Author: MM_ADMIN

MM Curator summary

[ MM Curator Summary]: IL dentists will get $10M in Medicaid payments next year.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

The Illinois State Dental Society (ISDS) advocated this past session to increase rates for dental care in the Illinois Medicaid program. ISDS was successful in the pursuit of the increased rates to the extent that $10 million was added to the budget for the rate increases.  

The Illinois Department of Healthcare and Family Services (DHFS) just announced these rate increases to the Medicaid Fee Schedule for select dental services that ISDS helped negotiate and are scheduled to begin January 1, 2022. The specific codes with rate increases can be found by clicking here. DHFS has highlighted the increased codes in yellow.

Highlighted in these new increases are restorative services, dentures, extractions, and anesthesia services.  To review the codes and see if participation in the Medicaid program would work in your practice, please click here to see the full Medicaid fee schedule.

To enroll and learn more about being a provider in the Medicaid program, please contact DHFS by calling 1-877-782-5565 (select option #1) or by going online to https://www2.illinois.gov/hfs/impact/Pages/ContactIMPACT.aspx.

We want to thank our members again for their persistent efforts in contacting and educating their legislators on the need for this additional funding. While we are very excited for this legislative win, our work is not done. We will continue, as always, to advocate for you, the members.

 
 

Clipped from: https://www.isds.org/news-details/2021/12/01/alert!-rate-increases-to-the-medicaid-fee-schedule

MM Curator summary

[ MM Curator Summary]: Florida is using an application process to distribute the recently approved federal funds for HCBS services, and providers want the money right now.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Florida may be getting a boost in money intended to help people with intellectual and developmental disabilities, but it doesn’t look like those additional federal Medicaid funds are going to be handed out soon.

And that’s a conundrum for a system that already is under strain.

The hopes were this “bonus money” could be distributed by the end of the year, but the administration of Gov. Ron DeSantis has pushed back the timeline to distribute the funds with the goal of having the money distributed by “winter 2022.”

Given the federal government approved the state’s plan to bolster home- and community-based services in September, the timeline has some wondering why it could take five months to see the money.

“It can’t come fast enough,” Sen. Aaron Bean, chairman of the health care spending panel, told Florida Politics Monday.

 
 

Agency for Health Care Administration Chief of Staff Cody Farrill told members of the Senate Appropriations Subcommittee on Health and Human Services earlier this month that the agency’s goal is to post employer and employee bonus applications on its website in December.

Of the $1.2 billion in additional federal money coming Florida’s way, the state is setting aside $403 million in one-time stipends for employers to apply for and another $266.6 million for their employees, Farrill said.

He said the AHCA is developing potential distribution methodologies but won’t finalize any until it determines how many employers applied for the stipends. Provider caseload will also be taken into consideration in the distribution formulas, but Farrill in his testimony offered few other details.

“We understand we want to get this out the door as quickly as possible, but also want to balance the fact that we make sure these (payments) are going to the right providers that are eligible,” Farrill said.

Philadelphia transplant Tamika Walker moved to Florida in 2014 to help care for her husband’s 100-year-old grandmother. Walker initially was hired by United Community Options of South Florida seven years ago at $10 an hour. After getting promoted, she now earns $11.30 an hour, well below the $17 hourly wage she was paid in Philadelphia.

 
 

Though she hasn’t gotten a pay raise since her promotion in 2015, Walker heaps praise on her employer. She told Florida Politics that while she’s able to “make do” because of her husband’s salary, she works with others who are financially struggling. Some staff, she says, can’t afford their own cars. They rely on Uber and Lyft to get to work.

“If they want to do it, just do it. Don’t tell us about it. Just do it.” Walker said of the pay raises. “We are trying to come out of a pandemic. We had to go to work every day and put our lives on the line.”

The DeSantis administration moved over the summer to take advantage of a 10% bump in federal Medicaid dollars available under the American Rescue Plan Act of 2021. Every state moved to tap into the increased federal funds, Farrill said.

Most Florida Medicaid patients who receive home- and community-based services either are enrolled in the Medicaid managed long-term care program or the Medicaid iBudget program. The former is for frail and elderly individuals who qualify for nursing home placement but choose to receive assistance with daily living activities, such as eating and dressing, that enable them to continue to live in their homes or another non-institutional setting.

Similarly, the Medicaid iBudget program allows adults with intellectual and developmental disabilities to tap into the home- and community-based services they require to continue living outside of an institution and in their family home or a group home.

Lawmakers in recent years have committed additional funding to serve more clients and whittle down what has been a lengthy waitlist. For the iBudget program to work, however, there must be a provider network willing to serve the clients. And there are worries that Florida’s network is beginning to erode.

The Agency for Persons with Disabilities reports that between March 1 and Sept. 30, 99 group homes closed, requiring relocation of 271 clients. But during that same time span, the state reports, 108 new group homes were licensed. The APD data doesn’t indicate how many clients the newly licensed homes serve.

The Florida Association of Rehabilitation Facilities data on closures tracks APD’s but FARF did not have information on new facilities opening.

