March 12, 2012 Print All Articles CONNECT google plus twitter facebook linkedin
Antipsychotic Drugs: See the March 29 CMS Webinar
Published On: Mar 09, 2012
Updated On: Mar 30, 2012

On March 29, the Centers for Medicare and Medicaid Services (CMS) launched a new initiative aimed at improving behavioral health and safeguarding nursing home residents from unnecessary antipsychotic drug use. CMS launched this new initiative with a 1-hour video streaming event.  

As part of the initiative, CMS developed a national action plan that will use a multidimensional approach including: 

  • Public reporting.
  • Raising public awareness.
  • Regulatory oversight.
  • Ttechnical assistance/training and research. 

The action plan is targeted at enhancing person-centered care for nursing home residents, particularly those with dementia-related behaviors.  

LeadingAge's senior vice president for public policy and advocacy, Dr. Cheryl Phillips, is a member of the CMS technical expert panel and has been working closely with the agency regarding the content of this initiative.    

Video-streaming information  

This program will be available for viewing up to one year following March 29, 2012, at  

This event is open to the public.  

Goals for the video-streaming event                 

CMS will provide an overview of the national initiative, resources for technical assistance, and plans for upcoming educational offerings on this topic. 


Handouts for this broadcast are available at:


Join the following experts in the introduction of this national initiative, discussion of behavioral health opportunities and the announcement of upcoming training sessions:   

  • Patrick Conway, M.D., M.Sc., chief medical officer for the Centers for Medicare and Medicaid Services and director of the Office of Clinical Standards and Quality.
  • Shari Ling, M.D., Centers for Medicare and Medicaid Services, deputy chief medical officer serving in the Office of Clinical Standards and Quality.
  • Alice Bonner, Ph.D., R.N., director for the division of nursing homes in the Office for Clinical Standards and Quality. 

Target Audience  

State Survey Agencies, residents and family members, nursing home staff, clinicians, providers, advocates, CMS Regional Offices, and others (Non-Mandatory)

GAO Report: CMS Should Improve Efforts to Monitor Implementation of the QIS
Published On: Mar 06, 2012

On March 2, the Government Accountability Office (GAO) released Nursing Home Quality: CMS Should Improve Efforts to Monitor Implementation of the Quality Indicator Survey, a new report recommending that the Centers for Medicare and Medicaid Services (CMS) develop a more systematic approach, including performance goals and measures, to routinely monitor the extent to which the Quality Indicator Survey (QIS) is meeting CMS objectives to improve the efficiency, accuracy, and consistency of the long-term care facility survey process. 

GAO Recommends 3 Actions 

As CMS continues to implement the QIS, the administrator of CMS should:

  • Develop a means—such as performance goals and measures—to routinely monitor the extent to which CMS is making progress in meeting the objectives established for the QIS.
  • Develop and implement a systematic methodology to track state survey agencies’ progress with implementation activities.
  • Develop and implement a systematic method for obtaining, compiling, and sharing information from state survey agencies about their implementation experiences. 

What the GAO Found 

  • CMS has not established the means—e.g., performance goals and measures—to routinely monitor the extent to which the QIS is meeting its objectives to improve the survey process.
  • While CMS has taken some steps to monitor and facilitate states’ implementation of the QIS-based routine survey,  these efforts are not systematic and Information on States’ implementation progress is incomplete.
  • CMS established 3 milestones to guide states’ implementation of the QIS: 
  1. Start dates by which each state is to begin training state surveyors.
  2. Completion of training for all surveyors within 3 years of the training start date.
  3. Use of the QIS for all routine surveys after all state surveyors have completed training. However, CMS relies primarily on quarterly teleconferences with SAs for information on the extent to which each state has completed surveyor training.
  • States may not always participate, and those that do may not provide complete information on their progress. For example, CMS was unable to provide GAO with information on completion dates for all state surveyors in states that completed training.
  • To facilitate QIS implementation, CMS has issued with periodic guidance and/or clarifications and updates; conducted presentations; and has provided opportunities to share  implementation experiences. However, the Agency has no systematic method for obtaining, compiling and sharing information on state experiences.

HHS/CMS Response 

HHS reviewed a draft of this report on behalf of CMS, concurred with all 3 recommendations and advised it “…would work to implement them expeditiously.” HHS said that CMS will:

  • Establish new or modify existing measures or processes to more effectively monitor CMS's progress toward meeting QIS goals and objectives.
  • Formalize the data collection method used to track states' progress with QIS implementation activities.
  • Enhance existing and add new methods of sharing information on the QIS with states.
  • HHS also notes “…CMS has reassessed the timetable for QIS expansion to additional states due to budgetary concerns, and the QIS will not be introduced to additional states in fiscal year 2012 as planned.”  “…CMS will instead focus efforts on more effectively implementing the QIS in those states where training of state surveyors has begun or has been completed, addressing barriers to QIS implementation, and completing the remaining components of the QIS.”
  • CMS expects the QIS to be implemented in all 50 States, DC, Puerto Rico and the US Virgin Islands by 2018.  

Quality Indicator Survey Background 

  • CMS developed the Quality Indicator Survey (QIS) to improve the efficiency, accuracy, and consistency of the survey process by improving surveyors’ identification and documentation of quality concerns; focusing resources on facilities, and on areas within facilities with the greatest quality concerns.
  • CMS commissioned 3 studies to evaluate the Quality Indicator Survey (QIS) process, but it does not routinely monitor the extent to which the objectives established for the QIS are being met.

