Medicaid Recipient Appeal Process/Early and Periodic Screening, Diagnosis, and Treatment

Attention: All Providers
Medicaid Recipient Appeal Process/Early and Periodic Screening, Diagnosis, and Treatment


Medicaid Recipient Appeal Process/Early and Periodic Screening, Diagnosis and Treatment (EPSDT) seminars are scheduled for the month of February 2010. Seminars are intended to address Medicaid recipient appeal process when a Medicaid service is denied, reduced or terminated. The seminar will also focus on an overview of EPDST – Medicaid for Children.

The seminar sites and dates will be announced in the January 2010 Medicaid Bulletin. Pre-registration will be required. Due to limited seating, registration will be limited to two staff members per office. Unregistered providers are welcome to attend if space is available.

Attention: All North Carolina Home Care Providers

Medicaid Identification Cards Once A Year

Upon approval of the State budget, the N.C. Medicaid Program will begin issuance of one Medicaid identification (MID) card per year to each recipient. The effective date of this change may be as early as September 8, 2009. The annual cards will be printed on gray card stock; DMA will no longer have blue, pink, green, and buff-colored MID cards. The cards will include the individual’s name, MID number, and CCNC/CA primary care provider information (if applicable).

This change means that the MID card will no longer serve as proof of recipient eligibility.

At each visit, providers must verify the card holder’s:

Identity (if an adult)
Current eligibility
Medicaid benefit category
CCNC/CA primary care provider information
Other insurance information

However, once eligibility has been verified during a particular month, the provider may assume that the cardholder’s identity, eligibility, PCP and other insurance information remains valid for the remainder of that month.

Note: Non-SembraCare agencies might want to consider talking to SembraCare about a package deal to do all of your eligibility checks automatically every month and manage your client and employee data.

Home Care Update on Budget

The North Carolina General Assembly ended this week with no Budget deal in sight, as Governor Perdue made clear she would not sign a Budget bill containing an income tax surcharge as a way to pay for needed state services. NC House and Senate leaders, who had been building support for their compromise money package, declared they would need another budget deadline extension – the current one expires July 31 – and that extensive further work would be needed. Then they all went home for the weekend.

In addition to some kind of revenue enhancement, it appears that further spending cuts, including changes to the so-called Restoration Bill that put back some money for Medicaid PCS services, might be necessary if the Governor’s announced goals (protecting education while not raising taxes for working families) are to be achieved in the face of a $4.7 billion budget gap.

Meanwhile, the increase in the federal minimum wage to $7.25 per hour goes into effect this week, impacting all North Carolina PCS providers, and debate continues on the federal legislation to overhaul the nation’s health care system. While there are several versions of health care reform bills under discussion, all provide for employers to pay for most of the cost of employee and family health insurance coverage, or else pay a hefty surcharge.

Exit interviews: What good are they?

Many who have given an “exit interview” to their company have described it with a shrug of the shoulders and a “for what it’s worth.” Exit interviews have an almost mythical reputation for being a waste of time. Did anything ever change at a company as a result of what comes out of an exit interview? Inc. magazine interviewed Michael Bloomberg, before he was Mayor of New York and Bloomberg said that when someone left his company (a $1.3-billion, 4,000-employee provider of global news and financial and business information), he took it as a personal insult. He considered those leaving to be “contravening his code of loyalty” and he didn’t wish them luck or even shake their hands on their way out the door. He couldn’t have cared less about what came out of an exit interview, unless an entire department left at once and that would signal a problem to him.

Well, that is one approach. On the other hand, SembraCare contends that a departing worker’s comments and thoughts may have value, even as you rejoice at his or her departure. Never be afraid of feedback.

When workers leave, it isn't just their skill set walking out the door. Departing workers can provide valuable insight and feedback that can help you improve your company. That's why you need to conduct well-planned exit interviews, and learn the appropriate etiquette needed for the final conversation. Our suggestions:

• Don’t expect too much.
• Don’t believe too much.
• Don’t ask too much.
  

Many exiting workers aren’t eager to invest much energy in answering too many questions. They’re more likely to give socially correct answers—like "the pay is better at the new job"—than candid ones. The trick to avoiding that scenario is asking a short list of specific questions. Try framing your exit questions in a neutral context that would elicit thoughtful responses rather than empty, safe platitudes. Avoid if possible putting a person in the position of having to directly criticize the people to whom she reported. You can also use exit interviews to reinforce security policies and legal matters. That is, you can talk to the employee about company policies that may continue to affect them as she or he becomes employed elsewhere. Examples are company trade secrets as well as issues of confidentiality in connection with other matters handled on behalf of the worker. Managers should give the exiting worker a copy of any confidentiality, trade secret or other binding documents signed during their tenure with the company as a reminder of the terms of those agreements. The exit interview is a chance to be sure the Company retrieves all its property, and to verify the exiting worker’s contact information should this person’s assistance be required in the future. The company should finalize, as much as possible, the terms on which such assistance would be provided. For example, the exiting worker might be hired on a consulting basis for a set period of time. It is important to negotiate these particulars while the worker is still waiting on getting paid. Respect can reap big rewards. Remember to treat a worker as you would like to be treated if you were in his or her shoes. Managers might be surprised at what they find out. A good exit conversation can provide insight on the following:

• Whether the departing individual’s new job is truly a better opportunity or simply an escape from an underlying problem in the company
• Whether the worker was actively recruited—and what you might do to prevent other desirable workers from being lured away—or whether the worker sought out the new job on his or her own

If you would like some help developing a security or separation policy, give SembraCare a call.

