Continuing Care Industry Updates — January 2007

Adminastar Federal has changed their name to National Government Services

Effective January 1, 2007, AdminaStar Federal will become National Government Services. This will combine AdminaStar Federal, Associated Hospital Service, Anthem Health Plans of New Hampshire, Inc., Empire Medicare Services and United Government Services. This is in an effort to consolidate services and to provide better customer service to beneficiaries and providers. According to Kathy Guran, the qualifications to file a low utilization December 31, 2006, Medicare cost report will not change from last year.

Medicare Bad Debt

Effective for cost reporting periods starting on or after October 1, 2005, providers will only be reimbursed 70% for bad debt patients that are not dual eligible. Dual eligible patients are still reimbursed at 100%. In addition, a majority of facilities have been receiving a “PIP payment” from the intermediary. For reconciliation of these payments in 2006 there is a pro-rated amount to consider for payments received on January 16, 2006 and payments received on January 15, 2007. For PIP payments received on January 16, 2006, .14286 should be applied to the 2006 payment reconciliation and for payments received on January 15, 2007, .92857 should be applied to the 2006 payment reconciliation.

Medicaid Cost Reporting Issues

Chart of Accounts
Updates to the State of Ohio CY06 cost report and chart of accounts are being finalized. Please find the attached updates that we are aware of. This may cause providers to change their internal grouping of accounts. The intended final release date for the cost report software is January 31, 2007.

Quality Points
There will be one additional quality point based upon your scores from the Nursing Home Family Satisfaction Survey. You can find your results at www.ltcohio.org/consumer/index.asp. Here you will see survey results regarding two questions: Would you recommend this facility to others? And overall, do you like this facility? We believe to earn a quality point your facility needs to have a score of 91% or greater for the second question. Also, if there is not a score indicated or states Too Few Respondents, we believe you will not earn a quality point. If you have questions about your facility results, please contact Ohio Department of Health at 614.466.7217.

In addition to resident satisfaction scores, the cost report generates four other possible quality points: Overall Census, Medicaid Utilization, Nurse Staffing, and Employee Retention. Therefore, we believe cost report schedules attachment 6 (wage and hour survey) and attachment 8 (employee retention rate) have become very important and require more attention. Based upon 2005 cost reports, the statewide averages to exceed were as follows: