Kenneth Daily, LNHA
Elder Care Systems Group
Kenn@qissurvey.com



CEUs for today ’ s program is 2 hours

Certificate of attendance
Staff changes and new e-mail addresses

3

April 28-May 1, Ohio Health Care Association
Annual Convention

May 27 - Small Houses, Susan McConn, Vice
President and Jeff Singleton, Administrator,
Otterbein Homes

County
LICKING
Case/Category/Sequence
9999999999/MA A/01
Eligibility Begin Date
01/01/13
Void After
1/30/13
Ohio Department of Medicaid
Consumer Hotline- 1-800-292-3572 or TDD 1-800-292-3572
Ohio
Medicaid

6

After MyCare goes live check MITS portal and get list of residents and health plan they were enrolled.

Contract care manager because it appears that all residents will have an assessment within 15-75 days of enrollment (days determined by risk level)

Check with ancillary providers on whether they are plan partner?

Making sure all residents are prior authorized for payment (this will vary by plans)

Plans will also need to know date of admission to facility

•
•
Those who are:
–
–
–
Eligible for Medicare (Parts A, B and D) and FULLY eligible for Medicaid;
Over the age of 18; and
Living in one of the demonstration counties.
This includes:
–
Individuals in nursing facilities, in some home care programs (PASSPORT, Choices, Ohio Home Care,
Transitions Carve Out, Assisted Living Waiver) and who are receiving behavioral health services in community settings

rd
8

Residents with Medigap Policies

According to the Department of Medicaid (ODM)
Medicare supplement (Medigap) policies are considered credible coverage and are not eligible for
MyCare Ohio

Make sure all residents with Medicaid have the 3 rd party insurance screen updated in Cris-E

For additional problems contact the toll free hot line –
4/13/2020

9

Originally Hospice services would be paid directly by plans

It appears that plans may only pay 95% and the remaining 5% paid by Hospices

Also at the meeting, Buckeye intend to pay the hospice instead of the SNF. Molina Healthcare will do the same, at least temporarily, until they complete an addendum to their SNF contracts for room and board payment.
4/13/2020

10

MyCare Ohio includes coverage for bed hold days.

Days and the payment rate are the same

Medicaid provides plans with the list of the SNFs that qualify for the 50% or the 18%.
 health plans (United, Buckeye, Molina) expect to require prior authorization for hold days

Authorization for the hospitalization or therapeutic leave being the first part and authorization for the bed hold being the second part???
4/13/2020

11

Plans all have clarified that prior authorization will not be needed for any beneficiary who already is in a skilled nursing or assisted living center when enrolled in MyCare.

Plans still will need to collect from the SNF the date of admission for each of their member patients.
4/13/2020


Part of the 12-month doc fix is a "skilled nursing facility value-based purchasing program

SNF readmissions reduction program to save an estimated $1 billion over the next 10 years.

No financial ramifications for 4 years

CMS will develop optimal risk-adjusted readmissions tool which will be ratified by The National Quality
Forum


FY 2019 (October 1, 2018), CMS will withhold 2% of payments to skilled nursing.

The 2% withheld, 50-70% will be used for value-based incentives returned to skilled nursing providers.

The higher-performing providers will additional monies based on on reduced rehospitalizations.

Most of the 2% retained will be distributed to facilities.

CMS will save about $1 billion over 10 years

 ODH announced last week that they will being completing the
LSC survey using the Short Form survey

S&C Memorandum 13-22-NH (4/5/13) -To be Eligible for the
Short Form Process the Facility Must:

Be fully sprinklered;

Generally not have any waivers or use the Fire Safety
Evaluation System – Health Care (FSES/HC) to be certified;

Have not been cited for K0062 Sprinkler Maintenance, K0054
Smoke Detector Maintenance, K0050 Fire Drills, K0104 Smoke
Barriers and 0051 Fire Alarms in the last two years.









K38 - Exit access
K39 - Exit corridor width
K47 - Exit signs operational
K50 - Fire drills
K52 - Fire alarm system properly maintained
K62 - Automatic sprinkler system properly maintained
K72 - Means of egress unobstructed by furnishings and decorations
K144 - Emergency generator properly maintained

K211 – Alcohol-based hand rubs properly used


ICD-10 implementation that was to begin on
October 1, 2014 but as part of the ‘Doc Fix’ it may have been pushed to October 2015

AHCA will continue to gather guidance from CMS on this new development and send information to our states affiliates to disseminate to the membership.

 CMS Currently only recognizes Life Safety
Code 101 (2000 Ed.)
 Promulgated by the National Fire Protection
Association (NFPA) (not a government agency)
 Code Versions 2000, 2003, 2006, 2009 and
2012
 Life Safety Code is not the only code facilities must meet but one of many i.e. International
Building Code (IBC), Ohio Fire Code, Ohio
Building Code, Uniform Building Code), Local
Codes and ordnances etc.
 It is NOT a building code. It focuses on safety of all persons in a building by protecting them from fire, smoke and toxic fumes

2012 Code
19

Combustible decorations

Gas Fireplaces

Fixed furniture in corridors

Kitchens open to corridor

Door locking

Delayed egress

Generator testing

Sprinkler testing

Recycling

Suites

Openings in exit enclosures

21

Administration

Referenced Publications

Definitions

Fundamentals

Gas and Vacuum Systems

Electrical Systems

Information Technology &
Communications Systems

Plumbing

HVAC

Electrical Equipment

Gas Equipment

Emergency Management

Security Management

Hyperbaric Facilities

Fire Protection