1. State Budget, Survey Update … CMS Initiatives
Kenneth Daily, LNHA
President
Elder Care Systems Group
OHCA District II
March 2014

2. District News CEUs for today’s program is 2 hours
Certificate of attendance
Staff changes and new addresses

3. Coming Events
April 3 What Are Regulators Up To? Changes in Survey, Quality, Payment and Systems (social workers)
April 15 - Congestive Health Failure in Nursing Home Patients, Anil H. Jhangiani, MD, FSCAI Advanced Cardiovascular Care, LLC
April 28-May 1, Ohio Health Care Association Annual Convention
May 27 - Small Houses, Susan McConn, Vice President and Jeff Singleton, Administrator, Otterbein Homes

4. Congratulations!!! OHCA OCAL Caregiver of the Year
Helen LeMaster, STNA
Nurse Aide
Piqua Manor
Personal Care Assistant of the Year
Angele Bubeck
Resident Associate
Garbry Ridge

5. Details later this month
Golf Outing
Annual
Golf Outing
Pipestone
August 28th
Shotgun 9AM
Details later this month

6. State Updates Mid-Year Budget Review- H. B. No. 472
Very little for long term care (thankfully)
2 things
ICF/ID facility operations issues which are no contested
Sex Offender registration and notification

7. MyCare
After MyCare goes live check MITS portal and get list of residents and health plan they were enrolled.
Contract care manager because it appears that all residents will have an assessment within days of enrollment (days determined by risk level)
Check with ancillary providers on whether they are plan partner?
Making sure all residents are prior authorized for payment (this will vary by plans)
Plans will also need to know date of admission to facility

8. MyCare Ohio Money Issues
All MyCare Ohio health plans agreed to not pend a claim when it shows a different amount for patient liability than the 834 file.
Plans should pay cross over payment for residents who have chosen both Medicaid and Medicare MyCare
Medicaid only the facility should receive a ‘no pay’ remittance letter

9. Creditable 3rd Party Coverage
Residents with Medigap Policies
According to the Department of Medicaid (ODM) Medicare supplement (Medigap) policies are considered credible coverage and are not eligible for MyCare Ohio
Make sure all residents with Medicaid have the 3rd party insurance screen updated in Cris-E
For additional problems contact the toll free hot line –
4/20/2017

11. CMS LSC Issues Budget Regional budget cuts Feds doing surveys
Increased survey time for region
Less interaction time
Hiring freeze
Reduce # of surveyors trained
Cultural change waivers
Sprinkler issues still abound; just starting
Obstructions in corridors
2012 code
Review by OMB starting Dec. 2013
Then publish for comments
Comments
Final adoption of the LSC - late 2014

12. S&C-13-58-LSC Waivers for Changes -2012 LSC
Door locking
Delayed egress
Generator testing
Sprinkler testing
Trash collection
Suites
Openings in exit enclosures
Combustible decorations
Gas Fireplaces
Fixed furniture in corridors
Kitchens open to corridor

13. Sprinkler Protection Not Required
Outbuildings on nursing home properties
Free standing outside smoke shelters
Free standing laundry buildings
Free standing kitchens or kitchens that service nursing home residents in a residential building on the same property