The Academy of Senior
Health Sciences, Inc.
17 South High Street
Suite 770
Columbus, OH 43215
614.461.1922
800.999.6264
Fax: 614.461.7168
cmurray@seniorhealthsciences.org



 

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
HB 166: House passes bill with new SNF quality payment  —  The Ohio House passed Amended Substitute H.B. 166 - the "Budget Bill" - late last week after the Finance Committee unanimously passed the bill. An omnibus amendment to the bill made several changes to the nursing home laws, the most significant changes were to the new quality payment. The amount of the payment was increased from 1.7% to 2.4% and an occupancy requirement was included. The four quality measures remained the same: pressure ulcers, catheter left in, decline in mobility, and urinary tract infections. Other key changes in the bill include changes to the certificate of need program, the removal of presumptive eligibility language and several regulatory changes, including reinstating the quality improvement program requirement. The Academy anticipates further changes will occur to nursing home policy during the legislative process. We will keep you updated as the bill moves through the process, which will finish at the end of June.

ODM considers PDPM and Medicaid case-mix scores  —  The Ohio Department of Medicaid met with nursing home representatives to discuss the upcoming change to PDPM and how it will impact Medicaid case-mix scores for rate setting. CMS is allowing states to use Optional State Assessments (OSA) that contain the data elements needed to calculate RUGs IV scores. It was uncertain at the meeting if Ohio was required to use the OSA beginning October 1 of if the OSA was even necessary. The general consensus was the OSA would not be required as the OBRA assessments are still being required by CMS. The admission assessment and 5-day assessment would contain the data elements necessary for the all-resident case mix score used for rate setting. ODM did note that they were open to other methods of determining case-mix score or reimbursement outside of the current system; however, they noted that they would prefer to only make a change once; changing the case-mix scoring or direct care reimbursement will take time and resources. Furthermore, it was noted that any additional assessment or data collection would put a strain on MDS nurses already coping with the PDPM change. ODM plans on issuing a FAQ document about PDPM implementation and Medicaid prior to October 1. They will seek feedback from the provider community prior to releasing that document.

PL process presentation  —  Myers & Stauffer have been hired by ODM to review the current patient liability process and make recommendations. Last week, Myers & Stauffer presented the results of their "environmental scan" of the managed care PL process. The firm looked at the process from when the data file is transferred to the MCO, the claims are processed, and encounter data reported to ODM. The report contained many recommendations. Some of the key areas addressed were:

  • MCOs and the timing of the different 834 files and claims submission;
  • The use of 270/271 report by providers to confirm PL amounts;
  • Pro-ration of PL amounts and how processed, including timing;
  • Improvements in the encounter data reported to ODM;
  • MCO PL discrepancy reports to ODM.
Myers & Stauffer will next look at the integrity of the data and why discrepancies occur during the process. Because the process only incudes the time from the 834 data is received by the plan to when a claim is adjudicated, Myers & Stauffer will not be looking at the data in Ohio Benefits.
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