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 releases QIT information for July 1 eligibility change
Beginning July 1, 2016, Ohio will change its eligibility for Medicaid to match SSI eligibility. The change will eliminate the need for spend down, but it will require some individuals to create qualified income trusts (QIT or "Miller Trust") to maintain eligibility. About 4,000 nursing home residents will need a QIT. ODM has sent letters this week to individuals that will be impacted, including those in NHs. ODM has also mailed a letter to NHs with a list of residents that will need a QIT. OHT released information earlier this week including a FAQ, trust template, eligibility calculator. Please click the links below for more information on QITs:
MyCare Ohio: Buckeye Part B therapy information
Buckeye has configured its claims processing system to impose the $3,700 limit on Part B PT/ST and $3,700 limit on OT. Providers that wish to provide services over that limit will need a prior authorization. Buckeye is working with Optum on managing therapy services; therefore, providers will need to use the Optum portal and work with the Optum NP prior to reaching that limit in order to get approval in a timely manner. Buckeye is also imposing the limit on CY2015 claims. According to Buckeye, they are currently reprocessing claims that were previously denied for being over a limit of $1,940 but under the $3,700 threshold yet the claim used the KX modifier. For 2015 claims over the $3,700 limit or that did not use the modifier, Buckeye is working with Optum on acquiring the necessary documentation to determine medical necessity. Medical necessity criteria will be the same as Medicare, including the use of InterQual. Should Optum not have the necessary information, Buckeye will reach out to providers to acquire the documents and determine medical necessity.
Bill would allow "medication synchronization" among other pharmacy changes
The Senate passed a bill this week, Sub. H.B. 116, that makes several changes to pharmacy regulations. Highlights of the bill include:
Medication synchronization: Requires that certain health insurers and the Medicaid program provide coverage for medication synchronization, which allows drugs that are dispensed for chronic diseases or conditions to be obtained on the same date each month. Authorizes a pharmacist to dispense a drug in a manner that varies from the drug's prescription for the purpose of medication synchronization.
Dangerous and controlled substances: Extends to three years (from two) the time that records related to controlled substances must be preserved or kept.
Pharmacist: Requires a pharmacist to exercise professional judgment in determining the amount of a drug to dispense or sell under an existing provision that authorizes a pharmacist to dispense or sell up to a 30-day supply of a drug without a prescription for a patient on a consistent therapy with a drug that is not a controlled substance.
Specifies certain information that must be included in a written consult agreement between a physician and a pharmacist for management of a patient's drug therapy. The bill replaces the current protocol requirements with provisions that the agreement must contain a description of the (1) drugs or drug categories the agreement involves, and (2) procedures, decision criteria, and plan the pharmacist is to follow in acting under the consult agreement. The bill also requires that the agreement contain a description of how the pharmacist is to comply with recordkeeping and communication requirements in existing law.
The bill clarifies that, with regard to certain immunities in existing law for pharmacists and physicians practicing under consult agreements, the pharmacist or physician must be acting in accordance with the consult agreement regarding the change in a drug for the immunity to apply.
Physician Assistants: Permits certain physician assistants who are licensed by the State Medical Board but not authorized to exercise physician-delegated prescriptive authority to become so authorized without obtaining a master's or higher degree. Modifies continuing pharmacology education requirements for physician assistants.
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