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Florida User Group Meeting on October 16, 2018

Florida users are welcome to a User Group Meeting being held at 1890 West State Road 436, Suite 295, Winter Park, FL 04210 on October 16, 2018. This is an opportunity for users in the state of Florida to meet and troubleshoot, network, discuss state and regional issues, clarify and learn about the latest Therap releases. We welcome you to join our user group meeting to discuss how Therap will work for individuals receiving services through the Florida Agency for Persons with Disabilities (APD), Agency for Healthcare Administration (AHCA), Florida Developmental Disabilities Council, to name a few. Learn how Florida Intellectual and developmental disabilities providers are using Therap to generate professional claims for Florida Medicaid while complying with Florida’s ADT Billing rules. Therap team members Maureen O’Connell and Tricia Woods will be at hand to answer technical questions and transmit the group’s consensus state needs and requirements to the Therap development team for review. Lunch will be provided for our registered attendees. We look forward to seeing you there!

Click here to register for the meeting!

Therap Supports Alabama Department of Mental Health and Local 310 Boards with Medicaid/TCM Billing

Alabama Providers Implement Therap’s LTSS Software Tools for Targeted Case Management and Early Intervention Services

BIRMINGHAM, Ala., March 8, 2016 /PRNewswire/ — Therap’s disability software is aligned with Alabama’s Division of Developmental Disabilities in their effort to improve quality of Case Management. Therap has previously collaborated with DMH to implement the software’s incident reporting tools across the state. The latest system features include specific tools designed for the use of case managers. Case Managers can record individualized service notes and enter service duration, location and type in Therap. These notes generate professional claims for billable services which are submitted electronically to Alabama Medicaid.

Therap’s Individual Home Page gives Case Managers a general case overview. From a central dashboard, Case Managers can review individual profiles and access demographic, contact and health information, and guidelines. They can also note the status of all plans, including the person-centered Individual Support Plan, supplemental Habilitation, Behavior and Care Plans, and check the case status of individuals on their caseload, including enrollment and discharge dates. Therap’s person-centered Individual Support Planbrings the full picture of supports and outcomes together, and allows case managers to quickly reference goals and individual outcomes statuses. Case Managers may review team plan minutes and create an ISP Agenda to drive meetings based on the needs and areas identified through the individual’s Personal Focus Worksheet. Interconnected modules ensure that service data collected in Therap generates reports and drives the progress of outcomes.

Therap’s Long Term Supports and Services software also assists Early Intervention providers in tracking contacts and service flow. Agencies find Therap’s Individual Data form an essential first step in establishing supports for children identified for early intervention.  Contacts such as doctors, speech pathologists and occupational and physical therapists can be added to universal directories for contact information, while personal contacts and family information can be added to the Individual Data form and Individual History.

About Therap Services

Therap’s HIPAA, ARRA and HITECH compliant Developmental Disabilities software applications are widely used in home and community-based services (HCBS for documentation, communication and reporting and by the broader Longer Term Supports and Services (LTSS) community. Therap offers a single software solution for data driven outcomes, quality assurance, electronic billing.

Learn more at www.TherapServices.net.

SOURCE Therap Services

By |2016-11-03T10:01:43+00:00March 9th, 2016|Categories: General|Tags: , |Comments Off on Therap Supports Alabama Department of Mental Health and Local 310 Boards with Medicaid/TCM Billing

Florida Medicaid Provider Self Audit Resources – Now Available

FLORIDA MEDICAID
A Division of the Agency for Health Care Administration

Florida Medicaid Health Care Alert
July 2015

Provider Self Audit Resources are Now Available on the Agency’s Website

Medicaid providers are encouraged to voluntarily conduct self-audits and remedy any issues of non-compliance that are identified, including either voiding/adjusting improper claims or submitting to the Agency’s Bureau of Medicaid Program Integrity (MPI), the self-audit findings and repayment of the improper claims.

MPI recommended that providers review claims with dates of service as old as five years to the present.  MPI also encourages providers to engage in routine self-audits of more current claims (most recent twelve months).  This allows providers to have the opportunity to remedy the claims before an Agency-initiated audit.  When the Agency conducts an audit, it is entitled to recover the costs of the audit and is required to assess sanctions for the non-compliance.  A provider who conducts a self-audit, submits the results, and remits payment, may avoid sanctions for their voluntary disclosure and repayment of overpayments so long as the Agency determines that the disclosure is valid and so long as it is not discovered to be an attempt to alleviate liability for fraudulent practices.

