Complete Story


The Pulse: March 9, 2012


Ohio Proposal to Integrate Medicare and Medicaid

The Ohio Medicaid office on February 27 issued a draft Integrated Care Delivery Systems (ICDS) demonstration proposal and summary that builds on the concept paper released in January regarding integrating services for individuals dually eligible for Medicare and Medicaid.

The new proposal reflects consumer and family caregiver recommendations to protect and enhance existing benefits. According to the Office of Health Transformation (OHT), the draft demonstration proposal remains a work in progress and will be posted on the OHT website for 30 days of public comment, ending March 27.

Ohio Medicaid will hold two public hearings to seek feedback from beneficiaries and other stakeholders on the draft demonstration proposal; comments may also be submitted in writing or by e-mail. Click here for written comment submission information and public hearing dates. Provider, consumer and stakeholder feedback is essential and this feedback will be used to mold the final ICDS proposal that Ohio submits to the federal government on March 30. According to the timeline recently released by Ohio Medicaid, the ICDS model will be implemented on January 1, 2013.

Midwest Care Alliance will provide testimony on the new draft ICDS demonstration proposal on behalf of our members and we welcome your feedback. As updates and changes continue, stay tuned to Midwest Care Alliance for instruction and possible impacts to your organization.

Contact Jeff Lycan at 614-545-9016 or for more information.

Justin Reiter Represents MCA on Capacity & Reimbursement Subcommittee

Ohio's Office of Health Transformation Director, Greg Moody, convened a new subcommittee Wednesday, the Nursing Facility Capacity and Reimbursement Subcommittee. This subcommittee is charged with helping move the state forward on a different way to look at Ohio's nursing homes -- and alternative forms of long-term care -- as well as to review the state's nursing home reimbursement methodologies.

Moody told the group that they have a deadline of producing a report by year's end so that the recommendations "will be in play for the development" of the state's FY14-15 biennial budget. Thank you to MCA’s representative on the subcommittee, Justin Reiter.  Mr. Reiter is Government Relations Manager at Hospice of the Western Reserve.

To lay the groundwork for the group's discussion, they heard first from Shahla Mehdizadeh of Miami University's Scripps Gerontology Center to highlight work her group has done looking at long-term care over primarily the last 16 years as one way to predict what the state might expect going forward. However, one of her observations was that long-term care has changed considerably in that time.

By meeting's end, the subcommittee had identified the following questions to explore in depth at its next meeting, which will tentatively be held Wednesday, March 21:

  • What should determine capacity? Moody said this would be a statement of principles.
  • What does the state intend to commit to going forward as it relates to capacity?
  • What distorts these goals?
  • Reimbursement
  • Certificate of Need (CON)
  • Alternative capacity for home- and community-based settings, housing and behavior health services.
  • Health care workforce.
  • Level of care.
  • Eligibility/evaluation/woodwork effect?

Unified Long Term Care Workgroup Meets

The Unified Long Term Care Services Advisory Workgroup, of which Midwest Care Alliance (MCA) is a member, met on March 8 to discuss several new and continuing initiatives that will impact Medicare and Medicaid services in Ohio.

The discussion included the new Integrated Care Delivery System Draft Proposal, which was sent to MCA Members via a Special Alert on 02/28/2012. One of the items discussed was the Balanced Incentive Payment (BIP) Program Application. The state is considering applying for BIP, which could provide enhanced FMAP if the state outlines a goal to rebalance care to 50/50 home- and community-based services versus institutionalized care. Many of the requirements of the program are already goals of the administration, so this may be a way to draw more funds to assist long term care services directly. 

Ohio Medicaid is holding a public hearing for providers March 13, where MCA will provide testimony; watch for further updates next week.

Contact Jeff Lycan at 614-545-9016 or for more information.

Medicaid Director on Care Coordination

Ohio Medicaid Director John McCarthy updated a joint legislative panel on February 21st on his office's progress toward budget goals for better care coordination, including a proposed timeline for an Integrated Care Delivery System (ICDS) to complement the federal push to align Medicare and Medicaid financing.

