Attention: Personal Care Services Providers
Implementation of In-Home Care (IHC) Services
Effective June 1, 2011, the Division of Medical Assistance (DMA) will no longer provide services under PCS and PCS-Plus and will implement two new services: In-Home Care for Children (IHCC) and In-Home Care for Adults (IHCA). DMA submitted these changes on October 25, 2010 to the Centers for Medicare & Medicaid Services (CMS) in response to Session Law 2010-31 (Senate Bill 897), Section 10.35 (http://www.ncga.state.nc.us/Sessions/2009/Bills/Senate/PDF/S897v8.pdf).
CMS approved these changes on April 15, 2011. Clinical coverage polices for the new IHCC and IHCA services will be available on the DMA website (http://www.ncdhhs.gov/dma/mp/index.htm).The
Carolinas Center for Medical Excellence (CCME) will continue to process recipient referrals and conduct independent assessments under the IHC programs. Beginning May 9, 2011, new referrals for personal care services will be processed instead as referrals for IHC services. Current PCS and PCS-Plus recipients’ eligibility to transition to the new programs will be determined automatically from the most recent independent assessment. Current recipients and their providers do not need to submit new referrals or other requests to be considered for eligibility under the new IHC programs.
In early May, DMA will send a letter that explains the program changes to all current PCS and PCS-Plus recipients. Prior to the June 1, 2011 IHC program implementation, CCME will then mail a Notice of Decision to each current recipient. CCME will also send a copy to each recipient’s PCS provider agency. Notices to recipients who qualify for IHC will indicate the prior authorized service level and period. Recipients who are denied IHC services will receive information on their appeal and maintenance of service rights in the denial notice.
Recipients eligible to transition will be prior authorized to receive services immediately upon implementation of IHC programs. They will be authorized to receive services from their current provider agencies at the same monthly service level that was prior approved under PCS.
Providers should note the following billing code changes:
|PCS||S5125||none||Up to 60 hours of PCS per month||End date May 31, 2011|
|PCS-Plus||99509||none||All claims for recipients authorized to receive greater than 60 hours of PCS per month||End date May 31, 2011|
|IHCC||S5125||HA||Attendant Care Services; per 15 Minutes||Effective June 1, 2011|
|IHCA||S5125||HB||Attendant Care Services; per 15 Minutes||Effective June 1, 2011|
CCME will offer regional provider trainings on the new IHC services in June. CCME will also continue to maintain the Independent Assessment website and Provider Interface (http://www.qireport.net). Please visit the Information Center by clicking on the “learn more” link on the QiReport log-in page (http://www.qireport.net). CCME will post additional information about the new IHC programs, upcoming provider trainings, and related forms, educational content, and announcements.
Providers who registered to use the Provider Interface under the PCS program do not need to re-register.
The Provider Interface allows home care agencies to receive and respond to IHC recipient referrals, view independent assessments and decision notices, update service area information, and perform other reporting functions using a secure internet-based system. If you would like to register to use the Provider Interface, please complete and submit the QiRePort Provider Registration Form available on the Independent Assessment website (http://www.qireport.net).
Questions may be directed to the CCME Independent Assessment Help Line at 1-800-228-3365 and by e-mail to PCSAssessment@thecarolinascenter.org. Please direct questions regarding recipient status or referrals to the Help Line for faster response and to avoid the transmission of protected health information over e-mail.