OHCA District II & Miami Valley Long Term Care Association

1. OHCA District II &Miami Valley Long Term Care Association November 2018 Kenn Daily, LNHA kenn@qissurvey.com

2. District Update • CEUs for today’s program is 2 hours • Certificate of attendance @ table

3. December Program • Holiday celebration with entertainer Chris Katros • Special guest presentation by - David Parker - President OHCA Board of Trustees and EVP, COO, HCR ManorCare • Scholarships • Leadership Award

4. OHCA Events • OHCA Winter Conference • January 15-16, 2019 -Hyatt Regency • LTC Update • Ohio Department of Medicaid Update • Survey and Enforcement Update • PMPD • OHCA Convention • April 29 - May 2 - Columbus, OH

6. Social Media • MVLTCA has launched a LinkedIn group site • Start a conversation • Post a job

7. MVLTCA & OHCA District II Golf Outing Annual Golf Outing August 22nd at Pipestone Golf Club

8. Golf Sponsors 2018 Platinum • Pinnacle Pointe Nursing and Rehabilitation Gold • Collaborative Pharmacy • Life Line Pharmacy • Legacy Village • Oaks of West Kettering • Carriage Inn of Dayton Silver • Otterbein Springboro • Management and Network Services • MobileX

9. 2018 Hole Sponsors, 4-Somes and Supporters • Buckeye Home Care • Concept Rehab, Inc. • Cypress Pointe • Dunbar Health and Rehab • Elder Care Systems Group • Friends Care Community • Gem City Home Care • Genesis Healthcare • Grace Brethren Village • Greater Dayton Construction • InRange Systems • Kettering Home Care • Laurels of West Carrollton • Medline • Springfield Manor • Wade Management Group

10. Ohio Governor - Mike DeWine

11. State Budget Picture SFY 2018 finished very well • Tax revenue - $573 million above estimate • Medicaid - $678 million below estimate (all funds) SFY 2019 • OBM revised tax revenue estimate upward by $531 million • Through September, $32 million above this revised number • Medicaid under estimate by $168.7 million through August (all funds) • What does this mean for next year’s budget?

12. Patient-Centered Medicaid Managed Long-Term Services and Supports (MLTSS) Study Committee ODM’s recommendations were: • Implement a statewide MLTSS program • Include stakeholders in the continued implementation of a MLTSS program • Continue to modernize Ohio’s long-term services and support system • Extend the benefits of person-centered care coordination to all individuals served by Medicaid • Implement a value-based purchasing strategy that awards high-performing providers

13. Federal Outlook • Medicaid Reform - likely dead because of split houses of congress • Medicare - PDPM still on track to be implemented • Regulatory oversight - House will likely sponsor a number of hearings but substantial legislation unlikely • Federal Agencies - HHS and CMS watched closely. Still expect CMS to finalize role back of the RoP (proposed in September) • Budget Cliff - October 1

14. Changes to Immediate Jeopardy Determination Process • CMS shared their current work product on revisions to State Operations Manual Appendix Q - immediate jeopardy. • Under the new draft guidelines, immediate jeopardy requires noncompliance that meets both of the following conditions: • Serious injury, serious harm, serious impairment or death are adverse outcomes which result in: • A significant decline in physical, mental, or psychosocial function, or harm (that is not solely due to the normal progression of a disease or aging process), that is permanent or long-lasting; or • Avoidable pain that is excruciating, and more than transient; or • Loss of limb, or disfigurement; or • Life-threatening complications/conditions, or death. • Need for Immediate Action: The noncompliance creates a need for immediate corrective action by the provider/supplier to prevent serious injury, serious harm, serious impairment or death from occurring or recurring.

16. ODH Data - Deficiencies

17. Total Deficiencies 42% Increase

18. Harm Deficiencies

19. Complaint Surveys

20. Top F Tags (FFY 2018)

21. Top K Tags (FFY 2018)

22. Leading E Tags (FFY 2018)

23. CMS Notice- Notice of Imposition in the Remedies • Directed In-Service Training (DIT) • According to Ohio Department of Health (ODH): • The specific deficient practice(s) identified in the Statement of Deficiencies (SOD) and enforcement letter imposing the DIT. The training should be focused on the specific deficient practices identified not just the Data tag cited. • Facility policies and procedures (P&Ps). • The specific needs of the resident population. The DIT should consider the characteristics of the facility resident population. • Skills/Return Demonstration. The DIT, regardless of the method of delivery, must include a skills/return demonstration component where appropriate. • Q&A. The DIT, regardless of the method of delivery, must include an opportunity for live Q&A.

24. Trainer Requirements • The organization or individuals providing the DIT may not be an employee, corporate staff or have direct ownership in the facility. • The individual conducting the DIT should be a qualified subject matter expert. • Maintain Compliance. The DIT shall include education of staff on the plan for ongoing, sustained compliance. • Compliance with one or more of these guidelines does not guarantee that ODH will approve the DIT.

25. 3701-17-25 Disaster/ Fire/ CO • Each nursing home shall install and maintain carbon monoxide alarms or carbon monoxide detectors in accordance with manufacturer's directions. Carbon monoxide alarms shall be installed in the following locations: (1) On the ceiling of each room containing a permanently installed fuel-burning appliance; and (2) Centrally located on every habitable level and in every heating/ventilation/air conditioning zone of the building. • Nursing homes licensed as such prior to the effective date of this rule have twelve months to come into compliance with paragraph (G) of this rule.

26. 3701-17-25 Disaster/ Fire/ CO (1) "Carbon monoxide alarm" means a single- or multiple-station alarm tested to underwriters laboratory standard 2034, that is intended for the purpose of detecting carbon monoxide gas and alerting occupants by a distinct audible signal comprising an assembly that incorporates a sensor, control components, and an alarm notification appliance in a single unit operated from a power source either located in the unit or obtained at the point of installation; (2) "Carbon monoxide detector" means a device tested to underwriters laboratory standard 2075 that is intended to be connected to a carbon monoxide detection system for the purpose of detecting carbon monoxide gas and alerting occupants by a distinct and audible signal; and (3) "Carbon monoxide detection system means" a system of devices that consists of a control panel and circuits arranged to monitor and annunciate the status of carbon monoxide detectors and to initiate the appropriate response to those signal.

27. Carbon Monoxide Safety • (G) Each nursing home shall install and maintain carbon monoxide alarms or carbon monoxide detectors in accordance with manufacturer's directions. Carbon monoxide alarms shall be installed in the following locations: • On the ceiling of each room containing a permanently installed fuel-burning appliance; and • Centrally located on every habitable level; and • In every heating/ventilation/air conditioning zone of the building. • (H) Nursing homes licensed as such prior to the effective date of this rule have twelve months to come into compliance with paragraph (G) of this rule.

28. Additional Considerations • Facilities must also install CO monitoring or alarm devices centrally located on each floor of a facility as well as in every heating/ventilation/air conditioning (HVAC) zone of the building. • An HVAC zone is the area served by a specific HVAC fuel fired appliance. In addition, the Ohio Fire Code requires an additional CO detector or alarm installed at the location of the first air vent or discharge from each fuel-fired furnace (this is normally found at the nearest room or area served by the furnace).