  • The first 2 studies, completed in 2006 and 2007, respectively, by Abt Associates were to determine whether the QIS process could be used “…under real-world conditions…” and whether the QIS meeting several of CMS’ objectives for the process.
  • A third study in 2011 identified aspects of the QIS that could affect how consistently surveyors identify quality problems and potential approaches for addressing these issues, e.g., during resident interviews, surveyors did not consistently probe for further information when provided with incomplete responses.
  • For this Report, GAO examined the extent to which CMS (1) evaluates whether progress is being made in meeting the objectives of the QIS; and (2) monitors and facilitates states’ implementation.

    • GAO reviewed CMS’ plan for evaluation and improvement of the QIS; CMS-commissioned studies of the QIS, policies, and guidance; interviewed officials from CMS’s Central and all 10 Regional Offices and officials from a “judgmental sample”’ of 9 state survey agencies (SAs) [AZ, CO. CT, FL, MD, MN, NY, OH, WV].
Bundled Payments: New Application Process and Deadline for Care Improvement Initiative Models 2-4
Published On: Feb 28, 2012
Updated On: Apr 09, 2012

The Center for Medicare and Medicaid Innovation (CMMI) announced that the application process for Models 2-4 has changed and must be completed online. The online portal will become available the week of April 23, 2012. Until that time, CMMI has provided applicants with:

  • Non-fill-able PDF documents posted on our website in mid March that reflect the questions and data tables that will be in the online application.
  • A webinar on March 8, 2012, to help applicants further understand the different applicant roles and the information we are requesting from the applicant and its Bundled Payment participating organizations.        

Because the online portal is still in development, CMMI is also extending the application deadline for the Bundled Payments for Care Improvement initiative for these models to June 28, 2012, 5 p.m. Eastern. This will give organizations more time to complete the application.  

New application request

CMMI has also announced a new application request that now asks applicants to select 1 of the 3 roles prior to filling out the applications, which will determine the applicant’s participation role.  

Skilled nursing facilities and home health agencies are eligible to participate in Model 2 (Retrospective Acute Care Hospital Stay and Post Acute Care) and Model 3 (Retrospective Post Acute Discharge Services Only).  

For more information on each role and application clarifications, you can visit CMMI.

The new application requests similar information from applicants as the fill-able PDF documents that were previously available on the CMMI website. However, one significant change is that CMMI is now asking applicants to select 1 of 3 roles prior to filling out the applications. 

The role the applicant selects will determine the information we need about the applicant and its Bundled Payment participating organizations:

  • Risk Bearing Non-Convener Awardee.
  • Risk Bearing Awardee Convener applying with episode-initiating Bundled Payment participating organizations.
  • Non-Risk Bearing Facilitator Convener applying with Risk Bearing Designated Awardees/Awardee Conveners.

CMS also offered a webinar on March 8 on “Distinguishing Between Applicant Roles in the Bundled Payment for Care Improvement (BPCI).” The purpose of this webinar was to ensure that all applicants to Models 2-4 have a clear understanding of the 3 different roles an applicant must choose from then applying to the initiative.

Did you submit a Letter of Intent? 

Prior to the release of the online application, CMMI will be sending an email to all organizations who submitted a Letter of Intent to apply for Models 2-4 asking them to designate the applicant role for their application. More instructions regarding this process will follow. 

It is critical that CMMI have the correct contact information for all potential applicants. The email will be sent to the project contact that was identified in your Letter of Intent.

CMMI recommends that you verify that the project contact listed on your Letter of Intent is still the individual at your organization who should receive this information.  If there has been any change in project contact, please email as soon as possible and please cc the original contact in your communication. 

For more information on the Bundled Payments for Care Improvement initiative, please visit Innovation Center or sign up for the Bundled Payments Announcement Email List.  

To ask a question, you can e-mail

NLRB Notice Poster: Federal District Court Upholds Requirement
Published On: Mar 06, 2012

On March 2, the Federal District Court in the District of Columbia issued an opinion that the National Labor Relations Board (NLRB) lawfully promulgated a rule requiring employers to place an 11" x 17" poster in the workplace informing employees of their rights under the National Labor Relations Act.

The court, however, struck down a provision of the rule that made the employer’s failure to post the notice a per se unfair labor practice.  

Additionally, the court also ruled that the NLRB cannot use the employer’s failure to post the notice as a basis to toll the 6-month statute of limitations employees/unions have to file and unfair labor practice charges.

An appeal is likely

The National Association of Manufacturers, which brought the suit, plans to file an appeal to the Federal Court of Appeals for the District of Columbia. Another challenge to the rule by the U.S. Chamber of Commerce is awaiting a decision by a Federal District Court in South Carolina.   

NLRB rule going into effect April 30

Despite the March 2 ruling, the NLRB rule is expected to go into effect on April 30.

Additional information concerning the rule and links to download a poster containing the necessary disclosures is available on

LeadingAge Awards: Nominations Are Open for 2012
Published On: Mar 09, 2012

The nomination period for the 2012 LeadingAge Awards is now CLOSED.

The 9 award categories are: 

  • Award of Honor.
  • Excellence in Leadership.
  • Excellence in the Workplace.
  • Innovation in Care and Services.
  • Hobart Jackson Cultural Diversity Award.
  • Dr. Herbert Shore Outstanding Mentor Award.
  • Excellence in Research and Education.
  • Public Trust Award and Outstanding Advocacy Award. 

