kenneth daily, lnha elder care systems group

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  • Slide 1
  • Kenneth Daily, LNHA Elder Care Systems Group
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  • District News CEUs for todays program is 2 hours Certificate of attendance Staff changes and new e-mail addresses
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  • Coming Events April 28-May 1, Ohio Health Care Association Annual Convention May 27 - Small Houses, Susan McConn, Vice President and Jeff Singleton, Administrator, Otterbein Homes 3
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  • Golf Outing Annual Golf Outing Pipestone August 28th Shotgun start @ 9AM Sponsorship materials are available
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  • County LICKING Case/Category/Sequence 9999999999/MA A/01 Eligibility Begin Date 01/01/13 Void After 1/30/13 Ohio Department of Medicaid Consumer Hotline- 1-800-292-3572 or TDD 1-800-292-3572 Ohio Medicaid
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  • MyCare After MyCare goes live check MITS portal and get list of residents and health plan they were enrolled. Contract care manager because it appears that all residents will have an assessment within 15-75 days of enrollment (days determined by risk level) Check with ancillary providers on whether they are plan partner? Making sure all residents are prior authorized for payment (this will vary by plans) Plans will also need to know date of admission to facility 6
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  • Who will be enrolled? Those who are: Eligible for Medicare (Parts A, B and D) and FULLY eligible for Medicaid; Over the age of 18; and Living in one of the demonstration counties. This includes: Individuals in nursing facilities, in some home care programs (PASSPORT, Choices, Ohio Home Care, Transitions Carve Out, Assisted Living Waiver) and who are receiving behavioral health services in community settings
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  • Creditable 3 rd Party Coverage Residents with Medigap Policies According to the Department of Medicaid (ODM) Medicare supplement (Medigap) policies are considered credible coverage and are not eligible for MyCare Ohio Make sure all residents with Medicaid have the 3 rd party insurance screen updated in Cris-E For additional problems contact the toll free hot line 8/23/2015 8
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  • Shifting Picture on Hospice Originally Hospice services would be paid directly by plans It appears that plans may only pay 95% and the remaining 5% paid by Hospices Also at the meeting, Buckeye intend to pay the hospice instead of the SNF. Molina Healthcare will do the same, at least temporarily, until they complete an addendum to their SNF contracts for room and board payment. 8/23/2015 9
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  • Bed Hold Under MyCare Ohio MyCare Ohio includes coverage for bed hold days. Days and the payment rate are the same Medicaid provides plans with the list of the SNFs that qualify for the 50% or the 18%. health plans (United, Buckeye, Molina) expect to require prior authorization for hold days Authorization for the hospitalization or therapeutic leave being the first part and authorization for the bed hold being the second part??? 8/23/2015 10
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  • Prior Authorization for Beneficiaries Already in a Center Plans all have clarified that prior authorization will not be needed for any beneficiary who already is in a skilled nursing or assisted living center when enrolled in MyCare. Plans still will need to collect from the SNF the date of admission for each of their member patients. 8/23/2015 11
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  • Corp Compliance Immediate Jeopardy Life Safety Code QIS QAPI Disasters Special Focus 5 Star Culture Change MDS 3.0 Quality Measures Audits QualityF Tags K Tags
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  • NF Value-Based Purchasing Program Part of the 12-month doc fix is a "skilled nursing facility value-based purchasing program SNF readmissions reduction program to save an estimated $1 billion over the next 10 years. No financial ramifications for 4 years CMS will develop optimal risk-adjusted readmissions tool which will be ratified by The National Quality Forum
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  • Value- based Purchasing FY 2019 (October 1, 2018), CMS will withhold 2% of payments to skilled nursing. The 2% withheld, 50-70% will be used for value-based incentives returned to skilled nursing providers. The higher-performing providers will additional monies based on on reduced rehospitalizations. Most of the 2% retained will be distributed to facilities. CMS will save about $1 billion over 10 years
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  • Life Safety Code (LSC) in Nursing Homes ODH announced last week that they will being completing the LSC survey using the Short Form survey S&C Memorandum 13-22-NH (4/5/13) -To be Eligible for the Short Form Process the Facility Must: Be fully sprinklered; Generally not have any waivers or use the Fire Safety Evaluation System Health Care (FSES/HC) to be certified; Have not been cited for K0062 Sprinkler Maintenance, K0054 Smoke Detector Maintenance, K0050 Fire Drills, K0104 Smoke Barriers and 0051 Fire Alarms in the last two years.
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  • Short Form Survey K38 - Exit access K39 - Exit corridor width K47 - Exit signs operational K50 - Fire drills K52 - Fire alarm system properly maintained K62 - Automatic sprinkler system properly maintained K72 - Means of egress unobstructed by furnishings and decorations K144 - Emergency generator properly maintained K211 Alcohol-based hand rubs properly used
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  • ICD-10 Delay??? ICD-10 implementation that was to begin on October 1, 2014 but as part of the Doc Fix it may have been pushed to October 2015 AHCA will continue to gather guidance from CMS on this new development and send information to our states affiliates to disseminate to the membership.
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  • CMS Announces move to 2012 Editions- NFPA 101/ NFPA 99 CMS Currently only recognizes Life Safety Code 101 (2000 Ed.) Promulgated by the National Fire Protection Association (NFPA) (not a government agency) Code Versions 2000, 2003, 2006, 2009 and 2012 Life Safety Code is not the only code facilities must meet but one of many i.e. International Building Code (IBC), Ohio Fire Code, Ohio Building Code, Uniform Building Code), Local Codes and ordnances etc. It is NOT a building code. It focuses on safety of all persons in a building by protecting them from fire, smoke and toxic fumes
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  • 2012 Code Combustible decorations Gas Fireplaces Fixed furniture in corridors Kitchens open to corridor Door locking Delayed egress Generator testing Sprinkler testing Recycling Suites Openings in exit enclosures 19
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  • NFPA 99 Health Care Facilities Plumbing HVAC Electrical Equipment Gas Equipment Emergency Management Security Management Hyperbaric Facilities Fire Protection Administration Referenced Publications Definitions Fundamentals Gas and Vacuum Systems Electrical Systems Information Technology & Communications Systems 21


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