PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES OFFICE OF LONG-TERM LIVING OLTL Updates PANAC Ruth Anne Barnard, BSN, RN MDS/OBRA Coordinator for Nursing Facility Field Operations Catharine B. Petko, BSN, RN Senior Manager, Myers and Stauffer LC 1 Agenda RAI Spotlight MDS Baseline Information Nursing Facility Report Portal Section S and CHC Details on Medicare Numbers Updates on Community HealthChoices OBRA Updates OLTL News 2 RAI Spotlight Quarterly newsletter by the DOH with contributions from DHS Posted on DOH Message Board (https://sais.health.pa.gov/commonpoc/login/login.aspx) and Nursing Facility Report Portal (http://nfrp.panfsubmit.com) Distribution list: qa-mds@pa.gov or cathy@mslc.com RAI Coordinators Panel Rotating group of state RAI Coordinators who work with CMS to respond to submitted questions Kiera Price, PA RAI Coordinator, now serving on panel 3 1
K0510B Feeding Tube Resident has PEG tube but it is not being used for feedings or fluids. Should it be coded at K0510B? MDS Items in K0510 Nutritional Approaches are intended to capture nutritional approaches to meet resident s nutritional needs If the tube is only flushed for maintenance with no nutrition provided, K0510B should not be checked Presence of the feeding tube alone (which is not being used for nutritional purposes) does not meet criteria for coding K0510B Feeding tube 4 M1200G Application of Non-surgical Dressings Should dressings on IV lines, etc. be recorded at M1200G Application of non-surgical dressings? No. IV and Port dressings cannot be included in M1200G as they are not being used to treat a skin condition as specified by the MDS 3.0 Manual. Section M as a whole relates to Skin Conditions. All items in Section M leading up to M1200 deal with ulcers, wounds and skin problems; this is the context for skin and ulcer treatments in M1200. Not all care is captured on the MDS. 5 Baseline Results RUG Elements Error Rates Percentage 12.00 10.00 8.00 6.00 4.00 2.00 0.00 Year 6 2
Baseline Error Rate Facility Count by Baseline Error Percentage Rate 600 # of Facilities 500 400 300 200 100 0 50.00+% 40.00-49.99% 30.00-39.99% 20.00-29.99% 10.00-19.99% Year 0.01-9.99% 0.00% 7 Top RUG Element Errors MDS Item Definition Current Error % Previous Error % O0500F Walking training 12.27% 11.60% O0700 Physician Orders (14) 11.03% 10.70% H0200C Current toileting 10.93% 13.7% program or trial C1000 Decision making - 10:74% 12.26% staff O0500B ROM (active) 10.50% 11.12% 8 Nursing Facility Report Portal http://nfrp.panfsubmit.com 9 3
User Account Maintenance Form 10 User Account Maintenance Form cont. 11 Changing Passwords 12 4
Changing Your Password 1 3 2 13 Changing Your Password Requirements: Must be at least 8 characters Must not contain or resemble Username Must contain at least one letter and one number Must not contain dictionary words Must contain both upper- and lower-case letters Must contain at least one non-alphanumeric character Must not match any of the previous 5 passwords 14 PA-Specific MDS CMS now designates the content of the MDS except for Section S. None of the changes proposed for October 1, 2018 affect the Medical Assistance calculations Must continue completing O0600 Physician Exams and O0700 Physician Orders. No changes to Section S Use number from Community HealthChoices card at S9085D CHC Member ID Use recipient number from ACCESS card and PA/FS 162 at A0700 Medicaid Number 15 5
More Numbers 16 Medicare Card change New Medicare Numbers/Cards https://www.cms.gov/outreach-and- Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/MedicareCard- FactSheet-TextOnly-909365.pdf Pennsylvania mailing: April Medicare Beneficiary Identifier (MBI) 11 numbers and upper-case letters Randomly generated 17 Edit -3878 Incorrect MC or MBI Fatal: The MBI or Medicare/railroad insurance number submitted in A0600B is invalid. For a Medicare/RR insurance number: IF the first character is numeric, THEN all 9 characters must be numeric. IF the first character is alphabetic, THEN there must be 1, 2 or 3 alphabetic characters and the remainder of the characters in this item must be numeric. 18 6
