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Less than a Month Remaining for the Regional Workshop in Kentucky and Tennessee

Did you know?

The regional workshop in Kentucky and Tennessee is less than a month away! The workshop is scheduled to take place on September 24-25, 2019 at the Hilton Garden Inn Bowling Green hotel. This workshop is going to be two days full of sessions by Kentucky and Tennessee Therap experts and it will give you a chance to network with your counterparts from across the state. Our Therap experts Tricia Woods, Marie Roland, Jason Laws, Milagros Mimi Roche, and Katy Head will be leading the workshop.

The event will be a good place to learn about recent developments in the Therap system, as well as individual support documentation and reporting, electronic health records (EHR) and training management from the technology leader in the developmental disabilities field. The training intensive event will include beginner, intermediate, and advanced level sessions conducted by Therap experts on various Therap modules.

The discussion will include:

  • Therap Basics
  • Therap’s Health Tracking/Nursing module
  • Scheduling/Electronic Visit Verification
  • Therap’s Employment History module
  • BI for Demographics/GERs/Health Tracking/Billing Data

Click here to register for the workshop.

Visit our state pages to know more on what Therap has in store for the users in Kentucky and Tennessee.

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.

Update – Change in Meeting Date: Provider Training: Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services

FLORIDA MEDICAID
A Division of the Agency for Health Care Administration

Health Care Alerts & Provider Alerts Messages
    May 2013


Provider Type(s): 05, 07, 16, 25, 26, 67, 68, 70, 71, 72, 77, 81 and 91  

Update – Change in Meeting Date
Provider Training: Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services

Provider training on “Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services” will be held on the dates and times listed below.  We will  provide guidance about Florida Medicaid policy for Applied Behavior Analysis services,  the prior authorization request process, and information  about service codes, reimbursement rates, and billing process.

This training session will be offered on Friday, May 17, 2013, at 10:00 a.m.ET and again onThursdayMay 30, 2013 at 1:00 p.m.ET.

To join the webinar on Friday, May 17, 2013, at 10:00 a.m., ET, please:

1. Dial: 1 (888) 670-3525 and at the prompt enter the Participant passcode 633 897 8710 then #

2. Go to: to

https://suncom.webex.com/suncom/k2/j.php?ED=178258682&UID=1372369707&HMAC=17138155dc0a0e0ce30ae5cdc38628fe18e8bbc3&RT=MiMxMQ%3D%3D

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.

You don’t need to register or reserve space; just call and log-in at the designated time. The training will follow a PowerPoint presentation found at the Florida Medicaid Provider Training e-Library website.

To download the presentation to view during the webinar, please click on the “Upcoming Training and Schedules” tab, then right click on the hyperlink for the Training Presentation, choose “Save Target As…” and save a copy of the presentation to your computer.  You may also click on the hyperlink for the training presentation and view it online.

If you have any questions about the webinar, please contact elibrarytraining@ahca.myflorida.com

To join the webinar on ThursdayMay 30, 2013 at 1:00 p.m., ET, please:

1. Dial: 1 (888) 670-3525 and at the prompt enter the Participant passcode 633 897 8710 then #

2. Go to: to

https://suncom.webex.com/suncom/k2/j.php?ED=178259457&UID=1372378112&HMAC=f08e088d2d4644a1592020a7ec3b9137b4be3acc&RT=MiMxMQ%3D%3D

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.
You don’t need to register or reserve space; just call and log-in at the designated time. The training will follow a PowerPoint presentation found at the Florida Medicaid Provider Training e-Library website.

To download the presentation to view during the webinar, please click on the “Upcoming Training and Schedules” tab, then right click on the hyperlink for the Training Presentation, choose “Save Target As…” and save a copy of the presentation to your computer.  You may also click on the hyperlink for the training presentation and view it online.

If you have any questions about the webinar, please contact elibrarytraining@ahca.myflorida.com.

 

Florida Regional Conference – A Success!