McCarthy testified on progress in a number of areas within Medicaid and the Office of Health Transformation before the Joint Legislative Committee on Long-Term Care Services and Supports. His testimony included updates on the following senior service and supports topics:

  • Health Homes for People With Severe and Persistent Mental Illness: The administration submitted a draft state plan amendment to the federal government on creating Medicaid health homes Dec. 23. Medicaid hopes to be able to begin enrolling people in the health homes by September.
  • Expansion and Streamlining of Home and Community-Based Waivers (HCBS): Medicaid and the Department of Aging released a concept paper on an initial proposal for the design of a new waiver program. The administration is backing away from the July 1 implementation date for a single waiver set out in the budget bill because it wants to ensure it has adequate opportunity to gather input.
  • Eligibility System Modernization: The current eligibility processes for health and human services in Ohio are overly complex, fragmented and reliant on outdated technology and the current system is not capable of handling the 935,000 Ohioans projected to enter the Medicaid system by 2014 as a result of the federal Affordable Care Act (ACA). The administration plans to release a white paper in early March and then submit a waiver request to CMS to simplify eligibility requirements.
  • Nursing Home Quality Measures: ODA and ODH, along with the Office of the State Long-Term Care Ombudsman, are developing a website to provide information and technical assistance to nursing facilities for meeting the quality measures needed to qualify for incentive payments under the budget bill and SB264 (Jones). Medicaid is also developing data collection tools for facilities and will begin reimbursing nursing facilities based on the quality measures July 1.
  • Medicaid Managed Care Improvements: Letters of intent from prospective plans hoping to bid on managed care contracts are due February 27; applications are due March 19 with tentative selections made April 9.
  • Federal Balancing Incentive Payments Program (BIPP): The state is reviewing requirements for BIPP, which offers financial incentives for achieving a 50/50 balance of home-based versus institutional care and is considering whether to apply for the program. The state made progress in the budget toward meeting the 50/50 goal, going from a 36-to-64 home-to-institutional ratio to a 42-to-58 ratio.

Senator Dave Burke (R-Marysville) said he was concerned about the state recognizing ACOs that do not agree to accept the full risk of coordinating care, saying it would leave taxpayers on the hook. McCarthy said he has seen resistance from organizations he has met with to assuming full risk and that the state has discussed the idea of "risk corridors" where costs are shared between the state and ACOs. He said he does not want to kill the entire idea of the ACO model just because organizations are not willing to accept full risk.

Senator Shannon Jones (R-Springboro) expressed some shock at McCarthy's estimate that 935,000 people will enter Medicaid under the ACA. McCarthy said that represents both the expansion of eligibility and the enrollment of people previously eligible that had not entered the program but would under ACA. He said that number causes him concern as well. To read Director McCarthy's testimony, click here, and to read the timeline, click here. Contact Katie Rogers at or (614) 545-9032, or Jeff Lycan at 614-545-9016 or for further information.


Click here for a list of key legislation Midwest Care Alliance is monitoring and its status, as well as news from around the state that affects legislation, regulations, and policy. Please note that there have not been many legislative changes as the General Assembly was recessed before the March 6 primary.


NAHC President Releases Statement on Diverting Medicaid, Medicare Funds

“On behalf of the members of the National Association for Home Care & Hospice (NAHC), I want to congratulate the Department of Health & Human Services, the Department of Justice, and Texas law enforcement agencies for taking forthright action to stem what appears to be a coordinated scheme to divert federal money intended for care of the aged and infirm. We believe that all Americans are entitled to the presumption of innocence, and we do not want to prejudge this case without having all the facts. However, the facts on the surface appear to be fairly compelling. 

NAHC has always had a zero-tolerance policy for those who would look to divert funds from Medicare and Medicaid for their own personal gain. We believe it is NAHC’s duty to help protect patients at all costs; similarly it is our collective duty to protect the integrity of public programs. NAHC has advocated for comprehensive integrity programs, such as screening home health agencies that seek to participate in the Medicare program, evaluating the background of those who own or manage home health agencies, and strengthening physician involvement in planning and delivery of home health care. We believe it is imperative that home health agencies faithfully execute physician orders calling for the extension of in-home medical care while following the highest standards of care. As disappointing as this case is, it is heartening to see federal and state officials collaborating to stop allegedly inappropriate and perhaps illegal activities.

The notoriety that this case has already received should send the message that government does not intend to sit back and allow the continuation of questionable practices. It should serve as a warning to providers that they will face greater scrutiny. The end result of all this should be to improve the fiscal integrity of government programs. All in all, this is good news for those who believe the receipt of government funds to care for the aged and ill is a sacred trust and should be treated as such.”

