Complete Story


The Pulse: April 5, 2012


MCA Provides Comments & Public Testimony on Medicaid’s ICDS Proposal

Ohio Medicaid held two public hearings on their 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.

Midwest Care Alliance provided public testimony on the new draft ICDS demonstration proposal on behalf of our members, as well as written comments directly to Ohio Medicaid. MCA’s testimony and comments included:

  • Definitions of terms and concepts within the proposal must be clearly defined;
  • Consumer protections, which include requiring the ICDS to publically report measured outcomes;
  • Provider protections, including prompt pay and prior authorization requirements, particularly for home health where delays can mean patients go without services for up to 14 days;
  • Rate floors for Medicare and Medicaid reimbursement for the duration of the ICDS demonstration (3 years);
  • Midwest Care Alliance’s members are well positioned and familiar with the MME population in order to help ICDSs coordinate care.

Thank you to Anne Shelley, MCA Vice President of Professional Development, for providing testimony on behalf of MCA members statewide. 

Click here to read Anne Shelley’s public testimony. 
Click here to read MCA’s detailed written comments submitted to Ohio Medicaid.

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

Ohio Medicaid Submits Final ICDS Prosal to CMS

On Monday, April 2, Ohio Medicaid submitted its final Integrated Care Delivery System demonstration proposal to CMS. Click here to read the proposal as well as statements of support from Area Agencies on Aging and AARP.

The proposal does include some changes from the draft previously released. The regions included in the demonstration have been changed to correspond with the Area Agency on Aging regions. Also, the timetable for implementation of the demonstration has changed, with the Youngstown, Akron, and Toledo regions starting in February 2013, and the other four regions starting the demonstration in May 2013.

Throughout this process, MCA has met with Ohio Medicaid and the Office of Health Transformation. As a result of our advocacy, and that of our member organizations, many of whom also provided feedback, the current final proposal to CMS includes:

  • No retroactive denials of services if given prior authorization by the ICDS;
  • ICDS’s must extend contracts to any provider for the first year of the demonstration;
  • There will be no rate cuts to Medicaid reimbursement for the first year of the demonstration;
  • Prompt payment must occur within 30 days of a clean claim, which is the current Medicaid standard, and if they do not comply will be assessed a monetary penalty;
  • ICDS plans will be required to have an expedited process for HCBS services that will help individuals live in the community as independently as possible;
  • ICDS plans will be required to make arrangements to allow individuals to continue to receive services from their current or existing providers, which may be accomplished through single case agreements, contracts, out of network authorization, etc.;
  • ICDS plans will report monthly enrollment figures, including utilization data, incident reporting, SNF census, which will then be posted on Ohio Medicaid website;
  • The final proposal also outlines the basic structure of the initial enrollment process, which begins with Medicare-Medicaid Enrollees (MMEs) receiving information letters this summer letting them know about the launch of the ICDS program in their region.

MCA will continue to review and work with the administration on the proposal to better understand and plan for how MCA members can benefit from the new model. In addition, the proposal is currently in a 30 day public comment period with CMS. We will keep members updated on how they can submit public comments to CMS during this period. Contact Jeff Lycan at 614-545-9016 or, or Katie Rogers at 614-545-9032 or for more information.

Dr. Ruth Thompson Presents RN Pronouncement of Death Resolution to OSMA House of Delegates

On March 23, 2012, MCA Board Member and Vice President for Medical Care at The Hospice of Dayton, Dr. Ruth Thomson, DO, FACOI, presented a resolution to the Ohio State Medical Association (OSMA) House of Delegates regarding RN pronouncement in the hospice setting. Although OSMA did not take an official position on the issue during their meeting, it was well received. Thank you Dr. Thomson for your continued advocacy on this issue.

MCA has created a white paper regarding support of allowing hospice RNs to pronounce patients receiving hospice services. By far, hospice RNs experience and care for more patient deaths than any other professional discipline in Ohio. Expanding RN authority to pronounce death in the hospice setting—where the expected outcome is death—would allow continuity in the dying process for Ohio patients, families, physicians, and caregivers.  Click here to download the white paper.

Contact Jeff Lycan at 614-545-9016 or, or Katie Rogers at 614-545-9032 or for more information.

MCA Hosts Honoring Wishes Task Force to Discuss MOLST Legislation

This week, MCA hosted a meeting for the Honoring Wishes Task Force to discuss goals and objectives of Medical Orders for Life Sustaining Treatment (MOLST) legislation.

There have been two previous MOLST bills, in the past two previous general assemblies. It is the hope of the Honoring Wishes Task Force members that interested parties can continue to work together on legislation with the following goals:

  • Be patient-centered and patient-driven. The uniform MOLST form will allow the patient, or decision-maker, to better understand and drive his or her own end of life care, including those decisions regarding the administration of life-sustaining treatment even if those instructions are inconsistent with instructions in a previously executed advance directive. The MOLST form will also allow patients to determine a medical decision-maker should the patient become unable to make those decisions.
  • Eliminate current Ohio DNR law, and replace it with MOLST and the MOLST form. The MOLST legislation and new language is intended to replace current DNR law in Ohio, to make end of life decision making more patient-centered and patient-driven.
  • Make clear that no one is required to complete a MOLST form. The MOLST form is a way to uniformly document and transfer end of life medical orders. Just like any medical order, a patient or decision-maker should discuss and understand the options carefully with his or her medical professional. No one is required to complete a MOLST form, and this statement will be included on the form itself. Further, nothing in the legislation, or on the MOLST form, will create a bias in favor of more aggressive or less aggressive forms of treatment.
  • Assure that the MOLST form is transferrable across settings of care. A MOLST form will be transferable across all settings, including emergency settings. A copy of a MOLST form is equally valid as an original, and medical professionals will be required to notify other medical professionals if they know a patient or decision-maker has completed a MOLST form.
  • Provide immunity to all health care workers who honor the medical orders outlined in a MOLST form, if acting under their scope of practice. Like current DNR law, new MOLST law will protect health care personnel from civil and criminal liability who follow end of life medical orders outlined in a patient’s MOLST form.

Congressman Steve LaTourette (OH-14) Visits Hospice of the Western ReserveCongressman Steve LaTourette Visits Hospice of the Western Reserve 2

Ohio Congressman Steve LaTourette, representing the 14th Congressional District, recently met with Hospice of the Western Reserve’s Chief Executive Officer, Bill Finn and Government Relations Manager, Justin Reiter to discuss current issues affecting hospice providers and Hospice of the Western Reserve.

The Congressman was briefed about the challenges hospice providers are facing related to regulatory and policy decisions made in Washington, DC, over the past several years. Hospice providers are in the third year of ten-year phased cuts that will see an overall 16 percent reduction to Medicare hospice reimbursement.

The Congressman has been a long-time supporter of Hospice of the Western Reserve, and was asked to co-sponsor HR 3506, the Hospice Evaluation and Legitimate Payment Act introduced last fall by Congressmen Reed, Thompson and Paulsen.

“We believe this legislation is a good step toward protecting the hospice benefit, an issue the Congressman has supported in the past as a co-sponsor of the 2008 Medicare Hospice Protection Act (HR 6873),” Finn said.Congressman Steve LaTourette Visits Hospice of the Western Reserve

During his visit to David Simpson Hospice House, the non-profit agency’s 42-bed, 33,000 square-foot residential hospice facility overlooking Lake Erie, Congressman LaTourette met Mrs. Caroline Rackovan and her family. 

“The meeting provided the Congressman with an opportunity to speak directly with one of our patients and her family, and to learn first-hand about the quality of care she is receiving,” Finn said. “We appreciate Congressman LaTourette’s continued support of Hospice of the Western Reserve, and his commitment to the care and well-being of hospice patients and their families.”


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.


Midwest Care Alliance Members Participate in Hill Day in Washington, D.C.MCA Members with Rep. Sutton

Last week, on March 27 and 28, MCA members took to Capitol Hill to lobby members of Congress in Washington, D.C. on home care, hospice, and palliative care issues as part of Hill Day for NAHC and NHPCO. In total 26 separate visits were made over the two-day period.  Some of the advocacy priorities included:

  • No Medicare copayments for home health services;
  • Support and co-sponsor the HELP Hospice Act (S. 722/H.R. 3506);
  • Reject the MedPAC recommendation to reduce the hospice market basket update in 2013.

For more information on NAHC and NHPCO’s federal advocacy efforts, visit NAHC Advocacy Efforts and NHPCO Hospice Action Network.

You can participate in Hospice Action Network’s Virtual Hill Day by clicking here. 

Contact Jeff Lycan at 614-545-9016 or, or Katie Rogers at 614-545-9032 or for more information on you can advocate for these important initiatives!

President’s Budget Proposes Medicare Cuts

The President’s FY2013 Budget continues to demonstrate the global threat of additional cuts to home and community based providers.  Released in February, his budget includes a home health copay identical to the President’s proposal in September 2011 along with reduced Market Basket Index (inflation) updates beginning 2014 to 2021.

The proposed update reductions of 1.1 percentage points each year affect all post-acute providers. Hospice is not affected. These reductions would be in addition to the 2014 home health rate rebasing and the productivity adjustments starting in 2015.  The proposed reductions are alleged to “build on” MedPAC recommendations. However, MedPAC did not recommend multi-year payment reductions. Further, rebasing is expected to wipe out an “excess” in home health payment rates with these further proposed cuts likely reducing rates below most provider costs.

Overall, the President’s budget is a restatement of many of the Administration’s previous policy proposals. The budget will be just one of several proposals that Congress will consider in late 2012 or 2013. Early reaction to the budget proposal is that it is DOA. That is usually the reaction when at least one house of Congress is held by the opposition party.

The key matter of concern at the moment is the congressional effort to fix/patch the Medicare physician payment system along with other so-called “extenders.” The budget proposal may have some limited influence on where Congress looks to find monies to fund the “physician fix.” In that respect, the huge Medicare ($302B) and Medicaid ($55.7) spending cuts in the budget hit almost every sector in health care, particularly drugs, hospitals, and SNFs. NAHC is seeking to avoid any home health cuts as the combined regulatory and legislative cuts over recent years exceed $77 billion already. If we are not successful with that goal, we contend that any cuts should be no more than home health’s proportionate share of Medicare spending (approx. 4%) and targeted in ways to control abuses and incentivize quality of care, such as a temporary moratorium on new HHAs.