CCME Asks for Your Help In Updating Contact Data for Recipients

CCME posted a notice November 2, 2010 asking providers to help update contact data for recipients. Our guess is that they are finding out, the hard way, about yet another challenge which providers handle every day in providing services to their consumers. Here is the text of the announcement on QiReport:

11/2/2010 - When CCME is conducting annual assessments for recipients, we have found that many recipients have had changes to their demographic information. We may ask for your assistance to get updated recipient addresses or phone numbers. Without this information CCME may not be able to complete the annual assessments. Medicaid recipients have signed releases allowing DMA and its contractors access to their health information. CCME already has access to the recipient's personal health information, so providing addresses or phone numbers over the phone does not constitute a HIPAA violation. CCME employees who may be calling you for this information will be the Independent Assessment field nurses or our IA schedulers. They will identify themselves as CCME employees prior to requesting this updated information. If CCME is unable to contact the recipient to schedule the annual assessment the recipient will not be able to continue to receive PCS. Thanks for your cooperation.

DMA Publishes New Clinical Coverage Policies

On October 29, 2010 North Carolina Division of Medical Assistance published two new proposed Clinical Coverage Policies for In Home Care Adults (IHCA) and In Home Care Children (IHCC), which are intended to replace the existing PCS/PCS Plus program. DMA is looking to close down the existing PCS and PCS Plus programs as soon as possible after January 1, 2011. The new replacement Policies have a 45 day comment period.

The most important aspect of the new proposed policies would be the change in the minimum requirements for PCS eligibility. Under current Policy 3C, a recipient must have two ADLs assessed as needing at least limited assistance. Under the proposed new IHCA policy, recipients must have at a minimum two ADLs, of which one must be at least rated as needing extensive assistance, or a minimum of three ADLs rated as needing at least limited assistance.

The new policies may be accessed here: http://www.ncdhhs.gov/dma/mpproposed/index.htm

Fax Errors by CCME

CCME finally admitted today what providers have been saying for weeks- that fax transmissions which CCME thought it had sent to providers may not have been received due to a “fax failure”.  Also, when the provider who was supposed to have gotten the referral did not respond in 48 hours, CCME apparently did not in all cases refer the consumer to another agency.  Providers in such cases who were selected by the consumer are getting a “second chance” to accept the consumer.  The effective date that governs is the effective date stated in the most recent letter which the provider receives.
Here is the text of CCME’s announcement:

8/10/2010 - If you receive a "Second Attempt" fax from CCME, this indicates that CCME has attempted to make a referral to your agency and has not received a response. The provider agency should fax back the referral form with a response indicating whether the provider accepts or declines the PCS referral. This response must be returned to CCME within 2 business days. In some cases, providers may not have received CCME's first attempt due to a fax failure. Currently, CCME is faxing "Second Attempt" letters to providers for whom referral responses have not been received. This is to ensure that agencies have every opportunity to accept a referral before CCME forwards it to the recipient's second choice provider.
The effective date of the authorization is indicated near the bottom of the referral letter. This date varies depending on the type of independent assessment conducted (Admission, Change of Provider, etc.) and on the results of the assessment. The "Second Attempt" referral letter does not change the 10-day service authorization start period that is listed on the authorization letter. If the provider accepts the referral on the "Second Attempt" letter, the 10-day start period is effective based on the date of the authorization letter (not the referral letter). In cases where the referral letter indicates that the service authorization is effective on "the first business day following CCME's receipt of your acceptance...", this will be based on the date of the "Second Attempt" referral letter.

Important Notice for PCS Providers About CCME Errors and Fixes

DMA confirmed today that, prior to this week,  the “end dates” for Medicaid benefits from PCS recipients were calculated wrong by CCME due to a miss-communication with the programmer about what the effective end dates should be.  This error affected 100% of the 1,089 individuals who were sent cut-off letters, and was brought to DMA’s and CCME’s attention by SembraCare.

A fix has been devised and will be implemented this week, so that end dates will henceforth occur on the correct date, and not before.  SembraCare clients do not need to take further action, as we will re-bill these items for you until they pay properly.

A second and separate problem has arisen from CCME’s failure to properly note the recipients’ rights to continuance of service even though they take appeals from CCME reductions or denials of benefits.

We recently demonstrated this error to DMA and CCME as well.  In response, DMA and CCME have now established a method of restoring coverage for PCS recipients who take appeals.  According to the CCME website, authorizations will be restored by CCME without the need for further action by providers or recipients for those PCS recipients who appeal within about ten days after the appeal is lodged.  CCME is unable to get copies of recipient appeal notices in time to adjust the end dates properly and prevent a cut off, and so is having to go back and make the adjustment after the fact.  Again, SembraCare customers will not have to take action to address this issue, as we will re-bill the time for you.

