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August PULSE


August PULSE

Midwest Care Alliance Policy Round Up

MCA’s Public Policy Committee meets on August 30th to begin discussions around planning for Ohio’s fiscal year 2013.  With the continuing fiscal uncertainty we face, both from a state and national perspective, there may be some great opportunities for Long Term Care Supports and Services (LTSS) along with Home & Community Based Services (HCBS) to develop further and become the pivotal reference point for consumers receiving health care.  Enclosed is a Policy Brief from the Scan Foundation that provides a vision that supports this type of future care.  Two references within the brief I would also point you to: one on page 14, reference number 4, an article by DeJonge titled Independence at Home.   The other is in Table 1, Summa Health’s work with what is known as the PEACE Trial, references 14 & 15 on page 15 of the report.  These articles help frame a structure that could redefine home care services to maintain independence at home.  Click here to access the Scan Foundation Brief.

This month’s PULSE will provide you with a summary of the most critical issues Midwest Care Alliance is currently working on. Please take a moment to read through the following issues, which may play key roles as the state prepares its 2014-2015 budget, officially beginning July 1, 2013

Dual Eligibles and Ohio’s Integrated Care Delivery System (ICDS)
The state continues to work on its proposal to integrate care for individuals dually eligible for Medicare and Medicaid. In July’s Pulse, we featured an article on the recent release of plan rankings for those plans who submitted applications to become ICDS’s in each of the state’s proposed seven regions. After the rankings were released, protests were filed by five plans: Anthem, CareSource, Paramount Care, United Healthcare, and WellCare.

Click here to find more information on the proposals and protests. Because the time period for filing protests was pushed back, Midwest Care Alliance anticipates that the most recent proposed timeline from the state regarding plan selection may also be pushed back. The state is still preparing for implementation on April 13.

BENHA Subcommittee of the ULTCS Advisory Workgroup
MCA has been representing home care and hospice providers on a State Subcommittee looking to reform and expand the scope of the Board of Examiners of Nursing Home Administrators (BENHA).  The state desires to modernize the board and make it more consistent with the rebalancing of care to more home- and community-based services.

The charge of the Subcommittee is: “To seek stakeholder input regarding proposals for changes to the structure and affiliation of the Board of Examiners of Nursing Home Administrators, as well as potential expansion of the Board’s authority and scope of practice to allow the Board to develop standards and a more inclusive curriculum appropriate for administrators of additional long-term care services and supports that places an emphasis on person-centered care.”

To date, the subcommittee has drafted a report of their vision for the future of BENHA, along with revising the board make-up to include HCBS representatives. The Board will include an emphasis on education, but will not and cannot create any additional licensure or certification requirements to administrators in home health or hospice unless otherwise enacted by the Ohio General Assembly.

Reimbursement and Capacity Subcommittee of the ULTCS Advisory Workgroup
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. This committee is now focused on reimbursement for nursing facilities. The group is working on defining value and pay for performance, as well as listing “hot spots” for the subcommittee to further work on as they prepare for the 2014-2015 state budget.

State Plan
A Work Group made up of the Department of Aging and Job and Family Services along with representatives from the Area Agency on Aging, home care and hospice have been meeting throughout the summer to discuss removing barriers and integrating State Plan and Waiver services so they may be provided sequentially if needed.  This is a shift from previous philosophy within the departments and administratively.  Much of the work that the group has focused on is around developing education for agencies and personnel.

MCA expects this work to wrap up toward the end of the summer.  While there is open agreement within the work group of the opportunity this change allows for coordination of care, one concern not yet addressed is how agencies will clearly identify and bill the separate services as care may be provided from the same personnel/agency from one scope of service to the next.

Governor’s Opioid Task Force
The Governor’s Cabinet Opiate Action Team (GCOAT) was established in the fall of 2011 to address the continuing epidemic of misuse and abuse and overdose from prescription opioids.  The GCOAT consists of five working groups: (1) Treatment--includes Medication Assisted Treatment; (2) Professional Education; (3) Public Education; (4) Enforcement; and (5) Recovery Supports. 

