Transcript NURSING HOME SPANS & MITS

NURSING HOME
SPANS & MITS
CDJFS Training 08/03/11
WELCOME
It’s a partnership…
LTCF Claim Representatives

Julie Davis, Policy/Operations Liaison

Lisa Rasmussen, LTC Payment Unit
Supervisor

Lakeisha Yawn, Direct Bill Manager (Direct
NF claim problems to [email protected])
Goals for NH Span Review:
 To
review the importance of the NH
spans
 To
explain how MITS changes make
NH spans even more important
JFS 09401
LTCFs (NFs & ICFs-MR) are required* to use
the JFS 9401 (Facility CDJFS Transmittal) for
reporting the following to CDJFS:
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*
LTCF admissions
LTCF discharges (including deaths)
Medicaid Hospice enrollment
OAC rule 5101:3-3-39
JFS 09401
A completed 9401 is to be returned to the
LTCF within 10 days to communicate:
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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
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)

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.
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
Helpful Hints
from 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.
Sending JFS 9401 to ODJFS
LTC Payment Unit
FAX to: 614-995-5959
Mail to: Long Term Care Payment Unit
P.O. Box 182379
Columbus, OH 43215
NH Spans in MITS
The NH Span in MITS lives in the
Recipient Subsystem and is called:
LTCF Payment Authorization Panel
Uses of NH Spans in MITS

For creation/generation of ICF-MR claims/payment for ICFMR residents
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To verify appropriateness of LTCF payments*
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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
LTCF Services & NH Spans
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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.
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.
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.
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.
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.
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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…
Waiver & CRIS-E
(New in MITS)
 LTCF
providers will use the new
Revenue Center Code 160 when
billing for waiver consumers in shortterm NF stays.
Waiver & CRIS-E

For waiver consumers in short-term NF
stays:
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 LTCFs
will still report the admission and
discharge using the JFS 9401.
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 CDJFS
will reference the short-term NF stay
in the CLRC notes.
Contact For NH Span Issues
LTC Payment Unit
614-466-7575
THANK YOU
FOR YOUR
PARTICIPATION!
QUESTIONS??