State Budget, Survey Update …
CMS Initiatives
Kenneth Daily, LNHA
President
Elder Care Systems Group
kenn@qissurvey.com
OHCA District II
March 2014
District News


CEUs for today’s
program is 2 hours
 Certificate of
attendance
Staff changes and new
e-mail addresses
Coming Events
3




April 3 What Are Regulators Up To? Changes in
Survey, Quality, Payment and Systems (social
workers)
April 15 - Congestive Health Failure in Nursing
Home Patients, Anil H. Jhangiani, MD, FSCAI
Advanced Cardiovascular Care, LLC
April 28-May 1, Ohio Health Care Association
Annual Convention
May 27 - Small Houses, Susan McConn, Vice
President and Jeff Singleton, Administrator,
Otterbein Homes
Congratulations!!!
4
OHCA




Caregiver of the Year
Helen LeMaster, STNA
Nurse Aide
Piqua Manor
OCAL




Personal Care
Assistant of the Year
Angele Bubeck
Resident Associate
Garbry Ridge
Golf Outing
Annual
Golf Outing
Pipestone
August 28th
Shotgun start @ 9AM
Details later this month
State Updates

Mid-Year Budget Review- H. B. No. 472
Very little for long term care (thankfully)
 2 things
1. ICF/ID facility operations issues which are no contested
2. Sex Offender registration and notification

MyCare
7





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
MyCare Ohio
8
Money Issues



All MyCare Ohio health plans
agreed to not pend a claim when it
shows a different amount for patient
liability than the 834 file.
Plans should pay cross over
payment for residents who have
chosen both Medicaid and Medicare
MyCare
Medicaid only the facility should
receive a ‘no pay’ remittance letter
Creditable
rd
3
Party Coverage
9

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 3rd
party insurance screen updated in Cris-E
 For additional problems contact the toll free hot line –
4/13/2015
10
CMS LSC Issues
11








Cultural change waivers
Sprinkler issues still
abound; just starting
Obstructions in corridors
2012 code
Review by OMB starting
Dec. 2013
Then publish for comments
Comments
Final adoption of the
2012 LSC - late 2014

Budget
 Regional budget cuts
 Feds doing surveys
 Increased survey
time for region
 Less interaction time
 Hiring freeze
 Reduce # of
surveyors trained
S&C-13-58-LSC
Waivers for Changes -2012 LSC
12




Combustible
decorations
Gas Fireplaces
Fixed furniture in
corridors
Kitchens open to
corridor







Door locking
Delayed egress
Generator testing
Sprinkler testing
Trash collection
Suites
Openings in exit
enclosures
Sprinkler Protection Not Required

Outbuildings on nursing home properties
 Free standing outside smoke shelters
 Free standing laundry buildings
 Free standing kitchens or kitchens that
service nursing home residents in a
residential building on the same property
13