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The Pulse: October 1, 2012

The Pulse: October 1, 2012


State Stakeholder Meetings with Providers and Plans

On Monday, Sept. 24, Midwest Care Alliance participated in a stakeholder meeting with Ohio Medicaid that included other provider associations as well as representatives from Integrated Care Delivery System plans. 

Ohio Medicaid Director John McCarthy confirmed that in order to implement Ohio’s ICDS demonstration, the state is applying for both 1915(b) and 1915(c) waivers with CMS. In addition, Director McCarthy released proposed enrollment dates by region:

  • April 2013: Northwest, Northeast Central, East Central
  • May 2013: Northeast
  • June 2013: Central, West Central, Southwest

In order to be prepared for implementation, the state will set up meetings by provider type to work through outstanding questions and issues.  Midwest Care Alliance will be part of these meetings. The work of the provider stakeholder meetings may also include providing input to the state on an FAQ document regarding ICDS. We will continue to keep our members informed as new information about the ICDS demonstration is released.

Meetings Set Up for Members to Meet with ICDS Plans

While the state prepares, Midwest Care Alliance has been working with LeadingAge Ohio to schedule regional meetings for our provider members to meet directly with the ICDS health plans in each region. Visit LeadingAge Ohio’s Master Calendar as we update the schedule regularly:

  • West Central (Montgomery, Greene, Clark counties) meeting with Buckeye and Molina – September 24, 8:30 - 10:30 a.m. at Bethany Village:
  • Northeast (Lorain, Cuyahoga, Lake, Geauga, Median counties) meeting with Buckeye, CareSource, and United – Oct. 8 and 9, time and place TBD;
  • Southwest (Butler, Warren, Clinton, Hamilton, Clermont counties) meeting with Aetna and Molina – Friday, October 12, 1:00 – 3:30 p.m. at Cedar Village
  • Central (Union, Delaware, Franklin, Madison, Pickaway counties) meeting with Aetna and Molina – TBD;
  • East Central (Wayne, Stark, Summit, Portage counties) meeting with CareSource and United– TBD;
  • Northeast Central (Trumbull, Mahoning, Columbiana counties) meeting with CareSource and United – TBD;
  • Northwest (Fulton, Lucas, Ottawa, Wood counties) meeting with Aetna and Buckeye – TBD.

More information on regional meeting will be sent directly to members as they are scheduled and planned.  Due to the intense nature of these changes and timing of the implementation of ICDS, scheduling and announcement of meetings may be made with little timing and advanced notice.  MCA is making every attempt to notify members ASAP as the meetings develop.  For more information regarding the ICDS proposal, please contact Jeff Lycan at (614) 545-9016 or

Notice of Public Hearings Affecting Home Care & Hospice

On October 11, 2012, the Ohio Department of Health will hold a public hearing on two rules affecting Ohio Home Care and Hospice providers.  One hearing the Director of Health proposes to amend Ohio Administrative Code (O.A.C.) rule 3701-13-01. This rule sets forth definitions for terms used throughout O.A.C. Chapter 3701-13, pertaining to Direct Care Providers; Criminal Background Checks. The proposed amendments remove language pertaining to “adult care facilities” and re-number subsequent paragraphs. Click here for a copy of the rule.

In the second hearing the Director of Health proposes to adopt a new rule, 3701-19-28 which is to establish a formal process by which hospice care programs may apply for waivers or variances to the regulatory requirements established in Chapter 3701-19 of the O.A.C.  Click here for a copy of the rule.

MCA continues to review and consider testimony regarding these rules. For additional information contact Jeff Lycan at

Criminal Record Checks for Home Care Providers

In the Midyear Budget Bill (HB 487) there were changes regarding Criminal Record Checks (CRC) that will affect home care providers.  Several items that providers will need to be aware of include such proposed changes as:

  • Home care providers will need to update all direct care employees CRC at least once every five years and every three years for those caring for patients served through DoDD waivers or services;
  • Individual Providers will need to complete a CRC at least once every year to be eligible to provide services;
  • Exclusions will be defined in a tiered system which will identify permanent exclusions, 10, 7, and 5 year exclusions as well as multiple offenses exclusions;
  • Rules from DoDD, Department of Aging, Job and Family Services, and Department of Health will be updated to create more transparency between the department of all the CRC rules;
  • Updating of the definition of “Direct Care Provider” which focuses on a “direct hands on” employee; and
  • The rules will identify a number of free data base searches a provider must check prior to having the CRC completed.

As these changes solidify MCA will notify members.  Hospice providers will continue to process their employee’s CRCs as they have in the past as they were not included in the legislative changes.  For additional information contact Jeff Lycan at


Governor and Legislative Committee Discuss Medicaid

Gov. John Kasich said last week that he is still "leaning" toward letting the federal government set up a health care exchange for Ohio, saying rules for exchanges under the federal Affordable Care Act (ACA) prevent Ohio from establishing an exchange that "reflects our values."