FARF President and CEO Tyler Sununu said many of the group homes that remain open have stopped accepting new clients or have limited the services they provide. Sununu surveyed his group home members this summer and found that on average there has been a 41% turnover rate at the facilities.

The survey also showed that 23% of the positions at group homes are vacant, Sununu said.

Sununu attributes the 100 closures group home closures to the trifecta of the COVID-19 pandemic, a tight labor force, and historically low Medicaid reimbursement rates

“We were really hoping the money would be available for the holidays and it looks like it’s not going to be. And that’s unfortunate,” he said. “But we are really happy the money will be coming.”

Sununu, though, has his eye on the bigger picture: getting lawmakers to increase by $147.5 million the amount Medicaid pays providers. Of that increase, about $93 million would be funded with state general revenue. The remainder comes from matching federal dollars. The increase, he maintains, would allow group homes to pay direct care workers an average $14 an hour, up from the current average wage of $11 an hour.

Bean has either helped craft or has taken the lead on developing the state’s Medicaid spending plans during most of his lengthy legislative career. He says he is awaiting the results of a state-contracted study on the state’s new minimum wage requirements and the impacts it will have on the rates providers need to be paid.

Bean said APD will get its attention during the 2022 session but made no promises about increasing provider rates.

“I fully acknowledge they are struggling. But everybody is struggling. Nursing homes are struggling, retailers are struggling, restaurants are struggling. It seems like everybody has a supply chain crunch and a working shortage. So this industry is not spared from all of the above,” he said.

Florida Developmental Disabilities Council
Executive Director Valerie Breen is less focused on the home- and community-based industry and more focused on the workforce needed to provide services now and in the future

“Definitely we need providers. But more importantly, there isn’t the workforce there to support them. That is the critical issue,” she said.

While APD certifies direct support professionals who can work in Florida, Breen said there is no professional designation for the staff, whether they provide home- and community-based services at a family home or at a community group home. She said the workforce needs to be recognized and incentivized.

“It is a huge crisis nationally and we are definitely seeing it in Florida,” she said.

To that end, Breen said the Council will launch a message campaign dubbed “Pay Fair for Care.” She said hundreds of constituents will share their stories with lawmakers about the difficulty in getting direct support professionals.

“We are looking at an extreme caregiving situation. Where families are having to take it on,” she said. “They are absolutely having to take it on and they aren’t getting any support because the workforce that we depend on for direct support professionals is slowly and surely diminishing.”

Clipped from: https://floridapolitics.com/archives/476321-state-timeline-medicaid-bonuses/

MM Curator summary

[ MM Curator Summary]: CO Medicaid is trying to recoup payments from years ago, and providers say they billed properly but a tech vendor took off key information.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Several behavioral health providers say they will no longer treat Medicaid patients after 199 providers received letters ordering them to return payment for therapy already completed.

 
 

 
 

The logo for the Colorado Department of Health Care Policy and Financing, which administers Medicaid in the state, on a sign in the department’s offices on Feb. 26, 2019. (John Ingold, The Colorado Sun)

As a single parent going back to college, Carla D’Agostino-Vigil signed up for Medicaid and used the government-run health insurance to attend “life-saving” therapy. So when she graduated and started her own mental health counseling practice in Westminster, D’Agostino-Vigil was adamant that she would open her doors to Medicaid patients. 

“When it was my turn, I felt very strongly about being involved,” she said. “The way things have played out, my heart is broken.”

Two years after opening her practice, D’Agostino-Vigil is among the latest round of health care providers in Colorado who are quitting the Medicaid program. Nearly half of the 175 patients at Ignite Counseling Colorado are on Medicaid, and during a six-month transition phase, D’Agostino-Vigil will “try like heck” to find other counselors who will take them. If that doesn’t work, she intends to continue helping some pro bono. 

TODAY’S UNDERWRITER

Her list of reasons is long. There was the 20% rate cut in 2020, just ahead of an increase in need for mental health care because of the isolating days of the pandemic. There were the threatening letters warning her that she was “overusing” a billing code — the code for a full hour of therapy — and that she should instead see patients for 30- or 45-minute sessions. 

But what pushed D’Agostino-Vigil, one of the only specialists in obsessive compulsive disorder taking Medicaid in Colorado, over the edge was a “recoupment” notice received by her practice and nearly 200 others in Colorado this fall. The letter said that due to incorrectly filed claims, providers would have to pay hundreds or thousands of dollars to the agency – called Colorado Community Health Alliance — that dispenses their payments. In some cases, recoupment amounts have totaled $17,000 or $18,000 for a single mental health therapist in private practice. 

The letters, copies of which were reviewed by The Colorado Sun, warn that providers have 60 days to pay up or the management agency could withhold future payments. 

 
 

Nearly 200 behavioral health care offices received letters requesting recoupment for claims that were incorrectly filed. The letters said that if providers did not pay within 60 days, the contractor could recoup the funds by withholding future payments.

