1.  Ohio Update Kenneth Daily, LNHA kenn@qissurvey.com

2. District News  CEUs for today’s program is 2.0 hours  Next meeting  September  Where is LTC Heading??? - Kenn Daily  October  Medicare PPS and Hot Topics In Therapy – Kim Saylor

3. OHCA Events  Aging Services Summit  August 20-21  Fall Conference  September 17-18

4. Golf Outing Annual Golf Outing Pipestone Golf Club August 27th Shotgun start @ 9AM

5. Ohio State Budget 2016-17  Now that the budget has been approved there are a lot issues remaining  Rebasing will occur in FY 2017 but what year will ODM pick to use?  The Governor veto RUGs 48 in budget so will they use RUGs 66?  New Quality Measures

6. Rebasing?  Rebasing is the process of taking more recent cost data and recalculating prices for the various rate components  Includes updated inflation factors and, for the direct care price, updated case mix scores  Rebasing with Administration’s changes = $84 million in SFY 2017  PA1/PA2 reduction = $23.5 million  Stated net increase to SNFs = $61 million

7. Key Rebasing Issues  Which cost report year will be used?  Which grouper will be used for the direct care prices and individual facility rates?  Which bed numbers will be used to calculate occupancy percentages?

8. Grouper  CMS designed 48 group model for Medicaid, 66 group model for Medicare (66 group model focuses on higher levels of therapy not needed or used by Medicaid patients)  HB 64 as passed by the legislature required change from current RUG III 44 group model to RUG IV 48 group model  BUT …Governor vetoed  Estimated difference between 48 and 66 group models = $40.9 million

9. Licensed vs. Certified  Statute prescribes imputed occupancy factors to be used in price calculations for ancillary/support, capital, and taxes  Occupancy not defined, but ODM historically interpreted as occupancy of Medicaid certified beds  There are about 2,000 more licensed than certified beds, so the impact of dividing by the larger number ~ $47 million

10. Revised Quality Incentives  Current (second generation) quality payment system goes away after SFY 2016 (Impacts FY 2017 rate)  HB 64 adds $16.44 to rebased rate for each facility without regard to quality measures  Funded by a deduction from each center’s rebased rate ($1.79 per day)  This money goes into a pool (~$30 million) that will be redistributed into centers’ rates at the beginning of the fiscal year  Redistribution is based on number of quality measures met

11. New Measures  Pressure ulcers  Combination of a nursing facility's short-stay residents had new or worsened pressure ulcers and the target percentage of long-stay residents at high risk for pressure ulcers had pressure ulcers  Antipsychotics  Combination of a nursing facility's short-stay residents newly received an antipsychotic medication and of the nursing facility's long-stay residents received an antipsychotic medication

12. New Measures  Potentially preventable admissions (PPAs)  PPAs = patients who are admitted from a SNF and classified by the hospital into one of a specified set of DRGs. Calculation is complex and based on hospital claims analyzed using proprietary software from 3M and will be based expected rate derived through patient level risk adjustment  Per ODM, statewide PPA rate in 2013 = 10.3% (2014 rate = 7.8%, but data incomplete because of MyCare)

13. Employee Retention  “The nursing facility's employee retention rate is at least the target rate”  Data source will be the Medicaid cost report  And should be based on the same method as previous system  Previous system set the threshold at 75%  Forty seven percent of centers met for SFY 2016  Data from ODM (2014 cost reports):  75 th percentile 81.1%

14. P references for E veryday L iving I nventory (PELI)  “The nursing facility utilized the nursing home version of the preferences for everyday living inventory for all of its residents”  It is a process measure: use of PELI required, not specific outcome  Must be used for all residents

15. Future?  We know all the quality money will be distributed  We don’t know how much each center will get: higher thresholds mean fewer SNFs will receive quality payments, lower thresholds mean more will receive payments  Key decisions such a which cost report, grouper and quality incentive thresholds will be decided