For two days, December 4th & 5th, over 100 attendees and a Therap Team of 6 came together in West Palm Beach Florida to share a common Thread: THERAP!

The opening Plenary on Day 1 welcomed all that came from across Florida and even a couple of folks from Georgia!

Florida Regional Conference Pic 1 Florida Regional Conference Pic 2

Therap’s new Training and Support Specialist for Florida, Chelsea Newby was introduced as well as Brie Nihan, Billing Specialist who just started last week and is working with Mr. Jim Kelley, Therap Vice Chairman to support our Billing customers.  Seasoned trainers, Stacey Kernisan and Leah Marshall, were also present to support and provide training sessions throughout the two day conference.

The feedback was as excellent as our weather and the hotel staff at the West Palm Beach Airport Holiday Inn did a stellar job in supporting our conference.  Not to mention our appetites as the food was quite delicious!

We really enjoyed seeing our Therap Customers as well as new ones and those who came to learn more.

Thank you all who participated in making this an excellent experience for all of us!

I hope to see many of you in East Hanover, New Jersey at the Theraps National Conference January 29th-31st!

ISP Data: Junk IN-Junk OUT

ISP Data is the most diverse and powerful tool in Therap for designing behavioral and training programs and reporting.

Here Certified Trainer, Bonnie Scott has done a Webinar which is posted in Therap’s You Tube Library: http://www.youtube.com/profile?user=THERAPSERVICES

Video: ISP Data: Junk IN- Junk OUT

 

 

DDNA Annual National Conference

The 2012 Conference began with the Pre-Conference on May 4th, with the Conference held May 5th – 7th. The Conference was held at the beautiful Rosen Plaza Hotel in Orlando, FL.   There was good attendance and it was an inspiring Conference which was opened by 10 year old girl who had a voice of a powerful angel.  This young girl was diagnosed with Autism and did not speak until she was 3 years old.  She thanked all the Nurses for the difference they make in the lives of children like her.  There wasn’t a dry eye in the room, including mine!

DDNA Annual National Conference pic

It was great having so many Nurses and others who are Therap Customers come over to our exhibit and say “Hello”!  I met so many wonderful, dedicated professionals and enjoyed sharing Therap Services with many interested folks across the Country!

I look forward to working with many new providers on reviewing and implementing Therap in their organizations and as always, supporting our faithful existing Therap Users to enhance their use, benefit and the further development of Therap Services for everyone!

 

More Cuts to Rates in Florida’s APD Budget

APD Continues Cost Containment Efforts

Tallahassee — On April 1, Agency for Persons with Disabilities (APD) will reduce the rates it pays for therapy assessments and all nursing services to the standard rate paid by the Medicaid State Plan. Currently, the APD Home and Community-Based Services Medicaid waiver pays higher rates for most of these services.

This rate change is the latest cost containment effort by APD to work toward bringing waiver expenses closer to the agency’s Legislative appropriation for the waiver.

The Legislature approved $810 million for APD’s Home and Community-Based Services Medicaid waiver for the 2011-12 state fiscal year that began on July 1. APD customers received $930 million worth of services last year.

While the agency is working to reduce Medicaid waiver expenditures, it is also looking for opportunities to increase waiver flexibility and equity for customers with the new iBudget Florida waiver. More than 3,000 APD customers in North Florida have transitioned to the new iBudget waiver which allows families to shift funding around to meet their current priorities.

APD annually serves more than 50,000 Floridians with developmental disabilities of autism, cerebral palsy, Down syndrome, intellectual disabilities, spina bifida, and Prader-Willi syndrome. The agency’s Medicaid waiver helps to support about 30,000 individuals with developmental disabilities so they may live and participate in their local communities. Those 30,000 people will all be transitioned to the new iBudget Florida waiver by July 2013.

For more information on iBudget, visit the website iBudgetFlorida.org.

For more information on the agency, call 1-866-APD-CARES or visit APDcares.org.

