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 7, 2019

Top Stories

Livanta to Replace KEPRO for Discharge Appeals Beginning Tomorrow; Are You Prepared for Change?
Diane Dietz
OHCA has been reporting for a couple weeks that effective June 8, 2019, Livanta will be Ohio’s new Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) responsible for, among other things, Medicare discharge appeals. It is important that skilled nursing facility, home health and hospice providers take the required steps to be ready for this change. First, all providers are required to complete a new Memorandum of Agreement (MAO) as a condition of participation with Medicare. The MAO Form with Instructions has been provided for your convenience and must be completed by June 8th. Second, providers are required to update beneficiary notices with the Region 5 (OH, IN, IL, MI. MN, WI) Livanta phone number which is 888-524-9900, TTY 888-985-8775. Specific notices that are required to be updated by SNF, home care and hospice providers include the Noticed of Medicare Non-Coverage (NOMNC) and the Detailed Explanation of Non-Coverage (DENC). Livanta’s New Medicare BFCC-CIO Announcement Bulletin provides complete instructions on updating all Medicare Beneficiary Notices with Livanta’s Helpline information and includes a link to the CMS BNI website where copies of all these notices can be found. Please take this opportunity today to complete all required steps to ensure your organization is in compliance with Ohio’s new BFCC-QIO beginning tomorrow, June 8, 2019.

Budget Update
Pete Van Runkle
In last week’s News Bites, we wrote that we expected the Senate’s version of the state budget bill early this week. After News Bites went out, the Senate scheduled a Finance Committee hearing for this past Wednesday and took the unusual step of announcing that the substitute bill would not be released at the hearing. It later turned out that they do not intend to issue the substitute until sometime next week.

Home Care

Therapy in PDGM Survey Results
Erin Begin
On June 4, NAHC presented results from their survey on expected therapy utilization in PDGM. Of the 700+ respondents, which consisted of both for-profit and non-profit providers, about one third of those respondents stated that they were anticipating no change in therapy utilization, nearly half stated that they were expecting a decrease in therapy utilization and the remainder were largely undecided. Even though therapy utilization was expected to decrease for half of the respondents, only 28% expected to reduce direct therapy staffing. For contract therapy, 26% of the respondents expected a decrease in rates, while 32% stated that they were unsure about therapy contract arrangements. One explanation for the therapy staffing levels not corresponding with the decrease in utilization may be that 77% of providers surveyed stated that they expect an increase of the therapy involvement on clinical collaboration of the Oasis. Top strategies provided by the participant pool for managing utilization in PDGM were:

  • Improved Case management/ Interdisciplinary Collaboration
  • Changes to Patient Mix
  • Focus on Coding and Documentation
  • Staff Education

NAHC also advised that therapy utilization impacts your Home Health Compare as well as Star Ratings, and patterns of changes in therapy utilization during claims review could trigger audits. A summary of updated changes to manual diagnosis instructions for PDGM, issued on May 24, can be accessed here.

Review Choice Demonstration Clarification
Erin Begin
As a result of concerns voiced during the first provider call for the Review Choice Demonstration, Palmetto has issued clarification regarding which episodes will be included in their review. All episodes of care starting on or after the implementation date are to be included in the RCD pre claim review submissions; including recertifications. This is a clarification from a previous publication which referenced episodes who have a start of care on or after the implementation date. Recertification claims should include the original face to face documentation with their submission. The Review Choice Demonstration is currently underway in Illinois, and there has not yet been an announcement for Ohio’s inclusion in the demonstration, which is one of five states selected. Providers will receive at least 60 days’ notice prior to the demonstration go live date for their applicable state.

Bill Introduced to Allow HSA Accounts to Reimburse Home Care
Erin Begin
The legislation introduced in the House of Representatives would allow Health Savings Account (HSA) funds to be eligible for disbursement to pay for qualified home care services, including those for assistance in activities of daily living. Currently, Home Care services are excluded from the disbursement, limiting access to services for some individuals who budget these pre-tax dollars for their health expenses. This bill closely mirrors CMS efforts to expand private duty nursing coverage for Medicare Advantage plans, which is expected to increase in 2020.