Information about conducting self-audits is available on the Agency’s website, on the MPI landing page.  Please see the below screen-shot which demonstrates how to navigate from the Agency’s home page to the MPI landing page.

Medicaid providers are encouraged to voluntarily conduct self-audits and remedy any issues of non-compliance that are identified, including either voiding/adjusting improper claims or submitting to the Agency’s Bureau of Medicaid Program Integrity (MPI), the self-audit findings and repayment of the improper claims.

Questions regarding conducting a self-audit may be directed to Pam Fante via email at Pam.Fante@ahca.myflorida.com and please include the question in the email.

By |2016-11-03T10:01:43+00:00August 18th, 2015|Categories: Uncategorized|Tags: , , , , , , , , , , , |Comments Off on Florida Medicaid Provider Self Audit Resources – Now Available

CMS Releases Heightened Scrutiny Guidance for Home and Community Based Services (HCBS) Rules

Washington, DC (June 26, 2015)

The Centers for Medicaid and Medicare Services (CMS) issued guidance on how they intend to address “heightened scrutiny” for settings that are subject to the home and community based services (HCBS) rule that went into effect on March 17, 2014.  The guidance restates the standard for settings that are presumed institutional (located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment, or in a building located on the grounds of, or immediately adjacent to, a public institution).  Additionally, any setting which has the effect of isolating individuals will be presumed to be institutional.  For any of these instances, a state may submit evidence to overcome the presumption and demonstrate how the setting does meet the HCBS standards set forth.  The new rules also offer states the option to develop “tiered standards for residential settings” which will allow states to “close the front door” to some providers while allowing existing providers of the same services to continue.  This means that a state could set one compliant standard for existing providers and set a different, higher standard for new providers.

CMS: New Manged Care and Quality Assurance Standards

The “correct” quality assurance program will always be a question until CMS requires states to standardize their Managed Care processes among MCOs in each state. We all have the opportunity to discuss standardization now, which will not come around again for years. Please see the below information from ANCOR. I encourage people to comment on the CMS proposed rules. CMS Issues

Landmark Proposed Rule on Medicaid Managed Care

On June 1, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule titled “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability.” The agency states that this proposed rule would modernize the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems.

Home care providers will want to be aware that the proposed rule proposes to add a definition for long term care support services (LTSS).  The CMS proposal defines LTSS as “services and supports provided to beneficiaries of all ages who have functional limitations and/or chronic illnesses that have the primary purpose of supporting the ability of the beneficiary to live or work in the setting of their choice, which may include the individual’s home, a provider-owned or controlled residential setting, a nursing facility, or other institutional setting.”  CMS states that they intend for community based services within the scope of this definition to be largely non-medical in nature and focused on functionally supporting people living in the community.  Examples of what CMS would consider community based LTSS include Home- and Community-Based Services (HCBS) delivered through a section 1915(c) waiver, section 1915(i), or section 1915(k) state plan amendments, as well as personal care services otherwise authorized under the state plan.

HCAOA also notes that CMS is seeking to amend the existing regulation requiring each state to establish a credentialing and re-credentialing policy that addresses all the providers, including LTSS providers, covered in their managed care program regardless of the type of service provided by such providers.

Comments on the proposed rule will be accepted through July 27, 2015. A copy of the proposed rule can be found at http://www.regulations.gov/#!documentDetail;D=CMS-2015-0068-0001

Met Life Foundation & UCP Life Without Limits Project

    

MetLife Center for Special Needs Planning has been working with UCP to develop a new campaign creating awareness for people with all disabilities and about living life without limits. As part of their new campaign, they’re asking for people to go directly to the campaigns’ page on Facebook and “Like” the new campaign to generate both interest and awareness for the project. In return, they’ve agreed to give us $2 for every like we raise between now and the end of tonight, up to $25,000.
The link to help out is here: https://www.facebook.com/metlife?fref=nf
As exhibitors and supporters of UCP and our vision for working with people with disabilities, we know you already support the work that we do. It’s wonderful to see large companies taking a stand and publicly working to help people with disabilities, so I’m asking if you could just take a second out of your busy schedules and share this link with everyone you’d know, that’d be wonderful (that is, after you click “Like” yourselves.)

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.

 

 

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.

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.