New Personal Care and Support Coordination Rates for APD providers

New Rates for July 1, 2015

APD announced that effective July 1, 2015, Personal Supports QH, Personal Supports Day, Support Coordination and CDC+ Consultant will all have an increased rate.  Please see the link below for all the new rates.  The changes to the cost plans and budgets will be made electronically and will not require the WSCs to redo any service authorizations and will not require the Regions to re-approve any service authorizations. That is the good news!

1) iBudget will be brought down on July 1st so the changes can be made.  All FY 15-16 cost plans must be in approved status.  Any cost plans that are in draft, or pending review status will have to be deleted by IT and any changes that have been made to those plans will be lost.

2) Please review all cost plans that are Pending Area Office Review for FY 15-16 and get them to approved status as soon as possible.  If the reason for the pending review is due to a rejected service authorization that you are unable to resolve, complete a help desk ticket.

3) State Office staff will be reviewing any cost plans in Pending State Office Review to get them in approved status.

4) If support coordinators have consumers who currently have a FY 15-16 budget, however; they will not have a cost plan built prior to 7/1/15; the support coordinator will need to work with Region staff to get the budgets adjusted manually.  Since those cost plans may or may not come for Region review, they will need to notify you who those consumers are.

5) Please encourage support coordinators to stop making any changes to cost plans after June 28, 2015 unless there is an emergency.  This will give both the Region and State Office staff time to assist with getting all plans into approved status.

14c Subminimum Wage Certificates-Talking Points

FARF-Rework-PRINT-REGSuzanne Sewell, President & CEO , Troy Strawder, Board Chair

On July 22, 2014, President Obama signed the Workforce Innovation and Opportunity Act.  The bill addresses unemployment across the spectrum – from vocational training, resume writing and English as a second language, to laid-off workers, disabled veterans and Americans with disabilities – the legislation casts a wide net through a host of federal government programs.  In terms of Americans with disabilities, the bill is aimed at helping to prepare a new generation of young people with disabilities to succeed in competitive employment and predominantly impacts individuals with disabilities who are 24 years old and younger.  This “new generation” will be required to first try vocational rehabilitation services before they are permitted to work in jobs paying less than the federal minimum wage.  The bill is compatible with Florida’s Employment First Initiative which Florida ARF supports.

Meanwhile, Congressman Gregg Harper of Mississippi is sponsoring the Fair Wages for Workers with Disabilities Act of 2013 (HR 831), that if passed, would phase out 14(c) special wage certificates under the Fair Labor Standards Act of 1938 over a three year period.  The bill has 94 sponsors and additional members of congress are poised to sign on.  In Florida, six members of the congressional delegation have already signed onto the bill – Corrine Brown, Kathy Castor, Ander Crenshaw, Alcee Hastings, Daniel Webster, and Dennis Ross.

Now more than ever, the insights and viewpoints of Floridians with disabilities and their representatives are essential to the policy discussions going on at the national level.  As we know, one size does not fit all.  Many Community Rehabilitation Provider Agencies serve diverse constituencies and it is imperative that we make sure our congressional leaders are provided with a balanced perspective on the concerns and merits of center-based work experiences and 14(c) certificates and the need for more oversight of the programs at the federal levels.  A number of variables play into the current equation including funding mechanisms, appropriate budget allocations and limits to disability compensations making it imperative that our congressional leaders recognize the true complexity of these issues.

We believe employees with disabilities and their representatives are the ones who should explain their experiences and tell their personal stories and that their representatives will hear and understand the complexities of the pending policy issues best when it comes from their own constituents.

Congressional Education Campaign

Florida ARF will be assisting its member agencies and interested parties with a campaign to educate members of the Florida Congressional delegation about the long-term implications of the policy decisions they are currently addressing.  We encourage recipients and community rehabilitation providers to demonstrate real-life examples of how the proposed legislation to phase out 14 (c) would impact Floridians with disabilities in each congressman and woman’s district.

Collecting Authentic, Florida Stories

First and foremost, the campaign will involve telling the stories of employees throughout the state about their experiences in center-based employment environments and 14(c) employment opportunities and what they and their caregivers would be doing if the programs were eliminated.

Even though we support federal legislation and Employment First trends for younger employees with disabilities for youth transitioning out of school, we still need to feature current employees that would not be served outside of their current environments so that every individual with a significant disability has employment options.  Therefore, we have developed a form to help your staff document the unique stories of the individuals they serve who receive 14 (c) subminimum wages.

Developing the Packet and Case Statement

With collaboration and final approval from each participating agency, staff will develop a packet of the top stories.  The packet will also include white papers from appropriate sources, a Florida ARF position paper, and other relevant materials developed in collaboration with staff from a member agency.

Schedule Visits to Congressional District Offices

The Florida ARF Grassroots webpage contains information on how to set up Congressional appointments and a link to each US Senator and Representative serving Florida.  Whenever possible, these visits should include employees with disabilities, their families, and other stakeholders on the scheduled visit to the congressional office.  Remember, the purpose of the visit is to ensure that each congressional office hears directly from the community that will be impacted by the pending policy changes and what repercussions it will have on both the employee and the employee’s caregivers’ quality of life.

Let’s make a difference nationally and empower all Floridians with disabilities to validate the current merits of their employment!

Home and Community-Based Services Settings Rule Training Sessions

Florida Medicaid Health Care Alert
July 2014

Provider Type(s): 05, 67, and 76
Home and Community-Based Services Settings Rule Training Sessions
The Agency for Health Care Administration (Agency) will conduct regular training session for individuals, providers and interested stakeholders on the federal Home and Community-Based Settings Rule.
The Agency has scheduled a session for:

Tuesday, July 15, 2:00 pm ET
To join the training session

1. Call-in toll-free number: 1-888-670-3525 (US) then enter attendee access code: 250 928 7551 #
2. Click on this link: Home and Community Based Settings Rule and Transition Planning.

3. Enter your name and email address.
4. Enter the session password: This session does not require a password.
5. Click “Join Now”.
6. Follow the instructions that appear on your screen.

For further information, please visithttp://ahca.myflorida.com/Medicaid/hcbs_waivers/index.shtml or contact Sophia Whaley at

1 (850) 412-4284 or email .Sophia.Whaley@ahca.myflorida.com

HCBS Settings Rule

In March 2014 the Centers for Medicare and Medicaid Services (CMS) issued a final rule for home and community based programs. The rule requires the Agency to provide an opportunity for the public to comment on substantive changes to home and community based service waiver programs and to ensure persons who receive Medicaid home and community based services do so in and environment, and from providers who:

  • Involve them in the care planning process;
  • Help them to be active in the community;
  • Provide a home-like environment if a person lives in a group home, assisted living facility or adult family care home; and
  • Enable them to make personal choices.

We have developed a preliminary transition plan detailing the steps to be taken to implement the new rule.  The preliminary transition plan contains the following information:

  • An overview of the federal rule;
  • Planned transition activities;
  • A timeline for when the comprehensive transition plan will be developed;
  • Impending waiver amendments and renewals; and
  • Details on the public comment process.

The final comprehensive transition plan will be available for public comment in the fall of 2014.

The preliminary transition plan is available for public comment from June 25th 2014 until July 25th 2014. Comments within this time period may be sent to:

FLMedicaidWaivers@ahca.myflorida.com
OR
Agency for Health Care Administration
Attention: HCBS Waivers
2727 Mahan Drive, MS#20
Tallahassee, FL, 32308

Therap Services Announces U.S. Patent Issuance for Secure Electronic Reporting of Abuse or Neglect for I/DD Provider Agencies

WATERBURY, Conn., June 18, 2014 /PRNewswire/ — Therap Services, leader in electronic documentation software for Intellectual Disability and Developmental Disability Service Providers, has received U.S. Government Patent No. 8,739,253 B2 for Managing Secure Sharing of Private Information Pertaining to Abuse or Neglect Across Security Domains on May 27, 2014.

Justin Brockie, Therap Services COO, states: “The award of this patent again confirms Therap’s status as the software leader in the intellectual disability community.  States and providers using Therap have shown the benefits of our approach to secure transparency and real time sharing.  These approaches can have a direct impact on the systems that support people with disabilities and prevent abuse, neglect and exploitation.”

Therap’s patented application for secure sharing of private information pertaining to abuse or neglect includes granting a staff user from one agency (such as an Oversight Agency) the ability to access private information stored within a secondary Provider Agency account when access authorization is in place through assigned caseloads and permissions. This method ensures that staff members are able to securely access private information based on ‘need to know’.

Therap Services applications and certified Electronic Health Record (EHR) provide the documentation components needed by Intellectual Disability and Developmental Disability Service Agencies to maintain their focus while adapting to a changing environment within the Human Services industry.  State and federal agencies and standards, including CMS and HIPAA, mandate strict requirements on accurately tracking incidents, including those reports of abuse and neglect and prevention of Medicaid fraud. Therap’s customers can complete and monitor documentation efficiently across secure domains, enabling them to focus on providing higher quality services to individuals with intellectual and developmental disabilities.

Therap’s applications are utilized across disciplines in the I/DD field per the CMS home and community-based services (HCBS) requirements. Therap applications include over 70 modules ranging from documentation of service provision through a daily note, to person centered planning tools, incident report management, health assessments and individual care plans, an electronic MAR integrated with an industry-standard drug database, an individual referral process for state and multi-provider systems, a comprehensive report library for internal and external audits, to electronic billing direct to Medicaid through a secure, HIPAA 5010-compliant method.

About Therap Services, LLC

Therap Services’ certified EHR and documentation software solution are utilized by over 220,000 users in 1300 Intellectual Disability and Developmental Disability Provider Agencies. Use of Therap Services is mandated by 5 state governments. Therap’s software solution is used in home and community-based services (HCBS), intermediate care facilities for the developmentally disabled (ICF-DD) and other settings to document waiver service provision, employment supports, case management, incident reporting, management of staff training records and for electronic billing claim submissions directly to Medicaid. Therap Services is HIPAA OMNIBUS ACT of 2013 compliant. Learn more at www.therapservices.net.

 

 

South Carolina Providers meet In Myrtle Beach

Last week, February 1oth, 2014 the SC Human Services Providers Association met in Myrtle Beach.  The opener on 2/10 included a Therap User Group session for South Carolina Therap Users.  Chelsea Newby, Training and Implementation Specialist with Therap was there to share her knowledge and answer questions.  It was great to have staff participate from  UCP of South Carolina, Colleton County DSN Board, Georgetown DSN Board, Verizon Wireless and others.

The Conference had an Opening Plenary Session with Dr. Beverly Buscemi, DDSN State Director who shared the state of the state!

The Conference ended a day early due to winter weather coming to South Carolina for the next couple of days.   This turned out to be a very good decision South Carolina was in a State of Emergency for the following 3 days due to ice and very dangerous road conditions.

We left Myrtle Beach at Noon and by 2:30 the Highway 20 & 77 around Columbia were covered in snow and sleet.  By the time we got to Fort mill, we had winter weather and quite a snow storm for the south over the following 24 hours.

Here is what we had coming down the next morning!

 

 

AHCA Alert-ABA for Children under 21

Florida Agency for Health Care Administration

Better Health Care for All Floridians

 

FLORIDA MEDICAID
A Division of the Agency for Health Care Administration

Florida Medicaid Health Care Alert
January 2014


Provider Type(s): 07, 16, 25, 26, 67, 68, 70, 71, 72, 77, 91

Revised Alert for Developmental Disabilities Home and Community Medicaid Waiver Providers:  Medicaid Coverage and Prior Authorization of Applied Behavior Analysis for Children Under 21 with Autism Spectrum Disorder

This alert includes information for Developmental Disabilities Home and Community Medicaid waiver providers. Information for other qualified provider types can be found in the applicable provider alert. This revised alert supersedes the information specific to Developmental Disabilities Home and Community Medicaid waiver providers in previous alerts posted on 4/2/12, 4/17/12, 5/17/12, 6/15/12, 7/6/12, and 9/6/12.

This alert describes provider qualifications, recipient eligibility criteria, the prior authorization request process, service codes and reimbursement rates, the billing process, place of service codes, and instructions for managed care plans. These services require prior authorization.

Provider Qualifications:

ABA services described in this alert must be rendered by Certified behavior analyst (CBA) and certified associate behavior assistant (CABA) providers who meet the qualifications outlined in 65G-4.003 of the Florida Administrative Code, are enrolled as Medicaid waiver providers through the Developmental Disabilities Home and Community Medicaid waiver programs and have received prior authorization from Medicaid for the service.

Recipient Eligibility Criteria:

Qualified treating practitioners may render medically necessary ABA to children under 21 years old having any of the following ICD-9 diagnosis codes:  299, 299.0, 299.00, 299.01, 299.1, 299.10, 299.11, 299.8, 299.80, 299.81, 299.9, 299.90, or 299.91.