EVV Phase 2 Training Reminder – Register NOW!
Erin Begin
The Ohio Department of Medicaid issued the following statement regarding EVV Phase 2 training:

EVV will be mandatory for Phase 2 services on August 5, 2019. We are partnering with the Ohio Department of Medicaid (ODM) to get the word out about EVV and the training that you are required to take. If you are a new EVV user, you must complete the training before you can access the EVV system. You can begin using the system as soon as the training is complete so you can become familiar with it before August 5, 2019.

There are several types of trainings you can choose from:

  • Instructor-led classroom training - Offered in seven different locations in Ohio
  • Instructor-led webinar training - Offered online
  • Self-paced online training - Offered online

Classroom and Webinar trainings are only offered until August 3, 2019. The feedback from providers has shown Classroom and Webinar trainings are the most effective ways to train. Visit EVV Training to sign up for the training. Agency and non-agency providers have separate trainings. Please be sure to sign up for the training that applies to you. To sign up for the training, you MUST have your ODM issued Provider Medicaid ID. If you are unsure what your ODM issued Medicaid Provider ID is, please contact your payer for assistance or check the training tab on the EVV webpage for instructions for finding your Medicaid ID.

If you experience any trouble registering for the training, please contact the EVV Provider Hotline at 855-805-3505. If you have general questions about EVV, feel free to reach out to the ODM EVV Unit at EVV@medicaid.ohio.gov.

Hospice

Hospice Room and Board Update: UHC Community Plan
Erin Begin
UHC Community Plan has confirmed that it will not be issuing any provider communications to hospice entities regarding the upcoming billing requirement change from ODM, which states that only hospice entities to bill Room and Board effective 7/1/2019. While a communication to the SNFs has been drafted, since either hospice or SNF could bill for and collect the room and board, no additional communication will be made to the hospice entities. Currently, many of the SNF providers were billing UHC Community Plan directly for room and board due to the cash flow advantage. Additionally, UHC Community Plan has confirmed that non contracted Hospice providers will require a single case agreement and authorization to bill for the room and board.

If you are in the North East, East Central or North East Central MyCare Ohio Regions, and were not previously billing and/or contracted with UHC Community Plan for room and board, please note the following information

  • If you are out of network with UHC Community Plan
    • A Single Case Agreement is required to bill room and board starting 7/1/19
    • You will request a Prior Authorization through UHConline.com or by calling 800-366-7034
    • The Single Case Agreement team will reach out to execute the agreement. There is no form available to complete online, but it is a requirement of payment.
  • Be sure to add your provider to their system before sending any claims. This can be accomplished by calling UHC at 877-842-3210. Enter your TIN, select "Credentialing" and then "Medical", then "join the Network". Request that the Customer Service representative load your provider information into the system
  • UHC Community Plan is accepting Hospice Ancillary contracts. In network providers do not require authorization for hospice room and board, and single case agreements are not necessary. To initiate contracting, you can call UHC at 877-842-3210 or submit your request through their RFP portal. Credentialing is completed through CAQH.

If you are already in network with UHC Community Plan, no authorization will be required. Be sure to run a Medicaid Eligibility on your room and board patients on 7/1/2019 to ensure all room and board has been set up to bill by your Hospice entity. Any patients with UHC Managed Care election, residing in a SNF, will need a SCA if you are out of network. Once final confirmation has been received by Molina Healthcare, OHCA will release a comprehensive guideline for billing and authorization requirements of the 5 MyCare Ohio Plans. 

Reminder: Provider Preview Reports Available (HIS/CAHPS)
Erin Begin
Hospice provider preview reports and CAHPS survey provider previous reports are now available through 7/1/2019. The Hospice Item Set (HIS) quality measure results span from Quarter 4, 2017 to Quarter 3, 2018, while the CAPHS survey results are from Quarter 4, 2016 to Quarter 3, 2018. Data will be refreshed again in August 2019. For more information on how to access these reports:

Managed Care

Anthem Home Health Billing Guidelines
Erin Begin
On June 1, Anthem Medicare Advantage posted an advisement to Home Health Providers regarding RAP and Final claims submission for episodic reimbursement. Please note, this advisement does not apply to any members that are contracted through a special ACO arrangement, or any services coordinated through MyNexus Care, or that are otherwise reimbursed per contract guidelines on a fee for service basis. 

In Ohio, Anthem Medicare National Access Plus PPO, such as Anthem Medicare Preferred PPO, plans are reimbursed through episodic reimbursement, and still billed directly through Anthem BCBS. These members do not require a contract. For more information regarding this benefit and network, please go here.

