AHFSA Monthly Conference Call

December 9, 2014
Minutes
Call: 888.278.0296
3331329
Call to Order and Welcome:
Kathy McCanna President. Kathy welcomed the participants at 1:00 PM EST.
Roll Call: x indicates present
Officers present on the call:
Kathy McCanna, President
X
Otis Woods, President Elect
Dean Linneman, Vice President
X
Mike Cook, Treasurer
X
Laura Hudspeth, Corresponding Secretary
X
Corinna Getchell, Recording Secretary
X
Alison Gibson, Past President
X

Regional Representatives present on the call:

Barbara Cass (Reg. I)
Stefanie Mozgai (Reg. II)
Margie Heald (Reg. III)
Tom Geary (Reg. IV)
Vacant (Reg. V)
Mary Henderson (Reg. VI)
Tracy Niekamp (Reg. VII)
X
Darleen Bartz (Reg. VIII)
X
Keith Ridley (Reg. IX)
X
Debby Ransom (Reg. X)
X

X
X
X
X

Bob Goodnow, Director of Operations

Other states present on the call:

X Alabama
X Alaska
X Arizona

X Hawaii
X Idaho

Arkansas
California
Colorado
X CT
X Delaware
Wash (DC)
Florida
Georgia

X
X
X
X
X

Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Mass

Michigan
Minnesota
Mississippi
X Missouri
Montana
Nebraska
X Nevada
NH
X New Jersey
NM
New York

X
X
X
X
X
X
X

N Carolina
N Dakota
Ohio
Oklahoma
Oregon
Penn
Rhode Island
S Carolina
S Dakota
Tennessee
Texas

X
X
X
X

Utah
Vermont
Virginia
Washington
W Virginia
WI
Wyoming

Review of Minutes: The minutes from the September 23, 2014 meeting were reviewed and
approved. The minutes are posted on the member website.
Officer Reports:
President Kathy McCanna: The strategic plan is posted on the member website; this will be
reviewed and updated at the January meeting.
Current issues that may be nominated for Surveyor Executive Training Institute (SETI) topics
include:
Pharmacy issues (this remains a concern in several regions)
The use of marijuana in many states
The definition of distinct part
Updates to the October meeting:
CMS published an Administrative Memo with educational opportunities for surveyors.
Surveyors can be nominated to attend one (1) of three (3) Association for Professionals in
Infection Control and Epidemiology (APIC) conferences. The deadline to nominate
surveyors is December 29, 2014.
There has been communication with CMS regarding the delay of the State Operations
Manual (SOM) updates being posted to the website. The department that updates the
online SOM is transitioning to Word 2010; however, there has been a delay in the
transition. This will be a topic for the January teleconference between CMS and AHSFA.
President Elect Otis Woods: Absent
Vice President Dean Linneman: No report
Treasurer Mike Cook: The year to date financial status is posted on the AHFSA website.
Hope to get membership dues collected by the end of the month to get the budget approved at the
January meeting. States pay their fees at various times throughout the year. For those not paying
by March, AHFSA may need to pursue more aggressively. Will discuss the collection of fees at
the January meeting.
Corresponding Secretary Laura Hudspeth: A thank you letter was sent to Thomas Hamilton
and Jan Tarantino for the SOM revision which allows for the use of training funds to be used for
attendance at the annual AHFSA meeting.
Welcome letters were sent to new directors. If anyone knows of a new director, please contact
Laura so a welcome letter can be sent.
Proposed guidance for the use of civil money penalties (CMP) was sent December 3, 2014. Any
comments related to this guidance are due to Laura by 12/18/14.
Recording Secretary Corinna Getchell: No report
Past President Alison Gibson: No report

