Human Services Secretary, Managed Care Organizations Discuss Ongoing Partnership
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ASERT Launches LANTERN Learning Management System
ASERT team members have officially launched their learning management system, LANTERN. LANTERN hosts trainings to support all stakeholders of the autism and intellectual disability communities across Pennsylvania, covering topics ranging from COVID-19 to anxiety management. For Autism Acceptance Month in particular, they have shared their ‘Welcome to LANTERN!’ course, which introduces the platform and provides a background on why we celebrate individuals with autism throughout April. To access this platform, please visit ASERT.
Children’s Committee Meeting Notes — March 31, 2021
DDAP Provides Responses to Recovery House Regulation Comments, Questions
The Pennsylvania Department of Drug and Alcohol Programs (DDAP) continues to receive comments and questions regarding its Final-Omitted Regulation on Standards for Drug and Alcohol Recovery House Licensure. DDAP’s responses to these concerns are available here for review. These regulations are on the agenda for the Independent Regulatory Review Commission’s (IRRC’s) April 15, 2021 public meeting.
Please note that any comments or questions received by DDAP or IRRC in response to this communication, or in response to the final-omitted regulation, will be forwarded and uploaded to IRRC’s website for consideration by IRRC. Additional information on drug and alcohol recovery house licensing is also available here.
Prudent Payment of Claims Suspended until April 2022
ODP Announcement 21-031 is to announce the continued suspension of Prudent Payment of claims for Medical Assistance providers through March 31, 2022. The Governor’s Budget Office has announced it will continue the temporary suspension of Prudent Payment of claims for Medical Assistance providers through March 31, 2022. Prudent Pay will be reinstated beginning April 2022 using a phased–in approach. For more information about Prudent Pay during the COVID–19 pandemic, please visit the Department of Human Services.
This action continues allowing providers to be paid in the next financial cycle after the claim is approved for payment. Please note all claims must still meet all other billing requirements before payment.
The ODP Intermediate Care Facilities (ICF) Rate Setting unit would like to remind all ICF/ID Providers that there is a regulation that requires providers to bill monthly:
§1101.68. Invoicing for services.
(a) Invoices. When billing for MA services or items, a provider shall use the invoices specified by the Department or its agents, according to billing and other instructions contained in the provider handbooks.
(b) Time frame. MA providers shall submit invoices correctly and in accordance with established time frames. For purposes of this section, time frames referred to are indicated in calendar days.
- A provider shall submit original or initial invoices to be received by the Department within a maximum of 180 days after the date the services were rendered or compensable items provided. Nursing facility providers and ICF/MR providers shall submit original or initial claims to be received by the Department within 180 days of the last day of a billing period.
A billing period for nursing facility providers and ICF/MR providers covers the services provided to an eligible recipient during a calendar month and starts on the first day service is provided in that calendar month and ends on the last day service is provided in that calendar month.
Split billing constitutes a regulatory violation. It has become apparent that PROMISe does not edit that situation properly; however, providers are still required to follow the regulation. Discovery of such violations can be found by any of the organizations within the Commonwealth that audit/review ICF/ID claims or expenditures, and can have negative consequences. Questions may be directed here.
Telehealth Service Codes to be Covered Under Medicare Physician Fee Schedule Through PHE
The Centers for Medicare and Medicaid Services (CMS) recently updated the list of telehealth codes to be covered under the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2021 through the end of the public health emergency (PHE). Included in this updated list are services provided by speech-language pathologists and audiologists. The entire list of all currently permitted telehealth services under the CY 2021 MPFS are located here.
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OCYF Releases Update to Title IV-E Invoicing Upgrades
The Office of Children Youth & Families (OCYF) has released a communication outlining the OCYF Title IV–E Invoicing system upgraded on April 12, 2021 to address changes that have been implemented due to the Consolidated Appropriations Act, 2021. These changes are specifically addressing the impact of the COVID-19 global pandemic on older youth in placement. This communication is being sent in advance of the patch release in order to provide counties with an opportunity to review the changes and make any necessary modifications to their processes. Only Foster Care (CY–63 FC) invoices are impacted by these changes.
To view the full communication, please view the link here. These changes will be implemented on April 12, 2021 and are retroactive to April 1, 2020.
If you have any questions, please email OCYF or contact RCPA Children’s Director Jim Sharp.
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