HCH Bites June 21 2019

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Elevating the Post-Acute and
Long Term Care Profession

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

June 21, 2019

Top Stories

Senate Passes Budget with Medicaid Waiver Rate Increases
Pete Van Runkle
The Ohio Senate yesterday voted 33-0 to pass its version of the state budget bill, House Bill 166. Following on the heels of a bipartisan vote in the House of Representatives, the unanimous Senate vote is historic. The bipartisanship in both chambers derives in large part from the state’s fiscal status, as revenue and spending announcements during the budget process trended uniformly positive after proceedings kicked off with an initial $700 million disparity between Office of Budget and Management and Legislative Budget Office projections for the upcoming biennium. When the six-member conference committee convenes next week to reconcile the House and Senate budgets, the first order of business will be updated fiscal projections, which everyone expects to be improved. For PASSPORT providers, the Senate enhanced rate increases that the House initially added to the budget. The Senate bill calls for a 5.1% rate increase for personal care services that would take effect at the earliest October 1, 2019. The Senate also passed language providing future increases, starting in State Fiscal Year 2022, to Medicaid rates for waiver personal care services based on the Medicare skilled nursing facility market basket. OHCA will advocate in the remaining nine days of the budget process to retain the Senate-passed waiver rate increases.

Home Care

Home Health Payment and Innovation Act- Grassroots Efforts Needed
Erin Begin
n response to the Patient Driven Groupings Model (PDGM) suggested 6.42% rate cut to home health providers, based on assumptions that providers will up code and add visits to LUPA cases to obtain episodic reimbursement, a bi-partisan group of Senators introduced The Home health Payment and Innovation Act 2019 (S.433/HR. 2573). This bill seeks to resolve this by removing the ability to adjust rates based on assumptions, and suggests that rate adjustments come from evidence in behavioral changes instead. This would also allow for waivers to the home bound requirement for Medicare Advantage plans. So far, the bill has 14 cosponsors in the Senate and 16 in the House. Additionally, the MedPAC released its June report on Friday, June 14th, suggesting a 5% rate cut in Home Health services and a unified payment system for post-acute care. To help protect our Home Health benefit please visit the NAHC Advocacy page to issue your support for this important legislation.

REMINDER: Medicare Dark Days
Erin Begin
The Common Working File and HIQA inquiries will not be available from Friday June 28th through Sunday, June 30th to accommodate for the quarterly processing July 2019 release.

The EDI and IVR systems for eligibility processing will still be available, but claims will be held and not processed until the following Monday, June 30.

Additionally, PECOS production extracts will not be processed on Saturday 6/29.

Hospice

Hospice Room and Board Update
Erin Begin

Molina Healthcare has provided OHCA with the provider bulletin detailing their confirmation of agreement to the mandate that Hospice providers will be the only providers eligible to submit for Hospice Room and Board Payment. The notice has not yet been posted to the Provider Bulletins page, and does not provide clarification on certain specific questions that we have posed, such as authorization requirements and out of network specifications for Hospice providers. Molina did clarify with OHCA that it is accepting contracts from hospices and billing requirements would be consistent with CMS.

UHC Community Plan provided clarification this morning on how the Single Case Agreement will be initiated. UHC Community Plan WILL require prior authorization for hospice room and board for out of network providers, as well as a single case agreement. However, they will not be accepting prior authorization requests until July 1st, 2019. Below are the numbers provided by UHC to call and request the authorization for hospice room and board:

• MMP Members: Hospice providers should call to request prior authorization at 800-600-9007.

• Medicaid Members: Hospice providers should call to request prior authorization at 800-366-7304 and request a Single Case Agreement.

• When Hospice Providers call for prior authorization they should request a 6 month authorization.

You can find additional resources in United Healthcare’s Provider Manual for Providers https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/OH-Care-Provider-Manual.pdf

Aetna Better Health of Ohio has provided all details relative to the upcoming change, including addressing vent rates and billing specifications. They have also stated that they will not require contracts or authorizations from hospice providers to bill for room and board.

OHCA is still awaiting clarification on authorization requirements for in and out of network providers from one health plan. Until this clarification is made, we are unable to finalize our summary Quick Reference Guide on hospice room and board billing for MyCare Ohio Plans. It is recommended that Hospice agencies run a Medicaid eligibility check on all inpatient residents on July 1st to ensure that all patients with room and board components are identified, and authorizations, if required, can be requested without penalty or delay.