Edit -3878 Incorrect MC or MBI Medicare Beneficiary Identifier Must contain 11 characters The 1 st character must be a number 1 9 The 2 nd, 5 th, 8 th and 9 th characters must be letters, excluding S, L, O, I, B, and Z. The 4 th, 7 th, 10 th and 11 th characters must be numbers. The 3 rd and 6 th characters must be numbers or letters, excluding S, L, O, I, B, and Z. Need to carefully enter the number once into the system to avoid repeated rejections due to mistyping. 19 CHC LAUNCH UPDATE 20 2018 Focus CHC SOUTHWEST LAUNCH: Assuring no participant service interruptions Assuring no interruption in provider payment Successful launch first phase CHC SOUTHEAST IMPLEMENTATION: Comprehensive participant communication Robust readiness review Provider communication and training Pre-transition and plan selection for southeast participants Incorporation of southwest implementation and launch lessons learned 21 7
Fee for Service The fee-for-service (FFS) payment system for nursing facility (NF) services will remain in effect during and after implementation of Community HealthChoices (CHC). The Department of Human Services (DHS) will continue to set quarterly per diem rates for each nonpublic NF and annual per diem rates for each county NF provider. NFs shall continue to submit cost reports and case-mix index (CMI) reports. Field Operations will continue to monitor: Minimum Data Set Preadmission Screening and Resident Review Medical Assistance (MA) billing until CHC start date 22 Nursing Facility Transportation The CHC-MCO must coordinate non-emergency medical transportation for nursing facility residents. CHC-MCOs must work with nursing facilities to provide this service or may use a transportation broker to arrange it. CHC-MCOs, through their service coordinators, are responsible for coordinating transportation for their Participants but may work with nursing facilities to complete this task. Denial notices are relevant for participants with transportation if not approved or reduced on their person-centered service plans. 23 Provider Feedback Problems Experienced: Communication challenges with the MCOs that, at times, have resulted in delays of payment. Non-Medical Transportation: MCOs handling it differently. Billing coding challenges New Participant Referral issues 24 8
Provider Feedback Problems Experienced: HHA Exchange Data Issues with HCSIS and SAMS Administrative Costs of Tracking Missed Shifts: PAS agency doing double-work responding directly to MCOs and reporting to outside service coordinators. Appropriate and timely referrals from IEB for CHC and LIFE programs 25 SOUTHWEST LESSONS LEARNED (SO FAR): Earlier stakeholder engagement opportunities with key population groups and group representatives Earlier in-person provider communication sessions Enhanced communication materials regarding Medicare vs. CHC More education and communication on continuity-of-care Addition report development on enrollment and plan transfer scenarios Earlier OBRA reassessments More communication on the LIFE program as an enrollment alternative Earlier data clean-up in HCSIS and SAMS Earlier pre-transition More provider information on IEB website More provider training on Medicare vs. CHC 26 ONGOING COMMUNICATIONS MLTSS SubMAAC Consumer SubMAAC LTSS SubMAAC MAAC Third Thursday Webinars Review data to be collected: o Stakeholders MCO Participant Advisory Committees Local Advisory Group SubMAAC Third Thursday Webinars CHC Website 27 9
