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News and Information exclusively for members of OHCA - please do not forward to non-members

May 31, 2019


Top Stories

Senate Poised to Release Budget
Pete Van Runkle
Although Senate President Larry Obhof (R-Medina) has not specified exactly when, Senate Republicans are expected to release their substitute budget bill early next week. This week, the Finance Committee held full-committee hearings at which dozens of witnesses reprised their testimony from earlier subcommittee hearings. In a sense, the full committee hearings were after the fact, as Senate members had to submit all amendments to be considered for the substitute bill by May 22. Senate Republican leadership has been reviewing the amendments since then. OHCA submitted three amendments, which are described in the written testimony we provided to the Finance Committee. As our main Senate sponsor, Majority Floor Leader Matt Huffman (R-Lima), suggested, each amendment bundles several proposals. Provisions in the amendments affecting home care would increase rates for Medicaid home health and private duty nursing and for nursing and aide services under Medicaid waivers such as PASSPORT by 5% per year. The House-passed budget contained a 2.7% rate increase for PASSPORT only. OHCA also supports an amendment that would require the Department of Medicaid (ODM) and Medicaid managed care plans to pay the SNF directly for room and board for hospice patients, but the Senate is unlikely to adopt that amendment because of concerns about federal law that led ODM to ban this practice in MyCare Ohio (see related article on this).

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Home Care

Emergency Preparedness Among Top Survey Deficiencies 
Erin Begin
According to the most recent CMS Survey Data for the first half of CY2018, 7 of the top 11 standard level deficiencies fall under Emergency Preparedness. The number one standard cited was related to the Plan of Care. Infection Control, QAPI and Agency Organization were also among the top citations. Surveyors appear to be focusing on parent/branch relationships and the Administrator’s role, as it relates to Agency Organization (sometimes referred to as “Improper Delegation”); while the QAPI citations go to the structure of the QAPI program, including the incorporation of infection control. Guidance on Plan of Care citations relate to the documentation of communication with the certifying physician when visits are missed or start of care is delayed, as well as failure to include all diagnoses, goals for care and advance directives.

From the Ohio specific survey data published in March 2019 for dates of service July 1 - September 30, 2018, Surveyor citations are heavily related to the development, execution and documentation of the plan of care. Hospice agencies seemed to have more citations related to the Agency Organization that we see more prevalent in the national data. Year to date, for CY2018, 40.85% of Home Health Agency standard surveys were deficiency free, which is up 19.23% from CY2014.

For more information on how your Agency can avoid Emergency Preparedness standard citations, please be sure to register for the Emergency Preparedness webinar series starting on June 4!

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Major Update to PACE Program
Erin Begin
On May 28, CMS released its final rule for Programs of All-Inclusive Care for the Elderly (PACE), which is the first major update to this program since 2006. PACE provides services to frail, elderly individuals who can still live safely in the community, many of which are dually eligible for Medicare and Medicaid. Many of the provisions are to strengthen protections and improve care, but they also provide some administrative flexibility for PACE Providers. This includes the ability for PACE team members to service more than one role on the team, allowing non-physician primary care providers to provide primary care services and eliminating the need to request waivers for allowing community based physicians to serve as the primary care provider on the team. Robert Greenwood, VP of Public Affairs at the National PACE Association, told Home Health Care News recently “As PACE programs grow faster and reach out into more communities, it will be unlikely that they’ll be able to just hire their own in-home staff to meet those needs. It will make more sense for them to contract in-home providers”. OHCA has confirmed that Cleveland and Cuyahoga area Home Health providers have the ability to contract with the McGregor PACE program in Ohio, and can bill for services electronically. For more information, please contact McGregor PACE.

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Hospice

Hospice Room and Board Billing Update
Erin Begin
OHCA has received confirmation from Molina, UHC Community Plan and Aetna Better Health, that they have had finalized conversations with ODM on the requirement to have hospices bill room and board to the Managed Care Organizations (MCOs). OHCA has requested that Aetna Better Health of Ohio provide clarification on authorization requirements for Hospice Room and Board, in addition to their detailed notice (https://www.aetnabetterhealth.com/ohio/providers/notices) issued on May 7th to providers regarding billing and contracting. While providers await guidance from UHC Community Plan and Molina Healthcare on the changeover for hospices to bill room and board services to them directly, which they state is currently in process, there are measures that we can begin to take to ensure there are no delays to payment:

1. Send W-9s to Aetna Better Health, UHC Community Plan and Molina Healthcare to load your provider information into their systems (if you are not already billing hospice services to these payors). It is likely that, as a hospice provider, you have never had to contract with them. Even though a contract is not likely a requirement to bill these services, you still must be registered as an Out of Network provider to submit claims and receive payment. 

