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

June 14, 2019




Top Stories

Senate Substitute Budget Bill
Pete Van Runkle
The Senate Finance Committee adopted a substitute version of House Bill 166, the state budget bill, which represents the upper chamber’s first foray into reshaping the budget in its image. The committee currently is in the midst of taking four days of testimony on the substitute. It then is expected to accept an omnibus amendment next week before sending the budget to the Senate floor. Relative to PASSPORT rates, the Senate substitute ups the ante on the version of the budget passed by the House of Representatives by increasing rates for personal care services 5.1% instead of 2.7%. OHCA had proposed a 5% increase in both years of the biennium. The Senate version also would adjust the personal care services rate by the skilled nursing facility market basket starting July 1, 2021. Unfortunately, the Senate substitute does not extend the 5.1% rate increase to Medicaid home health, although the market basket provision appears to apply to home health aide services. Relative to hospice, the Senate version adds a provision to the SNF patient bill of rights stating that it includes “[t]he right, if the resident has requested the care and services of a hospice care program, to choose a hospice care program licensed under Chapter 3712. of the Revised Code that best meets the resident's needs.” Language eliminating the hospice room and board pass-through did not get into the substitute.


Home Care

VA MISSION Act Update: Implications to VP3, VCA and new CCN
Erin Begin
On June 13, the Department of Veterans Affairs and AHCA held an informational session on the impact of the VA Mission Act for Skilled Nursing providers, which also included clarifications for Home Health and Home Infusion coverage. Key takeaways and timing of the program rollouts are as follows:

  • Patient-Centered Community Care (PC3) Beginning June 6th, 2019, the PC3 network, awarded to TriWest began coordinating Home Health Care for Skilled Care and Home Infusion therapies, while private duty and home health aide services continued to be coordinated by the local VA Medical center. This network serves as a temporary contract for the interim of the roll-out of the newly formed Community Care Network. Home Health providers already contracted with their local VA Medical Center were contacted by TriWest to establish a contracting, and those who are interested in becoming a TriWest provider can go here.

  • Veterans Care Agreements (VCA) Also beginning June 6th, local VA Medical Centers were to utilize VCAs to establish care coordination and payment for the non-skilled portion of their care. These agreements should have been executed prior to June 6th for existing VA Medical Center contracted providers to continue receiving referrals for non-skilled patients. If you have not been contacted by your local VA to enter into a VCA agreement, or if you are interested in becoming a VCA provider, you can access the form here.

  • Community Care Network (CCN) Meant to be the final model for a Veterans Care Network; the CCN network will cover both Skilled Home Health and Infusion Therapy as well as private duty and Home Health Aide services. Claims payments will be adjudicated by Optum, while the Local VA Medical Centers will still manage referrals and care management. For Region 2, which Ohio is a part of, the CCN is set to deploy in phases between October 2019 and April 2020. You can begin contracting with Optum now, but it is important to note that claims billing and payment, as well as referrals, through Optum will not begin until after our official deployment date for our Region. You can contact Optum at VACCNProviderContracting@optum.com

Some incentives for Home Health providers to participate in the VCA and CCN agreements include a prompt payment policy, with paper claims paid in 45 days and electronic claims paid in 30 days. There is also streamlined credentialing and contract provisions, regardless of the VA Medical Center associated. Providers who deliver care to veterans are required to complete online general competency training and submit claims timely, within 180 days.

ODH Survey Reports: E-Tag Clarification
Erin Begin
While reviewing the quarterly statistics from the Bureau of Survey and Certification from the Ohio Department of Health, OHCA sent a clarification to their Survey Administrator regarding the omission of statistics relative to Emergency Preparedness (E-Tags). The Survey Administrator responded, “When using the CALS report for TAG Frequency, the “E-Tags” do not specify which type of facility they apply to. I only use the appropriate “R-Tags” (for RCFs) and “G-Tags” and “L-Tags” (for Home Health/Hospice). Also, In ACO, when choosing RCF as the facility type and running the Tag Summary Report it only reports R-Tags. (Same for HHA and Hospice). Therefore the E-Tags are not included in the Top Ten lists.” We have inquired as to whether E-Tag citation trends by provider type may be available by request in the future.

EVV Phase 1 Providers – Technical Assistance and Outreach
Debbie Jenkins
ODM continues to see many providers required to be utilizing EVV for Phase 1, not being 100% in compliance with the EVV requirements. To assist providers, ODM will be offering technical assistance and reaching out directly to agencies they consider struggling providers. ODM released the following announcement regarding technical assistance:

The Ohio Department of Medicaid (ODM) is pleased to announce one on one technical assistance sessions for providers of Phase 1 services. Staff from Sandata and ODM will be available to assist providers with questions regarding EVV and the impact on claims. The sessions will be approximately 1 hour in length. Pre-registration is required.

Phase one service include the following services reimbursed directly by ODM:

  • Home Health Nursing 
  • Home Health Aide
  • Private Duty Nursing 
  • RN Assessment
  • Ohio Home Care Waiver Nursing
  • Ohio Home Care Waiver Personal Care Aide
  • Ohio Home Care Waiver Home Care Attendant.