Two More CCME Webinars

On June 15, 2010, from 9 am to 10 am, and on June 17, 2010, from 2 pm to 3 pm,  CCME will present a Webinar called “PCS Independent Assessment......continuing the journey”. This Webinar will explain the independent assessments now being issued, provide information about care plans which providers must prepare, and will touch briefly on billing issues. For Registration and additional information you should visit  www.qireport.net and click the Tab for “Learn More”.  We believe PCS providers should register as soon as possible. 

Budget Battle 2010: Contact Your Representatives and Senators Now!

Concerned about the effect of the 2010-2011 Budget Bill on PCS?  The Budget Bill is working its way through the North Carolina Legislature and is already through the Senate.   While most observers expect major changes before a final version is hammered out, PCS provider agencies should pay close attention to the details.  A provision in the Senate-passed budget plan would eliminate PCS services for most current recipients who have needs for limited assistance with fewer than 3 Activities of Daily Living (ADL’s).  The current PCS program, under the Senate plan, would be ended and replaced entirely with a new program expanding the reach of PCS Plus, focused on serving only those recipients with the greatest needs for assistance.  Estimates are that this new plan, if enacted, would end services for over half of current recipients.
Providers should contact their Senators and Representatives as soon as possible to express their views on this proposal.  If you want to learn more, there will be a statewide public hearing tonight on North Carolina's budget for the coming year, conducted by the House Appropriations Committee at North Carolina State University’s McKimmon Center in Raleigh. Community colleges in Sylva, Charlotte and Bladen County will also be video conference locations.

You can view the meeting on the Internet, and you can send e-mails and letters with your comments until Tuesday.  House Democrats plan to vote on the bill by June 4.

North Carolina House of Representatives Appropriations Committee
Public Hearing Information
Day & Date:    Monday, May 24, 2010
Time:    7:00 p.m. - 10:00 p.m.
Live Location:    McKimmon Center
N.C. State University
1101 Gorman Street
Raleigh, NC 27606
Community College Host Sites:    Bladen Community College (Teaching Auditorium), Dublin, NC
Central Piedmont Community College (Central Campus), Charlotte, NC
Southwestern Community College (Balsam Center, 3rd Floor), Sylva, NC

Click here for contact information and driving directions to each campus.

Internet Streaming:    Link will be posted to www.ncleg.net on day of the event.

Members of the public may offer suggestions and comments at the live location and the three Community College Host sites. Signup for speakers will begin at 6:00 p.m. on the day of the public hearing at the live location and the three Community College Host sites. Each speaker will have two minutes.
Members of the public who cannot attend a live video site, may offer suggestions and comments by the following methods:

EMAIL:    Town.Hall@NCLEG.NET (Until midnight, 5/25/2010.)
ONLINE:    http://www.ncleg.net/Applications/PublicHearingComments/ (Until midnight, 5/25/2010.)
MAIL:     House Appropriations Committee
Suite 401, LOB
300 N. Salisbury Street
Raleigh, NC 27603-5925 (If postmarked by 5/25/2010.)


Read more: http://www.newsobserver.com/2010/05/24/497721/nc-house-holds-public-hearing.html#ixzz0oqtIshh9

CCME Webinar

On May 19, 2010 CCME will conduct a Webinar called "Charting a New Course in Personal Care Services". This Webinar will cover changes in the PCS rules and other important information, and is designed for PCS providers and those who refer Medicaid recipients for PCS services. For Registration and additional information you should visit  www.qireport.net and click the Tab for “Learn More”.  CCME indicates that space is limited, and we believe all PCS providers should register as soon as possible. 

DMA - The need to remove prohibited task from care plans

DMA is reemphasizing the need to remove prohibited tasks from care plans by April 30, 2010.   We quote:

The new PCS and PCS-Plus Clinical Coverage Policy 3C includes changes required by Session Law 2009-451 (Senate Bill 202). Section 10.68A.(a)(3) of Senate Bill 202 mandated the addition of the following items to the list of tasks that are not covered by the Medicaid PCS program:
     •    nonmedical transportation
     •    errands and shopping
     •    money management
     •    cueing, prompting, guiding, and coaching
These and other non-covered tasks are listed in Section 4.3 of the new Clinical Coverage Policy.
Nonmedical transportation includes transporting a recipient outside of or away from the recipient's residence. Errands and shopping include making purchases or performing other tasks for the recipient outside or away from the recipient's residence. Such tasks are not covered under the PCS policy and must be eliminated from recipient POCs. In living communities in which laundry or other facilities are located outside the recipient's private apartment but on-site, these on-site facilities are considered to be part of the recipient's residence.

