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|
State progressing towards new ACAT, LOTISS system
The Front Door Stakeholder Workgroup met this week to review progress on the new LTC IT system termed LOTISS. The system will house the new Adult Comprehensive Assessment Tool and related screenings for services. It will also direct people to the "front door" agencies that will screen the individuals for the services they require. LOTISS has been tested for LOC determinations and all the algorithms are working. The next phase of testing is doing end-to-end testing including data entry, level II screening, work flow for hospitals and SNFs, and assignment of services. Medicaid is also developing training for specific providers, including SNFs. Medicaid will be looking for early adaptors to help with piloting the system. If you are interested, please contact The Academy.
MyCare Ohio: Medicaid discussing PL policy for MCOs
Patient liability and claims adjustment continues to be a boon for MyCare providers. Plans simply don't make the adjustments, reject the adjustment claims, or don't apply the correct calculation. Medicaid has been asked to become more involved in finding a solution to the problem, as the current "spreadsheet method" appears to be ineffective for some plans. Medicaid is still meeting internally to determine a policy around MyCare patient liability and is not prepared to bring everyone to the table at this time. The Academy will move forward with addressing individual provider PL issues with the plans directly until an alternative solution is found.
MyCare Ohio: Plans' prior auth requirements after a CHOP
The change of provider (CHOP) process can be cumbersome in the MyCare Ohio environment. Many residents belong to a managed care plan and thus have a significant impact on billing and revenue. While it is important to work as far in as advance of the effective date of the change with the managed care plan for contracting and loading purposes, it is also equally important that the necessary prior authorizations (PA) are obtained for claims to process properly. There are different PA requirements for a CHOP depending on the plan:
As always, please contact The Academy if you have any questions or concerns.
- Aetna: If there is a new TIN or provider number, new PAs need to be issued.
- Buckeye: New PAs will be needed with the updated provider information. Contact the memberís Buckeye Care Manager or Area Agency Waiver Service Coordinator to initiate these updates.
- CareSource: New PAs are not needed after a CHOP.
- Molina: PAs are linked to the provider; therefore, new PAs will need to be issued.
- UnitedHealthCare: The PAs are tied to TIN, provider number, point of service, and revenue code. New PAs are needed for a new TIN or provider number at a facility. New PAs are also needed if contract changes, including going from non-par to par, cause a change in revenue codes.
- Click Here to read The Academy Weekly in PDF format