NURSING HOME SPANS & MITS CDJFS Training 08/03/11

WELCOME It’s a partnership…

LTCF Claim Representatives Julie Davis, Policy/Operations Liaison Lisa Rasmussen, LTC Payment Unit Supervisor Lakeisha Yawn, Direct Bill Manager (Direct NF claim problems to

Goals for NH Span Review: To review the importance of the NH spans To explain how MITS changes make NH spans even more important

JFS LTCFs (NFs & ICFs-MR) are required* to use the JFS 9401 (Facility CDJFS Transmittal) for reporting the following to CDJFS:  LTCF admissions  LTCF discharges (including deaths)  Medicaid Hospice enrollment * OAC rule 5101:3-3-39

JFS A completed 9401 is to be returned to the LTCF within 10 days to communicate:  Eligibility for Medicaid LTCF services  Start date (Room & Board/Vendor Pay)  End date (Room & Board/Vendor Pay)  Patient Liability Amount  LOC – completed or needed (per AEILC)  Restricted Medicaid period  Hospice Enrollment

NH Spans in MITS A NH span is to be automatically created in MITS using the following information from CRIS-E:  Base Medicaid eligibility  LTCF provider number & start date (AEINH)  Patient Liability budget (AEBML)  LOC (AEILC)

NH Spans in MITS NH Spans are not automatically created for retroactive updates including:  open cases if patient liability budget requires changes (retroactive spans cannot overlap existing spans). When a NH span must be manually corrected, ODJFS needs a 9401 to substantiate making the NH span update in MITS.

Correcting a NH Span in MITS Send JFS 9401 to ODJFS (LTC Unit) when:  NH dates on AEINH are entered or backdated/changed retrospectively (including Hospice)  To correct a NH span in MITS  Upon request

Helpful Hints from CRIS-E Help Desk Since CDJFS cannot retroactively update NH spans for open cases if patient liability budget requires changes, send 9401 to LTC Unit.. CRIS-E can calculate up to 7 months of initial pro-rated (retro) spans if application is pending and case has not been authorized. If more than 7 months are needed because application pended longer than 7 months then a fiat can be completed to take the span back greater than 7 months but not more than 12.

Sending JFS 9401 to ODJFS LTC Payment Unit FAX to: Mail to: Long Term Care Payment Unit P.O. Box Columbus, OH 43215

NH Spans in MITS The NH Span in MITS lives in the Recipient Subsystem and is called: LTCF Payment Authorization Panel

Uses of NH Spans in MITS For creation/generation of ICF-MR claims/payment for ICF- MR residents To verify appropriateness of LTCF payments* To deny payment of certain services not paid for separately by JFS in a LTCF, instead of Living Arrangement Code (New in MITS) To price Hospice claims for consumers in a LTCF (New in MITS) * NH spans are not created for restricted Medicaid periods

LTCF Services & NH Spans Certain services are covered under a LTCF’s per diem rate paid by JFS. NFs must pay for the services included in their per diem payment (ex – O2, transportation, DME). MITS will deny payment for services that are the NF’s responsibility when a consumer is in a NF and has a NH span (no longer using the Living Arrangement Code). – (New in MITS) When services are denied inappropriately due to a NH span that is incorrect, send the JFS 9401 to the LTC Payment Unit for correction.

Hospice & NH Spans (New in MITS) A NH span must be present in MITS in order for JFS to pay a Medicaid Hospice provider for a LTCF resident.

Hospice & NH Spans (New in MITS) For LTCF residents newly enrolled in Medicaid Hospice: CDJFS must not end the vendor pay dates on AEINH. Add Hospice” behind the name of the LTCF on AEINH.

Hospice & NH Spans (New in MITS) For Hospice recipients newly admitted to a LTCF: CDJFS must complete AEINH screen (no LOC is required for Hospice enrollment) Add Hospice” behind the name of the LTCF on AEINH.

Waiver & CRIS-E Prior to MITS, CDJFS had to adjust spans in order for LTCFs to be paid for short-term residents who were enrolled on an HCBS waiver.. Beginning August 2, 2011, CDJFS will no longer adjust waiver or NH spans for short-term residents who are enrolled on an HCBS waiver. (New in MITS) Instead…

Waiver & CRIS-E (New in MITS) LTCF providers will use the new Revenue Center Code 160 when billing for waiver consumers in short- term NF stays.

Waiver & CRIS-E For waiver consumers in short-term NF stays:.  LTCFs will still report the admission and discharge using the JFS  CDJFS will reference the short-term NF stay in the CLRC notes.

Contact For NH Span Issues LTC Payment Unit

THANK YOU FOR YOUR PARTICIPATION!

QUESTIONS??