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The Pulse: September 4, 2012

The Pulse: September 4, 2012

Health Plans Selected for ICDS Regions

On Monday August 27th, Integrated Care Delivery System (ICDS) health plans selected the regions in which they will operate, based on previously released scoring results and established protocols. As a result, the following plans will be in each of the seven regions:

  • Northwest: Aetna and Buckeye
  • Southwest: Aetna and Molina
  • West Central: Buckeye and Molina
  • Central: Aetna and Molina
  • East Central: CareSource and United
  • Northeast Central: CareSource and United
  • Northeast: Buckeye, CareSourse and United

Click here for more information from the Ohio Office of Health Transformation. For more information on regions and the ICDS proposal, please contact Jeff Lycan at (614) 545-9016 or or Katie Rogers Colgan at (614) 545-9032 or

MCA Public Policy Committee Meets with Health Plans and AAA Associations

Dual Eligibles and Ohio’s Integrated Care Delivery System (ICDS)
Last week, the Midwest Care Alliance Public Policy Committee met to discuss key policy issues in Ohio around hospice, home care, and palliative care. The committee met with representatives from the Ohio Association of Health Plans to discuss the future of managed care in Ohio and implementation of the Integrated Care Delivery System (ICDS) in April 2013. Now that the health plans have been chosen for each of the seven ICDS regions, the selected plans are beginning to formalize their plans for implementing managed care for those dual eligible populations. The group discussed how Midwest Care Alliance members could contribute to planning and discussions on how members can be included in contracts with the Managed Care Organizations.  A major difficulty for everyone involved is not yet knowing what the “blended” payment rate for home care and hospice will be.

The committee also met with Larke Recchie, Executive Director from the Ohio Association of Area Agencies on Aging, who have been named in plans with the state as the “front door” and case manager of individuals in the ICDS over age 60 for home- and community-based services. Both associations expressed the need to work together with Midwest Care Alliance and our members to best serve individuals in Ohio who are dually eligible for Medicare and Medicaid.

Midwest Care Alliance will be setting up regional meetings with our members and health plans to help facilitate conversations and partnerships. Please look for more informations on meetings soon.

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 was: “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.” This would include home health and hospice administrators.

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. Implementation of the single waiver had stalled and wasn’t expected to be implemented until the Integrated Care Delivery System (ICDS) project begins in April 2013.  However, in August, ODA and JFS announced proposing a new ICDS Waiver (see Executive Summary) through a 1915 (c) application to begin April 1, 2013.  The purpose of the waiver will be to:

  • Permit Ohio to provide home and community-based services (HCBS) that are not otherwise available through the Medicaid state plan to individuals who are eligible for the ICDS demonstration and require a nursing facility (NF) level of care (LOC)
  • Waive §1902(a)(1) of the Social Security Act (statewideness) in order to furnish Medicaid HCBS only to those individuals who reside in the following counties:  Fulton, Lucas, Ottawa, Wood, Lorain, Cuyahoga, Lake, Geauga, Medina, Summit, Portage, Stark, Wayne, Trumbull, Mahoning, Columbiana, Union, Delaware, Franklin, Pickaway, Madison, Clark, Green, Montgomery, Butler, Warren, Clinton, Hamilton and Clermont
  • Provide for self-direction of selected HCBS
  • Assure continuity of care by offering a service package that is consistent with the services available in Ohio’s five NF-based LOC waivers (i.e., the PASSPORT, Choices and Assisted Living waivers administered by the Ohio Department of Aging (ODA) and the Ohio Home Care and Transitions II Aging Carve-Out waivers administered by ODJFS)  

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 continued to express concerns regarding the cost and its suggestion of every five years has been put forth in rule review except for Department of Developmental Disabilities which remains every three years.

Independent Providers will be required to complete a criminal records check every year.  For the purposes of consistency in the rules, the definition of “direct care provider” has been narrowed to identify those individuals with direct “hands on” interactions with beneficiaries.  Next steps are to continue to address 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. To that end, a stakeholder meeting has been scheduled for Sept. 25, 2012 at the Midwest Care Alliance office.

