Things That Keep Us Up at Night…

CALTCM has a robust public policy committee (officially the Policy & Professional Services Committee [PPSC]) with interdisciplinary members who have more than a century of combined post-acute and long-term care experience.  The group meets once a month on a zoom call to discuss major concerns and outline steps to address serious issues.


January’s meeting introduced discussion of the terrible outcomes documented in recent news and professional journal articles about the use of AI as a mechanism to regulate Medicare Advantage Coverage determinations, and even more frightening, long-term care coverage decisions by MediCal Managed Care organizations.


Jimmo v. Sebelius, the class action lawsuit settlement that stipulates that Medicare will cover services required to maintain a person’s function and prevent deterioration of existing or new conditions is impacted by the above-noted denied services.  This is playing out horrendously in unsafe discharges, often to inappropriate places, from SNFs and acute hospitals, which result in dramatic measurable increases in ER visits and rehospitalization across the nation, including in California.


Watch for pending legislation to be announced codifying the results from a recent statewide stakeholders' group in which CALTCM PPSC Members participated. This diverse group of professionals, advocates and consumers discussed the terrible outcomes for residents resulting from the recent public health emergency lockdown orders and varying interpretations and implementation of public health orders throughout the state. The group focused on the serious measurable issues which originated from locking down SNFs and excluding visitors of all types.  No one doubts well-documented harm done by excluding family and friends and not considering the services these non-staff visitors provided to SNF residents. (Feeding, bathing, social impacts are only the visible tip of this very large iceberg.) This new legislation will be designed to improve conditions for everyone if a public health emergency like COVID (or worse) occurs again. 


A discussion of the newest MDS changes revealed what experts were warning against. The Minimum Data Set has become more minimum with helpful data (especially on functional status and nutrition) no longer being collected during the MDS process.  


A white paper soon to be published, about the need to collect data on Medical Directors tied to quality care at individual SNFs, is being finalized.  Stay tuned for more information on the discussion with HCAI (Department of Health Care Access and Information), formerly OSHPD (Office of Statewide Health Planning and Development), the ultimate data collectors for all information about SNFs and costs in CA.  Enforcement of AB 749 requiring certified medical directors for CA SNFs requires data. Tracking quality is essential.


Last, although not the least worrisome, are concerns that the annual CA Staffing Audits in SNF do not have any ties to the Federally mandated Payroll Based Journal (PBJ) staffing reporting. Trying to get both federal and state mandates into a meaningful (and dare I say helpful) tool seems an impossible dream at this point.


These are just a few of the things keeping PPSC members up at night.  If you are interested in participating in the discussion, have ideas to solve any of these concerns, or can introduce someone  else who could be instrumental in the solution process, please consider joining or contacting the committee. Mike Wasserman and Lisa Grod co-chair the committee. Barbara Hulz is the person to go to for additional information and the zoom link if you are interested in attending.


Respectfully submitted: KJ Page RN-BC, LNHA committee member.

Policy & Professional Services Committee

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