2. Set up room and board payers in your system for Aetna Better Health, UHC Community Plan and Molina. MyCare Ohio plans follow Medicaid Billing guidelines for hospice room and board. 

  • Aetna Better Health Electronic Payor ID: 50023
  • Molina Electronic Payor ID: 20149
  • UnitedHealthcare Community Plan Electronic Payor ID: 87726

3. Sign your admission/intake and billing staff up for the UHC, Aetna Better Health and Molina web portals, as identified for your regions 


Managed Care

Reminder: Molina Changes in Prior Authorization Requirements for Home Health Care Effective June 1
Erin Begin
As reported in News Bites on May 17, Molina Medicare products, including MyCare Ohio Molina Medicare, are changing the prior authorization requirements for home health care effective 6/1/2019. For all Medicare/Skilled home health services, prior authorization is required for all visits after the initial evaluation plus two (2) visits per calendar year. Molina Medicaid, or non-skilled home health services, will retain the previous requirement; prior authorization is required for all visits after the initial evaluation plus six (6) visits per calendar year. This policy becomes effective for all services (distinct and separate from starts of care) after 6/1/2019. You can access the full Prior Authorization Molina Medicare Requirements lists here. Below is a list of applicable codes that the change in prior authorization requirement applies to:

042X
044X
056X
G0151
G0153
G0156
G0158
G0160
G0300
G0494
G0496
043X
057X
G0152
G0155*
G0157
G0159
G0161
G0299*
G0493
G0495
 

*Excludes Hospice.

Should you have any questions or concerns, please contact Clinical Specialties Network Department at 440-717-1700 Option 6

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TriWest Medical Records Submission Reminder
Erin Begin
Earlier in May, OHCA reported on the transition from the VCP program to PC3 for VA Skilled Services effective June 6, 2019. This change will require Home Health Care providers to contract with TriWest to continue servicing Skilled Services to our VA Medical center beneficiaries. This program does not apply to private duty nursing, which will continue to be administered by the local VA Medical Centers. Additionally, a recent VA change now requires all providers to submit medical documentation directly to the provider’s authorizing VA Medical Centers (VAMC) as soon as possible, but no later than 30 days from the date of initial service and end of the episode of care or hospital discharge. For Home Health Care, the Oasis is due within 3 business days of start of care and the final discharge summary is due within 5 business days of the episode completion 

Additionally, TriWest has reinstated a timely filing limit for claims of 120 days for services on or after June 6th, 2019.

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Department of VA: CCN Contract Awarded to Optum
From the Veterans Health Administration Update 5.21.2019

As of May 2, 2019, the Department of Veterans Affairs (VA) is moving forward with implementing Community Care Network (CCN) Region 2 in partnership with Optum Public Sector Solutions, Inc. (Optum). A kickoff meeting between VA and Optum is expected toward the end of May 2019. While VA builds out CCN as its new, nationwide contracted network, VA encourages community providers to partner with TriWest Healthcare Alliance (TriWest) through the PC3 network to ensure Veterans continue to get the care they need. TriWest is serving as a critical bridge between now and the time when CCN is fully established. In the meantime, VA is continuing with preparation activities. Full deployment dates for Region 2 will be negotiated between VA and Optum. Both VA and Optum are dedicated to ensuring Veterans are positively affected by this change and that community providers are kept informed of the transition to CCN Region 2, which includes the state of Ohio.

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Coventry Appeals Requests
Erin Begin
IIn Aetna’s June 2019 Provider Update, clarification was provided for provider appeals and grievances for Coventry members. Appeals must be accompanied by the Practitioner and Provider Complaint and Appeal Request form and sent to:

Coventry Provider Resolution Team
PO Box 14020
Lexington, KY 40512

The following items are not considered appeals and should not be sent to the appeals address above. Any documentation for the items below should be sent to the address on the back of the member’s ID card:

  • Claim reconsideration
  • Claim payment disputes
  • Contract disputes
  • Timely filing denial reviews
  • Medical records for any initial edit review
  • Itemizations for high-dollar-claim payment

If you claim reconsideration or payment disputes are denied, and appeal may be filed

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Meritain Claims Submissions
Erin Begin
In Aetna’s June 2019 Provider update, clarification was provided for claims submission of Aetna’s affiliated Meritain due to many claims being submitted directly to Aetna for reimbursement. Please note, Meritain has its own identifiable electronic payor ID (41124)

They have identified 3 ways to verify eligibility and benefits for Meritain Health members:

  1. Use Change Healthcare/Emdeon EDI number 41124.
  2. Visit meritain.com. First-time registration requires your NPI and TIN. There, you can get information about claims, benefits, eligibility and preapprovals. Call Meritain Health customer service at the number on the back of the member’s ID card for help logging in.
  3. Call Meritain Health’s Provider Relations team at the number on the back of the member’s ID card.

