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
CMS readies providers for ICD-10; be prepared!  —  CMS continues its outreach to providers in order to prepare them for the switch to ICD-10. The most recent edition of MLN Newsletter is devoted to the new resources CMS has released. The Academy is also ready to help you prepare for ICD-10-CM with in-person intensive training sessions to help your staff learn the ins and outs of ICD-10-CM. The trainings, Tuesday, August 18 in Independence and Thursday, August 20 in Wilmington, are designed to help your coders be successful in the transition to ICD-10. Register online or by faxing or mailing the registration form. Order by July 31 to ensure your personal copy of the training manual. Do not delay - get ready for ICD-10 now!

What can I expect for my July 1, 2016 Medicaid rate?  —  The question above has been asked by Academy members several times. Unfortunately, there is no clear-cut answer at this time. House Bill 64, aka the budget bill, made a few changes to the statutory language that establishes Medicaid rates. The most significant change was the return of the $16.44 to the rate and $1.79 tied to new quality measures. But there are two "non-statutory" changes that may take place for the July 1, 2016 (SFY 2017) rate setting. The first, price rebasing, is almost certain to happen. What is uncertain at this time is which cost report data will be used to rebase the prices. During the budget, the administration used 2013 cost report data as that was the most recent available. 2014 cost report data is ready and available to use should Medicaid decide to stay with the most recently available policy. The other uncertainty falls under the case mix score and the RUG category used to calculate it. The statute calls for RUGs III; however, the statue appears to give Medicaid discretion to change the RUG category and grouper via rules. During the budget, Medicaid expressed a desire to use the RUGs-IV 66 grouper. The Academy, along with OHCA and Leading Age, advocated for the 48 grouper as the best grouper for the provision of long-term care as primarily done in the Medicaid program. Medicaid has also remained quite on the grouper they will use. The choice will impact the case mix scores, both the one to reset the prices and individual facility direct care rates. The result of the rebasing and change in the RUG category on provider rates remains uncertain, . Rebasing should have an overall uptick for peer groups 1 and 2. The RUG switch will most likely have a negative impact on rates. Regardless, the impact could vary widely at the facility level. The Academy will keep you updated as we work with the administration on July1, 2016 rates. For now, the Magic Eight Ball remains "reply is hazy, try again" later.

MyCare Ohio: Academy pressing Medicaid to resolve claims issues  —  The Academy has stepped-up its efforts to resolve MyCare Ohio claims processing problems for its members and all nursing homes. After over a year of frustration acting as a liaison for plans and Academy members to resolve claims issues with mixed results, The Academy has began to involve the Department of Medicaid in the resolution process. The current focus is on two areas: delays in payment and patient liability. For the former, The Academy will be providing data to Medicaid on the number of outstanding clean claims beyond 30 days for each MCO. Regarding patient liability, The Academy will be meeting with Medicaid, the other associations, and the health plans to attempt to come to a uniform process on how to handle patient liability. The first meeting is scheduled for next week.

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