAH PMT will try to assess what might be causing the difficulties.
  National Healthcare Decisions Week Events
National Healthcare Decisions Day (NHDD) is held annually on April 16, the day after tax day, as a reflection of the adage, "the only things in life that are certain are death and taxes." For 2017, to celebrate the 10th anniversary of NHDD, which is a private, national initiative, and to accommodate for Easter Sunday, NHDD will be a weeklong event to promote the completion of advance directives and advance care planning. The schedule of suggested events and themes are listed below.
  • Sunday (4/16): Prepare
    • A day to get resources together
  • Monday (4/17): Start with Yourself
    • A day to think about your own health care decisions
  • Tuesday (4/18): Family/Friends/Loved Ones
    • A day to discuss your wishes with others (and learn their wishes)
  • Wednesday (4/19): Spread the Word
    • A day to tell others that you've engaged in advance care planning and encourage them to do the same
  • Thursday (4/20): Facilities Focus
    • A day for health care providers of all sorts to promote advance care planning
  • Friday (4/21): Professionals Preparedness
    • A day to ensure that all professionals (health care, clergy, legal, and others) understand and can promote advance care planning
  • Saturday (4/22): Reflection and Readiness
    • Consider what worked well for NHDD week and file/share your advance care plans so they will be available if needed
Using NHDD to Promote NY–RAH Goals
NHDD is an excellent opportunity for your facility to set aside time for advance directive discussions and to work with residents who have capacity to identify a health care agent and complete a health care proxy form. Since Phase One, the NY–RAH project has been working with participating facilities to increase the number of completed advance directives for all residents through the promotion of quarterly advance directive discussions as a best practice. The NY–RAH project set a goal in Phase One for 80% of each Group B facility's beneficiaries to have a quarterly advance directive discussion and a health care proxy. By the end of Phase One, 74% of NY–RAH residents had a quarterly advance directive and 56% had a health care proxy. NY–RAH will continue to strive toward the 80% goal for each in Phase Two.

NHDD Material Available from NY–RAH
Health care institutions across the country will be participating in NHDD, each doing its own special event. Some examples of events at nursing facilities include conducting resident and family council meetings to promote the goals of care conversations; using The Conversation Project Starter Kit to guide end-of-life care discussions; encouraging staff to have their own advance care planning discussions through lunch and learn events; and promoting NHDD on a facility's automated on-hold telephone recordings. NY–RAH will create flyers and other supplemental resources to help nursing facilities promote NHDD. The NY–RAH materials will focus on Thursday, April 20 for "Facilities Focus," to help promote internal palliative care activities and care conference with residents and families, and Friday, April 21 for "Professionals Preparedness," to help promote internal palliative care activities among staff and the new incentive payments for conducting care conferences as part of Phase Two. More information will be made available in March, so the NY–RAH team encourages facilities to start planning NHDD events now.

If your facility elects to hold an NHDD event that you would like featured in the next issue of NY–RAH News, please contact Megan Burns at 212-554-7243.
Group B Antibiotic Stewardship Webinar on March 1
The NY–RAH project is inviting all Group B facilities to participate in an exciting new initiative that aligns with our goals for 2017. GNYHA and the United Hospital Fund (UHF) are conducting a new antimicrobial stewardship program (ASP) for nursing homes.

Details about the ASP will be discussed during a GNYHA/UHF kickoff webinar on March 1. Information and next steps for nursing homes in developing an ASP in their facility will be discussed. Program faculty will also review the components and institutional commitments required for participation in the program.

DATE: Wednesday, March 1, 2017
TIME: 2:00 p.m. - 3:00 p.m.

The ASP certificate program will provide support for the appropriate management of NY–RAH Phase Two potentially avoidable conditions such as pneumonia, urinary tract infections, and skin infections, in addition to supporting new requirements for skilled nursing facilities that becomes effective on November 28, 2017 as discussed in the Medicare Long-Term Care Requirements of Participation final rule.

Pharmacists (including nursing home pharmacy consultants), infection prevention nurses, and physicians from nursing homes are all appropriate for this certificate, and continuing education credits will be available for pharmacists, physicians, and nurses.

Please contact Ashley Hammarth at 212-506-5421 with questions about the certificate program or upcoming webinar.
  CMS Initiative Around the Nation
NY–RAH is one of six organizations that received the Phase Two award for the CMS Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform. The organizations across the Initiative meet annually and speak monthly to learn best practices from each other. NY–RAH will highlight one of the other organizations each quarter to describe its unique features and best practices.

US Map

Alabama Quality Assurance Foundation (AQAF) is the quality improvement organization leading the CMS Nursing Facility Initiative in Alabama. Like NY–RAH, AQAF is a "hands-off model," which means that registered nurses are also working at Group B nursing facilities on education and building capacity in nursing facilities for quality improvement, and not providing direct care. The 23 AQAF Group B nursing facilities that were selected to participate in Phase One represented the nursing facilities with the highest hospitalization rates in Alabama. AQAFs main focus areas for Group B in Phase Two are:
  • Education on early recognition and communication of changes of condition through the use of the INTERACT Stop and Watch and SBAR tools
  • Leadership training to identify strengths, weaknesses, opportunities, and threats to make systematic improvements while changing the culture at the nursing facility
  • Creating and sustaining cross-functional Quality Assurance Performance Improvement programs using a data-driven PDSA-cycle framework, peer coaching, and sharing of best practices
For more information on the AQAF ECCP, please go to
  NY–RAH is supported by Funding Opportunity Number 1E1CMS331492-01-01 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.  
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