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

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

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

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

Details later this month Golf Outing Annual Golf Outing Pipestone August 28th Shotgun start @ 9AM Details later this month

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

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 15-75 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

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

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

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 2012 LSC - late 2014

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

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