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Humana Updates Provider Manual and Clarifies Appeals Process
Erin Begin
For the first time since 2013, Humana has issued an updated Provider Manual, effective July 9th, 2019. The major revision to the provider processes relates to appeals and grievances. Humana has had a Provider Payment Integrity (PPI) department for several years, and we are all familiar with their Documentation requests. The manual provides clear guidance on appeals and grievances in relation to PPI requests and also those which are not a result of the PPI department. An updated manual, as well as updated policies for the appeal review process, is provided below


Other News & Education

MMMNA to Increase July 1
Pete Van Runkle
Per an announcement from Chris Traylor, the new Medicaid Director at the Centers for Medicare and Medicaid Services, the Minimum Monthly Maintenance Needs Allowance (MMMNA) for spousal impoverishment cases is increasing on July 1 from $2,057.50 to $2,113.75. This increase will reduce patient liability for Medicaid beneficiaries who have community spouses affected by the spousal impoverishment rules. The Supplemental Security Income (SSI) amount remains unchanged, as do the Special Income Level and the Assisted Living Waiver room and board amount, which are both tied to SSI.

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Ohio AG Warns of Severe Weather Scammers
Steve Mould
Ohio Attorney General Dave Yost is urging Ohioans and businesses to watch out for home repair scammers and fake charities after powerful storms caused major damage earlier this week. Yost warned of storm-chasing contractors travel to affected communities to offer their services to homeowners and businesses who experienced damage, such as downed trees or roof damage. In many cases, they visit homes and companies claiming they can complete the work immediately. Unscrupulous contractors may ask for a large down payment or tell consumers to sign over their insurance checks, but ultimately they perform shoddy work or no work at all. Consumers can avoid home repair scams by following steps that are listed on the AG's website hereincluding the need for research, written estimates, contracts and caution with payments. Ohioans who suspect unfair sales practices or misuse of charitable resources should contact the Ohio Attorney General’s Office at www.OhioProtects.org or 800-282-0515.

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Complimentary Webinar: Handling the Dreaded Medical Records Request 
Diane Deitz
IAssured Partners, OHCA preferred insurance partner, is hosting a complimentary webinar on Thursday June 13 from 1 to 2 pm on handling the dreaded medical records request. This presentation, led by the senior living experts at AssuredPartners, will provide relevant information on regulatory requirements along with how to prepare the medical records for release. While the focus is on requests coming from a family or attorney related to liability insurance, the information provided is a best practice for any medical record request regardless of the source. The program has been approved for Continuing Education for 1.0 total participant hours by NAB/NCERS - Approval #20200612-1-A54913-DL. To register, please click here

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Palmetto Medical Review Targeted Probe and Educate Call 
Kathy Chapman
OHCA Regional Meetings are specifically designed to give the busy long-term services and supports professional, in a brief but informative luncheon program, an opportunity to learn about key topics affecting assisted living and skilled nursing providers today and to interact with OHCA staff. OHCA Regional Meetings will be held the third Friday of each month. The response from those in attendance has been positive:

  • This meeting was more intimate and allowed for the audience to interact. Really liked it!
  • I truly enjoyed this session and hope that OHCA will continue to offer regional meetings.
  • Pete was very interesting and the conversation was great. The venue and lunch were excellent.

.Please see the remaining 2019 schedule below. Each Regional Meeting begins at 11:30 a.m. and will include:

  • An update from OHCA staff or invited guest speakers
  • An open forum for Q&A, feedback, and general discussion
  • A shared meal
  • 1.5 CEs for NHAs, CEALs, Nurses, and Accountants

Please watch for information in your email and in Bites; registration and additional details are available at www.efohca.org.

