LeadingAge and the LeadingAge state affiliates (including LeadingAge Ohio) are working in conjunction with Pathway Health to provide tools to help members navigate through the Requirements of Participation for Phase I of the new Mega Rule.
LeadingAge and the LeadingAge state affiliates (including LeadingAge Ohio) are working in conjunction with Pathway Health to provide tools to help members navigate through the Requirements of Participation for Phase I of the new Mega Rule. The policies and tools, which will be available from the LeadingAge Ohio member/subscriber restricted website, have been designed for national distribution and comply with the CMS Mega Rule.
In early December, LeadingAge Ohio members joined their colleagues at three regional trainings on the new Requirements of Participation for nursing facilities. The trainings brought together industry experts Janet Feldkamp, Partner, Benesch, and Stephanie DeWeese, Quality & Regulatory Specialist - Long Term Care, LeadingAge Ohio, to work through the RoPs, one by one, providing helpful tips for implementation.
Yesterday afternoon, November 22, a federal trial court in Texas issued a nationwide preliminary injunction blocking the new FLSA salary regulations from going into effect on December 1. This means that, right now, the new regulations raising the salary threshold test for the white collar exemptions cannot be implemented by the U.S. Department of Labor (DOL).
Attention: Nursing Facility Providers
John Maynard, Program Integrity Director, Ohio Department of Medicaid (ODM) explained that ODM had completed the first wave of their “second look” of the 2011 post-payment claim reviews. Through this process ODM has reviewed 100% of the ICF/IID claims and the top 10% of the highest dollar amounts of nursing facility claims.
Preserving affordable senior housing is crucial in the face of increasing need. There are approximately 2,800 properties serving over 120,000 households headed by low-income seniors that are in great need of repairs and upgrades to meet the needs of their residents.
Revisions to State Operations Manual (SOM), Appendix PP - Revised Regulations and Tags
In the October 20 edition of The Source, we shared the potential impact on a specific piece of the new Rules of Participation slated to go into effect on November 28, 2016 for those communities who are Medicaid and/or Medicare providers.
The Centers for Medicare and Medicaid Services (CMS) issued the Final Rule: Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities that was published in the Federal Register on Oct 4.
Centers for Medicare and Medicaid Services (CMS) published the final rules revising the nursing home requirements of participation on Tuesday, October 4, 2016. This rule represents the most significant changes to the delivery of nursing home care since OBRA ‘87.
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 Ohio Department of Medicaid (ODM) is providing the following guidance to nursing facilities and county department of job and family services (CDJFS) regarding the backlogged ODM 9401s not processed before Ohio Benefits went live on August 1.
The LeadingAge Ohio Annual Business Meeting will be held in conjunction with the upcoming 2016 Annual Conference and Trade Show, Stronger Together, on Friday, September 9, 2016 from 9:45 a.m. - 11:15 a.m. Hyatt Regency Columbus.
ODM will audit Medicaid election statements from all Ohio Hospices serving Medicaid patients beginning late August. In discussions with ODM, they expect this audit to take place through October 31, 2016.
Effective August 1, 2016, the Ohio Department of Medicaid has updated the form and process for completing the ODM 9401, previously the Facility CDJFS Transmittal. Depending on the type of request and/or update, nursing facilities (NF) will submit the ODM 9401 to either:
Providers are fast approaching the August deadline for implementation of the Disability Determination Redesign, which will shift Ohio Medicaid beneficiaries who previously had a spend-down amount to using Qualified Income Trusts, or QITs, to maintain or gain eligibility for Medicaid LTSS.
At 9:30 this morning we received word from Ohio Department of Medicaid (ODM) that the nursing facility rates were not able to be loaded to the MITS portal and therefore providers cannot access their rates through the MITS system.
On May 25, the Ohio state legislature passed a bill that will legalize the use of marijuana in particular forms to treat certain medical conditions. LeadingAge Ohio’s lobbying firm, Barnes and Thornburg, has prepared the following clarifications which will help providers understand the scope of the bill, and how it may impact their practice.
Stakeholder Group Seeks to Curtail Harm with Policy Change, Discussion
Columbus, Ohio—June 3, 2016—Yesterday, a group of lawmakers, researchers, experts in aging, and other stakeholders met in Columbus, Ohio for the first of a three-part conversation on the viability of Ohio’s system of financing and providing care for Ohioans as they enter their golden years.
NURSING FACILITY COST REPORT SENSITIVE INFORMATION
EVERY CERTIFIED NURSING FACILITY PROVIDER should be getting their quality point for the PELI instrument. Cheryl Guyman, Nursing Facility Policy Administrator, Ohio Department of Medicaid has confirmed that there is nothing in rule to prevent a facility from using MDS Section F:
Terry Moore from the Department of Medicaid (ODM) released final prices based upon updated inflation factors and a detail audit from Myers & Stuffer, LLP. The good news is all prices are higher than the originally projected prices released in December. If you use the SWA average Medicaid case mix of 2.6500, the increased prices average $1.53 per day.
The Ohio Department of Medicaid (ODM) has issued a reminder that May 24, 2016 will be the first deadline for some nursing facilities to revalidate their provider agreement.
Recently, the Ohio Department of Medicaid (“ODM”) issued the Initial Post-Payment Claims Overpayment Review Reports for fiscal year 2011. As LeadingAge Ohio reported in an alert to members on February 29, following the issuance of these reports, ODM received a number of comments from providers and associations expressing concerns over the content of the reports. Today, as a result, ODM has made the decision to conduct another review of all the reports that were issued. In order to facilitate this review, ODM is waiving the 30-day requirement for providers to file a response to request a bureau-level resolution process (NF) or audit conference (ICF).
Effective July 1, 2016, the Ohio Department of Medicaid is changing its disability determination system so that individuals who qualify for Supplemental Security Income (SSI) will automatically qualify for Medicaid. In legal terms, this means the state is implementing section 1634 of the Social Security Act, rather than using section 209(b).
Recertification for existing EIDM-enrolled entities is due 3/15/2016. Access to PS&R data (through EIDM) is needed for the home health cost report, as well as for hospices in fulfilling their annual requirement to calculate and report their estimated aggregate cap by March 31 if the hospice’s MAC does not provide the data directly to the hospice.
A number of LeadingAge Ohio members have shared that their “Post-Payment Claims Overpayment Review” reports from the Ohio Department of Medicaid (ODM) for fiscal year 2011 are substantially larger than in previous years.
A number of LeadingAge Ohio members have shared that the “Post-Payment Claims Overpayment Review” reports for fiscal year 2011 that the Ohio Department of Medicaid (ODM) has been sending out to nursing facilities are substantially larger than in previous years.