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New Details Available on Hospice HEART Tool
Erin Begin
Centers for Medicare and Medicaid Services (CMS) is in the process of developing the Hospice Evaluation and Assessment Reporting Tool (HEART), a mandatory comprehensive quality reporting tool that will replace the Hospice Item Set (HIS) measures, and will begin testing in 2020. The development of this assessment tool will align hospice with other post-acute care (PAC) settings to establish a baseline and generate person centered support, and will likely be used to inform new payment models, according to CMS. As with other PAC quality reporting programs, CMS could issue payment reductions up to 2% for failing to report HEART data after the tool is finalized. The tool has been delayed due to a switch in vendor, but has started holding stakeholder meetings with NAHC and other major associations and experts to finalize recommendations before testing. One consideration that has been eliminated is the addition of an interim assessment for patients who are imminently dying, which CMS found during pilot testing to take focus away from supporting patients and family at the end of life. The finalization of HEART would replace HIS, but would not eliminate other Quality reporting requirements from Hospice Quality Reporting Program (QRP) and the Consumer Assessment of Healthcare Providers and System surveys (CAHPS).

REMINDER: Medicare Dark Days
Mandy Smith
The Common Working File and HIQA inquiries will not be available from Friday June 28th through Sunday, June 30th to accommodate for the quarterly processing July 2019 release.

The EDI and IVR systems for eligibility processing will still be available, but claims will be held and not processed until the following Monday, July 1.

Additionally, PECOS production extracts will not be processed on Saturday 6/29.

Managed Care

ODM Issues Request for Information on MCO Re-Procurement
Pete Van Runkle
State Medicaid Director Maureen Corcoran announced that the department is beginning what is expected to be at least a year-long re-procurement of Medicaid managed care organization contracts by asking interested parties to respond to a series of questions about Medicaid managed care. While the request pertains to Medicaid managed care, not MyCare Ohio, we suggest you consider responding to the relevant questions (you do not have to respond to all of them) that highlight issues common to both programs. Possible examples of areas for comment are effectiveness of the ODM managed care complaint process for providers, administrative challenges around changes of ownership, and prior authorization issues. Director Corcoran’s request follows:

The Ohio Department of Medicaid (ODM) has released a request for information (RFI) to gather public input as it begins the process to select managed care partners. ODM’s first step in the process is collecting feedback on current Medicaid services, what is working and ideas for improvement. Our mission in this process is to focus on the individual rather than on the business of managed care, and this request seeks information specifically from individuals receiving Medicaid services, providers and advocates.
Feedback is being sought in multiple areas, including:
How managed care organizations communicate and support individuals and providers
What benefits and services are most helpful
How to best coordinate individual care
How to file complaints and appeal managed care organization decisions
All feedback is being considered. If you would like to share your experience with the current program or your ideas and solutions for improving the program, please submit feedback through the RFI webpage. Thank you in advance for sharing this information broadly with your members and other stakeholders. Hearing from you is an essential part of our mission to put individuals first throughout the entire managed care procurement.

New VA Portal for Community Based Providers
Erin Begin
The Department of Veterans Affairs (VA) has created HealthShare Referral Manager (HSRM) to simplify the referral and authorization process. Providers can expect shorter times when contacting and authorizing VA Medicare Center services. Not only will the platform generate referrals, but it will also standardize episode start of care form data, allow providers to submit a Request For Services (RFS) and generate decision making support reporting. Access to and use of the HRSM portals is rolling out across regions 1 and 2 throughout 2019, and will only be available to VA Registered providers, including those registered through TriWest. There are single user logins with two-step verification processes for security. The Department of VA will provide training demonstrations every Tuesday from 1 - 2 p.m. (EST) through VHA Train. For more information about HRSN, you can visit the OCC Resources Page. OHCA has requested a status on the rollout for Region 2 of this tool.

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UnitedHealthcare: Do you know your network status?
Erin Begin
Since OHCA reported on the upcoming changes with room and board billing for hospice, there have been several questions relative to the network status for UHC plans. It is important to note that UnitedHealthcare has several branches.