You can nominate a person or organization that is making a difference. Submit entries online by April 30. Contact: Deborah Cloud at 202-508-9458. 

2011 Award Winners

Award of Honor

Public Trust Award

Joan Ann McHugh Award for Leadership in Long-Term Care Nursing


OIG Establishes Compliance 101 Web Page
Published On: Mar 09, 2012

The Office of Inspector General (OIG) has developed Compliance 101, an online educational resources to help health care providers, practitioners, and suppliers understand the health care fraud and abuse laws and the consequences of violating them. 

These compliance education materials can also provide ideas for ways to cultivate a culture of compliance within a health care organization.

PBCA Update: Court of Appeals Rules Against HUD
Published On: Jul 01, 2011
Updated On: Mar 26, 2014

On March 25, the U.S. Court of Appeals for the Federal Circuit ruled against the U.S. Department of Housing and Urban Development (HUD) in the lawsuit on the Performance-Based Contract Administration (PBCA) case. 

HUD has yet to issue a public statement of its intentions moving forward. 

For now, all existing PBCAs (the 42 and the 11) will remain in place.  

The U.S. Court of Appeals for the Federal Circuit reversed the earlier decision by the U.S. Court of Federal Claims. 

The Court of Appeals agreed with the Appellants that the PBCA Annual Contributions Contracts (ACCs) are procurement contracts and not cooperative agreements because the ACCs' primary purpose is to hire PBCAs to support HUD staff and provide assistance with the oversight and monitoring of Section 8 housing assistance. 

The Court of Appeals did not address the Appellants' argument that the NOFA's provision giving priority to in-state applications is arbitrary and capricious under the Administrative Procedure Act (APA).

Details from the PBCA Court Ruling

The Court of Appeals found that the PBCA ACCs should be awarded through procurement contracts because the ACCs' primary purpose is to hire PBCAs to support HUD staff and provide assistance with the oversight and monitoring of Section 8 housing assistance.  

The court cites as evidence HUD's stated intentions in creating the PBCA program in 1999, as well as more recent HUD statements describing how PBCAs have helped the Department reduce improper payments and improve efficiency. The Court rejected HUD's argument that it was appropriate to use a Notice of Funding Availability and cooperative agreement for the PBCA contracts.

The Court of Appeals decision concludes that because the ACCs are procurement contracts and because HUD did not comply with federal procurement law, the decision of the Court of Federal Claims must be reversed and remanded.  

The Court of Appeals does not address the Appellants' argument that the NOFA's provision giving priority to in-state applications is arbitrary and capricious under the Administrative Procedure Act (APA). 

Stakeholders are awaiting word from HUD on how the agency plans to respond and whether the U.S. Department of Justice plans any further action.  

At earlier public forums, including the LeadingAge annual conference in Dallas, HUD officials indicated that if the Court of Appeals were to rule in favor of procurement, the department would likely extend existing PBCA contracts for 18-24 months while it developed a procurement tool.  

Background (past updates)

U.S. Court Ruling Still Pending: HUD Extends ALL PBCA Contracts for 6 Months,  Moratorium Against PBCA-Initiated MORs Continues

In October 2013, despite the government shutdown going on at the time, the U.S. Court of appeals held a hearing on PBCA issue. A ruling was expected in December. At this time, however, no decision has been issued and it is unclear when one will be forthcoming.

In late February, HUD extended all existing PBCA contracts and obligations  (for the 42 contested states as well as the 11 uncontested ones) through June. Despite HUD's growing concern over the extended gap since the last MOR, there is no mechanism in the current 42 states contracts to reinstate them as previously articulated.  

Therefore, no MORs will be performed by PBCAs in the 42 contested states.  A recent memo from HUD field office contract administration oversight monitors (CAOMs) to PBCA's in their area reiterated the prohibition on such a practice. Even voluntary pre-MORs should not be conducted at this time.

However, MORs are still being conducted in the 11 states not being contested in court, and HUD itself can conduct an MOR at any time, in all states and territories.

Plaintiffs Cases Heard in U.S. Court of Appeals

On August 27, 2013, the United States Court of Appeals granted the Plaintiff-Appellants' motion for a stay pending appeal. Thus, HUD may not execute the new ACCs until the case is resolved. And, no transition activities should occur until further notice.

This means that previously announced plans regarding new awardees and contracts are suspended for now. Additional information will be provided as soon as it is available.

A preliminary hearing is schedule for Oct. 10, 2013. HUD is posting updates on PBCA NOFA.

2012 NOFA Awardee Transition Activity; New Contracts Intended to Take Effect Nationwide January 2014 Now Suspended

As previously announced, on Aug. 6, 2013, HUD posted the list of awardees from the latest Performance Based Contract Administration (PBCA) Notice of Funding Availability (NOFA). And, HUD posted revisions (dated July 30, 2013) to the original PBCA transition guidebook.

The plan was that, beginning January 2014, all contracts for the new 42 state AND the existing 11-state PBCAs (which were not contested under the NOFA and will not change this time either) would follow the NOFA risk-based model of Management Occupancy Reviews.

Any changes that would have occurred,  including the status/timing of new 2-year contracts (initially planned to take effect starting Jan. 1, 2014) are now called into question, pending resolution of the latest appeal.  

For the time being, all current PBCAs (both the 42 states being contested, and the 11 non-contested) continue to be provided 3-mos contract extensions.  

