03/14/2024

ODM Provides Updates on Rules, Private Rooms, Bed Tax, and Change Health Care

ODM Provides Updates on Rules, Private Rooms, Bed Tax, and Change Health Care

LeadingAge Ohio staff attended the Ohio Department of Medicaid's March 14 meeting and compiled the following updates provided by the Department.

Hospice 

ODM noted that hospice rules are up for five-year review and have been reviewed and revised. ODM will be sharing a draft of those rules in the very near future.

ODM stated they are aware of the concerns with the nursing facility rate reimbursement for hospice residents.

Nursing Facility (NF) Ventilator Rules

ODM received comments from all associations, nursing homes, and a pulmonologist on the ventilator services. The primary concerns were related to individuals with orders for noninvasive ventilation. Concerns were that treatment modality for non-invasive ventilation is costly to deliver and therefore may deter use in the nursing home setting. Taking these comments into consideration, ODM stated the proposed changes to the rule were modified to allow an enhanced payment rate for complex noninvasive ventilation to prevent hospitalization and possible intubation.

Minor modalities which are frequently used at home were excluded from payment. These minor modalities primarily focused on bi-pap and c-pap; a person would use these at home and bring their own equipment if they go into a nursing facility or the NF would provide the equipment. Bi-paps and c-paps are simple modalities that do not require monitoring.

Once the rules and the clearance comments are finalized, the rule will go through the BIA process. ODM anticipates having language to share in the next two to three weeks.  

Private Rooms

ODM stated that for the private rooms, they have received approximately 230 category 2 bed applications, which is on top of the 800 applications for category 1 beds.  ODM will have to track the beds to stay within the $160 million funding cap. At this time ,ODM stated it doesn't look like category 1’s would exceed the cap although they can still receive category 1 bed applications and preference has to be given to category 1 beds per legislation.

In regard to when payment will start, payment has to be tied to CMS approval. ODM has been in communication with CMS over the last year and a half on the private rooms. The actual approval will come from a state plan amendment submission which is under final review now. ODM stated the state plan amendment will be submitted next week and then they probably will have follow-up questions from CMS.

ODM noted that the payment will not be retroactive. The private rooms effective date is laid out in the ORC and it's the ladder of three possible dates: it cannot be any earlier than April 1st, 6 months from CMS approval, or the effective date of the rules, whichever is later. The timeline will be affected by if CMS has follow-up questions or has additional requirements from the SPA. Once approved, they will have to do the financial work for implementation.  

ODM stated it has been a lengthy process because they had to track to the terms of the statute and that included setting up the entire process around accepting new category 1 applications, accepting category 2 applications, and taking care of the rest of the rate increases. They also had rule and system work. ODM also stated that this was 1 of 5 state plan amendments via the budget bill they are working on.

Vendor Offsets and Bed Taxes

ODM stated they have had questions about some vendor offsets that have been taking place. Bed taxes are being appropriately offset from the claims, but there has been some confusion with information and how that information is being presented. ODM's advice is to make sure they have the most accurate information.

Lisa Osborne has offered to be the point person for future questions until ODM can get a little further down the road on this. Lisa Osborne is ODM’s lead for the bed taxes franchise permit fees, and she said that she can receive an email directly or through the NF policy mailbox. Her e-mail address is losborne@medicaid.ohio.gov.

While ODM is working on getting some information to the providers in a way that they can access it themselves, they were hoping to do that with the recruitment dashboard. They pulled that offline to retool it a little bit and are going to be adding some more specificity to that. Any concerns should be directed to Lisa Osborne.

Change Health Care

ODM stated that CMS is keeping a close eye on which providers this has impacted and would like to hear from impacted providers. MatrixCare interfaces in Change to bill out claims. In the interface, there this no ability to export the file. Providers are having to hand key all claims into MatrixCare. Although Change Health Care states they will have payments back online tomorrow, MatrixCare is moving to a new clearing house. There is also concern that Change Health Care never got claims when they were down. Managed care did immediately respond and provided an alternative way to submit claims and communicated that to providers. It was stated that MatrixCare has about 10% of the market share in Ohio. All claims, regardless of payor went through Change Health Care for MatrixCare. MatrixCare has communicated that it will take 7 to 9 weeks to change to the new clearing house.