New Hours Scoring Proposal

There is a new hours scoring proposal posted at http://www.dhhs.state.nc.us/dma/mpproposed/PCSProposedServiceAuthGrid.pdf 

Your opportunity to comment on this proposal expires April 16, 2010.  If you have an opinion, don’t be silent; please let it be known!

Please remember to always check the news that is posted on the QiReport.net website at https://www.qireport.net.

DMA Notifies Physicians About Independent Assessment

DMA Has Sent the Following Data to Doctors About the April 1, 2010 Implementation of Independent Assessment, Prior Authorization, and New Clinical Coverage Policy for Medicaid Personal Care Services (PCS) and PCS-Plus

Independent Assessment

The Carolinas Center For Medical Excellence (CCME) will conduct new referral assessments and continuing service and change of status reassessments for PCS and PCS-Plus, effective April 1, 2010.  Independent Assessments will determine recipient eligibility and authorized service levels.  Prior approval of PCS claims will be required, and claims for services that exceed levels authorized by CCME will be denied.

Transition Period

Up until April 30, 2010, PCS providers will continue to obtain physician referrals and Plan of Care (POC) authorizations for recipients whose assessments they conduct through April 30, 2010.

Beginning May 1, all PCS assessments will be conducted by CCME, and PCS provider agencies will not seek referrals or authorizations for these recipients. Also, Individuals applying for admission to PCS must obtain a referral through their primary care or attending physician and must schedule an office visit if they have not been seen in the previous 90 days

Physicians will complete and submit by mail or fax a one-page referral to CCME, who will contact patients to schedule the assessments.

Physician Attestation of Medical Necessity

The legislative mandate requires physician attestation of medical necessity for the service.  The physician’s signature on the referral form authorizes an independent assessment of the patient by CCME and is an attestation to the medical necessity of assistance with the patient’s Activities of Daily Living (ADLs).

New Clinical Coverage Policy

The new PCS and PCS-Plus Clinical Coverage Policy 3C will be available on the DMA website (http://www.ncdhhs.gov/dma/mp/) in April.  The policy includes changes in Non-Covered Tasks.  Providers must revise recipient Plans of Care (POCs) to comply with new policy requirements.  POC revisions made in response to changes in Non-Covered Tasks may be signed as RN updates; DMA will not require physician signature or approval of these changes.

Inquiries

Patients seeking admission, and providers and physicians with questions, may contact CCME using the Independent Assessment Help Line, 1-800-228-3365, or by e-mail, PCSAssessment@thecarolinascenter.org. 

Additional questions or concerns may be directed to:

Mr. Joseph Breen
NC PCS and PCS-Plus Program Manager
Division of Medical Assistance
(919) 855-4365
Joseph.Breen@dhhs.nc.gov

Gov. Perdue Kicks Off Campaign to Crack Down on Medicaid Fraud, Waste and Abuse

Gov. Bev Perdue today announced measures cracking down on Medicaid fraud, waste and abuse that costs taxpayers millions of dollars each year.  These include:

1.  newly created Medicaid SWAT teams, with specially trained investigators,
2.  better use of computer technology to detect and prevent abuse,
3.  a campaign to encourage the public and providers to report suspected Medicaid fraud, waste and abuse,
4.  toughening North Carolina’s anti-fraud laws by stopping kickbacks to providers that refer patients for Medicaid services,
5. ending the soliciting of patients for services they don’t need, and
6. doubling the staff size of the Attorney General’s Medicaid Investigations Unit, which every year recovers millions for the State.

PCS Cost Reports for NC Medicaid Suspended

DMA and the DHHS Controller's Office are suspending mandatory cost reporting effective December 31, 2009, including reports for community based personal care services. See the memo explaining this.

Please note that this is a suspension, not a complete elimination, of the cost reporting requirement, and that reports which were due prior to December 31, 2009 must still be filed. Providers still need to make entries in their accounting records which would enable them to produce cost reports when the cost reporting requirement is reactivated.

Medicaid Announces Public Hearing on Bond Rules

The Department of Health and Human Services, Division of Medical Assistance will hold a public hearing for Medical Assistance Eligibility, Provider Enrollment, Provider Performance Bond rules published January 4, 2010

The public hearing will be held 10:00 a.m., Wednesday, February 17, at Dorothea Dix Campus, Kirby Building room 132 (1985 Umstead Drive, Raleigh, NC 27603).

Verbal comments will be accepted for the following rules:

10A NCAC 22N .0401 – Default
10A NCAC 22N .0402 – Requirement for Provider Performance Bonds 10A NCAC 22N .0403 – Definitions

Concerns should be directed to Teresa Smith, DMA Rule-making Coordinator, by e-mail at Teresa.Smith@dhhs.nc.gov.