RESOURCES 28 CHC MCO CONTACT INFORMATION Pennsylvania Health and Wellness (Centene) information@pahealthwellness.com www.pahealthwellness.com 1-844-626-6813 (TTY 1-844-349-8916) UPMC Community HealthChoices CHCProviders@UPMC.edu www.upmchealthplan.com/chc - 1-844-833-0523 (TTY 1-866-407-8762) AmeriHealth Caritas South West AmeriHealth Caritas CHCProviders@amerihealthcaritas.com www.amerihealthcaritaschc.com - 1-855-235-5115 (TTY 1-855-235-5112) South East Keystone First CHCProviders@keystonefirstCHC.com www.amerihealthcaritaschc.com - 1-855-235-5115 (TTY 1-855-235-5112) 29 RESOURCE INFORMATION CHC LISTSERV // STAY INFORMED http://listserv.dpw.state.pa.us/oltl-communityhealthchoices.html COMMUNITY HEALTHCHOICES WEBSITE www.healthchoices.pa.gov MLTSS SUBMAAC WEBSITE www.dhs.pa.gov/communitypartners/informationforadvocatesandstakeholders/mltss/ EMAIL COMMENTS TO: RA-PWCHC@pa.gov PROVIDER LINE: 1-800-932-0939 PARTICIPANT LINE: 1-800-757-5042 INDEPENDENT ENROLLMENT BROKER: 1-844-824-3655 OR (TTY 1-833-254-069 (Open Monday through Friday, 8:00 a.m. to 6:00 p.m.) or visit www.enrollchc.com 30 10
PASRR PreAdmission Screening Resident Review 31 MDS: Preadmission Screening and Resident Review 32 PASRR Forms Both forms have been updated and are currently going through the approval process. Plan is to be effective July 1, 2018. MA 376 PASRR Level I This form is done prior to admission and must be on the resident s record/chart in a NF. MA 376.2 PASRR Level II This form is done by either the AAA or Field Operations based on the results of the PASRR Level I results. Both forms need to be completed (if both forms are required) AND a Program Office letter issued before admission to the NF. 33 11
Important websites Community HealthChoices http://www.healthchoices.pa.gov/info/about/community/ Long Term Care Nursing Facility Providers website: http://www.dhs.pa.gov/provider/longtermcarecasemixinformation/ index.htm 34 Long Term Care Nursing Facility Providers website: Automated Notification System for Nursing Facilities Average 5.12 CMI's in Pennsylvania Nursing Facility Field Operations Offices and Contact Information Healthcare-Associated Infection (HAI) Payments Normalized Nursing Only CMIs - 2/1/2010 Latest MDS RUG- III v. 5.12 44 Group Nursing Facility Frequently Asked Questions About PROMISe Preventable Serious Adverse Events for Nursing Facilities 35 Long Term Care Nursing Facility Providers website: Resident Data Reporting Manual (Updated 10/01/2016) Pennsylvania MDS Section S Form and Instructions (Updated 09/13/2012) Pennsylvania MDS Section S Form Effective 10/01/2017 MA Nursing Facility CMI Report Calendar (06/29/2016) Found on the Right side of the main Long Term Care Nursing Facility Provider page: Pennsylvania PASRR Process Rates Supplemental Ventilator Care and Tracheostomy Care Payments 36 12
Important Websites Pennsylvania PASRR Process Website: http://www.dhs.pa.gov/provider/longtermcarecasemixinformatio n/obratraininginformation/index.htm Out of State Process for PASRR http://www.dhs.pa.gov/provider/longtermcarecasemixinfor mation/obratraininginformation/nfcareprocess/index.htm Order MA Forms: http://www.dhs.pa.gov/dhsassets/maforms/index.htm 37 Pennsylvania PASRR Process Website PASRR Forms (available for download only) Level I PASRR Identification Form (MA 376) Level II PASRR Evaluation Form (MA 376.2) Resources for PASRR: PASRR Clarifications, Questions and Answer Document PASRR Bulletins MA376 MA376.2 Handouts for Webinar Training PASRR Level I Tool Form Training Webinar Who to contact for help with the Pennsylvania PASRR process: Field Operations Offices Program Office Contacts State PASRR Coordinator at 717-214-3736 38 Questions? Ruth Anne Barnard, BSN, RN PASRR/MDS/Field Operations Coordinator rbarnard@pa.gov 717-214-3736 Cathy Petko, BSN, RN Senior Manager, Myers and Stauffer LC 717-541-1203 (Office) 717-541 5809 (Helpdesk) cathy@mslc.com 39 13