08/15/2018
9401s Required for Processing of Medicaid Applications
The Ohio Department of Medicaid (ODM) at the monthly Nursing Facility (NF) Provider meeting on August 9 continued to emphasize the importance of the 9401 in the NF admission and discharge process.
When discussing issues around Medicaid eligibility, Ms. Roberta (Birdie) Schwamberger, Eligibility Compliance Manager stated that there were several examples in which the NF had not submitted the 9401. The 9401 on a NF admission triggers the “long-term care detail screen”, a critical step in the Medicaid application process. Similarly, the 9401 on discharge triggers the change in the “living arrangements” field in Ohio Benefits being updated to either a different NF or the community. For a Medicaid recipient discharging to the community if the “living arrangements” field is not updated then it negatively impacts the Medicaid recipient from receiving medications, DME, etc.
In the case of the receiving NF, its impacts the ability of the receiving NF to bill as the Medicaid recipient’s living arrangement still reflects the original NF. ODM also reported that there is evidence through their review of the data and case examples of NFs who are authorized representatives for residents not responding to several requests for documentation that ultimately leads to a denial of coverage for the potential recipient.
Ms. Schwamberger acknowledged that ODM continues to work with the counties in the resolution of Medicaid application process delays. As a point of note, Franklin County in moving away from it centralized processing of all Medicaid applications back to a decentralized approach. A point emphasized during the meeting by the associations was the importance of communication from the counties regarding the application process.
LeadingAge Ohio continues to advocate for solutions to the Medicaid eligibility determination process and this topic is a key priority for the LeadingAge Ohio SNF/AL subcommittee. Please send examples of unresolved or pending eligibility cases to Nisha Hammel at nhammel@leadingageohio.org.