 

IPad Kiosks for Therap in Residential & Day Programs

Carolina Autism Supported Living Services in Charleston South Carolina has found a great way to use IPads in their group homes for documenting in Therap!  Here is a description and pictures from Phil Blevins, Executive Director:

 

“We used iPadWallBracket.com for the enclosure. There are many other sites with similar products but this seemed best for our purposes. We chose the enclosure that covers the “home” button. Then we installed a Kiosk program on the iPad. We chose Kiosk Pro from the Apple store. It’s free but there is a paid version with more features. We set the Therap login page as the start page and limited the kiosks browsing range to the therap domain. There are a few things I could note about setting it up if you ever want details.

We mounted the enclosure to a rolling laptop stand from Office Depot. Since it is plastic we chose not to drill holes in it but used a metal/plastic polymer adhesive to attach the enclosure.

We used iPads with WiFi instead of 3g so we have to make sure there is a working wireless router in the houses. And I’ve noticed that the iPad can’t handle the pop-up body image when entering skin/wound notes. But the staff person can still choose body parts from the drop-down menu. There may be other iPad quirks but we haven’t run into them yet.”
IPad Kiosks for Therap in Residential & Day Programs1      IPad Kiosks for Therap in Residential & Day Programs3  IPad Kiosks for Therap in Residential & Day Programs2

Therap National Conference – A Big Success!

Therap National Conference pic1In preparation for Therap Services pre-conference meetings on Monday, some of us came in early on Sunday to catch the Superbowl at a local Sports Bar-Redds, right across the street from the Met-Life Stadium where the Giants and Jets play!  It was sweet victory for New York and very exciting to be in the middle of it all!

We had a great conference with around 350 attendees, 3 days of over 35 sessions including: Basic to Advanced User sessions, Provider Organizations Special Topic sessions and Brainstorming with Therap Programmers! 

Therap National Conference pic2

Of course, being New York, we always take a trip to “The City” and what a great time of eating pizza, walking around Manhattan to look at the sites!  

Therap National Conference pic3

                           Therap National Conference pic4   Therap National Conference pic5

If you missed it, you can still get to one of our Regional Conferences this year.  Check out when we are coming to a town near you!

      https://www.therapservices.net/conferences/

Florida APD: IBudgets To Roll-Out in Areas 1 & 2

For Immediate Release: Contact:

January 31, 2012 Melanie Mowry Etters
Communication Director
850‐488‐4257
APD to Implement iBudget Formula
TALLAHASSEE — The Agency for Persons with Disabilities (APD) is announcing that it will
implement the final component of the iBudget Florida program for its customers in Northwest Florida
and the Big Bend area by April 1.
iBudget Florida is a new way to deliver Medicaid waiver services that has been approved by both
the Florida Legislature and the federal Centers for Medicare and Medicaid Services (CMS). It provides
Floridians with developmental disabilities in the Medicaid waiver program more flexibility in choosing
their services.
The April 1 transition will include APD customers living in Escambia, Santa Rosa, Okaloosa, Walton,
Bay, Gulf, Calhoun, Jackson, Washington, Holmes, Franklin, Leon, Wakulla, Gadsden, Liberty, Madison,
Taylor, and Jefferson counties, which comprise APD's areas 1 and 2.
APD customers in areas 1 and 2 have been using the iBudget Florida program since October 2011.
Customers in other areas of the state will be enrolled into the program later this year. An enrollment
schedule will be announced soon.
iBudget Florida is designed to make the funding process fair and equitable for all Medicaid waiver
customers. Waiver support coordinators will assist customers and their families in managing service
approvals and other aspects of the program using an online Web‐based system.
APD annually serves more than 50,000 Floridians with the developmental disabilities of autism,
cerebral palsy, Down syndrome, intellectual disabilities, spina bifida, and Prader‐Willi syndrome. For
more information on this program and the agency, visit iBudgetFlorida.org and APDcares.org or call tollfree
1‐866‐APD‐CARES (1‐866‐273‐2273).