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
MyCare Ohio: Enrollment status issues plague start of Medicare passive enrollment services; 72% fully enrolled  –  2015 started off a little rocky for the MyCare Ohio program as the effective date hit for those that were passively enrolled into the Medicare benefit. Discrepancies between the Managed Care and the Medicare sections of the MITS report has led to some confusion over enrollment status. According to Medicaid, if the Managed Care section of the report says "Medicaid only," that indicates the person has opted out; however, Medicaid did say that the Medicare eligibility reports should also have accurate enrollment information. Medicaid also noted that 3,200 individuals had to have their opt-out data resent to CMS. They did that earlier this week and the systems should be updated. If you believe that there is a problem with the status of the individual because Medicaid did not process the enrollment properly, the authorized representative or beneficiary should contact the Medicaid hotline. They should be prepared to show evidence of the initial enrollment form to have the opt-out retroactive to 1/01/15, otherwise it will be as of 02/01/2015. If it is a systems issue where there is conflicting enrollment data, the authorized representative or beneficiary should contact the plan's member services. Note that only the beneficiary or authorized representative can make enrollment inquiries or changes.

In related news, Medicaid said that 72% of the individuals were fully enrolled into the MyCare program for both Medicaid and Medicare benefits. This is much higher than experiences in other states. They could not give a breakdown by service location (SNF, AL, HCBS). The number may change some as the issues mentioned above are fully resolved

MyCare Ohio: Reminders - get prior auths for skilled services; 100 day skilled stay caps  —  The MyCare Ohio health plans require prior authorizations for skilled services, including those that were being provided on Dec 31, 2014. The plans have indicated that they will allow a continuation of benefits until an assessment is done for services that were ordered prior to Jan 1; however, the provider must still request a prior authorization (PA). The plans noted that it is important to tell the individual that you are calling for services in a skilled nursing facility and to let them know if it is a skilled stay or custodial stay. Providers are encouraged to call for expedited PAs as that is the quickest way of obtaining the PA. One issue that we are still trying to resolve is the PA process for outpatient therapy services. Most of the plans will allow the evaluation and a small number of sessions without a PA. Buckeye is the only plan that has indicated they require a PA for initial outpatient therapy services.

The MyCare health plans, with the exception of Buckeye, have also indicated that they will be following the current Medicare practice of allowing skilled services under Part A for up to a maximum of 100 days. (Back to top)

Changes in LTC to continue in 2015  —  2015 will continue to see change in the long-term care industry. This is in large part because of the recent expansion of the MyCare Ohio program via the passive enrollment for the Medicare benefit. Initially this will impact provider admission and billing practices; however, the health plans will begin to look at new and different ways of controlling utilization and costs. The plans are supposed to share at least 50% of any savings from the program with providers. 2015 is also a state budget year. This opens up any current issues to be addressed legislatively. The expectation is to see the SNF reimbursement removed from statute in the governor's budget; however, it is also a "rebasing" year for prices. The Academy will continue to advocate for increased reimbursement for SNF services while addressing other issues that members have brought to our attention. Payment reform is still an issue at the federal level. MedPAC continues to call for a four percent reduction in Medicare SNF rates while rebasing the rates. It also recommends "setting neutrality" by equalizing rates for the same services provided in different settings. This would impact inpatient rehabilitation services the most, but could also impact SNF rates. Regardless of what 2015 bring to the LTC industry, you can rely on The Academy to be your voice and source of information heading into the new year.

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