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 coffers fill to the tune of $800 million  –  The Office of Budget and Management has projected a budget surplus of $800 million for FY2014 according to a Gongwer report (07/02/14). The funds will be used for tax cuts passed in the MBR last month while putting between $100 to $200 million more into the GRF rainy day fund. The surplus is mostly because of under spending, including in Medicaid, and tax receipts continuing to be above estimates.

MyCare Ohio: final regions commence, claims update, transportation  —  As of Tuesday, July 1, the MyCare Ohio demonstration program is fully up and running. Over 100,000 elderly and disabled people are now under the umbrella of managed care, with over 18,000 receiving both Medicaid and Medicare benefits from their plan. The final regions, EC (Portage, Stark, Summit and Wayne), C (Delaware, Franklin, Madison, Pickaway, Union) and WC (Clark, Greene, Montgomery), went "live" on Tuesday. The program is schedule to go until the end of 2017. A decision will be made to either continue the program, expand the program, or discontinue the program as that time approaches.

Claims update: We are over 60 days in for the NE region. Feedback form providers on the processing of claims have been mixed. While most of the plans are paying claims, there are still issues that need to be ironed out. Buckeye has notified The Academy that they are working through several issues around patient liability, prior authorization and Medicare EOB. They hope to have those corrected over the next week. UHC claims are processing, with mixed results. Some are going through and some are being denied. The Academy is trying to determine if there is a systemic problem or if the denials are due to unique circumstances. The only issues on CareSource claims have been related to patient liability and PA1 or PA2. In both cases it is not an issue around the claims being paid, but paid the proper amount. For patient liability, the plans have indicated that they want the PL amounts submitted in different ways. UHC, Buckeye and CareSource are following the guidelines and using value code 31 as the place for patient liability. Molina and Aetna have indicated to put PL amounts in box 54. All of the plans will be using the data from the 834 for patient liability amounts. The providers have to submit adjustment claims with supporting documentation (9401s) for changes in PL that occur during the month. The plans have indicated that claims will pay despite differences in PL for the first few months.

Transportation: Transportation continues to be hot topic under MyCare. Simply put, the plans must provide at least the same level of services provided under traditional Medicaid, meaning all medically necessary transportation. Transportation was "unbundled" as of January 1, 2014 from the SNF rate. Any services that were directly billed to Medicaid and paid prior to MyCare Ohio need to be covered by the plan. Plans can, and most do, prior authorize transportation services. And as noted in past Weekly editions, the plans use transportation brokers (UHC - MTM; Buckeye - Access2Care; Molina, Aetna, and CareSource - Logisticare). UHC has provided more information regarding the use of MTM for transportation, including a request form. The plans have said that they are willing to work with transportation providers and try to get them into their network.

ODA releases draft rules for NHQI program  —  House Bill 59 created a licensure requirement that all SNFs participate in a Department of Aging (ODA) approved nursing home quality improvement (NHQI) program. ODA has recently released draft rules of the requirements each program has to meet and the process ODA will follow to approve a project. The NHQI project will have to include a plan, action aimed at improving quality, evaluation of the action, and new action resulting from the evaluation. The Academy has been working with ODA on insuring that that rules be broad enough to incorporate a number of projects and that individual companies or facilities can develop their own projects that meet their respective quality improvement needs.

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