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Tags Posts tagged with "Medicaid"

Medicaid

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The Centers for Medicare & Medicaid Services (CMS) has released a set of frequently asked questions (FAQ) supplementing the 2021 State Health Official (SHO) letter about extending postpartum coverage in Medicaid and the Children’s Health Insurance Program (CHIP). The FAQ offer guidance to state Medicaid programs on the new option allowing states to provide 12 months of extended postpartum coverage to pregnant individuals in Medicaid and CHIP. They clarify what constitutes full benefits during this extended eligibility period and address whether states need to submit a state plan amendment (SPA) for coverage modifications. For more details, view the FAQ here.

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RCPA attended the Office of Mental Health and Substance Abuse Services (OMHSAS) telehealth webinar on Monday, January 29, alongside many provider members, regarding the Federal payment conditions related to the delivery of telehealth services and the requirement that the physicians or clinicians must present in the office, or that the client must be in the office during the telehealth session, to meet the guideline. It was explained that despite the standards outlined in the current OMHSAS Telebehavioral Health Bulletin, under the Federal “4 walls” statute, this is a required Federal Medicaid payment condition. These requirements cannot be waived.

The purpose of today’s call was twofold: explaining the “4 walls” requirements, and for providers to give vital feedback to OMHSAS on the impacts, challenges, and barriers to accessing services that this may create for consumers and families. This Medicaid standard remains in effect, and RCPA recommends provider members review their operating practices to ensure compliance.

During this time, RCPA will continue its efforts and work with OMHSAS, the HealthChoices partners, and stakeholders to ensure access to services via telehealth. You can review today’s OMHSAS telehealth webinar slide deck. We are also looking to obtain a recording of the webinar to share with our members.

If you have questions, please contact RCPA Policy Director Jim Sharp. The next RCPA Telehealth Operations Committee meeting is scheduled for Tuesday, February 27; however, we will be reviewing if we need to meet sooner based on current information.

Please share this information with your stakeholder networks.

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The Pennsylvania Department of Human Services (DHS) is developing an 1115 Medicaid program, Bridges to Success: Keystones of Health for Pennsylvania (Keystones of Health). DHS hopes to use this program to make health care more accessible, improve quality of care and services, and design and evaluate innovative strategies in health care to help people live healthier lives. The department’s goal and vision for the waiver is to address Pennsylvania’s Medicaid participants’ health-related social needs with interventions that are both lifesaving and cost saving. Visit the Keystones of Health web page for more details.

Keystones of Health will focus on four key areas:

  • Reentry from correctional facilities;
  • Housing supports;
  • Food and nutrition supports; and
  • Multi-year continuous eligibility for children up to age 6.

DHS is offering the public the opportunity to come to virtual forums to learn more about Keystones of Health and the proposed services. During the forums, the public will be able to ask questions and submit comments. If you are interested in joining the public forums, the information is below:

Public Forum 1

  • Date: Monday, December 11, 2023
  • Time: 12:00 pm – 1:00 pm
  • Register for Session 1
  • Join by phone: 312-626-6799; Webinar ID: 982 3951 9594

Public Forum 2

  • Date: Tuesday, December 12, 2023
  • Time: 6:00 pm – 7:00 pm
  • Register for Session 2
  • Join by phone: 312-626-6799; Webinar ID: 980 3834 3590

Public Forum 3

  • Date: Friday, December 14, 2023
  • Time: 9:00 am – 10:00 am
  • Register for Session 3
  • Join by phone: 312-626-6799; Webinar ID: 951 7040 4572

Please register to participate virtually. When you register, there will be an option to add the Public Forum to your calendar. Registration is not necessary to join by phone. Closed captioning will be provided during each public forum.

DHS also invites you to submit written comments on the draft application from December 2, 2023, through January 2, 2024, through the Public Comment Form.

View the Press Release

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Hole torn in a dollar bill with medicaid text

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.

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