Complete Story
09/21/2016
State Provides Important Clarification on Hospice Enrollees in NFs
Ohio Department of Medicaid (ODM) had provided clarification regarding the data entry required in Ohio Benefits when the Passport Administrative Agency (PAA) receives an ODM 9401 and the nursing facility resident does not require a level of care determination (based on OAC 5160-3-14 or the ODM Most Common Scenarios chart).
The guidance is around hospice enrollees in nursing facilities as that is the scenario that has arisen most often since Ohio Benefits implementation on August 1. ODM reports that there has been inconsistent information provided about whether ODM has changed its policy on requiring a level of care determination for hospice enrollees in nursing facilities. Some CDJFS workers have been informing nursing facilities and PAAs that a level of care is required for hospice enrollees and that is because the level of care field in Ohio Benefits is required in order for the CDJFS to process long-term eligibility for nursing facility residents.
ODM has not changed its policy on when a level of care determination is required. To ensure that CDJFS workers can process nursing facility cases in Ohio Benefits, PAAs must complete the facility LTC detail screen per the instructions in the attached memo when the LTC detail screen is not already completed.
ODM encourages provides to continue to email questions or issues to NFStay@medicaid.ohio.gov mailbox.