February 2015

Ohio State Budget 16-17

and Federal Long Term

Care Update

Kenneth Daily, LNHA

kdaily@beaconhc.net

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/ MVLTCAAnnual 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 64Ohio State Budget 16-17

Trending is positive in House related to removing from Statute

State is set on three thingsRebasingQuality 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 2015. 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

PA1/PA2 Reduce PA1/PA2 from

$130 to $91.70/dayIncentive 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 31st!

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 WeekMay 10-16