The Academy of Senior Health Sciences, Inc. (formerly The Ohio Academy of Nursing Homes, Inc.) seeks to provide public education and awareness initiatives to the long-term care community in Ohio. Our membership represents a true cross-section of the skilled nursing facility profession, from small sole proprietorships to larger Ohio-based multi-facility companies, as well as those businesses that service our industry. Through our public education and awareness efforts, the Academy brings the collective influences of the members together into a single voice on vital issues affecting our profession.
Founded in 1966, the Academy then identified one of its core purposes as "To foster a spirit of goodwill among those persons engaged in the nursing home industry, to promote ethical practices in their relationships with each other, their employees, and the general public to the end that all interests may be served fairly..." Though the organization has undergone several transformations over the years, most notably in 2011, its dedication and commitment to Ohio's most frail and elderly remains the same.
| The Academy Weekly Headlines from 2 Weeks Ago|
ODM to create PL "solution"
The Ohio Department of Medicaid has announced that it will create a solution to the vexing problem of patient liability amounts not matching on the managed care plan's 834 report and MITS when providers submit a claim. ODM told LTC associations and other interested parties that ODM will act as the arbitrator when a dispute arises because of PL discrepancies. ODM will hire an additional staff person that will review the claim and determine the proper PL amount. The exact process still has to be determined, such as if the provider should appeal the claim first. Furthermore, some MCOPs noted that they review claims for PL changes and providers should wait to allow for that correction to occur before turning to the state. ODM plans on working out the process over the next several weeks and hopes to have it implemented before 2019.
Updated MyCare Ohio resource guide, more CM docs
The MyCare Ohio resource guide that was created by a collaboration of managed care plans and LTC associations has been updated. UHC's transportation policy has been changed to reflect recent changes effective last month. You can download the guide in Excel format by clicking here. Also, the MCOPs have been creating care management (CM) guides to help providers. The guides provide information on the CM process for SNFs including when to expect CM to occur and who should be providing it. CareSource, Aetna and UHC are the latest to provide the guide. Click the MCOP name for their guide: CareSource CM guide; Aetna CM guide; UHC CM guide; Molina CM guide.
Free Eden training opportunity to reduce antipsychotic use
BWC proposes code changes that will impact SNF/AL rates
The BWC is proposing changes in how skilled nursing facilities and assisted living facilities are to code their employees to determine workers' compensation premiums. If you have any questions or concerns about this change, please contact The Academy. From BWC:
"PURPOSE: The purpose of the proposed changes for this industry is to revise the classification treatment for retirement living centers (RLCs) and nursing homes.
BACKGROUND: Nursing homes serve as permanent residences for people who are too frail or sick to live at home or as a temporary residence due to an extended recovery period. Nursing homes primarily provide skilled nursing care and related services to residents who require medical or nursing care, and rehabilitation services for the rehabilitation of injured, disabled, or sick persons. RLCs provide help with activities of daily living like bathing, dressing, and using the bathroom. They may also help with care most people do themselves like taking medicine or using eye drops and additional services like getting to appointments or preparing meals. Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some of these facilities have health services on-site. Continuing care retirement communities (CCRCs) are retirement communities that offer more than one kind of housing and different levels of care. In the same community, there may be individual homes or apartments for residents who still live on their own, an assisted living facility for people who need some help with daily care, and a nursing home for those who require more care. Residents move from one level to another based on their needs, but usually stay within the CCRC. For purposes of this executive summary, references to RLCs includes CCRCs.
Academy. From BWC:
Currently, NCCI's classification system applies the following national classifications for this industry:
Academy. From BWC:
- Code 8824óRetirement Living Centers Health Care Employees
Applies to all employees providing medical, nursing, or personal care to residents including but not limited to physicians, nurses, therapists, technicians, pharmacists, dieticians, aides, and orderlies. Not applicable to nursing homes or hospitals. Separately classify food service employees and all other employees engaged in non-health care activities.
- Code 8825 Retirement Living Centers Food Service Employees
Not applicable to independently operated restaurants. Separately classify health care employees to Code 8824 and all other employees to Code 8826.
- Code 8826 Retirement Living Centers All Other Employees & Salespersons, Drivers
Separately classify all health care employees to Code 8824 and all food service employees to Code 8825.
- Code 8829 Convalescent or Nursing Home All Employees
Based on current classification wording, nursing home operations of an RLC at the same location are not separately rated but are assigned to the RLC classifications. However, the current classification wording does not clearly indicate the classification treatment for a nursing home operation that also provides a limited number of residents with RLC-type services at the same location.
The industry is evolving and the distinction between nursing homes and RLCs is beginning to blur. Healthcare workers are performing their tasks in all areas of a facility with both operations, as do the non-healthcare workers. The goal is to simplify the classification treatment for this industry because facilities could have both nursing home and RLC operations at the same facility or location.
Industry Discontinued Class Code(s) Combine into Class Code(s)
Healthcare: 8825, 8829 8824, 8826
Centers & Nursing Homes
Change: Combining of Codes 8825 and 8829
Underwriting or Rate Impacts
NCCI Code Code 8825 Code 8829 Code 8824 Code 8826
Policy Year 2018 Base Rate $2.22 $2.91 $3.31 $2.33
Note : 2019 Base Rates will be made know and subject to approval at the March 2019 Board of Directors meeting.
The premium impact to individual employers will depend on the amount of payroll that transfers between retirement living center and nursing home-related classifications, as well as their associated loss cost/rate compared to the redefined classificationís proposed loss cost/rate. A negligible impact to overall statewide premium is expected resulting from these changes."
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