The Academy of Senior
Health Sciences, Inc.
17 South High Street
Suite 770
Columbus, OH 43215
614.461.1922
800.999.6264
Fax: 614.461.7168
cmurray@seniorhealthsciences.org



 

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 revenue woes continue as expected  —  Earlier this week the Office of Budget and Management released the latest revenue figures for Ohio. As expected, tax revenues continue to lag with a net effect of $67 million less than budgeted. The cumulative effective of the shortfall is about $841 million. The House had been directed to reduce the budget by $800 million. While there is some debate as to if the House did achieve that number when they passed H.B. 49, the Senate appears to have to reduce the budget by at least $40 million more. The concern is when the shortfall will stop. Legislators will have to decide during conference committee if an $850 million reduction is adequate and risk a mid-biennial budget review with fiscal pressures to further reduce spending or to expect further declines in tax revenue and budget accordingly. The silver lining is that overall state expenditures are $1.17 billion below estimates, allowing the state to finish SFY2016 in the black. Thus, the pressure on legislators is to hold back on new and increased spending, not necessarily reducing funding levels from SFY2016 expenditures.

ODM addresses audits for 2016; PL issues —  The switch to Ohio Benefits (OB) in 2016 along with continued patient liability (PL) changes in policy are going to create problems for the Medicaid audit team. At the latest ODM provider meeting, ODM staff acknowledged that 2016 was going to be a challenging year for audits. ODM is already preparing training for auditors related to MITS and policy changes. Furthermore, the confusion over how to handle patient liability will create some difficulties. As it stands now, ODM will be looking for documentation to support how the provider determined how much to bill Medicaid, such as MITS screenshots showing the PL. ODM has indicated that they will also be looking at consistency in the provider process; however, a recent ODM document outlining how providers should process PL may have caused providers to change processes. (Click here to view PL guidance document.) ODM may perform several onsite audits related to CHOPS first and hope to gain a better understanding of the processes that are in place to help with future audits. Final policy decisions around 2016 audits have not been made.

Notes from the ODM provider meeting —  The Ohio Department of Medicaid met with long-term care association representatives this week. Below are notes from the meeting:

  • PA1/2 Audits: ODM is reviewing the results of their recent audit of 12 providers for proper PA1/2 billing. In some situations, ODM's information did not match the providers. ODM wants to determine the process before proceeding with more audits.
  • Annual Audits: The CY11 and 12 audits are finished. The SNF 2013 audits will be run this summer. ODM is considering doing 13 and 14 together depending on the results of the latest audit process.
  • Third Party Liability (TPL): Providers are reminded to check for TPL. Providers can use Form 06614 and send it to the TPL mailbox (TPL@medicaid.ohio.gov). More information is available by clicking here.
  • Delayed Eligibility Billing: There is a process for a SNF provider to bill for Medicaid services retroactively if the eligibility determination takes more than one year. The date of determination is used and providers can bill up to 180 days after one year. Please note that this is not for pending Medicaid.
  • Living Arrangement Changes: The county has to process living arrangement changes if a resident is discharged to the community. The 9401 is sent to ODM. ODM closes the SNF span in MITS; however, the CDJFS has to update the living arrangement and address to update OB. This can impact pharmacy billing.
  • SNF FY2017 Rate Setting: ODM should have the rate sets by June 23. The quality points have not been calculated yet; however, it is expected they will have near the same value as last year - just under $0.60 per point. All providers will receive the potentially preventable hospital admission point as ODM still has concerns over the data.
  • PL: ODM continues to work on solutions around PL calculations and process. They did not provide a timeline for implementation. Providers are reminded that MCO's can retroactively apply PL changes when the 834 (and MITS) is updated so SNFs should withhold PL. SNF providers should work with the CDJFS to resolve discrepancies between the PL amount in MITS and the correct PL amount. Please refer to the ODM PL guidance document for more information by clicking here.
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