Kasich also reiterated his stance on the now-optional Medicaid expansion under the ACA, saying he first has to figure out how to address the "woodwork effect" of adding unenrolled but currently eligible people who will be forced to sign up by the ACA's individual insurance mandate, at an additional cost of hundreds of millions of dollars. Click here for more information on the administration’s evaluation of the woodwork effect.

But he said he thinks there can be some "middle ground" found on the program expansion, a topic he said he discussed recently at a meeting with other Republican governors. "I think we're going to need to get through an election before we see people willing to talk openly," he said.

His comments came late on Wednesday, Sept. 26, following an appearance by his now Cabinet-level Medicaid Director John McCarthy before the Joint Legislative Committee for Unified Long-Term Services and Supports in the morning. McCarthy, too, touched on the question of expanding the state's Medicaid program, telling the joint committee that the state's actuaries estimate there are 320,000 Ohioans who are currently eligible for Medicaid but not enrolled who will be pushed into enrolling the by ACA's individual mandate.

That will cost the state $700 million in state funds over two years, McCarthy said.

"Our first priority will be to figure out how to absorb within Medicaid the $700 million in new Medicaid costs that the federal law will impose on Ohio in 2014 and 2015. Only then will we begin to consider whether to expand Medicaid eligibility. This will likely occur in the context of the upcoming budget and will include conversations with a wide variety of stakeholders," McCarthy told the committee.

He did explain to the committee that Ohio will not see the windfall in savings by moving these folks from the ranks of "uncompensated care" to Medicaid that some other states will experience because in Ohio the state's Hospital Care Assurance Program (HCAP) which covers uncompensated care is "self funded" by the hospitals to generate the state share so there will be "no savings in the state budget. Savings will go back to the hospitals."

In answer to a question from committee member, Rep. Nickie Antonio (D-Lakewood), McCarthy said the decision to expand Medicaid "certainly has budget implications," but that the governor has made it clear it goes beyond the budget because of the effects on Ohioans and their lives "which is why we are looking at other options." One such option, McCarthy noted, involves the overlap between the targeted Medicaid expansion up to 138 percent of poverty and the coverage under the health exchanges which starts at 100 percent of poverty.

McCarthy spent a good part of his testimony on the state's progress in moving forward with its integrated Medicare and Medicaid services initiative for those individuals covered by both programs. He called the negotiations "tough," describing for the committee the domino effect of the Centers for Medicare and Medicaid Services (CMS) need to get their rates in place which affects the networks the managed care organizations will put into place  and how all of that meshes with other initiatives from the Office of Health Transformation (OHT).

State Considering Changes to BENHA to Include HCBS

Administration officials heard recommendations at the Sept. 13 Unified Long Term Care Services Advisory Workgroup meeting for revamping the board that licenses nursing home administrators to reflect trends toward a continuum of long-term care options.

Bonnie Kantor-Burman, the director of the Ohio Department of Aging, presented findings from a working group on the Board of Examiners for Nursing Home Administrators at the meeting. Under the proposals, the board would be renamed the Board of Executives of Long-Term Services and Support, to reflect the proposal to expand its scope and authority to cover administrators in leadership positions who practice in any long-term setting, and to ensure those executives are prepared to practice in a unified system built on principles of person-centered care.

Kantor-Burman said the new board would require members to have experience of a range of long-term care settings and have expanded membership. She said the workgroup also discussed the possibility that the board could be moved under the jurisdiction of a different department from its current home in the Ohio Department of Health.

OHT’s Upcoming Budget Priorities

Director Moody also presented to the Unified Long Term Care Services Advisory Workgroup on Sept. 13, and said that Director of Medicaid John McCarthy was to be officially sworn in Thursday afternoon as a cabinet-level officer as part of organizational changes made in Gov. John Kasich's mid-biennium review legislation. The administration plans to spin Ohio Medicaid off into a separate department.

He also presented a chart of the various OHT health and human services initiatives across three categories: Medicaid modernization; streamlining health and human services; and improving health system performance. The chart also tags specific initiatives that are prioritized for inclusion in the FY14-15 biennial budget, as follows:

Medicaid modernization

  • Reform nursing facility reimbursement
  • Update provider regulations to be more person-centered

Streamlining health and human services

  • Create a unified Medicaid budget and accounting system
  • Create a cabinet-level Medicaid department
  • Consolidate the Ohio Department of Mental Health and Ohio Department of Alcohol and Drug Addiction Services
  • Integrate health and human services information capabilities, including eligibility
  • Coordinate housing programs
  • Coordinate workforce programs
  • Coordinate programs for children
  • Share services across local jurisdictions

Improving health system performance

  • Provide access to medical homes for most Ohioans
  • Use episode-based payments for most acute medical events
  • Decide Ohio's role in creating a health insurance exchange
  • Promote insurance market competition and affordability

OHT Wants to Study Health Homes and Episodic Payments

Ohio's Office of Health Transformation Director Greg Moody told attendees at a September Columbus Metropolitan Club forum that the state is moving on to efforts to reform health system payments with a planned application to the federal government for funds. "But whether we get the money or not, we will be doing this," Moody added.

