11/12/2020

Today's COVID-19 Report: Friday, November 13, 2020

Friday, November 13, 2020

Here are the latest need-to-know updates for Friday, November 13 regarding the COVID-19 pandemic.

In Today's Report

• Patient liability changes became effective November 2
  
• ODM describes Provider Network Management module
• Hospital Discharges: New directive to payors to lift prior authorizations and/or pre-certifications
• Provider relief funds reporting requirements
• Palmetto GBA eServices scheduled maintenance
• Scholarship applications being accepted through December 31
• LeadingAge Need to Know

Patient liability changes became effective November 2

This week, the Ohio Department of Medicaid (ODM) shared changes related to how it is now managing patient liability. According to ODM's Rachel Hopmoen, Eligibility Policy Section Chief, the recent Interim Final Rule reinterpreted certain requirements contained in the Families First Coronavirus Relief Act (FFCRA); FFCRA requires states to maintain continuous enrollment in order to qualify for the enhanced federal medical assistance percentage (FMAP) match. Previous to the interim rule, state Medicaid departments were prohibited from terminating Medicaid enrollment or increasing patient liability when an individual’s income changed.

The reinterpretation will allow ODM to do two things: first, it will allow Medicaid to move individuals from one eligibility category to another in some instances. Second, it will allow states to increase patient liability based on a change in income. Ohio hopes to release state guidance regarding this change by Thanksgiving, so that ODM can make changes to patient liability at the same time as cost-of-living-adjustment (COLA) changes.  

This change will only affect individuals on or after November 2, and will not affect accumulated assets resulting from changes in income since the beginning of the pandemic. ODM confirmed that the Centers for Medicare & Medicaid Services (CMS) has not yet issued guidance on what to do retroactively, but they anticipate there will be a period of time allowed for assets to be spent. Once the guidance is complete, ODM will create provider communications.

ODM describes Provider Network Management module

As previously reported in the COVID-19 Report, the Ohio Department of Medicaid (ODM) will be transitioning to a new system for provider certification and enrollment beginning in March 2021. The Provider Network Management Module (PNM) is one of the larger-impact modules being rolled out as part of Ohio Medicaid Enterprise System.

The PNM is in testing now, and it will replace the Provider subsystem of MITS. The PNM is designed to address certain “pain points” like change of ownership and closure notices. Once the system is in place, providers will be able to submit these notices online. For nursing facilities, the PNM will centralize the credentialing process. After it is live, managed care plans won’t need to manage credentialing and contracting processes separately.

In preparation for a go-live date of March 8, ODM will have to clear provider applications from the queue. To prepare, ODM predicts shutting down provider applications by January 29 (tentative).

ODM is planning provider training, user manuals and guidance to ensure a smooth transition to the new platform. LeadingAge Ohio will update members as new information is released.  

Hospital Discharges: New directive to payors to lift prior authorizations and/or pre-certifications

LeadingAge Ohio was contacted and encouraged to distribute the following information to our members. The Ohio Department of Medicaid (ODM) is requiring Medicaid managed care organizations (MCO) and MyCare Ohio plans (for services where Medicaid is the primary payer) to lift all prior authorizations and/or pre-certifications for long-term acute care facilities and for all skilled nursing facility (SNF) admissions. Per ODM Deputy Director, Office of Managed Care, Roxanne Richardson, “It is imperative that Ohio respond swiftly to remove barriers to care and reduce administrative burden on hospitals and SNFs.” The MCOs and MCOPs are also required to assist providers with a number of discharge planning activities. If you encounter prior auth difficulties with a payor, please reach out to Susan Wallace at swallace@leadingageohio.org with details of the situation.

Provider relief funds reporting requirements

LeadingAge, in conjunction with CliftonLarsonAllen (CLA), will be hosting a webinar at 2:00PM on December 2 to outline how members can maximize use of payments received from the Provider Relief Fund while complying with current reporting requirements.

For more information and/or to register, please click here.

Palmetto GBA eServices scheduled maintenance

Palmetto GBA will be conducting scheduled maintenance on the eServices provider portal this coming weekend. This maintenance is expected to last from 1:00 PM on Saturday, November 14 and run until 8:00 AM on Sunday, November 15. Review Choice Demonstration functionality in eServices will be unavailable during this time.

Scholarship applications being accepted thru December 31

While COVID has delayed many opportunities to come together, the LeadingAge Ohio Foundation’s commitment to support members in the opportunities to “grow our own” through employee scholarships has never been stronger. For 2020, the Foundation Board has allocated funds to support the General Scholarship Fund. The Aging Services General Scholarship is awarded for up to $1,500 for an individual desiring to advance their careers in aging services fields, including nursing (i.e., those wishing to move from STNA to LPN, or LPN to RN, etc.); as well as dietary, activities, maintenance, therapy and other professional lines. Visit the LeadingAge Ohio website for all the details on eligibility, criteria and more. Applications are being accepted through December 31, 2020.

If you have questions or inquiries regarding the 2020 scholarship program, please contact Jennifer Taylor, Director Member Experience, at jtaylor@leadingageohio.org or by calling 614-545-9028. 

LeadingAge Need to Know: COVID-19 – November 13, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured information on the 2020 LeadingAge Award of Honor.

Check out the full report here.

Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register here.  

LeadingAge Ohio is working to ensure that the information in our daily alerts, on our website, and all coronavirus-related communications is as accurate as possible. However, LeadingAge Ohio makes no guarantees about the accuracy of the information.