Ohio UpdateKenneth Daily, LNHAkenn@qissurvey.com

District News

CEUs for today’s program is 2.0 hours

Next meeting September

Where is LTC Heading??? - Kenn Daily October

Medicare PPS and Hot Topics In Therapy – Kim Saylor

OHCA Events

Aging Services Summit August 20-21

Fall Conference September 17-18

Golf Outing

Annual

Golf Outing

Pipestone Golf Club

August 27th

Shotgun start @ 9AM

Ohio State Budget 2016-17

Now that the budget has been approved there are a lot issues remaining Rebasing will occur in FY 2017 but what year will

ODM pick to use? The Governor veto RUGs 48 in budget so will

they use RUGs 66? New Quality Measures

Rebasing?

Rebasing is the process of taking more recent cost data and recalculating prices for the various rate components

Includes updated inflation factors and, for the direct care price, updated case mix scores Rebasing with Administration’s changes = $84 million in SFY

2017 PA1/PA2 reduction = $23.5 million

Stated net increase to SNFs = $61 million

Key Rebasing Issues

Which cost report year will be used?

Which grouper will be used for the direct care prices and individual facility rates?

Which bed numbers will be used to calculate occupancy percentages?

Grouper

CMS designed 48 group model for Medicaid, 66 group model for Medicare (66 group model focuses on higher levels of therapy not needed or used by Medicaid patients)

HB 64 as passed by the legislature required change from current RUG III 44 group model to RUG IV 48 group model

BUT …Governor vetoed

Estimated difference between 48 and 66 group models = $40.9 million

Licensed vs. Certified

Statute prescribes imputed occupancy factors to be used in price calculations for ancillary/support, capital, and taxes

Occupancy not defined, but ODM historically interpreted as occupancy of Medicaid certified beds

There are about 2,000 more licensed than certified beds, so the impact of dividing by the larger number ~ $47 million

Revised Quality Incentives

Current (second generation) quality payment system goes away after SFY 2016 (Impacts FY 2017 rate)

HB 64 adds $16.44 to rebased rate for each facility without regard to quality measures Funded by a deduction from each center’s rebased rate ($1.79

per day) This money goes into a pool (~$30 million) that will be

redistributed into centers’ rates at the beginning of the fiscal year

Redistribution is based on number of quality measures met

New Measures

Pressure ulcers Combination of a nursing facility's short-stay residents had

new or worsened pressure ulcers and the target percentage of long-stay residents at high risk for pressure ulcers had pressure ulcers

Antipsychotics Combination of a nursing facility's short-stay residents newly

received an antipsychotic medication and of the nursing facility's long-stay residents received an antipsychotic medication

New Measures

Potentially preventable admissions (PPAs) PPAs = patients who are admitted from a SNF and

classified by the hospital into one of a specified set of DRGs. Calculation is complex and based on hospital claims analyzed using proprietary software from 3M and will be based expected rate derived through patient level risk adjustment

Per ODM, statewide PPA rate in 2013 = 10.3% (2014 rate = 7.8%, but data incomplete because of MyCare)

Employee Retention

“The nursing facility's employee retention rate is at least the target rate”

Data source will be the Medicaid cost report

And should be based on the same method as previous system Previous system set the threshold at 75% Forty seven percent of centers met for SFY 2016 Data from ODM (2014 cost reports):

75th percentile 81.1%

Preferences for Everyday Living Inventory (PELI)

“The nursing facility utilized the nursing home version of the preferences for everyday living inventory for all of its residents”

It is a process measure: use of PELI required, not specific outcome

Must be used for all residents

Future?

We know all the quality money will be distributed

We don’t know how much each center will get: higher thresholds mean fewer SNFs will receive quality payments, lower thresholds mean more will receive payments

Key decisions such a which cost report, grouper and quality incentive thresholds will be decided