Regional Reports:
Region I: Barbara reported that the QIO is participating in monthly calls with the regional office.
There has been no follow-up on the submission regarding the change in hospice survey intervals.
Region II: Stefanie reported that a lot of focus has been placed on Ebola in New Jersey. New
Jersey has an Ebola Preparedness checklist, which is completed during a brief interview with the
hospital contact. This tool has been completed for approximately one-third of all the hospitals in
New Jersey.
A pressure ulcer collaborative group has been developed to address the incidence of pressure
ulcers in New Jersey. This collaborative approach includes the Department of Health, the Quality
Insight Organization and the Long Term Care Association.
Region III: No report
Region IV: A conference call was held with the representatives from the region to discuss the
revisions to Chapter 5 - specifically 5080.2 the exit conference report to the provider. There are
inconsistencies among the states about what is discussed at the exit conference. The end result of
the conference call was that Region IV was going to contact the Central Office for further
dialogue.
Polly Weaver (Florida) was promoted to Assistant Division Director.
Region V: No report
Region VI: No report
Region VII: Tracy reported the following:
Missouri - Kristen Edwards is the new Section Administrator for Long Term Care. Julie Creach
is the new Non Long Term Care Director.
Nebraska - Helen Meeks retired. Becky Wisell is the new Administrator.
Region VII is getting ready to set the February meeting with the regional office. They are
currently having monthly calls with the states and state leads from the regional office. Over the
past few months there has been a work group which discusses issues related to potential
situations.
There has been discussion related to distinct parts and CMSs strict interpretation. Please let
Tracy or Mary Henderson (Texas) know if any other states are experiencing issues related to the
definition of distinct parts.
Region VIII: Darlene reported that Wyoming is in the process of filling their vacant positions
and now have training needs. States are experiencing difficulties finding qualified applicants to
fill the vacancies.
Experiencing issues related to the definition/reclassification of critical access hospitals. This
issue is being discussed with the CMS consortia and central office.
Working with hospitals regarding EMTALA and Ebola.

Region IX: Keith reported that states are filling positions; however, there have been difficulties
related to budget issues, as well as finding qualified applicants. The SAs continue to work with
the hospitals on Ebola issues and are having calls with the hospitals to provide a forum to discuss
Ebola preparations.
Region X: Washington Long Term Care has proposed legislation from stakeholders regarding
staffing and acuity in nursing facilities.
Washington Non Long Term Care:
The official last day for Bryon Plan will be September 15, 2015.
Surveyors are using the three (3) Patient Safety Initiative worksheets when they are on a survey.
SA feels the tools did not help, but took a fair amount of time to complete.
Shelby Larson, Alaskas former director, passed away around Thanksgiving.
Inquiries:
When the final Mission & Priority document would be released.
What is the expectation to attend the basic Life Safety Code surveyor training? The
Mission & Priority document states that the surveyor has to complete the test. The
Training Staff are reporting that the surveyor must have the full certification.
Committee Reports:
Finance: No report
Communications: Laura reported that the committee has been:
Having monthly calls, with the next call being next Thursday (December 18,
2014).
Working on making the webpage more useful. As of yesterday (December 8,
2014), the webpage had 616, 669 hits.
Clarifying who the SA directors want to receive the AHFSA e-mails.
Working on an annual survey to present during the September meeting.
Emergency Preparedness: No report. Will need to have conversation with the entire
membership regarding the Ebola survey & certification memo.
Conference Planning: Carol reported that the committee has been:
Working on the conference theme Making Historic Strides in Healthcare
Looking at a variety of keynote speakers and sessions.
Planning to contact the Department of Justice to see if they could provide a
speaker.
Planning to get feedback from the Board in January
If anyone has any suggestions, please contact Carol Mace at Carol.Mace@tn.gov.
When making suggestions, please provide thorough descriptions to be sure the
correct topic is covered.
Professional Development: No report
Discussion Items:

January Quarterly Meeting: January 27 29, 2015 in San Antonio, Texas. There will be a mix
of business and relevant speakers.
Revision to SOM Chapter 4 (4542.2): CMS revised SOM Chapter 4 to allow training funds to
be used to cover attendance at the annual AHFSA meeting.
Surveyor Executive Training Institute (SETI) and State Agency Directors Orientation
Course (SADOC): The SETI has been scheduled for April 13 15, 2015, and the SADOC will
follow April 15 17, 2015. Suggested topics that have been forwarded to Anita Segar include
complaint management, revising and improving training, coordination with the QIO. There will
probably be an e-mail requesting comments and suggestions. Please copy Kathy and Laura on
responses.
New Business:
Alison Gibson: New Jersey is working on a pressure ulcer collaborative group and will be going
to the Governors office with this issue in January. If any states have had any success working
with a groups related to this issue, please send information, forms, suggestions, etc. to Alison.
Next meeting is January 13, 2015 at 1:00 PM EST. There will also be a call during the
Quarterly Membership Meeting.
Call Adjourned at 1:55 PM EST.