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|
MyCare Ohio: Claims, transportation, prior auths and more.
Below are notes from the latest meeting with the MyCare Ohio managed care plans.
Transportation: UHC admitted that transportation has been a problem. They continue to work with MTM and are also working on a more permanent solution in the next few weeks for SNF runs. CareSource provided an information sheet outlining the various benefits and differences based on service setting. One thing to note is the CareSource will prior auth services retroactively and also currently allows the use of non-par providers. Certain runs, such as for dialysis, do not require a PA. Aetna still uses Logisticare for their non-emergency runs, although they noted that SNF providers can work with their transportation provider (who should go through Logisticare to schedule). All of the plans have indicated that they can issue PAs for non-par providers. The Academy continues to recommend that you work with your transportation providers on developing the best method for scheduling transportation for each plan.
Claims: Claims processing should pick-up over the next few weeks. Aetna has indicated that they are finishing loading providers and are in the process of fixing their system so claims auto process. Until then, they continue to manually process claims. UHC has a patch in place for the infamous "S23" denial. Those claims should now be processing. A permanent fix will be in place by September. For July 1 rate changes, the plans will make the adjustment; however, if providers are not seeing the adjustment or believe it is incorrect, the plans are asking providers to notify them instead of filing adjustment claims. Furthermore, the plans are interested in establishing a reconciliation process for claims that paid with the incorrect patient liability so providers can quickly clear over payments off of their balance sheet. Stay tuned for more on that process.
Prior authorizations: Prior authorizations for the institutionalized population has been an issue since the start of MyCare. Another consideration is the use of PA numbers on the claims. Both UHC and Buckeye will eventually require PA numbers on claims in the future. Buckeye has been issuing the PAs and plans to have the western region done in time for October claims (Sept. dates of services). UHC continues to encourage providers to get PAs. Molina, Aetna, and CareSource have indicated that the prior auth number is not needed on the claim, but a prior authorization will be needed. They can process the claims without the prior auth by cross referencing their systems for a prior auth when the claim is processed. While the plans have said that the use of a prior auth number on a claim does not change the processing time, it may be best to include it on the claim.
Dental services: The plans are working with dental providers that service SNFs. UHC currently uses Dentaquest to schedule dental services. Many of the plans are open to expanding their network to include other dental providers. If you have concerns over the provision of dental services to MyCare residents, please contact The Academy.
LOC documentation: All of the plans have to do a comprehensive assessment that includes the elements for the Medicaid Level of Care (LOC) assessment. The question was raised as to if the plans will provide LOC documentation (similar to Form 3697) to SNF providers. CareSource and Buckeye have indicated that they will work something similar to the 3697 in their systems for providers to access. UHC, Molina, and Aetna are all looking into how they can allow providers to extract the information found on the 3697 from their assessment tool. It is uncertain at this time why providers need this information.
Bulk PL and non-covered days: The state has indicated that they will want any bulk, one-time patient liability recorded differently on the claims. UHC has indicated that a provider can follow current Medicaid practices. We will continue to work with the plans on how they want these values submitted. The state has also said they are not concerned about non-covered days. Currently, only Molina has indicated to put non-covered days on claims.
"Innovation" heads to human services in JFS
Governor Kasich has announced the creation of a new office in JFS: Office of Human Services Innovation. The office is headed by former ODJFS director Doug Lumpkin and is charged with coordinating public assistance programs (education, health care, and job and family services) that will help Ohioans prepare for life and the dignity of work. The office is to improve programs that help Ohioans get jobs, maintain employment, and move out of poverty. The office was created in the MBR passed this summer.
ODA surveying AL facilities regarding new CMS HCBS rules
As reported in the August 1 edition of The Weekly, CMS recently change the definition of what it means to provide services "in the community." The Ohio Department of Aging is in the process of helping to develop Ohio's transition plan that lead to the implementation of the new rules. One area of concern is whether or not an assisted living facility is considered in the community or not. The 24 question survey, sent via email to the AL waiver facilities in the state, attempts to gather information about the facilities to see how well they fit CMS's definition of being in the community and allowing community access. The results will help shape Ohio's transition plan around the AL waiver. AL waiver providers were asked to return the survey by August 22.
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