Under the leadership of Dept. of Health Director Dr. Ted Wymyslo and Department of Aging Director Bonnie Kantor-Burman, Emergency Department Guidelines have been developed so that drug-seekers would not be able to shop from one location to another until finding a physician willing to prescribe opiate painkillers. This was done through a multidisciplinary effort involving many state medical and health care associations, emergency departments and acute care facilities, state agencies and boards, as well as individual physicians, nurses and other clinicians. The link below contains a final copy of the background document as well as multiple attachments for the Emergency and Acute Care Facility Opioid and Other Controlled Substances Prescribing Guidelines (ED Guidelines).  Click here for more information. 

As work continues, MCA is represented on the Professional Education Task Force. One critical focus area which is being developed is around prescribing guidelines for Ohio’s clinicians.  The Task Force is also identifying where provider education is needed to achieve appropriate pain management and where rules are needed to assess provider performance.  The state, along with technical assistance from the CDC, has identified setting a trigger (Recommended Trigger: >80 mg MED* average daily dose (over a 90-day period) received by the patient, as recorded in OARRS database) for performance assessment at a level of opiate use associated in the literature with an increased rate for unintentional overdose and death.  Recommendations will be forthcoming following a consensus process used within the group of involved clinicians on the committee. MCA Board of Directors and Public Policy Committee will be reviewing these recommendations. Malignant and terminal pain continues to be exempted.

Single Waiver
The single waiver group, led by representatives from the Ohio Department of Aging and Ohio Department of Job and Family Services continues to meet. However, implementation of the single waiver has stalled until the Integrated Care Delivery System (ICDS) project is implemented in April 20123.

Criminal Background Checks for Home Health
When the Mid Biennial Review budget (HB 487) was passed earlier this year, it included a provision to make consistent requirements across state agencies for criminal background checks of employees working in home health. A group of stakeholders are meeting and Midwest Care Alliance is part of this group. Currently, the state has proposed requiring Home Health employers to conduct criminal records checks for employees who are in contact with patients at the time of employment, and every three years.  However, MCA continues to express concerns regarding the cost and is suggesting this be every five years.  Next steps are to continue to address the definition of “direct care provider” and evaluate the cost of a “RAPBack” program which would be an ongoing criminal background check program run through a state agency which provides real time updates of criminal changes on employees for those programs that register their employees.  Currently the state administers this program for several agencies as well as the Ohio Education School Systems.  Hospice is not included in this requirement.  MCA will continue to keep members informed of important changes.

Medical Orders for Life Sustaining Treatment (MOLST)
Midwest Care Alliance continues to work on draft legislation to replace DNR law in Ohio with Medical Orders for Life Sustaining Treatment (MOLST). We are working with the many stakeholders involved to reach consensus on legislative language before the bill can be introduced.

If you would like to learn more, please contact Jeff Lycan at (614) 545-9016 or or Katie Rogers Colgan at (614) 545-9032 or

Ohio Medicaid to Become Stand-Alone Cabinet Agency

COLUMBUS – Last month, Greg Moody, director of the Governor's Office of Health Transformation, announced plans to transform the Office of Ohio Health Plans (Ohio Medicaid) from a division of the Ohio Department of Job and Family Services (ODJFS) into a state agency effective July 1, 2014. The change of Medicaid to department status is the next step in a series of Kasich Administration reforms to improve the performance of Ohio's $18.8 billion Medicaid program.   

"This is a change that is overdue," said Moody. "It has been recommended by separate study commissions in 2005 and 2006 but never acted on. Governor Kasich believes it is time to act and time for Medicaid beneficiaries and Ohio taxpayers to begin seeing the improvements that this transformation will provide, which is a program that will run better and more efficiently." 

"Transforming the Office of Ohio Health Plans into its own department will help streamline administrative processes and allow ODJFS to focus more singularly on employment services, family assistance, child welfare and child support," said ODJFS Director Michael Colbert. "I look forward to working with staff, stakeholders and the Office of Ohio Health Plans on a smooth transition and the next phase of our shared mission of helping vulnerable Ohioans."