The one on one technical assistance sessions are being held in the ODM offices located in the Lazarus Building, 50 West Town Street, Columbus, Ohio. Interested providers of Phase 1 services can sign up on the ODM website.

Additionally, ODM issued the following statement earlier this week:

In an effort to identify Phase 1 providers who may be having trouble meeting with EVV requirements, ODM has been reviewing EVV data compared to claims information. If problems are identified, providers will receive an email. If providers do not reach out to the EVV Unit after receiving this email, we will call them using our automated interactive voice response system. Providers are encouraged to check their emails and reach out to the EVV Unit for any assistance they may need in response to these communications. 

If you provide any of the services included in EVV Phase 1, it is imperative that you comply with the EVV requirements. As OHCA has shared previously, even though ODM is not currently denying claims upfront, these claims are subject to post-payment review and overpayment findings can require payback if providers do not fully meet the EVV requirements. For any questions related to EVV, please contact OHCA’s Debbie Jenkins.

Alternate EVV Webinar Opportunity
Debbie Jenkins
Are you thinking of using an alternative EVV vendor to meet the EVV requirements? The Ohio Department of Medicaid has scheduled a webinar for Tuesday, June 25 at 2:30 to provide additional information on what it means for an agency provider to use an alternate EVV system. The webinar will also cover key information regarding the requirements for using an alternate EVV system and the Alt EVV Certification Process. Interested providers can register here.


Hospice

Hospice Room and Board Billing Update
Erin Begin
With July 1 quickly approaching, the Managed Care plans are in the final phases of communication and system set up provisions to allow for only hospice providers to bill for room and board by the effective date. OHCA is still awaiting communication from Molina Healthcare on this topic and alerted the Ohio Department of Medicaid’s Managed Care Policy Group of this during a recent meeting. In the meantime, two of three impacted health plans have issued final communications on this topic:

  • Aetna Better Health of Ohio issued a final notice, to be posted on their provider bulletins today, clarifying that they will NOT require authorization for room and board, and also clarifying payment for hospice patients on ventilators. They also reiterated that they are not contracting with Hospice providers and out of network guidelines apply. 
  • United Healthcare Community Plan issued its first and final notice stating that they are also complying with the directive effective 7.1.2019. At this time, it is still our understanding that UHC Community Plan will require Single Case Agreements to process claims for non-contracted providers. To avoid delays in payment, please contact UHC Community Plan regarding provider contracting.

OHCA will continue to pursue guidance from Molina Healthcare on their billing, contracting and authorization requirements for hospice providers in response to this change. Once final communication is issued, we will issue a one-page Quick Reference Guide for all five MyCare Ohio plans in relation to Hospice Room and Board Billing.

ODH Survey Reports: E-Tag Clarification
Erin Begin
While reviewing the quarterly statistics from the Bureau of Survey and Certification from the Ohio Department of Health, OHCA sent a clarification to their Survey Administrator regarding the omission of statistics relative to Emergency Preparedness (E-Tags). The Survey Administrator responded “When using the CALS report for TAG Frequency, the “E-Tags” do not specify which type of facility they apply to. I only use the appropriate “R-Tags” (for RCFs) and “G-Tags” and “L-Tags” (for Home Health/Hospice). Also, In ACO, when choosing RCF as the facility type and running the Tag Summary Report it only reports R-Tags. (Same for HHA and Hospice). Therefore the E-Tags are not included in the Top Ten lists.” We have inquired as to whether E-Tag citation trends by provider type may be available by request in the future.

Discrepancy Between Hospice SOM and Code of Federal Regulations
Mandy Smith
OHCA recently made CMS aware of a discrepancy between the current requirements in the Code of Federal Regulations (CFR)42 §418.110 Condition of participation: Hospices that provide inpatient care directly. This discrepancy effects hospice tags L728 through L758. Starting with §418.110(d) and running through §418.110(o). The rule that is referenced does not match the language reflected in the SOM. CMS Midwest Division of Survey & Certification out of Chicago Region V staff verified the discrepancy. Although they did verify the issue, they reported that at this time they have no information as to when CMS Central Office will release a QSO memo or SOM update. Region V staff will make them aware of this discrepancy in the public materials so they may take whatever action they feel is necessary. OHCA will continue to monitor the regulations and notify members of any changes.

ODM Reports Progress on Eligibility Backlog
Pete Van Runkle
Michelle Horn and Rachel Hopmoen of the Department of Medicaid (ODM) discussed the department’s efforts to help county departments of job and family services reduce the backlog of pending Medicaid applications. Ms. Horn said the total number of pending cases has been reduced from 100,000 to 65,000, which includes between 30-32,000 that have been pending fewer than 45 days. For long-term services and supports cases, the number of total pendings in February was approximately 6,400 and now is 3,300-3,500. ODM focused first on Cuyahoga and Franklin Counties, which reportedly have improved, and now is adding 14 other counties that ODM identified as also having significant problems. We would appreciate continuing to hear about your experiences locally so we can provide feedback to ODM as well as potentially help move specific cases that have been pending for long periods of time.


