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NURSING HOME SPANS & MITS

This training session covers the importance of NH spans in MITS and explains how recent changes make them even more crucial. It also discusses the process for correcting NH spans and addresses various issues related to NH spans in MITS.

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NURSING HOME SPANS & MITS

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  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??

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