ANCOR Shares Fact Sheet on Medicaid Enrollment and Eligibility Renewals for Individuals With I/DD
Enrollment
Statewide Briefing on Medicaid Unwinding & Expanded Enrollment Options Planned for April 25
On April 25, 2024, at 12:00 pm, a virtual statewide briefing will be conducted on Medicaid unwinding and expanded enrollment options. This event will feature Health and Human Services (HHS) Regional Director Melissa Herd, Pennsylvania Department of Human Services Secretary Val Arkoosh, and Pennie Executive Director Devon Trolley.
The agenda will include a briefing on what’s happening at the federal level when it comes to Medicaid, an update on the Medicaid “unwinding” process currently wrapping up in Pennsylvania, and the expanded eligibility requirements for enrolling in Pennie coverage even when it’s not open enrollment.
To register, please visit here.
PPL Accepting New Enrollments for the VF/EA Model of Service
The Office of Developmental Programs (ODP) has shared ODPANN 24-027. The purpose of this communication is to announce that effective March 1, 2024, PPL is accepting new enrollments and referrals in the VF/EA model of service. Please view the announcement for additional information and details.
CMS Provides Medicare Enrollment Update and Additional Guidance
CMS Medicare Clinician Enrollment Guidance: Resolution to Rejections & Addiction Counselor Clarification
RCPA and the National Council for Mental Wellbeing have worked together to resolve the recent concern with Medicare enrollment rejections for Marriage and Family Therapists as well as Mental Health Counselors. There have been many cases where the applications were rejected because applications did not include documentation or verification of the required 3,000 hours of supervision or the 2 years’ experience. RCPA met with the Centers for Medicare and Medicaid Services (CMS) on several occasions, outlining that the applications that meet the Medicare enrollment criteria have met this standard as part of the PA State License.
Initially, CMS cited that it was a requirement to provide the documentation. After communicating with CMS leadership, however, CMS responded that RCPA was correct and clarified that if a provider is licensed and the hours are a requirement for the licensure, said provider does not require the verification.
If your agency has received a rejected application, please contact RCPA Policy Director Jim Sharp, who will connect your agency to the proper department that will address the denial.
SUD Addiction Counselors Eligible for Medicare Enrollment
There have been several members who have attempted to enroll their SUD counselors who have met the enrollment qualification being told by CMS that the enrollment does not include these SUD professionals.
RCPA has confirmed with CMS leadership that if the provider is licensed as an addiction counselor or alcohol and drug counselor (ADC) by the state in which the services are performed, they can also enroll as an MHC as long as all other requirements are met.
MHCs are defined as individuals who:
- Possess a master’s or doctor’s degree, which qualifies for licensure or certification as an MHC, clinical professional counselor, or professional counselor under the state law of the state in which such individual furnishes the services defined as mental health counselor services;
- After obtaining such a degree, have performed at least 2 years or 3,000 hours of post-master’s degree clinical supervised experience in mental health counseling in an appropriate setting, such as a hospital, SNF, private practice, or clinic; and
- Is licensed or certified as an MHC, clinical professional counselor, professional counselor, addiction counselor, or alcohol and drug counselor (ADC) by the state in which the services are performed.
RCPA is recommending that this language accompany any future enrollment applications to CMS for SUD Addictions Counselors enrollment documentation.
Reminder for Marriage/Family Therapists and Mental Health Counselors to Enroll in Medicare
Clarification on IDD Providers’ Role in Medicaid Renewal Process
Deputy Secretary Ahrens has shared information regarding avoidable Medicaid non-renewals for individuals. If an individual is receiving waiver services and loses their MA, this has the unfortunate outcome of the individual being dis-enrolled in the waiver. In turn, services rendered during a time when the individual is ineligible will not be paid through waiver funds.
If your agency serves as a representative payee or provides waiver services, especially residential services, this can have a serious impact on both your agency and the individual receiving services. Of note:
- As of 10/17/2023, the Office of Developmental Programs (ODP) has a record of 444 enrolled individuals (223 of whom are waiver participants) whose MA was not renewed procedurally. These participants’ renewal dates span April through September 2023.
