- “Bundling” a new buzz word for Medicaid ancillary services and one we in long term care are fast becoming very familiar with. After August 1st, 2009, ODJFS will no longer process claims for custom wheelchairs and repairs; physical, occupational and speech therapy; medical transportation; oxygen; and certain over the counter drugs. The Ohio Ambulance and Medical Transportation Association sued the Ohio Department of Job and Family Services, the goal being elimination of bundling of transportation services. A temporary restraining order against bundling was filed August 14, 2009 as attempts to negotiate with ODJFS had not been productive. The suit has been settled and transportation services will be bundled although a six week reprieve has been granted.
- Some facilities are receiving case mix penalty letters related to their annual case mix score calculation because of errors in their records at the end of the first quarter of 2009. ODJFS states reasons for the penalty include failure to submit appropriate modifications or discharge tracking records by the eightieth day after the reporting period end date, quarter assessment records exceeding their certified capacity, and Social Security Number errors. Currently there is no appeal process for case mix score penalties.
- ODH survey entrance checklists are available for download on line at OHCA Survey and Certification web page. This is a great tool for facilities to use for survey preparedness.
- Long term care provider groups met with Survey and Certification Director Thomas Hamilton, other CMS officials, and numerous other stakeholders in regard to the Five Star Program. Highlights of the discussion were:
- Survey scoring: Survey’s are being done better, so the number of deficiencies cited will increase as CMS continues to improve and refine the survey process.
- Staffing: CMS is looking at collecting staffing data from facilities electronically through payroll data.
- Quality Measures: Hospital-based and possibly post-acute facilities should be compared to one another rather than continuing to include them in the total population of Skilled Nursing Facilities.
- Possible Satisfaction Measure: DCMS proposes that information about Satisfaction Surveys be included on Nursing Home comparisons as information that a facility does conduct resident and family Satisfaction Surveys.
- The federal minimum wage went from 6.55 per hour to 7.25 per hour July 24, 2009. Ohio’s minimum wage is currently 7.30 per hour for employers grossing over 267,000 per year.
- The National Pressure Ulcer Advisory Panel has released its recommendations and brief case examples for appropriate coding of suspected deep tissue injuries on the MDS 2.0. The NPUAP document compares the expected clinical finding, MDS 2.0 coding recommendations, and basic treatment recommendations. The document is posted on the NPUAP website.
- The authority for the administration and enforcement of the Health Insurance Portability and Accountability Act of 1996 (HIPPA) has been delegated to the Office of Civil Rights. Through a separate delegation, CMS continues to have authority for administration and enforcement of the HIPAA administrative simplification regulations, other than privacy and security of health information.
- Fifty percent of counties in Ohio have reported cases of H1N1. The most heavily populated counties continue to show the most cases. Prevalence has been highest in younger people. The advisory committee on immunization practices recommended targeting the following populations for H1N1 vaccine; pregnant women, household contacts of children under 6 months old, healthcare and emergency personnel, children and young adults between the ages of 6-months and 24 years, and non-elderly adults with conditions that make them high risk. The elderly are not a targeted population because to a large extent, this virus has spared that population.
|
