MHTL 3345-10-01 (Disallowance of Separate Reimbursement for Blood-Glucose Testing in a Long-Term Care Setting)

Medicaid Handbook Transmittal Letter (MHTL) No. 3345-10-01

November 22, 2010

TO:                  Long-term care facilities

Independent laboratories

Other providers of laboratory services

Trading partners

Directors, County Departments of Job and Family Services

FROM:           Douglas E. Lumpkin, Director

SUBJECT:     Disallowance of separate reimbursement for blood-glucose testing in a long-term care setting

Policy Statement

Under current administrative rules governing laboratory tests, claims that are submitted to Medicaid by a long-term care facility (LTCF) for drawing blood specimens and for performing routine procedures are not separately reimbursable. Paragraph (B) of rule 5101:3-3-19 and paragraph (B) of rule 5101:3-3-19.1 of the Ohio Administrative Code specify that "costs incurred [by a long-term care facility]...for drawing specimens and forwarding specimens to a laboratory...are reimbursable through the facility's cost report" (i.e., payment is included in the facility's per diem amount). Paragraph (K)(1)(b) of rule 5101:3-11-03 of the Ohio Administrative Code states that "routine laboratory and screening procedures" are not reimbursable at all.

It is the policy of Ohio Medicaid that blood-glucose testing performed for a resident of a LTCF is a routine laboratory screening procedure. Therefore, it is not separately reimbursable to either LTCFs or independent laboratories. (Applicable procedure codes include but are not necessarily limited to CPT 36416 for taking a blood sample and CPT 82948 and 82962 for performing the analysis.)

Accordingly, neither LTCFs nor independent laboratories may submit claims for blood-glucose testing performed for LTCF residents. Even if the Medicaid claims-processing system should accept them, such claims are disallowed by policy. Any resulting reimbursement is subject to recovery.

Access to Rules and Related Material

The Ohio Department of Job and Family Services maintains an "electronic manuals" web page of the department's rules, manuals, letters, forms, and handbooks. The URL for this "eManuals" page is http://emanuals.odjfs.state.oh.us/emanuals/.

From the "eManuals" page, providers may view documents online by following these steps:

(1)       Select the 'Ohio Health Plans - Provider' folder.

(2)       Select the appropriate subfolder (e.g., 'Laboratory Services').

(3)       Select the appropriate topic (e.g., 'Laboratory Rules' or 'Medicaid Handbook Transmittal Letters') from the document list.

(4)       Select the desired item from the 'Table of Contents' pull-down menu.

The Legal/Policy Central - Calendar web site ( http://www.odjfs.state.oh.us/lpc/calendar/ ) is a quick reference for finding documents that have recently been published. This site includes a link to a separate web page ( http://www.odjfs.state.oh.us/lpc/mtl/ ) that displays a list of ODJFS manual transmittal letters. The list is categorized by subject and transmittal letter number, and each item is linked to an easy-print version in Portable Document Format (PDF).

Additional Information

Questions pertaining to this MHTL should be addressed to:

Office of Ohio Health Plans

Bureau of Provider Services

P.O. Box 1461

Columbus, OH 43216-1461

(800) 686-1516