NURSING HOME SPANS & MITS

1. NURSING HOME SPANS & MITS CDJFS Training 08/03/11

2. WELCOME It’s a partnership…

3. LTCF Claim Representatives • Julie Davis, Policy/Operations Liaison • Lisa Rasmussen, LTC Payment Unit Supervisor • Lakeisha Yawn, Direct Bill Manager (Direct NF claim problems to NFDIRECTBILL@jfs.ohio.gov)

4. Goals for NH Span Review: • To review the importance of the NH spans • To explain how MITS changes make NH spans even more important

5. JFS 09401 LTCFs (NFs & ICFs-MR) are required* to use the JFS 9401 (Facility CDJFS Transmittal) for reporting the following to CDJFS: • LTCF admissions • LTCF discharges (including deaths) • Medicaid Hospice enrollment * OAC rule 5101:3-3-39

6. JFS 09401 A completed 9401 is to be returned to the LTCF within 10 days to communicate: • Eligibility for Medicaid LTCF services • Start date (Room & Board/Vendor Pay) • End date (Room & Board/Vendor Pay) • Patient Liability Amount • LOC – completed or needed (per AEILC) • Restricted Medicaid period • Hospice Enrollment

7. NH Spans in MITS A NH span is to be automatically created in MITS using the following information from CRIS-E: • Base Medicaid eligibility • LTCF provider number & start date (AEINH) • Patient Liability budget (AEBML) • LOC (AEILC)

8. NH Spans in MITS NH Spans are not automatically created for retroactive updates including: • open cases if patient liability budget requires changes (retroactive spans cannot overlap existing spans). When a NH span must be manually corrected, ODJFS needs a 9401 to substantiate making the NH span update in MITS.

9. Correcting a NH Span in MITS Send JFS 9401 to ODJFS (LTC Unit) when: • NH dates on AEINH are entered or backdated/changed retrospectively (including Hospice) • To correct a NH span in MITS • Upon request

10. Helpful Hintsfrom CRIS-E Help Desk • Since CDJFS cannot retroactively update NH spans for open cases if patient liability budget requires changes, send 9401 to LTC Unit. . • CRIS-E can calculate up to 7 months of initial pro-rated (retro) spans if application is pending and case has not been authorized. If more than 7 months are needed because application pended longer than 7 months then a fiat can be completed to take the span back greater than 7 months but not more than 12.

11. Sending JFS 9401 to ODJFSLTC Payment Unit FAX to: 614-995-5959 Mail to: Long Term Care Payment Unit P.O. Box 182379 Columbus, OH 43215

12. NH Spans in MITS The NH Span in MITS lives in the Recipient Subsystem and is called: LTCF Payment Authorization Panel

13. Uses of NH Spans in MITS • For creation/generation of ICF-MR claims/payment for ICF-MR residents • To verify appropriateness of LTCF payments* • To deny payment of certain services not paid for separately by JFS in a LTCF, instead of Living Arrangement Code (New in MITS) • To price Hospice claims for consumers in a LTCF (New in MITS) * NH spans are not created for restricted Medicaid periods

14. LTCF Services & NH Spans • Certain services are covered under a LTCF’s per diem rate paid by JFS. • NFs must pay for the services included in their per diem payment (ex – O2, transportation, DME). • MITS will deny payment for services that are the NF’s responsibility when a consumer is in a NF and has a NH span (no longer using the Living Arrangement Code). – (New in MITS) • When services are denied inappropriately due to a NH span that is incorrect, send the JFS 9401 to the LTC Payment Unit for correction.

15. Hospice & NH Spans(New in MITS) A NH span must be present in MITS in order for JFS to pay a Medicaid Hospice provider for a LTCF resident.

16. Hospice & NH Spans(New in MITS) For LTCF residents newly enrolled in Medicaid Hospice: • CDJFS must not end the vendor pay dates on AEINH. • Add Hospice” behind the name of the LTCF on AEINH.

17. Hospice & NH Spans(New in MITS) For Hospice recipients newly admitted to a LTCF: • CDJFS must complete AEINH screen (no LOC is required for Hospice enrollment) • Add Hospice” behind the name of the LTCF on AEINH.

18. Waiver & CRIS-E • Prior to MITS, CDJFS had to adjust spans in order for LTCFs to be paid for short-term residents who were enrolled on an HCBS waiver. . • Beginning August 2, 2011, CDJFS will no longer adjust waiver or NH spans for short-term residents who are enrolled on an HCBS waiver. (New in MITS) Instead…

19. Waiver & CRIS-E(New in MITS) • LTCF providers will use the new Revenue Center Code 160 when billing for waiver consumers in short-term NF stays.

20. Waiver & CRIS-E • For waiver consumers in short-term NF stays: . • LTCFs will still report the admission and discharge using the JFS 9401. . • CDJFS will reference the short-term NF stay in the CLRC notes.

21. Contact For NH Span Issues LTC Payment Unit 614-466-7575

22. THANK YOU FOR YOUR PARTICIPATION!

23. QUESTIONS??