What to do:

Providers should study these rules now to determine whether they would be required to post a bond, and, if so, begin making arrangements to be able to do so at the time the Rules go into effect. If you have comments, send them to DMA or attend the Public Hearing to express your views.

NC IAE update

DMA announced in the February 2010 Medicaid Bulletin that the IAE (CCME) has finished the reviews of the PACT forms submitted by the January 8, 2010 deadline, and that the mailing of prior authorization and hours determination letters is being "voluntarily delayed" pending the outcome of the AHHC lawsuit.

Furthermore, DMA plans to begin performing the IAE reassessments in March 2010: "Implementation of independent assessment of all individuals applying for PCS and PCS-Plus and all reassessments and change of status reviews is scheduled for March 2010."

SembraCare Sponsors Home Care Agency Meetings

SembraCare is sponsoring two Home Care Agency Meetings, January 26, 2010 in Lumberton, NC, and January 28, 2010 in Statesville, from 10 am to 12:30 pm. These are open to Licensed Home Care Agencies, there is no cost or obligation for attending these meetings, and you are invited to have two representatives attend. Just let us know you are coming! The Agenda is below.


Statesville LOCATION:

Holiday Inn, Statesville
(704) 878-9691


Lumberton LOCATION:

Holiday Inn, Lumberton
(910) 671-1166


RSVP: Richard 919-376-1133 or Liz 919-376-1111

Agenda

I. General Overview – Including the New DHSR Rules on Companion and Sitting Services, the New Provider Enrollment Packets, the New Clinical Coverage Policy and the New Formula for Hours

II. The PACT Reviews This Fall

III. The IAE Assessments Next Year

IV. The NEW Provider Participation Agreement – what’s new in it which you need to know!

V. What Can You Do?

• a. Strategies for Protecting Your Business:
• b. Prepare for the new Clinical Policy 3C
• c. Prepare for Hours reductions
• d. Preparing for IAE assessments
• e. Focus on Best New Business Opportunities

Refreshments will be provided. Lunch on your own.

Alert: Provider Enrollment Packets

On behalf of DMA, CSC is currently carrying out a 12-month process to verify provider information and conduct credentialing activities for enrolled Medicaid providers. Because of ongoing discussions with provider associations related to the Medicaid Provider Participation Agreement, DMA has agreed to extend the time allotted for providers to return the required information to CSC. Providers have been asked to return the packet materials (except as discussed below DO NOT SIGN AND RETURN the Participation Agreement) within 60 days from the date of receipt of the verification packet or February 1, 2010, whichever is later. A provider who has not received a verification package or who has questions about completing the enrollment forms within the package should contact CSC (1-866-844-1113) directly.

DMA and the N.C. Attorney General's Office are currently reviewing and evaluating provider comments on the Medicaid Provider Participation Agreement that is part of the verification package. DO NOT RETURN that Agreement with the rest of your package until further notice from N.C. Medicaid. It may change substantially!

SembraCare urges you to review the packet of materials carefully before submitting anything. There are legal terms used in that agreement which could have broader or different meanings than you might expect and you should talk to your lawyer about them and what they mean. We will be working on an outline of considerations and things to do to help you in filling out the packet.

2010 Check Write Schedule

Month	Electronic Cut-Off Date	Checkwrite Date
January	1/7/10	1/12/10
	1/14/10	1/20/10
	1/21/10	1/28/10
	1/28/10	2/2/10
February	2/4/10	2/9/10
	2/11/10	2/17/10
	2/18/10	2/25/10
March	2/25/10	3/2/10
	3/4/10	3/9/10
	3/11/10	3/16/10
	3/18/10	3/25/10
April	4/1/10	4/6/10
	4/8/10	4/13/10
	4/15/10	4/22/10
May	4/29/10	5/4/10
	5/6/10	5/11/10
	5/13/10	5/18/10
	5/20/10	5/27/10
June	6/3/10	6/8/10
	6/10/10	6/15/10
	6/17/10	6/24/10
July	7/1/10	7/7/10
	7/8/10	7/13/10
	7/15/10	7/22/10
August	7/29/10	8/3/10
	8/5/10	8/10/10
	8/12/10	8/17/10
	8/19/10	8/26/10
September	9/2/10	9/8/10
	9/9/10	9/14/10
	9/16/10	9/23/10
October	9/30/10	10/5/10
	10/7/10	10/13/10
	10/14/10	10/19/10
	10/21/10	10/28/10
November	10/28/10	11/2/10
	11/4/10	11/9/10
	11/10/10	11/18/10
December	11/24/10	12/1/10
	12/2/10	12/7/10
	12/9/10	12/14/10
	12/16/10	12/22/10