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 releases 01/01/20 Medicaid SNF rates
The Ohio Department of Medicaid released the January 1 Medicaid SNF rates last week. The posted rates can be viewed on ODM's website by clicking here. The rates are the first to contain the new Medicare quality payment based on four CMS quality measures. ODM calculated the payment per point to be $0.40. The average quality payment for providers that received a payment was $5.38, around 13.5 points. 759 of the 929 providers received a payment. The highest payment was $9.00 per day and the lowest was $0.60. Almost all of the providers that failed to receive a payment was because they were part of a change of ownership or were a new facility. Providers have 30 days to file for a rate reconsideration if they believe their rate is incorrect.
MyCare stakeholder group convened
The Ohio Department of Medicaid held a meeting last week to address ongoing concerns with the MyCare Ohio program. Providers, consumer advocacy groups, managed care companies, and state agency officials attended the meeting. The meeting germinated from ODM hearing of problems with MyCare during the budget process, including The Academy's efforts to standardize the billing process. The meeting began with a brief history and overview of the program. It was noted that MyCare was recently extended to Dec 31, 2022, with limited changes to the contract. The group also reviewed the evaluation of the program done by CMS. The Medicare data revealed no significant financial findings and the Medicaid data was not available at the time of the report. There were some changes in utilization, with a 21.3% reduction in inpatient admissions and 15.3% reduction in SNF admissions. Preventable emergency room visits increased 10.3%. ODM did note that the evaluation was focused on issues important to CMS, not the state. They also noted that there has only been one report in the five-plus years MyCare Ohio has been active. To address the lack of program evaluations and determine the study parameters, ODM plans on contracting with Scripps Gerontology Center to perform both a process and impact evaluation. Scripps hopes to have the process evaluation done by December of 2020 and the impact evaluation finished before the next contract period expires (Dec. of 2022). Scripps will be seeking input from providers, consumers, and state agencies as they develop the evaluations. Finally, the workgroup discussed the need to standardize the billing process for MyCare, A variety of workgroup participants representing providers noted the many differences between how the plans are billed. The group agreed that the problem is not necessarily in the UB-04 form, but how the form is filled-in for each managed care company. The workgroup will look more closely at this issue, patient liability, provider loading/CHOP processing, and other issues raised by providers or consumers. Providers were encouraged to take an anonymous online survey for their input into the process. The workgroup will meet again in February to review the list of concerns and develop a plan of action as necessary.
Notes from the ODM SNF provider meeting
The Ohio Department of Medicaid met with nursing home provider representatives last week. Below are notes from the meeting:
The next ODM provider meeting is scheduled for February. If you have any questions or concerns you would like addressed at the meeting, please contact The Academy.
- HOMEChoice Update: As noted in a previous edition of the Weekly, ODM will be doing outreach to skilled nursing facilities regarding the HOMEChoice program. While all SNFs in the state will receive a letter providing information on the program and offering to meet with staff, ODM will focus their efforts on select facilities. These will be facilities that have contacted their office in the past with questions or have a significant number of residents that may be able to benefit from the program. Be on the lookout for the letter within the next few weeks.
- 2019 Cost Report: ODM reported few changes for the 2019 cost report. The PELI question was removed as it was no longer necessary for reimbursement purposes. The filing and extension deadlines will be the same as in the past. Providers are reminded they must request an extension if they need extra time. The group did discuss the possibility of improving the instructions on how days are recorded. There appear to be some providers that report days in multiple columns (MyCare, Managed Care, etc..) with the result being a double counting of days. There will be future discussion on the topic, most likely for the 2020 cost report.
- PASRR: ODM notified the group that HENS is now generating resident review letter results that providers can access for documentation purposes. Questions or issues with the transition to electronic filing, accessing the letters, or any other PASRR related concerns should be addressed to ODM's PASRR mailbox (PASRR@medicaid.ohio.gov). ODM will be providing more webinar trainings for PASRR on a quarterly basis. Please see the "Odds and Ends" section of this newsletter for more information.
- LTC Eligibility Update: ODM continues to work on the backlog of pending Medicaid eligibility. The open enrollment period for the federally funded marketplace has increased the number of pending cases counties have to process. ODM continues to work with 15 counties, mostly in the metropolitan areas, on a weekly basis to reduce the cases that have been pending more than 90 days, with a focus on those more than 180 days.
- PDPM: The department has contracted with Myers & Stauffer to evaluate the impact of PDPM. The initial work will compare PDPM to current case-mix and determine the impact PDPM would have had if ODM were to have used it. They will also be looking at the removal of Section G and the use of the Optional State Assessment Oct 1, 2020 instead of PDPM. And Myers & Stauffer will investigate the shortfalls of PDPM as it relates to measuring the acuity of a long-term stay population. Related to that issue is the openness of ODM to consider alternative payment or acuity measures instead of PDPM.
- MDS Exception Reviews: The reviews for the quarter ending 9/30 have been finished. Of the 45 providers reviewed, 15 have failed. There will be January 1 rate adjustments for those 15 providers. They will have the ability for rate reconsideration. If the adjustment is upheld, it will be retroactive to January 1. Those providers should be receiving an official letter in the next few weeks. ODM anticipates a 10 to 12 day turnaround time in the future now that the process has been established. It was noted in the meeting that most of the findings were related to ADLs and lack of, or fabrication of, documentation. The example of the same staff person filling out the care plan notes every day of the week, despite payroll data indicating the person did not work every day.
- Cost Report Validation: ODM has contacted 20 providers for cost report validation purposes. The providers were based upon a risk assessment. As of last week, 18 of 20 providers have responded to the letters. Many of the providers indicated that they need more time to gather the documentation requested. In response to provider concerns and working with a few of the providers, ODM notified providers that "there may be viable alternate approaches to achieve the intended results of this verification process. Please postpone efforts related to retrieving and/or submitting requested documents until further instruction. ODM anticipates additional instruction being sent in the next few business days."
- Post Payment Review: Everything prior to FY15 has been completed. Only a few payments are still being collected. All but about 5% - about 62 - have been closed for FY16. FY17 and 18 will be done at the same time with the initial mailing in May or June.
- Waiver Rules: The rule package proposing waiver service rate increases was original filed on 1/7/2020. Links to the rules filed and details regarding the public hearing are listed below:
The public hearing for these rules is scheduled for 2/7/2020 at 11:30 a.m.
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