Management Occupancy Review Schedule

Though the most recent MORs in the contested 42 states are several years old now, HUD does not plan to have new inspections conducted to establish a new baseline. Instead HUD has indicated it will keep to the “risk based” management reviews schedule, which means:

  • All properties that last received “below average” or “substandard” shall be inspected annually.
  • Those that most recently scored a “satisfactory” shall be visited once within the initial 2-year total ACC term.
  • Sites that last received “Above Average” or “Superior” shall not be reviewed during the initial 2 year term.

One major exception, however, is that all Mark-to-Market Projects with PBCA Administered HAP Contracts must still be inspected annually.

HUD has posted information regarding current/latest MOR ratings as follows:

  • MOR Ratings for Projects (Excel: sorted by state, this list does include Mark-to-Market Projects: Options 1, 2, 3a and 4) as of June 4, 2012. The following States have been updated: DE, NC, NJ, PA, SC and WV.
  • Mark-to-Market Projects (Excel: sorted by state: Options 3b) updated June 4, 2012. The following States have been updated: DE, NC, NJ, PA, SC and WV.

Historical Timeline

After the 2011 notice of funding availability (NOFA) to solicit bids for performance-based contract administrators (PBCA) contracts was completed, several PBCAs brought a lawsuit against HUD, claiming that the NOFA was not an appropriate vehicle for awarding PBCA contracts.

On April 19, 2013 the U.S. Court of Federal Claims ruled in favor of HUD, upholding its authority to use the NOFA process to select PBCAs. But on May 10, 2013, another appeal was jointly filed by 9 contract administrators.  

And, on June 6, 2013, HUD posted the following statement to the PBCA website: 

"Unless we are prohibited from doing so by the United States Court of Appeals for the Federal Circuit, HUD intends to announce the selection of PBCAs pursuant to the NOFA on August 1, 2013."

In the meantime, contract administration works continued on the same restricted (no MORs) basis under a series of 3-month contract extensions.

The U.S. Court of Federal Claims in Washington, DC, heard additional oral arguments on Feb. 19 about HUD’s use of a NOFA to select PBCA and HUD’s restriction against out-of-state applicants in states where qualified in-state applicants submitted bids.

The judge, Thomas Wheeler, who had previously indicated he expected to decide the case at that time, or by the end of the month, instead requested additional information from all parties and conducted a thorough review of all arguments and what the court itself described as a "morass of arcane housing assistance statutes and regulations."

Although HUD has indicated in several public forums recently that it is ready to announce the successful PBCA bidders, at least 1 of the initial plaintiffs has filed an “emergency” motion for clarification and a request for a stay pending clarification or the outcome of its appeal, so the ultimate outcome is not yet clear.

In the meantime, HUD continues to extend the existing PBCA contracts in 3 month increments. Depending on the end result, HUD may be forced to recompete the contracts altogether, though this is looking increasingly less likely.

Here is what HUD posted on its PBCA website in the interim:

Litigation had been filed in the Court of Federal Claims seeking to enjoin HUD from proceeding with the PBCA NOFA. HUD agreed not to proceed with making the awards until the Court ruled on the matter. A decision was expected to be reached by or before February 22, 2013. Although the court had originally indicated that it would provide a verbal ruling at yesterday’s hearing (February 19, 2013), due to the complexity of the program and issues involved, the court requested more time to consider the arguments. Because the current PBCA contracts have been extended through June 2013, the court stated that it would make a decision before the end of June. The court has also reserved the right to call parties back for a supplemental briefings, though it did not set a definite schedule. The cases have been consolidated under docket number: Fed Cl no. 12-852C.

At recent public meetings, HUD stated that they are prepared (depending on the court ruling), to go forward with public announcement of the PBCA awards as early as September, which would mean a transition period from October to December, and formal commencement of the new 2-year only contracts starting Jan 1,2014. 

While LeadingAge has no particular position or preference in the resolution of this issue, we have repeatedly reached out to HUD staff to urge careful coordination of transition timing, with particular consideration of such things as: 

  • The need for a smooth data transition (and expected implementation of the 202D TRACS changes).
  • Minimized opportunity for funding gaps (given the likelihood of another continuing resolution).
  • Staffing considerations for all stakeholders given the end-of-the-year holidays.

The bottom line, for now, is that owners/agents will continue sending tenant certifications and rental subsidy vouchers as they have been, until they are told to change, and management occupancy review (MOR) activity by the PBCAs remains completely suspended.

Whatever may happen, HUD has expressed an urgent desire to have PBCA's resume Management Occupancy Reviews once new contracts are issued and indicated that they will be conducted according to the risk-based proposal in the NOFA, and based off the last management occupancy review (MOR) scores. 

Background on Performance-Based Contract Administrators Awards Solicitation in 2012, and Earlier

What began in July 2011 continues to be unresolved.  

The U.S. Department of Housing and Urban Development (HUD) was expected to announce 42 state PBCA notice of funding availability (NOFA) awards on Dec. 14, 2012, but due to lawsuits filed in the U.S. Court of Federal Claims by 5 plaintiffs just days prior.

The plaintiffs, many of which filed protests earlier with the Government Accountability Office (GAO), were successful in getting an injunction on HUD's announcing awards under the NOFA and HUD agreed to refrain from implementing any awards, even in those states where HUD received only 1 application and were not contested in the lawsuit.   

