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.

    What's New: April 11, 2014

House moves MBR bills before spring break  — The Ohio House of Representatives moved several bills this week prior to their spring break. One of the bills, H.B. 483, is the Mid-biennial Budget Review bill that addresses appropriations. The MBR has limited language that impacts skilled nursing facilities despite an omnibus amendment that want through committee earlier in the week. One section of the bill would require SNFs to notify residents and their guardians or sponsors if a sex offender was admitted to the facility. The Academy opposes the language as written, and is working on changes that remove the notification while ensuring the health and safety of the residents. Another section of the bill makes changes to the CON regulations that would allow an RCF to convert 20 beds to SNF beds using licenses from a neighboring county. It is believed the language is directed at Madison county. The bill heads to the Senate where it is expected to move rather quickly after the break.

MyCare Ohio: Hospice and bed hold PAs  — The MyCare Ohio demonstration project is less than three weeks away from going live in the NE region. The latest news centered around the Medicaid room and board rate for hospice services, currently paid to the SNFs from hospice providers. The Academy had noted in past Weekly articles and other updates that the MyCare managed care plans would allow the SNFs to bill for the hospice service. The Academy learned earlier this week that Buckeye will not allow SNFs to bill for the Medicaid room and board, but the hospice company will bill Buckeye directly. Molina has said it would do the same because hospice is not in their SNF contracts; however, Molina may amend the contracts in the future to allow for SNF billing. UHC has the opposite situation; the hospice benefit is in the SNF contract, but they do not have contracts with hospice providers. They expect the SNF to bill them for the Medicaid room and board. Aetna and CareSource have not confirmed what their billing process with be for hospice Medicaid room and board. On a similar note, the plans have different approaches for prior authorization of bed hold days. All of the plans will be paying at the discounted Medicaid rate based on occupancy. The difference is prior authorization (PA). UHC and Buckeye have said that they will need a PA for those bed holds, meaning that if it is for a hospitalization, two PAs would be needed (one for the bed hold and one for hospital visit). Molina and Aetna are unsure at the moment, while CareSource said the authorization is for the SNF service over that authorized time period, regardless if the person leaves the facility for a hospital stay. This means a new PA is not needed for the bed hold. All of the plans suggested that getting a PA should not be a problem since any change in condition that requires a hospitalization or if a therapeutic stay is in the care plan, the care manager should be aware and able to facility the PA.

MyCare Ohio: Loading providers and training updates  —  One of the concerns The Academy has heard the most from our members is prompt payment for MyCare Ohio services. One of the keys to getting paid timely is to be "loaded" into the system. According to the plans, they are currently working on loading the providers they have contracted with. If a provider has not been credentialed and does not have a final contract, some plans are "pre-loading" provider information based on available data, while other plans will load providers once the claims are received using claim data. For "non-par" providers, a single case agreement is necessary for payment purposes. The process can cause a delay in payment versus being a contracted provider. While it is too late for NE region providers to begin the credentialing process and finish by May 1, there may be some time in the other regions. If you have not contracted with the plans and wish to do so, please contact the plan as soon as possible to try and avoid any delays in payment. Even if you plan on not being a network provider, you may want to contact the plan and let them know so you can be loaded into the system as a non-par provider for the future MyCare Ohio beneficiaries currently in your building.
In other news, the managed care plans will be providing training to MyCare Ohio providers, including SNFs and/or long-term care services and supports providers. Most of the training for LTC will begin the week of April 23rd. The plans have yet to confirm dates and times for the training. Most of the training will be web based. The Academy will notify you once the dates are made available.

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