Prior Authorization Request Process:

ABA services must be prior approved by Medicaid.  If a physician determines that a Medicaid eligible child diagnosed with an autism spectrum disorder needs Applied Behavior Analysis (ABA), the provider must submit a request to the Medicaid area office. The following information must be included:

  1. Recipient name, date of birth, Medicaid ID, and current mailing address.
  2. Requesting provider name, national provider identifier, address, and telephone and fax numbers.
  3. Diagnosis of recipient and diagnosis code.
  4. If already assessed, expected duration of ABA treatment.
  5. The primary focus of ABA treatment.
  6. Medical records that document the diagnosis of autism spectrum disorder.

An optional form for this purpose is available online at the Child Health Check-Up web page. This optional prior authorization form has been revised effective January 10, 2014.Prior authorization documentation as described above must be submitted to the recipient’s Medicaid area office. Contact information for the area offices can be found on the Public Provider Web Portal.

Service Codes and Reimbursement Rates:

Instructions for Developmental Disability Waiver Providers
to Bill Fee-For-Service for Non-Waiver Recipients

ABA services must be prior approved by Medicaid. Providers should consult the Medicaid Developmental Disabilities Waiver Services Coverage and Limitations Handbook for provider qualifications and documentation requirements (requirements for review of documentation by a Local Review Committee and submission of documentation to the waiver support coordinator do not apply). Billing for ABA services in a group setting is not allowable. A total of up to 160 quarter-hour units per week of combined service may be authorized. Eligible service codes and rates of reimbursement for Applied Behavior Analysis services are:

Description of
Service

Procedure
Code

Modifier
1

Modifier
2

Rate

Limits

Assessment Services
Behavior Analysis Assessment for Autism

H2020

UD

$299.85 per assessment

One assessment per state fiscal year

Treatment Services
Behavior Analysis Level 1 for Autism

H2019

UD

HP

$19.05 per quarter hour

Maximum combined daily limit of up to 32 quarter-hour units
Maximum combined weekly limit up to 160 quarter-hour units of all treatment services

Behavior Analysis Level 2 for Autism

H2019

UD

HO

$16.64 per quarter hour

Behavior Analysis Level 3 for Autism

H2019

UD

HN

$10.35 per quarter hour

Behavior Assistant Services for Autism

H2019

UD

HM

$4.31 per quarter hour

 Instructions for Developmental Disability Waiver Providers
for Waiver Recipients

Scenario Coverage
Existing DD waiver recipient receives ABA waiver services APD continues to cover these ABA hours through the waiver.
Existing DD waiver recipient receives ABA waiver services but requests an increase in services APD reviews the request to determine if additional hours are medically necessary. If yes, then APD will cover the additional hours through the waiver. If no, then the recipient may request authorization to receive ABA through the state plan.
Existing DD waiver recipient, who does not receive ABA services, requests ABA APD reviews the request to determine if additional hours are medically necessary. If yes, then APD will cover the service through the waiver. If no, then the recipient may request authorization to receive ABA through the state plan.
Individual on the DD waiver waiting list who is Medicaid eligible applies for the waiver through the crisis process. ABA is one of the identified service needs. APD will refer the individual to the ABA state plan authorization process for coverage of ABA.
Individual on the DD waiver waiting list who is Medicaid eligible and requests ABA services. APD will refer the individual to the ABA state plan authorization process for coverage of ABA.

Billing Process:

To bill for the services, providers must submit claims in accordance with the Provider Reimbursement Handbook, CMS-1500 located on the Provider Handbook page of the Public Provider Web Portal. All claims for ABA services for children with autism spectrum disorders must be billed fee-for-service, even for those recipients enrolled in a Medicaid managed care plan. When billing for services for treatment of autism spectrum disorders, the claim must include one of the following primary diagnoses: 299, 299.0, 299.00, 299.01, 299.1, 299.10, 299.11, 299.8, 299.80, 299.81, 299.9, 299.90, or 299.91. Enter “1” for the diagnosis code reference number (pointer) to relate the procedures performed to the primary diagnosis.

Billing is allowed for dates of service beginning with the date of prior authorization.

DO NOT SEND any attachments or medical records to the Medicaid fiscal agent with the CMS-1500 claim form. Regardless of place or dates of service, attachments for Applied Behavior Analysis are not required. All CMS-1500 claims for Applied Behavior Analysis services for children with autism spectrum disorders will be processed per these instructions.

