February 2015 Ohio State Budget and Federal Long Term Care Update Kenneth Daily, LNHA

District News CEUs for today’s program is 2 hours Next meeting April LGBT in Long Term Care (3.5 hours + SW) May – Future LTC Architecture (2.0) June – Assurex Health – Future of Medicine? (2.0)

OHCA District II/ MVLTCA Annual Golf Outing Thursday August 27th Pipestone Golf Course 9AM Shotgun start Sponsorships and 4- somes being accepted

Federal Update SGR (sustainable growth rate) A failure to approve a plan has the potential to capsize the Medicare system. Medicare patients pay doctors and the reimbursement physicians receive from the federal government is now around 22 percent less. Permanent Doc Fix Reduce FY 2018 market basket.5% = 10 years saving +$7 billion No fix for therapy cap (2 year extension)

House Bill 64 Ohio State Budget Trending is positive in House related to removing from Statute State is set on three things Rebasing Quality Remove from statue

CMS MDS Focused Surveys Piloted Surveys in 2014 by CMS to assess MDS coding practices and its relationship to resident care in nursing homes Expand the MDS focused surveys to all States and include a review of nursing home staffing. Training will be in April States select a minimum of three surveyors Deficiencies identified during the surveys will result in relevant citations and enforcement actions.

HB 64 Replace current Quality Measure program and roll in $16.44 from quality to direct care. Problem is that any facility whose CMI is less than state average will lose reimbursement. Re-purposed monies equal ~ $7.00 per case mix unit

PA 1 /PA 2 Reduce PA1/PA2 from $130 to $91.70/day Incentive for discharge – numbers have not changed in past 4 years Reduces NF funding by $23.5 million

Medicaid Announcement Ohio is currently a 209(b) state and is working with CMS to transition to a 1634 State. The change will do a few things: 1) Individuals who receive SSI will now automatically be enrolled on Medicaid 2) There will no longer be a spend down for individuals over the income limits 3) A "look-alike" category will be created for folks who are 65+, blind or disabled, but who do not have SSI Individuals who need NF or ICF-IID care or services under an existing waiver will have an income limit of 300% of the Federal Benefit Rate (for 2015, $2199). Individuals who have income in excess of that amount will need to create a Miller Trust, a type of qualified income trust, which is a special legal arrangement that allows Medicaid to disregard an individual's income over the limits.

Miller Trust A Miller Trust only helps with the income eligibility requirement of Medicaid. Income that is routed into a Miller Trust each month, as received, is no longer counted for Medicaid eligibility. The trust provides a specific manner in which funds in the trust will be spent each month. The state normally recovers the balance of Miller Trust upon death

Quality Incentive Payment State sent out letter informing facilities to report their 2014 quality measures For fiscal year (FY) 2016 beginning July 1, 2015 and ending June 30, 2016 the current per diem rate of $16.44 will be paid to nursing facilities which achieve meeting certain measures. $3. 29 each measure (up to 5) Must meet at least 5 to earn the full payment Complete on-line tool by May 31 st !

Quality Incentives Performance -4 Satisfaction Survey Advancing Excellence Resident Review Compliance Survey Performance Clinical – 6 Pain Pressure Ulcers Restraints Urinary Tract Infections Hospital Admission Tracking Immunizations Environment – 2 Private Rooms Alternate Med Cart Staffing -5 Consistent Assignment Staff Retention Staff Turnover – STNA Aide Participation in Care Conferences Lic. Social Worker Choice – 3 Choice in Dining Choice in Bathing Choice in Rising and Retiring

National Nursing Home Week May 10-16