Val J.  Halamandaris served as Counsel to the U.S. Senate and House Committees on Aging for 20 years. Before coming to NAHC as its CEO in 1982, he helped write the laws creating the Office of Inspector General in the Department of Health & Human Services, making Medicare and Medicaid fraud a felony, outlawing kickbacks, upgrading the mail fraud statute, and creating state Medicaid fraud units.

IRS Announces Two Month Suspension of IRS Modernized e-File Operations for 990 Filers; Advises Hospital Organizations About 2011 Filing Requirements

In order to facilitate systems and programming changes, the IRS today notified tax-exempt organizations that the IRS Modernized e-file (MEF) system will not be available from January 1, 2012 through February 29, 2012 for electronic filing of Forms 990, 990-EZ, 990-PF and 1120-POL information returns. The IRS is suspending the availability of the system to implement changes to IRS programs and systems for the 2011 tax year. The 990-N e-postcard filing system will not be affected by the temporary suspension of the MeF system.

To minimize the impact on affected organizations, the IRS is granting an extension of time to file to March 30, 2012 to organizations whose due date or first extended due date for returns is January 17, 2012 or February 15, 2012. Affected organizations required to file electronically may file electronically prior to January 1, 2012 or between March 1, 2012 and March 30, 2012. Organizations that are not required to file electronically may do the same and, alternatively, may file a paper return anytime before March 30, 2012. In addition, as described in Notice 2012-4, certain affected organizations normally required to file electronically will have the option to file a paper return during the suspension period.

An affected organization that has not previously received an extension and wishes to extend its filing due date until after March 30, 2012 may request an automatic 3-month extension by filing Form 8868, Extension of Time to File an Exempt Organization Return, by its original due date. If an affected organization has already obtained an automatic 3-month extension, the IRS will grant the organization an additional 3-month extension if the organization properly completes and files Form 8868 by its first extended due date. Organizations that have already been granted two extensions for a total of six months may not request a further extension.

Organizations are reminded that an extension of the time to file, including the automatic extension to March 30, 2012 provided in the Announcement, is not an extension of time to pay any tax liabilities that may be due for the year.

Organizations with a filing due date (or first extended due date) between January 1, 2012 and February 29, 2012 that file their returns by March 30, 2012 will be considered to have timely filed. In the case of an organization with a second extended due date that falls during the suspension period, the organization will have reasonable cause for late filing and will not be subject to the late filing penalties if it files by March 30, 2012. The organization should attach a Reasonable Cause Statement to its return referencing Notice 2012-4 , in order to avoid receiving a system-generated penalty notice for late filing. Some organizations generally required to file electronically that have already obtained two three-month filing extensions may be uncomfortable with taking advantage of the late filing penalty relief provided in this notice. In that circumstance the organization may file its return on paper during the suspension.

Reminder for Hospital Organizations

The IRS has released a draft version of the 2011 Form 990, Schedule H, Hospitals and its instructions. The IRS continues to seek input from the public on how to improve the Schedule. The IRS revised Schedule H to add Part V, Section B for tax year 2010 to gather information on hospital organizations' compliance with new requirements imposed on tax-exempt hospitals by the Affordable Care Act.

Hospital organizations required to file Form 990 and Schedule H must complete all parts and sections of Schedule H for the 2011 tax year except for lines one through seven of Part V, Section B which relate to community health needs assessments. These lines will remain optional for tax year 2011 and are required only for tax years beginning after March 23, 2012. Hospital organizations must also attach a copy of their most recent audited financial statements to their tax year 2011 Form 990.

The IRS has considered public input on Schedule H, Part V, Section B, and has revised this section and its instructions for tax year 2011. The IRS welcomes public input on Form 990 and its schedules, including Schedule H.

Such input must be submitted to or by mail to the following address by January 15 to be considered for tax year 2012 form revisions:

Internal Revenue Service
Attn: Stephen Clarke (Notice 2012-4)
1111 Constitution Avenue NW
Washington, DC 20224

IR-2011-120, December 16, 2011, Filing Deadline Extended to March 30 for Some Tax Exempt Organizations

OIG Releases Alert on Sanctions for Noncompliant Home Health Agencies

This early alert memorandum report provides information related to the Office of Inspector General’s ongoing study Survey and Certification of Home Health Agencies (OEI-06-11-00400)1 and alerts the Centers for Medicaid & Medicare Services (CMS) regarding Federal statutory requirements to implement intermediate sanctions for noncompliant home health agencies (HHAs). Click here to read the alert.