Budget Bill Update
Pete Van Runkle
The Kasich Administration’s final budget (House Bill 49) is again very challenging for skilled nursing centers. Proposals to cut Medicaid rates by $263 million over two years, to move dual-eligible beneficiaries in Ohio’s rural counties (and eventually all counties) into Medicaid managed care, and to increase regulatory pressure on SNFs certainly make it appear that the profession is a major target. The rate cuts would reduce the direct-care price (not the overall rate) in each peer group by 7% and would count PA1 and PA2 patients in the Medicaid case-mix score of each center that serves them. These reductions would take effect October 1, 2017. The managed care proposal, which actually does not appear in the language of the bill, is for the Department of Medicaid to procure new contracts for a third Medicaid managed care program that would be in addition to existing Medicaid managed care and MyCare Ohio, with an effective date of July 1, 2018. The regulatory piece would give the Director of Health authority to order SNFs to take certain actions and potentially to subject them to more fines. The good news is that, as with all budget measures, these proposals must pass the General Assembly. OHCA actively opposes each of them and is working to secure their defeat. The legislative process is at an early stage, as the House Finance Committee only has just begun subcommittee hearings. Next week, the Health and Human Services Subcommittee will start to delve into the areas of the budget that come under the purview of the major human services agencies. We expect deliberations in the House to continue through late April. It seems there are many elements of the Executive Budget proposal – not just in the human services portion – that are not palatable to the legislature. We believe the rate cuts and managed care expansion fit into that mode, for different reasons. The rate cuts are a deliberate rejection of the rate rebasing formula that the legislature devised and approved just two years ago and that the state implemented just last summer. The managed care expansion comes before the MyCare Ohio “experiment” is concluded and despite numerous concerns about the program on the part of long-term services and supports providers and others. We urge OHCA members to reach out to their local legislators, both House and Senate, to express your concerns about the Administration’s budget proposals. The most effective setting for this conversation is a facility visit, but that is by no means the only possible vehicle. The request to legislators is to remove the rate cuts and to block the managed care expansion. Please see our one-pagers on rate cuts and managed care for talking points. We also are available to assist with facility visits or other contacts with legislators.

New 9401 Form and New Mechanism for Reporting Changes in Income/Lump Sums Coming in March
Diane Dietz
After much discussion with the Ohio Department of Medicaid (ODM), OHCA is pleased to report that a new and hopeful final version of the ODM 09401 Facility Communication form will soon be posted for public comment and is projected to be put into use on Monday March 13, 2017. We are happy to say the new 9401 has been streamlined considerably and will only be used to report admissions and discharges for both Medicaid FFS and Medicaid Managed Care beneficiaries to PAAs or ODM directly. With respect to reporting changes in income or lump sums, ODM has decided to create a separate form that will be required to be consistently adopted by all 88 counties when receiving information that could potentially alter a beneficiary’s Medicaid eligibility. The new form--ODM 10203 Report a Change for Medical Assistance will be the communication tool that all Medicaid beneficiaries will be required to use to report and provide verifications to County Departments of Jobs and Family Services (CDJFS) for Medicaid eligibility purposes. This new communication tool supports 5060:1-2-08 Medicaid: individual responsibilities whereby Medicaid beneficiaries must inform their local CDJFS within ten calendar days of various changes to themselves or persons living with them which could alter their medical assistance. Again, this will be the new form that beneficiaries in nursing facilities will use to report changes in income or lump sums. A few important things to note:

• ODM will be posting a NF training webinar on the use of the new ODM O9401 in early March which we have been told will support the projected implementation date of Monday March 13, 2017. As soon as OHCA receives information on that webinar, and the final version of the ODM 09401, we will share it with members. 
  
  
• The new ODM 10203 is set to be released at the same time as the ODM 09401. While ODM could not share specific plans for training on tis form, they told us that counties will be educated on its use, and the mandatory nature of using this form to receive changes and verifications for all Medicaid beneficiaries going forward. Once OHCA has the final version of the form, we will share it with members and educate to the best of our understanding. 
  
  
• The new ODM 10203 does not include a mechanism for CDJFS caseworkers to return information to a nursing facility about changes in patient liability amounts. Nursing facilities will need to stay on top of these income changes/lump sum submissions and watch MITS for any change in patient liability. 
  
  
• Another important note with respect to the ODM 10203. This new Report of Change for Medical Assistance form requires a submitter signature verifying the information is accurate and informs the submitter that by signing it, they are subject to penalties under federal law should the information be false or untrue. Per 5060:1-1-01 Medicaid: definitions, “reporting” is defined as notifying the administrative agency of any changes that may affect an individual's eligibility for medical assistance. Reporting changes and providing verifications is the responsibility of any individual, person, or entity who has a legal or financial responsibility for or who stands in the place of an individual, including: the individual; the individual's spouse, including a community spouse; the individual's parent, legal custodian, legal guardian, or caretaker relative; and the individual's authorized representative. While OHCA recognizes that many of our members attempt to become the authorized representative for their Medicaid residents, should a facility not be the authorized representative, they will need to proactively educate families on how to submit this signed form timely within the 10-day requirement. 
  

OHCA will continue to monitor the process surrounding the release of these two new forms and advocate to help ensure our members can proactively assist their residents with maintaining their Medicaid eligibility.

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