This State Models Innovation grant, would go beyond state agencies and involve large private

payers and insurers as well, Moody said. He said the intent is to identify just a few ways that health care could be paid for differently by all involved as a way to shift from "paying for units of service" -- that is, the current fee for service system -- to paying for value or performance or outcomes. He said the intent is to identify common ground among all payers. That grant application was submitted Sept. 23.

Along these lines, Moody also highlighted the shift in the current budget of tying 10 percent of the nursing home reimbursement to performance criteria. While saying that 10 percent was a very aggressive number, with other states doing it with 1 to 2 to 3 percent of the nursing home funds, Moody did say that to get it passed in the current budget required the 20 quality measures be set at "introductory" levels. He said the administration is looking to ramping up the benchmarks in the next budget.

Payment reform follows this year's efforts, Moody said, to "get our own house in order." Specifically, this includes eligibility simplification, moving toward the creation of a separate Medicaid agency, the merging of the departments of mental health and alcohol and drug addiction services and the creation of a unified Medicaid budget and accounting system, among other items.

The CMS grant application can be found on the OHT website at by clicking here.

MCA-PAC Debuting at Annual Conference

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 this year’s Annual Conference, members will be introduced to the Midwest Care Alliance Political Action Committee (MCA-PAC)! The MCA-PAC is a way for our members to come together as one and support legislators in Ohio who are friends and leaders in home care, hospice, and palliative care issues in Ohio. Please join us and consider making a contribution to MCA-PAC at Annual Conference by participating in the new MCA-PAC Raffle!

The MCA-PAC Raffle features several fun, themed gift baskets. You can purchase tickets to enter for your chance to win a gift basket, and find out more about MCA-PAC, at our PAC booth. Winning raffle tickets will be drawn Tuesday, Oct. 30 during Casino Night. Thank you for your support of home care, hospice, and palliative care advocacy!

If you have any questions, please contact please contact Jeff Lycan at (614) 545-9016 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.


Hospice PEPPER Training Recording, Q&A Now Available

The recording of the Hospice PEPPER (Program for Evaluating Payment Patterns Electronic Report) training, which was conducted on September 13, 2012, is now available at on the Hospice Training and Resources page. A document with the questions and answers from the session is also available.

In addition, mark your calendars for an upcoming Hospice PEPPER Q&A Session: Thursday, Oct. 4, 1:00 p.m. - 2:00 p.m. CT, 719-325-4908 or 877-718-5108, Participant passcode 4303581, there is no need to register to participate.

Reps. McGovern, Jones Urge Their Colleagues to Join in Letter Asking CMS to Use Moratorium Authority

Reps. Jim McGovern (D-MA) and Walter Jones (R-NC) began circulating a “Dear Colleague” letter inviting members of the House of Representatives to sign a letter urging the Centers for Medicare and Medicaid Services (CMS) to use its authority to put a temporary and targeted moratorium on new home health agencies to prevent waste, fraud and abuse. The National Association for Home Care & Hospice (NAHC) has supported the use of temporary, targeted new provider moratoria as a way to address concerns about fraud, waste, and abuse and commends Reps. McGovern and Jones for their efforts. NAHC included the implementation of CMS’ moratorium authority in its list of recommendations to the Senate Finance Committee on how to address waste, fraud and abuse.

NAHC is encouraging home care advocates to call their representatives and ask that they sign on to this letter. To find out the name of your representative and obtain contact information, click here. Advocates may forward the "Dear Colleague" and sign on letter if their representative’s office has not seen them yet.

NHPCO Releases Briefing Paper on Sequestration

Congress returned to Washington for a few short weeks of work prior to an election recess scheduled to begin in October. There are a few "must-do" items they need to address during September, but the majority of legislative activity will be punted until after the November elections.  Despite this delayed legislative timeline, political posturing and public debate on the "fiscal cliff" has already begun and is expected to kick into high gear with this week's anticipated report from the Obama Administration on their plans for the implementation of sequestration.

Have questions regarding the "fiscal cliff" and/or sequestration?  Wondering what they even are and how they might affect hospice? NHPCO's Office of Public Policy has prepared an in-depth analysis for you to be "in the know" before these issues start moving on the Hill.  Click here for the brief.

Whatever the turnout of the elections, or the Administration's implementation plan, NHPCO and the Hospice Action Network have been working for months to educate key policy makers on how these huge economic packages could impact access to high-quality, compassionate end-of-life care throughout the nation.  You'll be hearing more about these efforts and how you can get involved in the coming days and weeks.  In the meantime, this briefing paper gives you just enough information to be prepared for the future - in your program, and as a Hospice Advocate. 

The issues surrounding the "fiscal cliff" are complex and there are many moving parts. Additionally, there are still many unknowns. Please do not hesitate to contact NHPCO at if you have questions, and stay tuned for future updates.