UnitedHealthcare- Commercial and Medicare Advantage Members
UnitedHealthcare Community Plan- Medicaid HMO members
UnitedHealthcare Community Plan Connected- MyCare Ohio Medicare/Medicaid members

It is important to review your contract. If you have a UnitedHealthcare Community Plan addendum that does not specifically state that is for UnitedHealthcare Community Plan Connected, then you are out of network with the MyCare Ohio plans and will require a single case agreement for room and board. If you have other contracts with UnitedHealthcare and are missing that agreement, please contact your network contractor to inquire about adding the MyCare Ohio addendum for in-network status.

Aetna Teams with Carelinx to Deliver Home Care
Erin Begin
Aetna publicly announced on Wednesday that it has partnered with CareLinx to deliver Home Care (private duty) services in 5 states in the Western United States. In April 2018, CMS announced it would allowing some non-medical in home care benefits for Medicare Advantage plans in 2019, and subsequently added to that further expansion of benefits in 2020. While experts are still forecasting that most of the in home service Medicare Advantage expansion will be more prevalent in 2021, this is the first of fully disclosed partnership from a major health plan towards those efforts. Care transitions seem to be the greatest focus of the models under development. No details could be provided at this time regarding expansion to future states or the current number of beneficiaries being served in the Aetna Carelinx platform.

Other News & Education

NAHC Comments on Immigration Restrictions
Pete Van Runkle
In a CNN story, NAHC’s Bill Dombi was quoted on a recent immigration proposal and its impact on the long-term services and supports workforce. As stated in the story:

"We are going to need immigrants. Whether or not we have the channel of such workers to come into home care is a big question," said William Dombi, president of the National Association of Home Care & Hospice, which represents about 2,700 agencies. His group has not been able to land a meeting with Trump administration officials, though it does talk to congressional staffers, he said. Home health aides and personal care aides are projected to be among the fastest growing jobs between 2016 and 2026, according to the Bureau of Labor Statistics, even though they are also the lowest paid on the list, earning typically $24,000 a year.

Association Decries New Tariff Proposal on Health Care Products
The following article is by Provider magazine’s Amy Huaiquil.

The nation’s largest association representing long term care service providers is denouncing a proposal from the Trump administration that would impose tariffs on Chinese-supplied critical health care products used in nursing facilities. The American Health Care Association (AHCA) is concerned that the proposed scope of List 4 under Section 301: China’s Acts, Policies, and Practices Related to Technology Transfer, Intellectual Property, and Innovation includes critical health care products used daily in nursing facilities, including wet wipes, drapes, underpads, and exam and surgeon gloves. Mark Parkinson, AHCA president and chief executive officer, issued the following statement on the proposal: “The administration’s proposal to impose tariffs on critical health care products such as gloves and drapes will have a dramatic impact on the long term care profession. These products serve a vital role in providing safe, efficient care to our residents and are subject to strict FDA [U.S. Food and Drug Administration] requirements and regulations—including a two-year review period.”

AHCA also submitted a letter to The Office of the U.S. Trade Representative requesting the exclusion of certain critical health care products from any tariffs imposed under Section 301. “Because these products serve a vital role in providing safe and effective health care to our patients, they are subject to FDA requirements and regulations,” the letter said. “FDA regulations treat these products as medical devices that require strict FDA regulatory approval prior to any manufacturing and sale.” A part of the FDA regulatory approval is a two-year period to qualify a new supplier for the products. AHCA says that while these products are relatively inexpensive compared with other health care costs, they are used in large volumes and will result in a significant cost increase. Previously, the products were removed from the tariff inclusion list (List 3) due to being strictly regulated by the FDA the same as medical devices. AHCA says an imposition of tariffs on the products will result in a substantial increase in patient costs and translate to higher health care costs for the broader U.S. economy. “Because these products were initially included in the proposed scope of List 3 but not included in the final scope of List 3, AHCA hopes that the administration has recognized the significant negative consequences that additional tariffs on these products would have on health care costs,” the letter said.

“Most long term care facilities do not have the ability to readily switch from their current FDA-approved products to alternative, non-Chinese suppliers,” Parkinson said in his statement. “They work every day to deliver the highest quality care for millions of seniors and disabled individuals, and imposing tariffs on these vital products threatens to derail these noble efforts.”

