The Re-KAPP 10.7.16

1. Monthly Summary/Daily Note Workgroup:  KAPP representatives have finalized recommendations to the Cabinet lead, Teresa Leilart, all the way down to suggested “templates” and outlining documentation requirements for each service based upon CMS Federal Regulations which are very simple and minimal.  These recommendations will be combined with other suggestions and shared with Commissioner Anderson by Tuesday 10/11.  Hopefully, a proposal will be submitted to all providers in the next couple of weeks, with suggested language for an emergency regulation.  The goal is for that to be in place before the year’s end.
2. Exceptional Rate Protocol Workgroup:  KAPP representatives had a productive conference call earlier this week and have collaborated to prepare actual numbers/examples of what a residential model looks like when staffed at a 1:3 ratio, then what happens when you add a 2nd staff, etc. considering actual reimbursements and costs.  We feel it is a very practical, compelling argument and will present it to Commissioners Miller and Anderson in the next 2 weeks.  Both Commissioners agree that providers should be reimbursed for any services provided and support a modest profit.  These understandings are the basis of our proposals to revamp the protocol and include new language in the emergency regulation to drop this year.
3. Recoupment Workgroup:  This group met on Wednesday for the first time and the KAPP representatives went in prepared with the pre-questions answered and documented.    The push for changes in regulation is to make everything straightforward and minimal, not to require anything that is not a CMS federal requirement.  The concept of “substantial compliance” versus “strict compliance” was a topic of discussion, as well as the role of Quality Assurance staff…that their responsibility is to ENSURE compliance, to help providers comply and succeed.  The workgroup is compiling notes to propose to Commissioner Anderson by next week.

• Stakeholder Update Meetings were held in person and via webinar on September 22nd and September 30th.  If you were unable to attend I posted a copy of Lynne Flynn’s presentation in an earlier blog post.
• One of our members notified me that Category 4 providers who will be included in the first round of submissions to CMS started getting notifications this week. There is a webinar scheduled for 10/19 for only those in the 1^st round of submissions to answer questions about how the process will work and to go over expectations for compiling transition plans.
• The Cabinet for Health and Family Services (CHFS) has been working towards compliance with the Home and Community Based Services (HCBS) Federal Final Rules in order to meet the requirements and implementation deadline of 2019. Over the last several months, CHFS has collected information on settings that are designated as Category 4, presumed not to be home and community-based. Over the next few months, CHFS plans to compile the collected information (from providers and site visitors) into a summary for each setting. These summaries will be published for public comment and then will be submitted to the federal Centers for Medicare and Medicaid Services (CMS) for review and final determination.Before submitting these settings and their evidence of home and community-based characteristics to CMS, CHFS developed a review process to determine whether the evidence collected supports that the setting overcomes the presumption of not being home and community-based. In order to ensure that all stakeholders are represented, CHFS would like to involve various stakeholders in the review of the summaries. They are asking for KAPP’s participation in this review process. They have scheduled two all-day review sessions in order to collect stakeholder input on the summarized evidence of the settings in the first round submission to CMS. Each stakeholder group is invited to identify one representative at each meeting and please ensure that the same individual is present at both meetings.  I will be representing KAPP in these meetings.Review Session Dates:Tuesday, November 29: 9:00 AM – 4:00 PMTuesday, December 6: 9:00 AM – 4:00 PM

• KAPP and ANCOR continue to support the Disability Community Act, HR 5902, but advise providers that compliance by 12/1/16 is recommended.  
• The Department of Labor’s Final Overtime Rule updates the salary level required for the executive, administrative, and professional (“white collar”) exemption to ensure that the Fair Labor Standards Act’s (FLSA) intended overtime protections are fully implemented, and it provides greater clarity for workers and employers. The final rule updates the salary threshold under which most white collar workers are entitled to overtime compensation to equal the 40th percentile of weekly earnings of full-time salaried workers in the lowest wage Census region, currently the South. The final rule will raise the salary threshold from $455 a week ($23,660 for a full-year worker) to $913 a week ($47,476 for a full-year worker) on December 1, 2016.This information is intended to provide more information on the Department’s announcement of a Time-Limited Non-Enforcement Policy for providers of Medicaid-funded services for individuals with intellectual or developmental disabilities in residential homes and facilities with 15 or fewer beds.  See the following FAQ’s.
• KAPP  realizes this presents Tough Choices for Providers and want to support you!  I’ve started a thread on the Message Boards for you to share ideas and suggestions…how your agencies plan to comply.  This is a secure member forum that we encourage you to use.  ANCOR is also compiling survey results for how members are changing business practices to comply.  I will share that soon.
• Reach out to our Senators, McConnell & Paul to let them know how this affects us and ask for their support.  This is a very simple tool.  Kentucky should target our Senators, so just check that option when using the SOS tool!  Contact your SENATOR!

• Our waiver redesign group will reconvene in the next 2 weeks.
• Ken Lovan (ResCare) and I are part of a National Waiver Redesign Workgroup through ANCOR that is compiling a white paper on Best Practices/Guiding Principles for Rate Setting that CMS has requested.
• Commissioner Anderson and Commissioner Miller are weighing the options of rewriting the 1915c’s or creating ONE 1115 for all.
• To prepare for the “bootcamp” waiver redesign process, KAPP will be forming multi-workgroups to focus on breaking down each SECTION and SERVICE of the waivers utilizing conference calls/meetings with a group point person, to recommend service changes, rate changes, reduction of administrative burden, cost and regulations.  We need to do a comprehensive review and be prepared to give suggestions within the next couple of months.  Be prepared to answer a survey very soon as to what groups/areas you’d like to help with.  We need ALL HANDS ON DECK for this important project!
• We will be expected to incorporate “managed care principles” into this waiver redesign.  Commissioner Miller is cautiously aware that our population is not one that can go “straight managed care.”  That messaging has been effective!  More to come on that topic…

KAPP Strategic Planning

• Thank you for participating in the Town Hall Strategic Planning Session at the KAPP Conference!  Those ideas will be reviewed at….
• The KAPP Board of Directors Retreat in Louisville on Wednesday, November 16th.  ***All board members were eligible to continue in their terms for 2017 and agreed to do so.
• Please continue submitting your demographic information and strategic planning ideas via the KAPP Demographic Survey

Thank you and have a wonderful weekend!!!   Shannon