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.