06/07/2017

ODM Ventilator Rule Update

Cheryl Guyman, Nursing Facility Policy Administrator, Ohio Department of Medicaid (ODM) shared the final rule for the nursing facilities ventilator program that is effective June 9, 2017.  Under the emergency rule filing, the effective date for fee-for-service Medicaid was February 1, 2017 and MyCare was April 1, 2017. Per Ms. Guyman providers will need to negotiate the enhanced vent rate for managed care other than MyCare Ohio with each plan. 

The list of approved providers is highlighted in green and have officially been set up in MITS with the ability to bill at the enhanced rate of $640.03 per day. The three facilities without the green shading will be set up in MITS today. 

Key reminders when billing:

• Make sure to change the charge in your billing system to at least $640.03 to ensure proper payment.
  
  
• Use revenue code 419 for vent days in the same manner as billing for bed-hold or waiver days.
  
  
• Bed-hold days for these individuals should be billed using the standard bed-hold days of 0183 for therapeutic days and 0185 for hospital leave days.
  
  
• Remember to notify your hospice providers of the enhanced rate in the event you have a ventilator-dependent hospice individual. You should bill your hospice providers in accordance with your contract which is typically 95 or 100 percent of your per diem. 

Also provided is a spreadsheet to track data for the quarterly report – the beginning date of the quarter is April 1. The first calendar quarter report is due July 25 and should be emailed to nfpolicy@medicaid.ohio.gov.

 

Nursing facilities NFs: Ventilator Program