"In the past 18 months, we have passed legislation and begun implementing comprehensive reforms to improve the quality of health care for individuals served in the Medicaid program, saving the state more than $1.5 billion in the process," said Ohio Medicaid Director John McCarthy. "But we have more work to do to create a Medicaid program that is easier for Ohioans to navigate, improves health outcomes and is fiscally sustainable. As a cabinet agency with more direct oversight of Ohio's Medicaid costs, we can better tackle these challenges."

Medicaid is the largest health payer in Ohio, serving 2.2 million Ohioans through a network of 75,000 health-care providers at a total cost of $18.8 billion in 2012. Ohio Medicaid/ODJFS is currently the single state agency responsible to the federal government for the administration of the state's Medicaid program, though five other state agencies-Ohio Departments of Developmental Disabilities, Mental Health, Aging, Health, and Alcohol and Drug Addiction Services-also administer Medicaid-funded programs, with cross-agency coordination provided by the Office of Health Transformation.

"A multi-agency team will begin working immediately, and in collaboration with the legislature and affected stakeholders, to lay the groundwork for creating a stand-alone Medicaid department," Moody said. "A package of proposed legislative changes to finalize this change will be included in Ohio's FY 2014-2015 budget, to be unveiled early next year. We are not expecting any layoffs and we will work hard to make the process as seamless and transparent as possible for staff and stakeholders."

Ohio's Medicaid program was established in 1968 as part of the Ohio Department of Public Welfare (now ODJFS). Ohio Medicaid has 388 employees. ODJFS has 3,280 non-Medicaid employees and a non-Medicaid budget of $3.6 billion. ODJFS will continue to oversee the state's public assistance, child protection, child support, workforce development and unemployment compensation programs.

For additional information, click here.


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 the legislative news has not changed because legislators are not in session, but the statehouse news is updated.


Affordable Care Act

The Health Policy Institute of Ohio has released a review of the Affordable Care Act decision and its impact on Ohio. This policy brief summarizes the Governor's Office of Health Transformation's "Medicaid Eligibility Modernization Project," a Section 1115 Demonstration Waiver request that would change eligibility for Medicaid in Ohio.

Released on June 6, the proposed waiver request has several components:

  • Simplify Medicaid eligibility categories, from the current 150+ categories to three;
  • Procure and implement a new eligibility and enrollment system to replace the 30-year old Client Registry Information System-Enhanced (CRIS-E). (This system will handle eligibility, enrollment and renewals for Medicaid and other primary public assistance programs.);
  • Streamline state and local responsibility for eligibility determination.

Click here to read the Health Policy Institute of Ohio brief “Modernizing Medicaid Eligibility: A review of Ohio's proposal.”

Office of Inspector General

On June 28, the OIG issued a report that Medicare may be paying twice for Prescription Drugs for Beneficiaries under hospice care. Click here to read the report.


PEPPER - stands for Program for Evaluating Payment Patterns Electronic Report - Hospices can expect to receive one (or, if you have multiple provider numbers, some of your own) very soon. It will provide a comparison of your billing practices with three other groups of hospices – those in your state, your MAC jurisdiction and in the nation.

The first round of reports focuses on two target areas: live discharges with a length of stay of less than 25 days and beneficiaries on service for more than 180 days during the cap year (November – October).  Click below for brief summary by Hospice Fundamentals, an Excel file detailing PEPPER and use the link to the official PEPPER website and register for the upcoming Hospice web-based training session scheduled for Thursday, September 13 at 1:00 CT.

Click here for a summary of the PEPPER Report by Hospice Fundamentals. (NUMBER #51531)

Click here to view the PEPPER detail information in excel. (NUMBER #51533)

Click here to register for the upcoming Hospice web-based training session scheduled for Thursday, September 13 at 1:00 CT.

For questions or comments about Midwest Care Alliance’s policy and advocacy efforts, contact Jeff Lycan at (614) 545-9016 or or Katie Rogers Colgan at (614) 545-9032 or