These states were: 

  • Arizona
  • Idaho
  • Kansas
  • Kentucky
  • New Mexico
  • Oklahoma
  • Oregon
  • South Carolina

Background on the GAO protest regarding the NOFA

On March 10, 2012, HUD posted the NOFA to restart the competition for the awarding of the outstanding 42 contracts for administration of the project-based Section 8 program.

The NOFA and the new contract reflect a number of significant changes in the manner of selection and the content of expected work, now called “performance-based tasks (PBT).” Among the most significant, in-state applicants will have a distinct advantage over potential out-of-state applicants; and management reviews will no longer be required annually.

Contrasting this NOFA with the contract offered as part of the earlier 2011 procurement process, the main changes are:

  • Introduction of “risk based” management reviews (essentially a tiered process, so that properties with “above average” or “superior” scores the last time they were visited will not have to be visited every year).

  • Reduction in the cap on allowable administrative fees (2011 procurement bids could seek no more than a 2.5% profit margin; this NOFA caps the fee at no more than 2% - and the selection process scoring will awards more points for those willing/able to do the work for less).

  • A preference for applications of in-state entities such that, if there is an eligible applicant from a given state, no out-of-state applicant will be considered; but if no in-state application is made, out-of-state (but still eligible) entities will be considered.

  • Significant changes in the scoring methodology for review of the applications.

There is also a summary of highlights and the latest Q&A document.

Over the summer of 2012, a number of entities filed protests with the GAO as much because of the form of the NOFA as for the restrictions on competition (across state lines) that came along with it.

Applications to be considered for the PBCA program were due June 11. You can check out the full details, including the contract, NOFA and state attorneys general opinions on prior actions.

In August of 2012, the GAO issued a decision that HUD's use of a NOFA to obtain bids for contracts in 42 states was improper and recommended that HUD cancel the NOFA and solicit the contract administration services for the Project-Based Section 8 rental assistance program through a procurement instrument.  Such an action would mean, effectively, a third competition for awards in the contested 42 states.

Though HUD was allowed up to 60 days to advise the GAO whether it will follow the recommendation, HUD advised the GAO in October that it was "still in the process of assessing the [r]ecommendations" of the GAO decision, and on December 3, HUD informed the GAO that is "had decided to move forward with the [NOFA] awards."   

At that time, an orderly timeline for implementation was proposed - but ultimately not carried out.  

PBCA NOFA Timeline for 2012 

  • Published NOFA March 9. 
  • Application Deadline June 11 (initially April 10, changed March 15/6).
  • Award Announcements August 31. 
  • PBCA Transition period September 1 - November 30. 
  • Interim ACC’s will expire September 30. 
  • Interim ACC’s will extend October 1 – November 30. 
  • Effective date of new ACC’s December 1. 

PBCA Contract/Rebid Activity in 2011

The U.S. Department of Housing and Urban Development (HUD) announced July 1, 2011, its selections for the new PBCAs, who were expected to perform Section 8 contract administration duties under a new contract to take effect on Oct. 1, 2011.

HUD received and reviewed a total of 130 applications for the 53 contracts under consideration nation-wide:

In August of 2011, HUD withdrew 42 previously announced awards of new performance-based contracts and stated that HUD would re-compete them again shortly under a new NOFA.

Six-month extensions were offered to current contract administrators in the interim.On Aug. 10, the HUD explained that it is withdrawing 42 previously announced awards for new PBCA contracts due to “the large number of protests” filed at the GAO on the awarding of the contracts

HUD said it had plans to re-compete the contracts again shortly under a new notice of funding availability (NOFA), which it hoped to issue within 60 days.

Implementation of New Contracts in 11 Jurisdictions

Implementation of new contracts did move forward in the 9 uncontested states and 2 territories in 2011.  These jurisdictions had only 1 applicant and had no protests were filed. The new contracts became effective Oct. 1, 2011 in:

  • Iowa
  • Maine
  • Minnesota
  • Montana
  • New Hampshire
  • North Dakota
  • South Dakota
  • Vermont
  • Wyoming
  • Puerto Rico
  • The U.S. Virgin Islands

With the exception of the Virgin Islands, which did not previously have a PBCA, this involved no change in selected PBCAs.

PBCA Transition Guidebook

As proposed back in 2011, and continuing now, should future changes occur, HUD has indicated it will stick to the planned 3-month transition period.   Full details are provided in the stakeholder recommendations that were compiled into a PBCA Transition Guidebook, which includes what to expect in terms of communications from new PBCAs to owners, to residents, what steps will be taken to transition work in progress related to management reviews, subsidy payments, contract renewals and more.

[NOTE: All HUD properties with Section 8 rental assistance contracts are impacted, including all Section 202 and Section 208s.  HOWEVER, Section 202/PRAC and Section 811 PRAC properties are not involved in this Section 8 contract administration/rebid initiative. As has been the case with PRAC programs and other non-Section 8 issues, the HUD field offices will continue to do the daily operational oversight including budget and management reviews, subsidy payment authorization, etc.]

Dixon Hughes Goodman
Senior Housing Survey: Response Deadline Extended
Published On: Feb 03, 2012
Updated On: Mar 09, 2012

LeadingAge is a sponsor of the 2012 State of Senior Housing Survey and we need your input for to achieve a representative picture of the field.

We ask that you forward this survey to the appropriate individual in your organization to complete in its entirety. Completed surveys should be submitted by close of business Monday, April 16, 2012.

Questions about the survey should be directed to Colleen Blumenthal of HealthTrust, LLC at 941-363-7502.

Is your property eligible?