Place of Service Codes:

Services must be billed using the correct place of service code for the location of the service provided. These services may be provided in the provider’s office, the recipient’s place of residence or anywhere in the community. However, in all cases, behavior analysis services must also be provided in the setting(s) relevant to the behavior problems being addressed.

The following place of service codes should be used by DD Waiver Providers when submitting claims (see page 2-22 of the Developmental Disabilities Waiver Services Coverage and Limitations Handbook):

11 – Office
12 – Home
13 – Assisted Living Facility
14 – Group Home
49 – Independent Clinic
53 – Community Mental Health Center
99 – Other Place of Service

Place of service code “99 – Other Place of Service” is not acceptable except for unusual circumstances that are documented in the recipient’s treatment or service plan, or in the recipient’s treatment notes.Medicaid will monitor providers who frequently utilize place of service code 99.

Instructions for Managed Care Plans:

Managed care plans are not currently required to authorize or cover Applied Behavior Analysis Services for the treatment of autism spectrum disorders. If a child enrolled in a Medicaid managed care plan requires ABA services, the plan may refer the recipient to any of the identified qualifying providers to receive the service under Medicaid fee-for-service. Alternatively, the managed care plan may refer the recipient to the Medicaid area office for assistance with finding a qualified provider. Managed care plans must share information on how to access ABA services with their contracted community behavioral health and physician providers.

Other Key Information:

For questions, contact your local Medicaid area office. Contact information for the area offices can be found on the Public Provider Web Portal.

 


 

LINKS

Florida Medicaid Web Portal | Florida Medicaid Health Information Network | Florida Medicaid HIPAA Information | HIPAA Transactions & Code Sets Standard | National Provider Identifier Standard (NPI) | Florida Medicaid EHR Incentive Program | FloridaHealthFinder.gov


QUESTIONS ABOUT FLORIDA MEDICAID?

Please direct questions about Medicaid policies to your local Medicaid area office. The Medicaid area offices’ addresses and phone numbers are available on the Area Offices Web page.


ALERTS INFORMATION

The Florida Medicaid program has created an e-mail alert system to supplement the present method of receiving Provider Alerts information and to alert registered subscribers of “late-breaking” health care information. An e-mail will be delivered to your mailbox when Medicaid policy clarifications or other health care information is available that is appropriate for your selected area and provider type.

Visit the Florida Medicaid’s Health Care Alerts page to subscribe now. You may unsubscribe or update your subscription at any time by clicking on the “Manage your subscription” icon in the footer of each e-mail. Other questions regarding the e-mail alert system can be sent to the Florida Medicaid Alerts Administrator.

 

© 2014 Agency for Health Care Administration

 

 

This message was sent from Florida Agency for Health Care Administration tocswilley@floridaarf.org. It was sent from: Florida Agency for Health Care Administration, 2727 Mahan Drive Tallahassee, FL 32308. You can modify/update your subscription via the link below.

Therap Services Receives CCHIT Federal Certification

 

Logo of CCHIT

Certification Facts™

Therap Services, LLC.
Therap Services EHR 2013.2.8

Long Term and Post Acute Care EHR

This product has been inspected against integrated functionality, interoperability and security criteria independently developed by CCHIT’s broadly representative, expert work groups. Using CCHIT’s testing methods, this product has been found in full compliance with the criteria in effect on the date of inspection.

 

©2012 Inspected and certified by the Certification Commission for Health Information Technology (CCHIT®).

 