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

PASSPORT Enrollment Stalls in FY2012

This month, The Center for Community Solutions released a report entitled “PASSPORT Enrollment Levels Stall in FY 2012 as State Prepares for New Medicaid Dual Eligible Project.” Report hightlights include:

  • The Ohio Department of Aging’s PASSPORT Medicaid waiver program provided home- and community-based services to over 33,000 older Ohioans each month in FY 2012. Services included help with bathing, eating, dressing, and household tasks intended to keep consumers in their homes and avoid more costly nursing home stays.
  • The PASSPORT program was the subject of extensive cost-containment measures that were planned in H.B. 153, the biennial budget bill. These measures affected PASSPORT agency staffing levels, consumer care plan costs, and service provider reimbursement rates, and played a role in keeping enrollment stagnant in FY 2012 following a 6.1 percent growth rate in FY 2011.
  • Most PASSPORT consumers who live in urban areas will become part of a planned Integrated Care Delivery System (ICDS) project for Medicare-Medicaid dual eligibles scheduled to begin in calendar year 2013. Under the ICDS, Medicaid Managed Care Organizations will become responsible for coordinating medical and non-medical care for this vulnerable population. It is vital that policymakers, practitioners, and advocates understand the implications of recent changes in the program.
  • Some of the recent changes to PASSPORT include:
    • Weekly reports from PASSPORT agencies to the Department of Aging on the costs of consumer care plans.
    • Required submission of corrective action plans from PASSPORT agencies with an average per member/per month care plan cost above the target level of $1,085.
    • A 3 percent across-the-board cut to provider rates and an even larger rate reduction for services delivered in group settings.
    • Prioritization of state Medicaid plan services and Medicare services in consumer care plans as a substitute for PASSPORT personal care services.
    • Initiation of a new performance management system that creates small financial incentives for PASSPORT agencies meeting key targets.
    • Tighter controls on the use of state-funded, presumptive eligibility for new consumers.
    • Combined spending on PASSPORT and Assisted Living was $29.1 million, or 4.7 percent, below projected levels in FY 2012. Despite this, the Ohio Department of Aging proceeded with an additional planned 5 percent cut to PASSPORT agency site operations in FY 2013.
    • Enrollment in Assisted Living, another Ohio Department of Aging waiver program, continued to grow at a strong pace in FY 2012 leading to a waiver amendment that raised enrollment limits.

Click here to read the full report.

What is a PAC and Why is it Important?

A Political Action Committee (PAC) is an important tool in an organization’s advocacy tool shed. A PAC is a combination of two or more persons, the primary or major purpose of which is to support or oppose any candidate, political party, or issue, or to influence the result of any election through express advocacy. Organizations like Midwest Care Alliance can use a PAC to help support political candidates who are leaders and supporters of home care, hospice, and palliative care issues in Ohio.

At times, watching the news at night or reading the paper in the morning can be overwhelming and feel like you have little control over how the country, or even the state, is being run. Decisions are taking place everyday that affect aspects of your life even as personal as your child's education, the freeway you use everyday, and the ways you are allowed to practice medicine. Don't let this overwhelming feeling stop you from taking action to make a difference in the way those decisions are made. Health care reform proposals are being debated as you read this. The voice of home care, hospice, and palliative care needs to be heard on these issues! PACs allow indivuduals who support the same goal – the ability to provide quality care in home, hospice, and palliative care – to come together and have a stronger voice.

We will continue to provide more information on PACs in the coming months. If you have any questions, please contact Katie Colgan at at (614) 545-9032 or


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.

MCA Meets with CMS Region V

On Tuesday and Wednesday of last week all state associations from Indiana, Illinois, Wisconsin, Michigan, Minnesota and Ohio met with CMS Region V representatives in Chicago.  The meeting is an opportunity for sharing across a broad range of “hot topics” and upcoming CMS educational programming.  The following are some noted highlights:

  • Hospice continues to grow both in providers and number of beneficiaries being cared for
  • In 2009, the Department of Justice and Health Human Services created the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to fight Medicare fraud 
    • The OIG identified approximately 17 Ohio hospices during this past HEAT evaluation with high volume (66% or greater of ADC) NF residence. CMS announced a Recovery Auditor Prepayment Review Demonstration process that will continue to evaluation such activity with Ohio, PA, NC and Michigan identified as four states that fall under this review
    • Updated ABN process for Hospices
    • ICD 10 delayed until October 1, 2014
    • Medicare Advantage (MA) plans now service 27% of Medicare Beneficiaries, continuing to grow
    • PEPPER Q&A will occur on October 4th at 1pm Central Time
    • CMS preparing to identify a couple hundred more ACOs by 2013
    • Home Health Therapy Services, extension of the Therapy Caps Exceptions Process. Click for more.
    • Althought Home Health has been performing a Medicaid F2F for a while now, CMS is just now preparing to issue guidance to states.

Ohio ICDS waiver specific notes:  While the state has released the names of the MCOs that will be managing services in the seven regions in Ohio there are still many unanswered questions regarding specifics to the contract between the state and CMS.  Chicago CMS Region V indicated that they will be administering the contracts. Ohio OHT representatives are meeting with CMS representatives later this week, continuing discussions to move the process forward. As MCA learns more, we will move details forward.