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|
ODM releases new revenue codes for reduced PA1/PA2
The Ohio Department of Medicaid has released new revenue codes for reduced PA1/PA2 rates that took effect July 1, 2016. The old rate of $130 became $115 on July 1, 2016; however, there is a reduced rate of $91.70 if the provider does not cooperate with the Ombudsmen in directing appropriate care. The revenue codes for SNF Medicaid billing are listed below:
More information is available from ODM by clicking here.
- RCC 0101 – Full Covered Day
- RCC 0160 – Full Day: Short-Term Stay for Waiver Consumer
- RCC 0183 – Leave Day: Therapeutic
- RCC 0185 – Leave Day: Hospital
- RCC 0220 – Flat Fee Full Covered Day
- RCC 0169 – Flat Fee Full Day: Short-Term Stay for Waiver Consumer
- RCC 0189 – Flat Fee Leave Day
- RCC 0229* – Flat Fee Full Covered Day (reduced rate)
- RCC 0769* – Flat Fee: Short-Term Stay for Waiver Consumer (reduced rate)
- RCC 0180* – Flat Fee Leave Day (reduced rate)
More clarification from ODM around eligibility, QIT; fax number issue
The Ohio Department of Medicaid has provided the following clarifications regarding the new eligibility and QIT:
SSI COLA updates: A Social Security COLA at the end of this year will not require a redetermination (and a QIT for a person already over the SIL), any other change of income of any amount will.
QIT documentation: The QIT is properly executed when properly filled and signed. The QIT and the verification form is all that is necessary to show proof of a QIT for eligibility purposes.
Home equity and eligibility: New rules state the home is considered an asset unless the person signs a statement that they intend to return. This statement can last indefinitely. The 13-month rule and the provision for extending it while the house is up for sale are gone. If the individual does not intend to return and there is no other reason to exclude it (spouse or dependent family member residing in the home, undue hardship to sell, etc.), then the home will be considered a resource and the individual will have to sell it. There is currently no rule or policy (since August 1) that allows the home to be excluded as a resource while the person makes a reasonable attempt to sell it. ODM is willing to consider this policy as there are concerns the person will lose Medicaid eligibility until the house is sold.
Lump sum clarification: Lump sums are treated as income in the month received and could make the individual ineligible for the month if not deposited into the QIT. Counties should treat lump sums in accordance OAC 5160:1-3-05.8. The only change that was made when Ohio switched to 1634 is that retroactive lump sum payments from SSI are given a 9 month exemption. Prior to conversion, the exemption was only 6 months.
9401 ODM fax number: ODM has also acknowledged that there is an issue with the fax number for sending the 9401s to ODM. They are in the process of fixing this issue.
MyCare Ohio: Molina billings need to contracted rate
Molina's claim processing system is designed to accept billing that is below the contracted rate. For MyCare Ohio, Molina has increased rates by 1% for the inclusion of bad debt payments that would have normally been paid to the SNF. The Molina claims system has been loaded with the contracted rates, including those that have the 1% increase for bad debt. Providers should bill Molina their contracted rate to avoid any payment reductions.
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