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June 11, 2020


Dr. Acton resigns. Today Dr. Amy Acton, Director of Health, stepped down after a year and four months in her position. Dr. Acton became famous for her daily press conferences with Governor Mike DeWine and Lieutenant Governor Jon Husted in the early days of the COVID-19 pandemic, during which she dispensed science lessons and an empathetic attitude toward people suffering from the virus and health care providers dealing with it. Later, she became a target for demonstrations, personal attacks, legislation, and lawsuits by people unhappy with the series of orders she issued closing businesses and restricting social activities. Dr. Acton will remain as a health advisor to the Governor, while Lance Himes resumes his previous role as Interim Director of Health.

Legislature passes July 1 SNF reimbursement changes. Today the House of Representatives concurred in Senate amendments to House Bill (HB) 481, originally a land conveyance measure. The Senate had inserted a number of extraneous provisions, including the long-awaited language that reverses Governor DeWine’s veto, last summer, of an increase in the SNF quality incentive payment for the State Fiscal Year beginning July 1. The reimbursement provisions in HB 481 are identical to those OHCA and other provider representatives negotiated with the Administration last fall, but which were not enacted until now. HB 481 is an emergency measure, meaning it will take effect immediately upon the Governor's signature. The most important aspect of the legislation is it increases the State Fiscal Year 2021 quality incentive payment from 2.4% to 5.2% of the statewide average Medicaid rate, which could amount to as much as $90 million in increased reimbursement.

Other July 1 SNF rate details. In a call today with staff from the Department of Medicaid (ODM), we learned it is unlikely rates will be ready before July 1, in part because 14 providers have not yet filed their 2019 cost reports. ODM's Terry Moore expects the rates to be finished sometime in July. ODM will use the cut points in the April 2020 Centers for Medicare and Medicaid Five-Star Technical Users' Guide to assign quality points for the new quality incentive. Under the old incentive, the short-stay pressure ulcer measure will be used again this year. Ms. Moore said the department plans to apply the 2018 family satisfaction survey for the satisfaction point because COVID-19 halted the 2020 resident survey. OHCA argued that the point simply should not be awarded (or all providers should receive it) because the 2018 data are antiquated and fewer than half of all SNFs have satisfaction scores. ODM intends to implement, in October 2020, MDS changes proposed by CMS as an option for states to generate Patient-Driven Payment Model (PDPM) Health Insurance Prospective Payment System (HIPPS) codes for OBRA assessments. This would allow ODM to compare the impact of PDPM against the current RUG-IV system.

Important information on Medicaid Targeted Distribution. As we learn more about the federal Provider Relief Fund payments for Medicaid providers, there are a few things to point out. First, only one person can serve as the program administrator per tax identification number (TIN). The administrator accepts responsibility to act on behalf of their organization, so each organization will need to determine who should act as program administrator. Second, the organizational TIN used to file a tax return should be used when applying for the relief funds. The organization may have one or more subsidiaries that do not file tax returns, so subsidiary TINs can be included in the application form. The Department of Health and Human Services (HHS) will validate the TINs in the application against a list of TINs submitted by State Medicaid Agencies. HHS will create an additional process to validate TINs not on the state list, but that process is not available yet. Additionally, providers will need to upload the following documents along with their applications:

1. The applicant’s most recent federal income tax return for 2017, 2018, or 2019, or a written statement explaining why the applicant is exempt from filing a federal income tax return (e.g. a state-owned hospital or healthcare clinic).

2. The applicant’s Employer’s Quarterly Federal Tax Return on Internal Revenue Service (IRS) Form 941 for first first quarter of 2020, Employer's Annual Federal Unemployment (FUTA) Tax Return on IRS Form 940, or a statement explaining why the applicant is not required to submit either form (e.g., no employees).

3. The applicant’s FTE Worksheet provided by HHS.  

4. If required by Field 15, the Gross Revenue Worksheet provided by HHS.

CGS COVID-19 Medicare Part B question and answer session. On June 18, 2020, at 5:00 p.m., CGS Part B Provider Outreach and Education will offer a provider question-and-answer session to discuss recent updates to Medicare waivers and to address common questions about COVID-19 services during the Public Health Emergency. Providers may ask questions about the recent expansion of telehealth billing for outpatient therapy to SNFs and home health agencies. Interested providers can register here.

UHC waiver end dates and billing guidance. UnitedHealthcare (UHC) recently posted a clarification and resource summary for their COVID-19 program dates and billing guidelines. Please see the following summary of applicable upcoming deadlines:

  • June 1- all prior authorization requirements resume.
  • June 30 - claims with dates of service on or after January 1, 2020, will not be reviewed for timely filing if submitted by this date.
  • July 24 - COVID-19 telehealth service coverage expansion and related cost-share waivers for group health plans terminate.
  • September 30 - COVID-19 cost-share waivers for Medicare Advantage plans terminate.

OHCA "Hospice Visitation in SNF" member call recording. During yesterday’s member panel discussion, participants from OHCA member hospice agencies shared collaboration strategies whereby SNF and hospice providers can ensure residents continue receiving hospice care during the ongoing visitation restrictions. OHCA would like to thank Catie Bryan of BellaCare Hospice, Elie Jakobovits of Harmony Hospice, and Lori Revis of Hospice of Southwest Ohio for sharing their experiences with our members. Please see the OHCA COVID-19 resource page for a recording of this call.