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:

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.

CCME, 1-800-228-3365

Weekly Audio Conferences

May 27, 2011

May 20, 2011

May 13, 2011

May 06, 2011

*Older audio conferences are currently archived offline

General Information

QiReport
DHSR (Licensure)
DMA website
Billing Calendar
Clinical Coverage policies
Proposed Clinical coverage policies
Basic Medicaid Billing guide
General library
Monthly Medicaid Bulletin

SembraCare Related

SembraCare News Blog

First, it is imperative to get your clients ready for letters from DMA or CCME which cut their hours.  They should know that they will have only ten days to get their appeal filed, and that your home health care agency will help them get this done pronto – no delay!  If the appeal isn’t filed in the ten day window, your clients’ right to keep their hours stops until the appeal is received.  This can cost you a lot!

Second, don’t let your client file their own appeal, especially without your home health care agency being named as representative!  Why so? Simple:  clients will be confused and intimidated and will not know what to say without you; CCME won’t give you key hearing dates, so your staff will not play a role; DMA will keep the result of the appeal a secret from you; and you will pay the aide but DMA won’t pay you.

Third, DMA has finally set some standards which CCME and other vendors will have to meet in handling appeal cases.  CCME must get the Maintenance of Service authorization completed within five business days from their receipt of the appeal.  So, keep your fax transmit report, to prove when the appeal was sent!

This posting adds to the advice in October 2010 Basic Medicaid Billing Guide, found on DMA’s site at:

http://www.ncdhhs.gov/dma/basicmed/index.htm

You can visit this page often for some tips but imagine the information you get if you’re our customer.  At SembraCare, our expertise and tech tools max your money while you work on building and maintaining  your home health client base.  We scour the web for the info you need, and we break it down here, http://www.sembracare.com/category/latest-news/, saving you time and headaches.

The following table lists the cut-off dates, checkwrite dates, and the electronic deposit dates for January through December 2011.

Source

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.

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