The debacle is the latest headache for Medicaid providers who for years have complained of redundant paperwork and clogged bureaucracy. And in this case, it’s not that therapists and counselors were overpaid — they are being asked to return money for services they provided during the prior two years, all because of a provider identification number that was not included in the claims. 

Multiple behavioral health clinicians told The Sun they included the provider identification number. It was the computer system used by their payer, Colorado Community Health Alliance, which is owned by private insurance giant Anthem, that scrubbed the identification numbers from its claims, thinking they were not needed. 

The health alliance, which is the middleman between providers and the state Medicaid program, realized its mistake two years ago and began warning therapy practices back in March 2020 that they would have to resubmit claims, said spokeswoman Colleen Daywalt. The provider number is required by state and federal law, so when the alliance discovered the problem in July 2019, the agency began working to correct its software system to include the number on its claim forms. The problem was fixed in October 2020, Daywalt said. 

Colorado Community Health Alliance, which is the payer for behavioral health providers in Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park and Teller counties, began notifying providers in March 2020 that claims filed during a two-year period were out of compliance. But many of the 1,175 providers under the alliance did not take action, overwhelmed by the task of resubmitting hundreds of claims. 

A therapist who saw a client weekly during those two years would have filled about 104 claims — and that’s just for one patient. 

Last month, the health alliance sent 199 letters asking for “recoupment” payments, setting off panic and a firestorm of complaints, including in a private Facebook group where therapists and counselors vent about Medicaid frustrations. 

 
 

Colorado Community Health Alliance sent letters to 199 mental health care providers asking for money to recoup payment for claims “paid in error.”

Daywalt said it’s not the health alliance’s intent to recoup any payments, only to comply with state and federal law. She would not say the total amount of money involved in the out-of-compliance claims or the range of recoupment amounts sent to providers. 

But several therapists contacted The Sun regarding the payment debacle and shared their recoupment amounts. 

Allison Harvey, who works at a small group practice in Arvada, said the health alliance is asking for $7,000 for 74 claims in 2020. “The problem is that we submitted all of these claims correctly with all of the information necessary for payment,” she said. “The data is getting removed sometime after the claims leave our hands. Our group, like all providers who choose to serve Medicaid clients, just want to simply be paid for the work we do with this important clientele.” 

 
 

Christia Young, with Badass Therapy in Brighton, was asked to return $7,200. Now Young has stopped taking Medicaid patients through Colorado Community Health Alliance. Even before the latest claims issue, she was spending 80% of her time dealing with Medicaid claims because the health alliance was “repeatedly auditing” her filings, she said. 

And Sarah Carlson, a licensed marriage and family therapist who has accepted Medicaid for 13 years, is quitting her Medicaid contract with the health alliance effective next month. She founded The Parent-Child Interaction Center, one of the largest group practices that accepts Medicaid in Larimer, Weld and Boulder counties. 

Carlson said she’s been fighting about claims with the health alliance for years. The agency owes her thousands of dollars in past claims and now is asking for about $6,000 in recoupment on payments she received for 2020 and 2021, she said. 

“I love how they can find the claims suddenly when they want the money back, but somehow manage not to have the others on file?” Carlson said. “It’s a game, and it’s disgusting. Especially during the pandemic when the need has been soaring.”

 
 

Carlson said she would struggle to pay her office rent just serving Medicaid clients and has to subsidize Medicaid patients with those who have private insurance. “Sadly, it’s my underserved clients who will suffer, but I cannot continue this way any longer,” she said. 

The Colorado Department of Health Care Policy and Financing, which runs the Medicaid program and contracts with Colorado Community Health Alliance to disperse payments to the providers, said providers have been warned of the claims error via multiple newsletters and meetings in 2020 and 2021. 

“While we understand this is frustrating for providers, providers and payers are responsible for submitting and processing compliant claims,” said an emailed statement from department spokesman Marc Williams. “Our contractor identified a system issue preventing this and corrected the issue. They have given providers 21 months to submit corrected claims, which they are still able to do before the recoupments take effect.”

While some providers are ending their Medicaid contracts this fall, the number of behavioral health providers who take Medicaid has grown statewide in the last year, Williams said. Practitioners in the network reached 8,371 in June, compared with 6,029 in April 2020, he said.

But Stephanie Farrell, CEO of Left Hand Management, a consulting group that helps behavioral health care offices across the state with billing and training, said the health alliance caused the problem and should have to fix it — not put the burden on small counseling centers. Colorado Community Health Alliance should pay the consequences, Farrell said, including any potential federal fines for submitting incomplete paperwork. 

TODAY’S UNDERWRITER

“It’s just a clerical issue. A data issue,” she said. “Can’t they say, ‘Let’s call it a mulligan?'”

It’s the latest example in what Farrell says is a messed-up system in which the people providing the mental health care have no voice and are buried by mountains of paperwork. She blames the organizational structure and the contractors that dispense payment.

“It’s the wild, wild West,” she said. “They just do whatever they want and they are grinding up providers in the process.” 

Clipped from: https://coloradosun.com/2021/11/29/medicaid-mental-health-claims/