  • December 20 – Findlay
  • November 15 – Akron
  • October 18 – Dayton
  • September 20 – Bellville
  • August 16 – Cambridge
  • July 19 – Independence
  • June 21 – Perrysburg

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Certified Executive for Home Care & Hospice
Kathy Chapman
The next Certified Executive for Home Care & Hospice (CEHCH) program is scheduled for October 8, 9, November 12, 13 at the OHCA offices. Ohio CEHCH is a comprehensive certification program designed to elevate the skills and professionalism of home health, palliative and hospice care executives in Ohio by combining national competency standards with Ohio most comprehensive state-specific training. The CEHCH program is aligned with the National Association of Long Term Care Administrator Board (NAB) Home & Community Based Services Examination, allowing credentialed individuals to meet national competency standards. Obtaining the Ohio CEHCH will empower individuals to excel and enhance their distinction within Ohio's growing and competitive home & community based marketplace. For details and registration information, please go to www.efohca.org.

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CMS Hospice QRP Training
Registration is now open for the CMS Hospice Quality Reporting Program review and correct report overview. The webinar is scheduled for June 11th from 2-3:30 ET. The purpose of the webinar is to increase providers’ awareness of how to use the new Review and Correct Report to verify the data displayed on the Hospice Compare website for their facility is accurate. You can register here.

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Palmetto Medical Review Targeted Probe and Educate Call 
TPalmetto has announced a new series of calls to begin on June 3rd. These calls are open to all providers. Please mark your calendars to join our Medical Review Subject Matter Experts as they discuss and answer your questions concerning current TPE process. You can register here.

NAHC Webinar: Therapy in PDGM: What We Learned from the National Survey
NAHC is offering free webinar on June 4th for members and non-members to report on a recent survey they issued on impact to therapy utilization across its membership base. You can register here.

Palmetto Medicare Workshop Series Hospice
The next Palmetto Medicare Workshop series is scheduled for June 4th in Indianapolis, IN. The series is great for new billers or as a comprehensive refresher on most recent policies and procedures for existing staff. You can register here.

Palmetto Medicare Workshop Series Home Health
The next Palmetto Medicare Workshop series is scheduled for June 5th in Indianapolis, IN. The series is great for new billers or as a comprehensive refresher on most recent policies and procedures for existing staff. You can register here.

Home Care and Hospice: Emergency Preparedness Requirements New Interpretive Guidelines 2019
EFOHCA is partnering on a four part series on Emergency Preparedness from June 4th-25th. Through attendance in this web series, participants will increase their understanding of the newly updated federal emergency preparedness requirements that are part of the home health and hospice Conditions of Participation (CoPs) and become knowledgeable in how to apply the federal requirements for disaster preparedness in their own specific agencies. Enhance disaster plan development for all community based agencies. You can register here.

CMS Hospice QRP Training
Registration is now open for the CMS Hospice Quality Reporting Program review and correct report overview. The webinar is scheduled for June 11th from 2-3:30 ET. The purpose of the webinar is to increase providers’ awareness of how to use the new Review and Correct Report to verify the data displayed on the Hospice Compare website for their facility is accurate. You can register here.

In the News
Steve Mould
OHCA is providing In the News, a summary of stories of interest to busy LTC Administrators and others in 100-words-or-less. The compilation is provided by Drew Vogel, CNHA, FACHCA, a long-time OHCA member with nearly 30 years’ experience as an administrator. Prior to that he spent 25 years as a radio reporter, honing his skill at condensing news reports. As the Ohio Mentoring Coordinator for the American College of Health Care Administrators Drew provides this compilation to ACHCA members nationally and is making it available to OHCA members, as well. The latest issue is available here, and on the OHCA Website here

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Association News/Services

Heroes Needed!
Nominate your Hero of Long-Term care today! The OHCA Heroes of Long-Term Care program honors individual long-term care employees for their service to residents, the company, and to their community. Heroes are nominated from long-term care employees across the state. The program is also intended to provide good news opportunities for use in local and statewide markets. Program details and copies of the Heroes of Long-Term Care nomination form are available at Heroes of Long-Term Care.

Free Job Posting Available to Members
Steve Mould
Members may post openings in the "Job Opportunities" section of the OHCA website for 30 days at no cost. To post an opening, go to the Long Term Care Careers page at www.ohca.org log in and post the job through your account. You will need to be logged into the site with your user name and password before you attempt to post a position. For additional information contact Stephen L. Mould, APR (smould@ohca.org), 614/540-1325.

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Home Care & Hospice Bites
HC&C Bites is distributed electronically each week (except for holidays and special occasions). Member representatives who would like to be added to or deleted from the distribution list should send an email to 
Debbie Jamieson (djamieson@ohca.org), including the individual's name, company, and email address. Individuals will be added to the email listing for all of OHCA's HC&C electronic bulletins and publications.

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