- 176 individuals (45 of whom are waiver participants) were registered and had their MA closed due to ineligibility.
The primary reasons appear to be that asset limits were exceeded and determination paperwork had not been returned (procedural closure). There are individuals who receive residential services in these groups. Please note that sometimes paperwork may go to a guardian or representative payee. In those situations, it’s important that there is communication between the provider and the responsible person. In particular, providers should be aware of the following:
- Individuals receive MA renewal paperwork in the mail at their home address. Providers/SCOs should ensure that the CAO always has up-to-date contact information for individuals receiving MA.
- Renewal dates differ. Individuals should receive renewal info about 90 days prior to the due date.
- If a provider has questions about renewal dates for individuals, AEs and SCOs are provided data on all individual MA renewal dates.
Please ensure that your agency is aware of the renewal dates and is prepared to respond quickly and/or assist the guardian or family member who may be receiving the paperwork. Additionally, please be cognizant of the asset limits and consider opening an ABLE account if all the individual’s needs are met.
For any questions, contact Carol Ferenz.
CMS 2024 Physicians Fee Schedule Final Rule: MFTs, MH, & SUD Counselors Medicare Enrollment
DHS Eliminates MA Provider Enrollment Backlog
Message From the Department of Human Services
June 8, 2023
Harrisburg, PA — The Shapiro Administration today announced it has completely eliminated a backlog of Medicaid provider enrollment and revalidation applications, paving the way for more health care providers to become part of the Medicaid program, and giving Medicaid recipients more options for care. This announcement follows news in late April that the Department of Human Services (DHS) had already reduced the provider backlog by 75 percent within Governor Shapiro’s first 100 days in office.
As of January 2023, there was a backlog of more than 35,000 provider applications and revalidation applications that were more than 30 days old. Within the first 100 days of the Administration, the number of waiting applicants was reduced by 75 percent to under 8,500 applications, and that backlog has now been entirely eliminated.
“Pennsylvania is fortunate to have so many caring, high-quality health care providers and professionals who want to be part of the Medicaid program and care for some of our most vulnerable friends, neighbors, and loved ones,” said DHS Acting Secretary Dr. Val Arkoosh. “I want to thank them and DHS staff who worked so diligently on this issue. They have helped to ensure that Medicaid recipients in the Commonwealth can continue to get the care they need and deserve.”
By federal law, organizations are not able to offer care to patients under the Medicaid program unless they are enrolled providers. In addition, DHS must revalidate Medicaid service providers every five years. Any backlogs in processing applications means that providers who want to offer services to Medicaid recipients cannot do so until their applications are approved.
The Medicaid program in Pennsylvania serves more than 3.7 million people, including children, seniors, and people with disabilities. Recognizing the scope of the backlog and its impact on Pennsylvanians, the Shapiro Administration and DHS staff and leadership acted quickly to address it, removing roadblocks to processing applications quickly and cutting red tape.
Read the full announcement here. If a member has not been notified of the status of a pending enrollment or revalidation, please contact your RCPA Policy Director.
REMINDER: Consumers Must Select a HealthChoices Plan by Aug 16
REMINDER
Message from the Department of Human Services (DHS)**
Pennsylvania’s Department of Human Services (DHS) is changing which Physical Health Managed Care Organizations (PH Plans) are available for Medical Assistance (MA) consumers. This is an opportunity for DHS to be sure that the program and our partners are continuing to strive towards improved access to care and superior quality of care and support provided by the PH Plans to MA consumers.
The PH plans available in your county may change. In some counties, your current MCO will no longer be available, and in others, you may have new options to pick from. If you have to select a new plan, DHS is committed to helping you find a plan that meets your individual needs, while also allowing you to keep your current health care providers. It’s important for you to consider what doctors, hospitals, or other health care providers are in a PH plan’s network.
This enrollment period is your opportunity to compare the health plan options in your region and choose the best plan for you.
Please note that the above information means that your agency needs to alert your consumers to the change so they can make an informed decision. Otherwise, they will be auto-assigned. Visit here for more details regarding which plans are available by county.
**Does NOT affect current Behavioral HealthChoices or
Community HealthChoices participants.**