Managed Care

Aetna Better Health of Ohio Provider Check Delay
Erin Begin
On June 13, Aetna Better Health of Ohio posted the following notification on its provider bulletin page:

Due to a system error, we are notifying you that Aetna Better Health of Ohio’s check run that is normally scheduled to happen each Saturday will not occur this week as planned. Our Saturday June 15th check run will be delayed and will now occur on Tuesday June 18th. We do not anticipate any future check run delays related to this issue.

We apologize for the delay and any inconvenience this issue may have caused. However, the delay is being done in an effort to ensure provider’s checks are received for the correct amounts. If you have any questions, please do not hesitate to reach out to our Provider Services department by calling 1-855-364-0974. We appreciate your understanding, and for your service to our members. 

Sincerely, 
Aetna Better Health® of Ohio
Provider Experience



Other News & Education

Board of Nursing Mailing Renewal Notices to RNs, APRNs
Mandy Smith
The Ohio Board of nursing is emailing renewal notifications from late May through June, using nurses' email address on record with the Board. Check the Board website at www.nursing.ohio.gov for renewal information. Renewal begins July 1st for RNs and APRNs.

Seniors Should Beware of DNA Testing Scam
Steve Mould
The Ohio Department of Insurance and the Ohio Department of Aging are warning Ohioans of a new scam targeting seniors. Ohio consumers should be cautious of genetic testing firms visiting senior communities or making unsolicited phone calls and mailings related to DNA screenings. In the scheme, which has been reported in Ohio and other states, firms reportedly collect consumers’ personal information under the pretense of DNA testing to screen them for cancer, Alzheimer’s, or other life-threatening diseases. Victims are told that Medicare will cover the cost of their testing. However, Medicare provides limited coverage for DNA testing (which is why consumers should consult their health care providers). As part of the scam, consumers often are asked for their Medicare card number and Social Security number. Seniors and others should be alert if anyone conducting DNA cheek swabs requests that you agree to be billed for services in the event Medicare does not pay. These types of “testers” may be committing Medicare fraud because they are attempting to bill Medicare for a procedure that has not been ordered by a health care provider. If you suspect wrongdoing or if you believe someone may have been victimized, call the Ohio Department of Insurance’s Fraud and Enforcement Hotline at 800-686-1527 or the Ohio Senior Health Insurance Information Program at 800-686-1578.

CMS Video Tutorials to Assist with Coding Specific Section GG Items
Erin Begin
The Centers for Medicare & Medicaid Services is releasing a series of short videos to assist providers with coding select Section GG items on the OASIS. These videos, ranging from 4-12 minutes, are designed to provided targeted guidance using simulated patient scenarios. To access the videos, click on the links below:

Home Care and Hospice: Emergency Preparedness Requirements New Interpretive Guidelines 2019
Erin Begin
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 Webinar: Delivering Dementia Capable Care Within Health Plans, Why and How?
Erin Begin
CMS Medicare-Medicaid Coordination Office (MMCO) is offering a free webinar to providers and other stakeholders on Wednesday, June 19th, from 12pm-1:30pm (EST). Presenters will share strategies and tools for the delivery of dementia-capable care, as well as tips for leveraging resources within federal, state and local environments to build more responsive systems of care delivery. CEs are still being evaluated. Please register here.

CMS Webinar: Home Health Quality Reporting Program: Achieving a Full APU/ Market Basket Increase 
Erin Begin
The Centers for Medicare & Medicaid Services (CMS) will be hosting a webinar on Achieving a Full Annual Payment Update (APU)/Market Basket Increase for home health providers on Wednesday, June 19, 2019 from 2:00 to 3:30 p.m. ET. The purpose of the webinar is to educate providers about the Annual Payment Update (APU) process and the requirements associated with achieving a full APU. To register go here.

CMS Webinar: Promising Practices for Supporting Dually Eligible Older Adults with Complex Pain Needs
Erin Begin
CMS Medicare-Medicaid Coordination Office (MMCO) is offering a free webinar to providers and other stakeholders on Thursday June 27th, from 11:30am-1pm (EST). This interactive webinar will discuss the common causes and types of pain among dually eligible older adults, identify promising practices for biopsychosocial pain management, and demonstrate practical strategies for conducting geriatric pain assessments, delivering evidence-based treatment interventions, and supporting older adults in achieving their pain management and wellness goals. Speakers will also discuss appropriate use of opioids and strategies to help older adults with opioid use disorder effectively manage chronic pain. CEs are still being evaluated. Please register here.

Palmetto Webinar: Untangling the Mystery of Hospice Transfers 
Erin Begin
The Medicare hospice benefit allows a beneficiary to transfer from one hospice agency to another once every benefit period without interruption. Whether you are transferring a beneficiary’s care to an agency across town or the country, the Medicare regulations remain the same. In order to transfer a beneficiary and preserve the benefit period/election, additional documentation and billing are required. During this webcast, the MACs will explain Medicare transfer regulations, transferring hospice agency responsibility, receiving hospice agency responsibility, billing and coding for transfers, process for transfer disputes and answer general transfer related questions from the audience. 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


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.


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.