Properties eligible for inclusion in the State of Seniors Housing sample include the following:

  • For-profit or not-for-profit communities.
  • Communities where the majority of units provide independent living, including senior apartments.
  • Communities where the majority of units provide assisted living services.
  • Communities where the majority of units provide Alzheimer’s care.
  • Continuing care retirement communities (CCRC).
  • Skilled nursing facilities (SNF).

{Please do not complete surveys for properties where rates are subsidized, such as Section 202 elderly housing.}

What is the purpose of the State of Senior Housing Survey?

The survey collects current financial performance data on senior housing communities, information which can be critical to attracting new sources of capital. 

The quality of our industry’s data relates directly to the size and composition of this sample. 

In 2011, we collected data from over 1,700 properties. If you contributed data for a given property last year, it is particularly important that we obtain information about that property this year also, so that “same-store” industry trends in revenues, costs, and census can be analyzed.

In a constrained capital environment such as the one we are currently experiencing, transparency is a necessity if our industry hopes to attract new sources of capital to invest in seniors housing. 

Since 1992, the State of Seniors Housing survey has captured and widely-disseminated financial performance data for seniors housing communities. We need your participation in order to provide a representative picture of the industry. 

For owners or managers of multiple properties, please submit data for as many of your properties as is practical. We will adjust overall results so large portfolios are neither over-represented nor under-represented.

What are the benefits of participating? 

All organizations that complete surveys will receive a complimentary copy of The State of Seniors Housing 2012, which compiles the survey results for comparisons to your own operations.

What organizations are participating?  

  • American Seniors Housing Association (ASHA).
  • National Investment Center for the Seniors Housing and Care Industry (NIC).
  • LeadingAge.
  • Assisted Living Federation of America (ALFA).
  • National Center on Assisted Living (NCAL).

If you receive a similar email asking you to participate in the State of Seniors Housing 2012, please accept our apologies for the overlap and understand that we are working collectively to try to improve the quality of our profession’s data.

Is the data collected confidential? 

As always, the State of Seniors Housing data will be handled with complete confidentiality and the results presented only in the aggregate.

A Tool to Assess Housing Residents’ Needs
Published On: Feb 21, 2012

The LeadingAge Center for Applied Research has released an easy-to-use tool that senior housing properties can use to assess the health and functional status of their resident populations. 

The Resident Assessment Tool, developed by the center in partnership with Enterprise Community Partners, gives housing providers the information they need to design programs and services that can help residents remain healthy and independent for longer.

“Whether by choice or by lack of choice, people in senior housing are aging in place in their homes,” says Cheryl Gladstone, program director for senior housing at Enterprise Community Partners, which has raised and invested approximately $1.7 billion to develop more than 30,000 affordable senior housing units since 1982.

“Enterprise has already seen how structured services can transform the lives of formerly homeless people living in our supportive housing properties," Gladstone said. "We wanted to see how services could improve the lives of low-income seniors living in our properties.”

Resident Assessment Package 

The Resident Assessment Tool represents a good first step for housing providers interested in integrating services into their housing communities. The tool is included in a 4-part package that LeadingAge members can download by clicking on these links:  

  • A Guide to Conducting Resident Assessments offers direction on using the self-assessment tool, which residents complete themselves or with help from housing property staff or an outside community partner. The guide also provides strategies that properties can use to respond to the needs identified through the survey process. guide
  • The Resident Assessment Tool Part II captures information about activities that interest residents, including services and programs in which they would willingly participate.
  • An Excel Spreadsheet helps properties tabulate the assessment results and view, in one place, an overall picture of their resident populations.

Years in the Making 

The Center for Applied Research developed the Resident Assessment Tool during the course of several research projects that called for an assessment of resident health and functional status. After modifying the tool for use by housing properties, the center asked Presbyterian Senior Living, a LeadingAge member in Dillsburg, PA, to test the tool and recommend modifications.

“Conducting a resident assessment will help housing properties gain a comprehensive picture of their residents,” says Alisha Sanders, senior policy research associate at the LeadingAge Center for Applied Research. “This picture can help housing properties engage partners and focus on bringing the services and resources to their property that will meet the specific needs and interests of their community,”

Since 2005, the Center for Applied Research has been studying the role that housing with services could play in meeting the growing need for health and long-term services and supports among low-income elders. As part of that effort, Enterprise and the center collaborated on the National Summit on Affordable Housing and Services in May 2010 and the Summit on Aging in Public Housing in March 2011. 

In addition, the center provides a host of resources on Expanding Affordable Housing Plus Services.

Read about a Member's Experience

Presbyterian Senior Living (PSL), a LeadingAge member in Dillsburg, PA, helped the Center for Applied Research test its Resident Assessment Tool in two housing communities. Read more about how the tool brought benefits to PSL and its residents.

President Obama Declares May Older Americans Month
Published On: Feb 28, 2012
Updated On: May 02, 2013
Older Americans Month 2013

May is Older Americans Month, an opportunity for us to celebrate all the contributions that our elders have made to their families, communities and society. 

President Obama issued a proclamation declaring May Older Americans Month and saying, "Our seniors deserve the best our country has to offer. This month, we pay tribute to the men and women who raised us, and we pledge anew to show them the fullest care, support, and respect of a grateful Nation."

This year's theme, "Unleash the Power of Age," encourages older Americans to stay engaged, active and involved in their own lives and in their communities.

LeadingAge members with adult-day, PACE, and housing with services have developed innovative programs to help our elders remain active.

