Report MyCare “False Positives”
Pete Van Runkle
OHCA/OCID has heard from members that some individuals have received “friendly letters” from the Department of Medicaid (ODM) suggesting they are eligible for MyCare Ohio even though they are not eligible. Examples of these individuals are people who live in ICFs-IID, people who have third-party coverage (such as a Medicare Advantage plan through State Teachers Retirement Service), people who don’t live in a MyCare region, or people who are not currently enrolled in both Medicare and Medicaid. These “false positives” are a particular concern because if the state’s records are not corrected, these individuals could end up being enrolled in a MyCare managed care plan even though they are not eligible for the program. We also have heard from many members that none or very few of their patients or residents have received the state’s notification. OHCA communicates regularly with ODM about MyCare Ohio, so we ask members to let us know about specific instances of beneficiaries who mistakenly have received or not received the MyCare friendly letter.

CMS Final HCBS Rule May Impact Ohio DD Waivers
Pete Van Runkle
CMS issued its much anticipated final rule defining Home and Community-Based (HCBS) settings under Medicaid waiver programs on Friday, January 10. Under the final rule it appears CMS has sought to maintain choice as a mainstay for people with disabilities. The final rule drops references to disability specific housing as constituting an institutional setting as written in original drafts. Services provided on or adjacent to an institution or that have the effect of isolating individuals from the community will be considered to be an institution, and subject to heightened scrutiny. The final rule requires that all home and community-based settings meet certain qualifications, including:

• The setting is integrated in and supports full access to the greater community;
  
• Is selected by the individual from among setting options;
  
• Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
  
• Optimizes autonomy and independence in making life choices; and
  
• Facilitates choice regarding services and who provides them.
  

The final rule also includes additional requirements for provider-owned or controlled home and community-based residential settings. These requirements include:

• The individual has a lease or other legally enforceable agreement providing similar protections;
  
• The individual has privacy in their unit including lockable doors, choice of roommates and freedom to furnish or decorate the unit;
  
• The individual controls his/her own schedule including access to food at any time;
  
• The individual can have visitors at any time; and
  
• The setting is physically accessible.
  

There is still much that is not know, including how this will impact Ohio's DD waiver programs. DODD has scheduled a teleconference with stakeholders on January 24 to discuss how the Department will identify the issues and ensure that they are in compliance with the rule. OCID representatives will participate in this call and follow up with additional information to members. The final rule will take effect March 17, 2014 (60 days after the rule is published in the Federal Register on January 16, 2014). There is a transition period after the effective date. CMS is allowing states a one-year maximum timeframe to submit a transition plan for compliance with the final rule and CMS may approve transition plans up to five years to approve transition plans to ensure full compliance as supported by individual state's circumstance.