Miami Valley Tornado and Utility Outage: After-Action Report
Steve Mould
Memorial Day 2019 saw more than a dozen tornadoes touchdown in Western Ohio – Miami Valley region. The worst event struck the north Dayton communities of Brookville, Trotwood, Clayton, Harrison Township and Dayton. Many senior living facilities have been affected with wind and storm damage, and utility outages including electricity, water, telephone and natural gas.

OHCA conducted a disaster "hotwash" on Wednesday June 5. A hotwash is the immediate "after-action" discussion and evaluation of a facility’s response and performance following an exercise, training session, or major event, such as the Memorial Day tornadoes. Nearly 120 facilities and organizations participated in the hotwash, including two dozen which were directly affected. The OHCA LSC/Disaster Preparedness Committee has summarized the hotwash comments and feedback to draft an After Action Report-Improvement Plan. Facilities affected by the tornadoes and/or the utility outages may want to utilize the AAR-IP as the documentation for compliance with the CMS Emergency Preparedness requirements for facility exercises. Facilities using this AAR-IP must complete Appendix A, the Improvement Plan. This plan should be based on the AAR-IP goals and objectives and the specific circumstances which occurred at each individual facility. The audio recording of the Hotwash is available here; the slide deck is available here.

Corrective actions from the AAR/IP, such as additional training, planning, and/or equipment acquisition, should be assigned to an individual responsible and with start and due dates. Facilities are then to track to completion, ensuring that exercises result in tangible benefits to preparedness. If you need any assistance, please feel free to reach out to Steve Mould at OHCA or to OHCA LSC/Disaster Management Chair Kenn Daily.

CDC Data Briefs Available
Mandy Smith
The CDC and the National Association of Chronic Disease Directors (NACDD) have released the State of Aging and Health in America: Data Brief Series. This series includes Coronary Heart Disease, Myocardial Infarction, and Stroke data brief; Caregiving Data Brief; and the Subjective Cognitive Decline (SCD) Data Brief. These briefs provide public health professionals with the most recent data available on health and aging-related conditions, including the importance of brain health, the management of chronic conditions, and caregiving burdens, to help identify needs and mitigate the future effects of a growing older population.

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 4 - 25. 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: 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 27, from 11:30 a.m. - 1 p.m. 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
Palmetto is presenting a free webinar on July 16 at 2 p.m. regarding Hospice Transfers. 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.

EFOHCA Webinar Mental Health: Care and Services to Address Substance Abuse and Addictions
Erin Begin
EFOHCA is presenting a webinar on June 25 from 2 - 3:30 p.m. As our nation continues to battle the growing issues of substance abuse and opioid addiction, long-term care facilities are facing similar challenges. The population of residents being admitted on one or more pain medications known to be addicting is growing, making the development of focused approaches to the management of chronic pain essential to every facility. Considering the liberalization of laws concerning marijuana and contemporary social views on alcohol consumption, a proactive approach is necessary to meet the needs of a new generation. In this session, strategies for establishing liaisons with community-based addiction counseling and support services and developing wellness protocols in anticipation of the needs of those challenged by addiction are the central focus. You can register and find more information for this webinar here. Please contact Erin Begin for assistance if your Home Care and Hospice membership is pending approval.

EFOHCA Webinar Behavioral Health: Family and Caregiver Education and Support
Erin Begin
EFOHCA is presenting a webinar on July 23, from 2 - 3:30 p.m. as part of the Achieving Compliance in Behavioral Health series. The involvement of families in the development of person-centered plans of care is important in identifying and addressing the individual’s specific needs. Too often, the relationships between family and professional caregivers are strained due to poor communication, complicated emotions, or family baggage not yet revealed to the professional staff. Ensuring families and community and/or private-duty caregivers are provided with appropriate education and included in the ongoing conversation about the care of the person they represent is vital to establishing a positive care partnership. This session describes a variety of ways in which the successful orientation, education and ongoing communication between family, community/private-duty, and the professional caregiving staff can be developed and sustained. You can register and find more information for this webinar here. Please contact Erin Begin for assistance if your Home Care and Hospice membership is pending approval.

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.

Elevating the Post-Acute and Long Term Care Profession

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Elevating the Post-Acute and
Long Term Care Profession