During the month of May, we encourage you to use the following tools from the Administration on Aging (AoA) to promote the good work you do:

  • Nominate an older adult in your community who demonstrates the positive difference elders can make.
  • Host an event in your community celebrating people as they age.
  • Use social media to promote Older Americans Month activities.

Sharing Your Older Americans Month Activities

We hope you will share your Older Americans Month activities with other LeadingAge members by posting on the HCBS listserv.

Tenant Protection Vouchers: Are Your Residents Eligible?
Published On: Mar 09, 2012

On Feb. 24, the U.S. Department of Housing and Urban Development (HUD) released Notice H 2012-03: Guidance on Eligibility for Tenant Protection Vouchers Following Certain Housing Conversion Actions, which provides information on accessing tenant protection vouchers following prepayments or opt outs of rental assistance (or, in HUD parlance, “certain housing conversion actions”).

Typically residents of nonprofit owned developments are not eligible for tenant protection vouchers although in HUD’s discretion they may be eligible if participating in RAP, Rent Supplement or a pre 1974 Section 202 property. 

This notice describes the situations under which tenant protection vouchers would be made available to residents of non profit owned properties.

In 2011, HUD had the authority to extend expiring Rent Supplement (RS) and Rental Assistance Payment (RAP) contracts. Now, Notice H 2012-03 describes the situations under which tenant protection vouchers can be made available to residents of non profit owned properties where the existing RS or RAP contracts are due to expire this year.

Rental Assistance Demonstration

And, under the new Rental Assistance Demonstration (RAD) program, authorized new this year, Rent Supp and RAP properties can seek to have tenant protection vouchers (which go or stay with the resident, at their choice)  converted to project-based vouchers (which stay at the property, to help preserve affordability and access at that site for future residents). 

The 2-fold goal of RAD is  to ensure preservation and allow residents choice and some mobility on where to live. 

AT this time, RS/RAP properties with contracts due to expire this year should contact their local HUD office to begin the process of working with the local Public Housing Authority to seek tenant protection vouchers and/or project-based voucher conversion.  HUD conducted a webcast on what this means and how the process would work on March 16, which can be viewed in archive.

Rent Supplement and Rental Assistance Payment background

RS/RAP properties historically had no option for renewal. Their subsidy was originally issued as 30- to 40-year contracts, authorized when the contracts were first issued and no provisions for the years that would follow. Most RS and RAP contracts will reach expiration by 2016, and all will have expired by 2019.  

However, under a newly released notice PIH 2012-18 Rental Assistance Demonstration -- Partial Implementation and Request for Comments Section III, both implements and solicits comments on the RS/RAP conversion/demonstration authority.  

Under the RAD demonstration program for Rent Supp and RAP properties only, there is no cap on the total number of units and no competition, but participation IS subject to funding availability in any given year.

What about Section 202 property funded before 1975? 

For 202s funded prior to 1975, the requirements for tenant protection vouchers are detailed in housing notice 2010-14.  

However, under the legislation passed in 2010, pre 1974 202s which are refinanced will be eligible to receive project based assistance for unassisted residents.  This will be known as Senior Preservation Rental Assistance Contracts or SPRAC.  

HUD will be issuing guidance for SPRAC in the near future (we hope). As soon as that guidance is available we will let you know.

NIOSH Study Touts Gains on Reducing Needlesticks
Published On: Mar 09, 2012

The February 2012 issue of the New England Journal of Medicine includes a study supported by the National Institute for Occupational Safety and Health (NIOSH) that shows how the Needlestick Safety and Prevention Act (NSPA) and the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens standard have significantly reduced needlesticks and bloodborne disease exposure for healthcare workers. 

OSHA's revised standard requires employers to provide safety-engineered devices to workers who are at risk for exposure to bloodborne pathogens, to include workers in the selection of these devices, to review exposure-control plans at least annually, and to maintain specific sharps-injury logs. 

For more information about bloodborne pathogens and needlestick prevention, you can visit OSHA's Safetyand Health Topics.

Rental Assistance Demonstration: Final Notice Issued
Published On: Mar 09, 2012
Updated On: Jul 26, 2012

The Consolidated and Further Continuing Appropriations Act of 2012 (Public Law 112-55) authorized the Rental Assistance Demonstration (RAD) to test new preservation tools for the HUD-assisted housing stock.  

RAD allows Public Housing Agencies (PHA), as well as owners of Moderate Rehabilitation (Mod Rehab), Rent Supplement (Rent Supp), and Rental Assistance Payment (RAP), projects to convert their current forms of rental assistance to long-term, project-based Section 8 assistance. 

This conversion will allow PHAs and owners to leverage federal funds with private debt and equity to fund much-need capital repairs.

What's New?

On July 26, the U.S. Department of Housing and Urban Development (HUD) posted the Rental Assistance Demonstration: Final Program Notice in the Federal Register.  The Federal Register notice outlines the highlights of  changes to the initial notice and timeframes and final details for the full implementation of RAD.  

And  Notice PIH 2012-32 was posted later the same day at HUD RAD, providing 182 pages of specific details. 

A very helpful RAD final notice overview has also been developed.

The conversion of Rent Supp and RAP properties under Section III of the Program Notice, which is updated by PIH–2012–32, has been effective since March 8, 2012. And those portions of the notice impacting the public housing and Mod Rehab properties go into effect immediately (July 26, 2012), except for certain waivers which go into effect 10 days later (Aug 6).