About Therap Services EHR
Therap Services was designed to help care providers record and maintain documentation for people with developmental disabilities. It is the needs of the Individuals and caregivers that together drive Therap’s product development. This has led to a comprehensive range of applications to document almost every aspect of Individual care. Over the years, Therap has become the recognized national leader in providing a web based, HIPAA compliant, Commercial-off-the-Shelf (COTS) Software as a Service (SaaS) application suite designed specifically for the intellectual and developmental disability community that address: – Electronic Health Records – Incident Reporting – Individual Profiles – Medicaid Billing – Medication Administration – Documentation and Reporting – Quality Assurance Everyday people are logging in from thousands of facilities, programs and community based locations to enter information on approximately 150,000 Individuals. Therap is programmed to be usable “out of the box” but also configurable to meet state regulations, requirements, and workflows. Using Therap’s Individual specific modules, agencies can create care plans and medication profiles for each Individual. Therap stores external documents including Referral Documents, Admission Orders, Authorization, Consultation Reports, Discharge Orders, Incident Reports, Progress Notes and Lab Results. Therap also works with Medicaid Waiver Provider Agencies operating community based programs and providers who operate ICF/DD programs and wish to track Service Authorizations and Electronic 837P/837I claims.Product URL: https://www.therapservices.net/products/
About Therap Services, LLC.Therap Services, LLC. is a web-based service organization that provides an integrated solution for documentation, reporting and communication needs of agencies providing support to people with developmental disabilities. Therap applications, forms and modules are HIPAA compliant. Therap offers services to care providers in the ID/DD field which is an alternative solution to completing immense amounts of paperwork manually. Therap has expanded to over 47 states in the United States and provinces in Canada. In North Dakota, Nebraska, New Mexico, Delaware and Montana, all provider agencies are mandated to use Therap applications. Therap provides state specific functionality, support and training materials for users in different states. Therap’s patented technology (US Patent# 8,281,370) for managing secure sharing of private information across security domain guarantees that users can communicate effectively in a HIPAA compliant manner. The use of Therap Applications enables providers to efficiently share and communicate Protected Health Information (PHI) in real time. Therap maintains high-end, industrial-strength equipment and infrastructure software with redundancy of devices and system components and managed parallel communications access. Therap also conducts scheduled backups with offsite storage. Therap thrives to meet and exceed the need of the ID/DD community with their commitment to service availability and data security through a highly redundant set of hardware and software.
Vendor Phone: 203-568-1360

Non-Profit to Pay $50,000 for HIPAA Violation

Idaho Non-Profit Agrees to Pay $50,000 for HIPAA Violation

By Carlton Purvis

01/03/2013 –Picture of Security ManagementIn a first of its kind settlement, a non-profit medical facility in Idaho will pay the U.S. Department of Health and Human Services (HHS) $50,000 for HIPAA violations surrounding potential exposure of patient information.

The settlement is the first involving a breach of electronic protected health information affecting fewer than 500 individuals.

“This action sends a strong message to the health care industry that, regardless of size, covered entities must take action and will be held accountable for safeguarding their patients’ health information.” said OCR Director Leon Rodriguez in an HHS press release published Wednesday.

In February 2010, Hospice of North Idaho (HONI) reported to HHS that an unencrypted laptop containing information on 441 patients was stolen from inside an employee’s car.

An OCR investigation found that HONI had no policies or procedures in regard to mobile device security as required by HIPAA. Additionally, HONI had never done any type of electronic protected health information risk analysis.

The laptop was never recovered.

When a breach impacts more than 500 individuals, companies are required tonotify all major media outlets in their state, as well as the government. A notice is included on the Department of Health and Human Services Web site in accordance with the Health Information Technology for Economic and Clinical Health (HITECH) Act.

For breaches that affect fewer than 500 people, organizations keep a log that is turned in to the Secretary of Health and Human Services annually.

In addition to the fine, the December 28th agreement includes a two-year corrective action plan that mandates that the facility immediately report any future breaches to HHS.

“The theft of the laptop was out of our hands, but the measures we have taken since then to ensure the security and privacy of our patients’ information have been numerous,” Brenda Wild, Hospice of North Idaho Board President said in a written statement.

Since the incident, the facility has increased security on any equipment that contains patient information, including encryption and increased password protection, and scheduled security training.

HONI’s staff of more than 100 people is North Idaho’s only inpatient hospice facility. The organization serves members of the community regardless of their ability to pay.

MeckLINK to go to Cardinal

Mecklenburg to turn over MeckLINK, fed money

Posted: Wednesday, Oct. 30, 2013
 Mecklenburg County will abandon an idea to create its own authority to govern MeckLINK Behavioral Healthcare and the millions of dollars in federal Medicaid money it uses to provide mental health services.

Instead, a MeckLINK committee of four county commissioners is set to recommend to the full board next Tuesday that the county negotiate the best deal possible to turn over the program to Kannapolis-based Cardinal Innovations Healthcare Solutions. That would effectively dissolve MeckLINK and send Cardinal nearly $200 million in Medicaid funding that county uses each year for services to 120,000 patients.

It was clear from the committee’s Tuesday meeting that board members have all but given up the fight to keep MeckLINK and want to negotiate what is best for the consumers and providers – and MeckLINK’s 200 employees. Committee members were clear in what they want the county to get in the negotiations.