Budget analysis by Legislative Fiscal Research

Home Care agencies who have been following the budget crisis in North Carolina might want to peruse the latest (May 6, 2009) discussion of projected Revenue, available online. Dr. Barry Boardman, of the Fiscal Research Division of the General Assembly, citing consensus estimates, projects as follows:

“Revised consensus numbers suggests if normal
long-term growth resumes in 2011-12, then it will
be 2013-14 before revenues equal the $20.8
billion budget number of 2008-09”

In other words, it could be four years before the State again has enough money to pay for Medicaid what it did in the current fiscal year ending June 30.

The full analysis by Dr. Boardman, et al, is available here.

This projection by Dr. Boardman, if it comes true, will drive structural changes in the State’s Medicaid budgeting that will force PCS providers to change the way they do business.

We suggest you take his projections to heart and make plans for your business to be more efficient over the long haul by contacting SembraCare.

More Budget News

The Raleigh News and Observer reports that today Governor Perdue, having looked over the revenue collections from April 15, has decided that the 2008-2009 deficit is about a billion dollars worse than feared and has ordered that all state workers will have their annual pay reduced ½ % , including judges, legislators and administrative personnel. Also, there will be unpaid time off – furloughs. This is just to get through the end of fiscal 2008-2009.

It appears ever more likely that the $55 million (or perhaps more) in cuts to the PCS program for the next two fiscal years will be implemented. This makes it imperative for Home Care agencies to get efficient.

Changes Coming for PDN Providers

North Carolina Home Care agencies providing Medicaid Private Duty Nursing services should check out the new Proposed Clinical Policy 3E for PDN services, available on DMA’s website here.

Among the changes is a limitation in total daily hours of service to 16 hrs per day, with the possibility of added hours in exceptional circumstances. [As you may be aware, this change is in the current Senate approved version of the 2009-2010 North Carolina Budget]. Visit the DMA website and let them know your comments.

North Carolina Budget Update

Budget concerns continue to rise for North Carolina Home Care agencies. A review of the Senate approved budget for fiscal year 2009-2010 reveals that the Senate proposal – the latest version – is to cut $55 million from the Personal Care Services program during the next fiscal year by beginning reductions on October 1, 2009. This is referred to by the Legislature as a “15% cut” – meaning that 55 million is about 15% of the cost of the whole program for the fiscal year. That’s a big pill to swallow.

But is it really only a cut of 15%? In order to save $55 million in the nine months remaining of the fiscal year after October 1, no money would be saved from July 1 to September 30th. Spending would presumably continue at the current higher rate until October 1, 2009. Then, the $55 million would be cut from the $225 million of funding remaining for the year. This means that for the last nine months of the year, the Personal Care program would have to be cut 24.4%, not 15%. Plainly, this can’t be accomplished via a rate cut, (which would mean reducing reimbursement rates to about $11.10.) More likely, DMA will have to look to a mix or combination of other means – such as prior authorization, tightening scoring rules, and reduce the number of hours per month – to limit costs. For example, if DMA implemented a 25% reduction in hours per month, recipients now getting 60 hours per month of PCS services would be limited to about 45 hours per month. We think this could be among the most significant challenges providers will face in the coming year. What to do? First, providers need to be active in supporting the efforts of the North Carolina Association for Home and Hospice Care, which has a great track record and has been proven very effective in advancing the interests of personal care recipients as well as providers. Second, we suggest you go over your internal operating budget and decide how you would accommodate a reduction in PCS Medicaid hours of 20 - 25%. If you would like some help, let us know.

What to do about Budge Cuts

Welcome to the brave new world of budget cutting, as brought to you by the North Carolina General Assembly, Medicaid, and the Governor’s office.

The world of in home personal care services is always changing and becoming more challenging with slow or no rate increases, costs challenges, and regulatory challenges. We can expect finances to get tighter as the federal minimum wage goes to $7.25 per hour in July 2009. Governmental payers are looking for ways to pass along the consequences of their budgetary shortfalls to the provider community. This year, it may not be sufficient for our industry to point out that spending money on in-home care saves a lot of money in the long run by keeping the elderly and disabled out of nursing homes. The sense in some quarters in the North Carolina Legislature is that the Personal Care program is “over utilized” – that is, that there are too many undeserving persons receiving benefits, as well as many persons receiving too many hours. This year, the axe is out and sharpened. Indeed, the Governor’s proposed budget as submitted to the North Carolina General Assembly would a) wipe out all planned inflationary or other rate increases, b) change Private Duty Nursing to reduce cost and 3) reduce the cost of the Medicaid PCS program about 15% by “modifying” Personal Care Services benefits to reduce “overutilization” of benefits.