Key changes

Key changes made to the original program notice, PIH 2012–18, include:

Project-Based Vouchers: Applicable to both public housing and Mod Rehab properties converting assistance to PBVs:

  • Provides new language prohibiting any involuntary displacement in properties using PBVs for income mixing purposes.
  • Clarifies that in excess of 50% of the units in a project can be project based if the units qualify for exemption as elderly, disabled, scattered site, or receiving supportive services. Further clarifies that services do not have to be provided directly by the PHA or owner.
  • Grandfathers current residents from any requirement to receive supportive services in a property converting assistance to PBVs.
  • Removes the proposed requirement that PBVs be subject to Uniform Physical Inspections Standards; rather such properties will continue to be subject to Housing Quality Standards (HQS).

Rent Supp and RAP, covered in Section III:

  • Allows, for prospective conversions of assistance for Rent Supp and RAP, an owner to secure another agency to administer the PBVs in the event that that the local agency does not consent to administering such assistance.
  • Provides additional instruction on the inclusion of unassisted units in the event of a preservation-eligible mortgage prepayment that triggers provision of Enhanced Vouchers.
  • Clarifies that Rent Supp or RAP contract units occupied during the 24 months prior to contract termination may be included in a RAD conversion of assistance.
  • Creates a process for allocating limited TPV resources to projects with Rent Supp or RAP contracts with expiration dates after September 30, 2013 when an owner requests to prepay the mortgage.
  • Establishes a new centralized submission processing system to allow for ease of administration.

Specific Provisions from the Final Notice

Notice PIH 2012-32 provides 182 pages of program eligibility and processing details.   The introductory paragraphs of Section III of the notice discuss how owners of projects funded under the Rent Supplement (Rent Supp), Rental Assistance Payment (RAP), and Mod Rehab programs are allowed to convert tenant protection vouchers (TPVs) to PBVs, upon contract expiration or, for owners of Rent Supp and RAP projects, termination, occurring after October 1, 2006, and no later than September 30, 2013.

Starting at page 120, the notice states that "While there is no cap on the number of units that can convert assistance under this component of RAD, and no requirement for competitive selection, actions under this component are subject to the availability of TPVs. Sections II and III of this Notice provide further instructions for owners of Mod Rehab projects and owners of Rent Supp and RAP projects, respectively." While in the past funding for continued subsidy programs has not been a problem, given the current fiscal constraints and ongoing budgetary concerns, such "subject to availability" conditions should be noted and considered.

Following are the paragraphs which introduce and summary program requirements:

Because Section III of PIH Notice 2012-18 was effective immediately, any Rent Supp or RAP owner that has submitted a complete RAD conversion request to the MF Hub for review under PIH Notice 2012-18 prior to the date of this final Notice will be subject to PIH Notice 2012-18. All requests that have not yet been submitted are to be subject to the terms of this final Notice.

Under the Demonstration, an owner may elect to receive a 15-year Section 8 project-based voucher (PBV) contract at the property, subject to annual appropriations, in lieu of tenant protection vouchers (TPVs) that would be provided to eligible project residents or have been provided to eligible project residents as the result of a Rent Supp or RAP contract expiration or termination. This component is non-competitive but is subject to annual appropriations and the availability of TPV funding. In such cases, TPVs (including Enhanced Vouchers [EVs]) that convert to PBVs will have rents determined in accordance with PBV program requirements.

Subject to the availability of appropriations, owners of expiring Rent Supplement or RAP contracts may seek extensions of contracts at current funding levels for a one-year term. The one-year extension may be used in conjunction with RAD to provide adequate time for owners to prepare and submit requests under RAD before contracts reach expiration dates. Extension requests are made to the Multifamily Hub office with jurisdiction over the project. The one-year contract may be terminated early if the RAD conversion occurs prior to the one-year expiration.

Timing is critical in the selection of options, and is detailed in the notice along with project eligibility and resident income limit specifics

Background and Additional Resources

All RADcasts archives can be found on the RAD website.  

To help in the selection of video archive components, the schedule for the RADcasts was as follows:

  • Notice Overview: March 12 at 2 p.m. Eastern.
  • Notice Section I: Public Housing: March 15 at 3 p.m. Eastern.
  • Notice Section II: Mod Rehab: March 16 at 2 p.m. Eastern.
  • Notice Section III: Rent Supp and RAP: March 16 at 3 p.m. Eastern.
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Aging Services Career Center: New Opportunities
The Aging Services Career Center is the easiest way for your organization to fill open positions. From the executive level to skilled nursing, let us make your position available to our huge audience of qualified candidates.
Careers posted in the past week (Apr. 08 - Apr. 15):
Allied Health
Genetic Counselor - Ann Arbor, MI
Physical Therapist - Manhattan, NY
Registered Dietitian - Show Low, AZ
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Physician Director - Huntington, WV
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Administrator - Manheim, PA
Executive Director - Newman, GA
Director of Health Services - State College, PA
Director of Nursing - West Chester, PA
VP of Patient Care - Lancaster, PA
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General Nursing
RN - Various Locations
Coordinator of Care - Manhattan, NY
Operating Room Nurse - Flagstaff, AZ
MDS Care Plan Coordinator - Dublin, OH
Managed Care Coordinator - Brooklyn, NY
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Sr. Application Analyst - Manhattan, NY
Media Relations Representative - Baltimore, MD
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Forum Director - Alexandria, VA
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