Provider Support Call 5-22-17 Notes

Agenda

 4.2% Increase Update  ACES$ Update  Background Check Transfers  CRT/ECC Merge  Psychological Assessment Process TOPICS 4.2% Increase Update for Providers and Case Managers

At the conclusion of the Wyoming Legislative Session in March, the Home and Community Based Developmental Disability Supports and Comprehensive Waivers received $5 million dollars for the biennium to increase rates across all services. The Division has created a Waiver Amendment for CMS to increase service rates using this money.  The Acquired Brain Injury Waiver was not included in the legislation and therefore will not be part of this increase.

Updates: The Division submitted the Waiver Amendment that included the rate increase to CMS on April 11, 2017. CMS has 90 days to either approve or deny the Waiver Amendment. The Division has created a work group that involves Division staff, staff of Conduent, EMWS, and Healthcare Financing in order to implement the 4.2% Increase. This work group has worked on system updates needed and communication plans with participants, providers and guardians. Here are some of the timelines that have been established for providers and case managers. Each Provider Support Call will elaborate on more timelines and updates:

For Plans of Care submitted into EMWS: June 19th, 2017: ALL modifications must be approved. This includes all modifications that are in a rolled back plan. June 26th, 2017: The Division will have all Plans of Care approved. June 26th, 2017: Please have ALL or AS MUCH AS POSSIBLE billing up to date. This will cut down significantly on any billing issues after the rate changes are made and getting providers paid in a timely manner.

For 7/1/17 plans:

In an effort to stream line the upcoming 4.2% rate increase changes, we have updated the July 1, 2017 and August 1, 2017 plans with the new rates and the new IBAs associated with those cases. This was completed by our programmer on May 5, 2017. These plans must be submitted within the IBA since the full 4.2% increase was given for the new plan year.

Please contact your PSS with any questions.

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ACES$ Information

When a participant is moved off the waitlist for the Self Direction Program, the participant or their guardian will receive a letter indicating that they have 30 business days to make contact with ACES$ and begin the enrollment process to self-direct services. If they do not contact ACES$ in the 30 business days, then they will be moved to the bottom of the wait list and the next name on the list will be contacted. The participant will then have 60 days to complete the enrollment process with ACES$. If the participant does not complete the enrollment process in the 60 day timeframe, they will be moved to the bottom of the waitlist and the next available name on the list will be contacted to start the process.

For case managers who are notified that their participant is moving off of the wait list, ACES$ or the Division will not accept budget information or approve any modifications until the participant has completed the full ACES$ enrollment. Until this paperwork is completed, this participant cannot self- direct any services and is not considered “good to go” to do so. Please contact your PSS if you have further questions.

Complaint and ACES$: If you have a complaint you would like to file about ACES$, please be as detailed as possible when submitting a complaint. We will need dates, times, names (first and last), and any paperwork pertaining to the complaint including emails.

CLARIFICATION: There is a Jennifer that works for ACES$. This is NOT the same as Jennifer Adams that works for the Division. Background Checks The Division would like to inform all providers that it is still allowed for them to transfer background check results for new employees. This enables the newly hired staff to begin providing direct care services sooner. However there are a few requirements: 1. The previous background check must have been completed specifically for DD purposes. 2. It has to have been conducted within the past five years. In addition, please note that transfers of background check results are not allowed in the following situations: 1. New provider applicants. All new applicants must undergo the background screening process before becoming active providers. 2. No transfers to or from ACES$ are allowed for any reason.

CRT/ECC Merge

The Developmental Disabilities Section has decided to merge the functions of Clinical Review Team (CRT) with the Extraordinary Care Committee (ECC), in order to streamline the requests that are often submitted to both the CRT and the ECC. The change in the process will take effect as of June 1, 2017. .

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The ECC shall now have the authority to approve, modify, deny or provide consultation on a submitted request for change in service level and/or funding level based upon participant need for any person deemed eligible for one of the Home and Community Based Services (HCBS) Supports, Comprehensive, or Acquired Brain Injury Waivers. A bulletin and forms providing clarification on the procedure, providing a clear flow for the ECC process and communicating the ECC decisions will be sent out this week.

Please note, if a case manager does not delete incomplete, outstanding CRT request, any that remain in the system after May 23, 2017 will be deleted after 90 days. If the case manager intends to move forward with the request, they must cancel the CRT request, submit it as an ECC request, and move any documentation from the CRT request to the ECC request.

Any outstanding CRT requests must be submitted by COB on May 23, 2017 for the team to review.

Psychological and Neuropsychological Assessments:

The Division has been working closely with Conduent over the past few months to design an online add process for payment of psychological/neuropsychological assessments. This new process will allow the Division to add one day of eligibility to MMIS so that the psychologist may bill Conduent directly for services.

The new process will be for most initial and all subsequent psychological assessments as well as neuropsychological assessments. This process will ensure that the Division is upholding the Medicaid rule regarding payments being made directly to Medicaid Enrolled providers.

In order to bill, the psychologist will submit the signed assessment report and an invoice to the case manager. The case manager will upload the assessment report and email the invoice to the Participant Support Specialist (PSS). The PSS will verify receipt of the report and submit an online add to open eligibility for the date of the evaluation so that the psychologist may bill for that one day.

The PSS will notify the case manager when the eligibility has been created so the psychologist may be notified. In some cases with initial psych/neuropsych evaluations, if the applicant is on a full coverage Medicaid program, the psychologist may bill Conduent directly using the applicants Medicaid number. In this case, the psychologist will bill using 96101 for psychological evaluations or 96118 for neuropsychological evaluations, as they have done in the past for initial evaluations.

If the Waiver applicant is not on a full coverage Medicaid program, there must be an open Targeted Case Management (TCM) line in order for the psychologist to be paid for an initial evaluation. In this case, the PSS will create on day of eligibility and the psychologist would bill using T2024 as the process flow sheet outlines.

This process was implemented on May 1, 2017 and any evaluation that was completed May 1st or after, will follow this new process. Evaluations completed prior to May 1st, will follow the old process.

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The PSS will notify the case manager of the appropriate route for billing once the report has been received.

**** Question regarding Home Health Program Inquiries. All Home Health Program inquiries should be sent to Amy Buxton, Department of Healthcare Financing Medicaid. She can be reached at 307-777-5081 or at [email protected].

WRAP UP Next call is on June 26th, 2017

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