Those wishes include:

• A “proportionate” representation on the Cardinal board to give Mecklenburg a significant say in how its Medicaid money is used. The 15-county Cardinal oversees services for 187,000 consumers, compared with MeckLINK’s 120,000.

• Cardinal reimbursing at least some of the money Mecklenburg has sunk into MeckLINK. The county has spent $8.4 million to get the agency running and continues to pay $90,000 in monthly operating costs. Assistant County Manager Michelle Lancaster said in conversations with Cardinal CEO Pam Shipman that Shipman wasn’t against some level of payback.

Dena Diorio, also an assistant county manager, told the committee that MeckLINK’s reserve fund of as much as $4.5 million would be retained, possibly lowering the reimbursement request.

• Cardinal hiring MeckLINK employees who are “in good standing for positions they would want to hire” and MeckLINK consumers being able to keep the same providers if they choose.

In late December, the predecessor to N.C. Health and Human Services Secretary Aldona Wos tried to reassign MeckLINK to Cardinal. But after Mecklenburg threatened to sue, Wos allowed the county to continue operating – and governing – MeckLINK.

But in June, state legislators passed a law that forced the agency to operate under a single-county, independent authority or merge with an already existing multi-county authority by April 1.

For weeks, relatives of consumers and many providers have urged the county to pursue a single-county authority. In the end, commissioners said it would be too costly.

Commissioner Trevor Fuller, who chairs the committee, said he believes Mecklenburg has leverage to use in the negotiations. “We do have something they want,” Fuller said. “They want these people (the 120,000 consumers), and they want the ability to manage that amount of money.”

The new law requires county commissions in each of the authority’s counties to approve how Cardinal appoints its board. If Mecklenburg doesn’t approve the method, the authority wouldn’t comply with the law. “They would need our approval to do what they want to do,” Fuller said.

County Attorney Marvin Bethune told the committee that Mecklenburg could simply walk away from MeckLINK and tell the state “we’re terminating our contract on March 31. We’re not doing anything more – do what you want to do.”

That option didn’t seem to get much support from committee members. But “it is an option,” Fuller said. “We certainly can’t allow ourselves to be put in a position where get completely run over. So as a last resort, we can say, ‘fine, you want it, you manage all the issues, you pay for all the transition. Don’t ask us for anything.’

“But that gets messy.”

Still, he said, the county could use that threat to get state help with the negotiations. “If Cardinal is recalcitrant, we will need the state to control them a little,” Fuller said.

Lancaster said Shipman told her that Cardinal could transition MeckLINK within 120 days after a deal is sealed.

“The clock’s ticking,” said commissioner Bill James, a committee member.

Before the committee takes its recommendations to the full board on Tuesday, it wants to meet on Monday with Wos, Cardinal CEO Shipman and her board chair, and Rep. Nelson Dollar of Wake County, a key author of the law requiring MeckLINK to be governed by an authority.

“We want to hear from the secretary and Rep. Dollar what their vision is for what they’re trying to accomplish,” Fuller said. “And we want to have a conversation with (Cardinal officials) about how to get to where we need to be. We need some beginnings of commitment.

“We have looked at all the options, and are trying to do the best we can in a bad situation.”

Perlmutt: 704-358-5061
Read more here: http://www.charlotteobserver.com/2013/10/29/4425126/mecklenburg-to-turn-over-mecklink.html#.UnFMBfnrwh9#storylink=cpy

Florida AHCA Alert: ADT Daily Billing

 

Better Health Care for All Floridians

FLORIDA MEDICAID
A Division of the Agency for Health Care Administration

Florida Medicaid Health Care Alert
   September 2013


Provider Type(s): 67,  096,  098

Update to Billing Instruction Reminder

Developmental Disabilities iBudget Providers should bill according to the Individual Budgeting Waivers Provider Rate Tables.  For example, providers billing for services under procedure codes T2021UC or S5102UC must use hourly units of services, up to a maximum of 8 units per day.

Please disregard recent instructions regarding situations when the same number of units of service is provided daily on consecutive days, and completion of the date span using the “From—To Dates” dates of service.

A new claim line must be used for each day.

Please contact your local Medicaid Area Office for assistance with billing issues. Contact information for your local Medicaid Area Office may be found at http://mymedicaid-florida.com.

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