UHC Network Bulletin Summary
Erin Begin

  • UHC Commercial plans are offering a voluntary Cancer Support Program for its members, for those both in active treatment and end stage management. The program is meant to complement provider services by support our treatment plans and instructions, ensuring patient understanding of medication management, and resolving healthcare administrative issues obtaining access to care and medications. They can also assist in coordinating support groups and financial support services. Members can be referred by calling 866-936-6002 or by the member visiting myuhc.phs.com/cancerprograms

  • UHC Commercial Plans are now allowing changes to approved authorizations. This is particularly helpful to Home Health Agencies, who often add or change services in the plan of care throughout the episode. Previously, if additional services were needed, a separate prior authorization request would need to be submitted, which could sometimes cause confusion during claims payment. Only certain home health services require prior authorization. 

  • UHC Medicare Advantage Expands NPWT Coverage In the medical policy update for Wound Treatments, effective April 16th, 2019, UHC Medicare Advantage plans added both CPT codes (97605 and 97606) for traditional Negative Pressure Wound Therapy (NPWT) devices. Previously, only the disposable NPWT device codes were listed (97607 and 97608).

Other News & Education

Nationwide Shortage of Tuberculin Skin Test Antigens: CDC Recommendations
Mandy Smith
The following is a portion of a more extensive article by the CDC

The Centers for Disease Control and Prevention (CDC) is expecting a 3 to 10 month nationwide shortage of APLISOL®, a product of Par Pharmaceuticals. APLISOL® is one of two purified-protein derivative (PPD) tuberculin antigens that are licensed by the United States Food and Drug Administration (FDA) for use in performing tuberculin skin tests. The manufacturer notified CDC that they anticipate a supply interruption of APLISOL® 5 mL (50 tests) beginning in June 2019, followed by a supply interruption of APLISOL® 1 mL (10 tests) in November 2019. The expected shortage of APLISOL® 1 mL (10 tests) could occur before November 2019, if demand increases before then. The 3-10 month timeframe for the nationwide shortage is the manufacturer’s current estimate and is subject to change. You can access the full article here. Please contact Mandy Smith, OHCA Regulatory Director with any questions. 

OHCA Holds Tornado "Hotwash"
Steve Mould
On Wednesday, June 5, OHCA held a free tornado emergency "Hotwash" session as an "after-action" discussion and evaluation of members' response and performance following the Memorial Day Tornadoes that impacted Ohio. More than 110 member locations participated in the experience. The program enabled providers to share their experiences, and for those who were not directly involved in an emergency to hear about what worked and what changes need to be made. The main purpose of a hotwash session is to identify strengths and weaknesses of the response, which then leads to "lessons learned"; the evaluation is intended to guide future response and avoid repeating errors. Using the information from the hotwash, we will produce a full "after-action" report which will be made available to members. Anyone affected by the storms may complete the hotwash worksheet and send it to Steve Mould at OHCA to be included in the report (participants will not be identified). The audio recording of the Hotwash is available here; the slide deck is available here.

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 Hospice QRP Training
Erin Begin
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.

Hospice Assessment Tool Open Door Forum
Erin Begin
The Center for Clinical Standards and Quality of CMS is hosting a special Open Door Forum to allow hospices to ask questions on the development of the Hospice Assessment Tool on June 12, from 2-3 p.m. Participants can join by calling 800-837-1935 using conference ID 9490006 for this conference call (no webinar content). Hospice is currently the only PAC setting without a CMS-mandated assessment instrument. The Hospice Evaluation and Assessment Reporting Tool (HEART) is meant to be mutually beneficial to hospice providers and CMS. The key concepts for developing this tool are to understand the care needs of people through the dying process and to ensure the safety and comfort of individuals enrolled in hospice. Go here to learn more about HEART.

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: 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.

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

New Associate Members Support OHCA
Cindy Lee
We are pleased to welcome the following new Associate Members. If you are in need of any of these services or products please contact these vendors and thank them for their support of the long-term care community in Ohio. We have over 300 vendor members that provide the goods and services you need daily. If you are looking for a specific product or service you can contact Cindy Lee for a list of members specializing in that area or you can look up an associate membership business partner or type of service using our vendor locator. 

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.

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