Are you ready for a 15% reduction in revenue? You as a licensed North Carolina Home Care provider must be prepared to adapt quickly to maintain survival and prosperity. Somehow, you are going to have to save money, and do more with less. If you want to grow, or even stay the same size, you cannot afford to utilize your office staff and RN’s in the same way. To put it bluntly, we think that successful, surviving agencies will have to adapt and get more done with the same or lower head count.

How? The answer is technology and efficiency. You may have read that President Obama’s stimulus package provides incentives for the health care industry to improve efficiency through health information technology. In some cases, these incentives can ease the transition to a more efficient system powered by computers and software. We think we can help you to move forward with technology improvements. If you have been considering upgrading your software and lowering your overhead, give us a call.

North Carolina Sick Pay Bill

The bill (House Bill 177) would require any business with 10 or more employees to accrue and pay sick time.

Sick time shall begin to accrue at the commencement of employment. Paid sick time shall accrue at the rate of one hour of pay for every 30 hours worked

The maximum accrual is 56 hours. This bill would apply to most if not all home care agencies who have employees (as opposed to bona fide contractors). There is no exemption for domestic workers except for those who employed in the home of their employer. This might exempt CAP Choice workers who are in theory under an employer of record system which might make their employer the homeowner where they serve the client.

This is a perfect example of a possibly disastrous unfunded mandate. Last year, the federal government approved an increase in the minimum wage, but the NC General Assembly gave North Carolina Home Care Agencies no rate increase to allow them to pay their employees more.

What does this mean financially for your home care agency? The average CNA worker has two clients at 30 hours a week. That means every week they accrue 1 hour of paid sick time and at the end of the year they would have 52 hours of sick time. This is an equivalent of a 3.3% rise in costs before taxes and workers comp with no increase to support this.

We think every home care provider should ask the General Assembly, where is the rate increase to cover this cost?

CNA Testing and Skills Validation Will Likely Get Stricter

North Carolina’s Division of Health Service Regulation (formerly called the Division of Facility Services) released a Request for Proposals (RFP) on February 3, 2009, concerning a contract to test the qualifications of CNA’s and Medication aides who assist clients in regulated facilities – including the home care environment. This RFP reveals DHSR’s thinking about home care CNA’s and what they should be trained and tested on by their employers.

DHSR intends to tighten up training and testing for CNA’s hired in home care who will be required to pass both a written or oral test (minimum 6th grade, maximum 8th grade level language used) and a practical demonstration test, including demonstrating skills on an anatomically correct manikin for “intimate” services such as dressing and undressing, and perineal care.

This requirement is separate and apart from the requirements to graduate from a North Carolina Board of Nursing approved CNA or Medication Aide course.

DHSR’s plan is for an independent contractor do the testing, supposing that skills testing by a third party training will be more accurate. Spanish language testing must be permitted, and once an employee is hired you cannot charge for the training or testing.

We suggest that you review your own in house CE requirements and skills checks to see whether your system would prepare your CNA’s to pass a competency and skills test like those described in the RFP.

Here is a link to the proposal documents: https://www.ips.state.nc.us/ips/AGENCY/PDF/06648000.pdf

May 2009: End of the Road for MPN's for Billing

According to this, May is the end of the road for using for the Medicaid provider numbers for billing. We hear May 5th is the actual date. This is only for billing as of now. This year's cost report will still need to use provider numbers as the state's system is tied heavily to the MPN numbers.

NYT: Three Part Series on Home Health Care Aides

The third and final part of Home Health Care Aides article is up and it makes for a great read. Regardless of if you're in need of an home care worker or if you are an owner or manager of a home care agency, it's worth a read along with the first and second articles. We think this quote is a great starting point for all workers in this industry.

The place to start is to recognize that certified home health aides provide a specialized service. Only when aides are properly trained and supervised can they provide the highest quality of care, and at the end of the day, that is what we all want for ourselves and the people we love.

New DHHS Secretary Selected

Governor-elect Beverly Perdue on Tuesday named Lanier Cansler, a lobbyist and former legislator, as secretary of the beleaguered state Department of Health and Human Services.

Cansler, who served as DHHS deputy secretary from 2001 to 2005, has been a partner in the Cansler Fuquay Solutions lobbying and consulting firm for the past four years. The firm represented Computer Sciences Corp., which recently won a $265 million contract to handle North Carolina's Medicaid billing system.

See more here.

Home Health Aide Turnover

Just wanted to point out an article just published on how to hire a home health aide from the consumer's point of view and a quote from that article:

The first person you hire, or even the second or third person may not be the right one. Don't get discouraged, the right match is out there. Do not settle for someone that does not meet all your expectations.

So as an agency owner, please do not get discouraged if it takes multiple aides to find the right one as the consumer has a right to find the perfect fit.