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FL- Applications keep rolling in for Medicaid home and community based grants

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[ MM Curator Summary]: FL has received 359 applications for providers wanting the additional HCBS money from federal COVID relief funds.

 
 

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 Agency for Health Care Administration reports 359 applications have been submitted to the state as of Jan. 6 from home and community-based providers looking to tap into hundreds of millions in additional Medicaid dollars meant to fortify the delivery system that keeps people with developmental and intellectual disabilities out of institutions and in communities.

Nearly 70% of the applications were submitted by providers that want both stipend and retention payments. Sixty-four applications were submitted by providers that want retention payments only and another 30 applications were submitted by providers that are only seeking stipends.

Six applications were submitted by providers wanting to install delayed egress systems.

Twelve applications, AHCA told Florida Politics, were improperly filled out or didn’t have the correct information.

Florida Developmental Disabilities Council
Executive Director Valerie Breen told Florida Politics Friday the association is waiting for AHCA to develop a “Frequently Asked Questions” document that will help providers better understand how to fill out the applications.

 
 

Nevertheless, Breen said, “We are very encouraged that the application process has become available and people are applying.”

The state announced three different funding opportunities for providers that work with people with intellectual and developmental disabilities: $403.7 million for one-time stipends; $266.6 million for bonuses and incentives meant to grow and retain a workforce; and $12 million for delayed egress systems meant to thwart elopement from community group homes.

The Gov. Ron DeSantis administration quietly moved over the summer to take advantage of a 10% bump in federal Medicaid dollars available under the American Rescue Plan Act of 2021.

President Joe Biden’s administration approved Florida’s proposed request to tap into an additional $1.2 billion in September.

AHCA announced Dec. 17 the opening of a 60-day window for providers to apply for the funds. The state
is accepting applications through Feb. 14.

 
 

It’s not clear how much each individual provider will receive in grants, though egress grants cannot exceed $10,000. AHCA Chief of Staff Cody Farrill told lawmakers in November the agency couldn’t determine individual grant amounts until the state knew the level of interest by providers that want both stipend and retention payments.

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Clipped from: https://floridapolitics.com/archives/484396-applications-keep-rolling-in-for-medicaid-home-and-community-based-grants/

 
 

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NJ/Fraud- $3.6M Medicaid Fraud Allegations Tied To Ex-NJ Nursing Home Owner

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[ MM Curator Summary]: A NJ nursing home operator is on the run from the law.

 
 

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.

 
 

Crime & Safety


Arkansas authorities are looking for Joseph Schwartz, linked to Andover Subacute’s facilities where 17 bodies piled up during the pandemic.

 
 

Jennifer Jean Miller,

Patch Staff

 
 

Posted Wed, Dec 29, 2021 at 3:41 pm ET

 
 

Arkansas authorities are looking for Joseph Schwartz, linked to Andover Subacute’s facilities where 17 bodies piled up during the pandemic. (Shutterstock)

ANDOVER TOWNSHIP, NJ — An ex-owner of a Sussex County nursing home where bodies were stacked in a makeshift morgue after COVID swept through it, is being sought in Arkansas for tax evasion and a $3.6 million Medicaid fraud.

That investigation has raised questions in New Jersey about the status of a state investigation into the Andover Subacute facilities, now known as Limecrest Subacute and Rehabilitation Center and Woodland Behavioral and Nursing Center, where Joseph Schwartz, who owns Skyline nursing homes, is linked to the ownership.

NBC Nightly News with Lester Holt aired a segment in November about what happened at the Andover Subacute facilities during the pandemic below, interviewing a former employee who spoke for the first time about what happened on Easter weekend in April 2020, when the morgue became so packed, one body was placed in a storage shed.

Find out what’s happening in Hopatcong-Sparta with free, real-time updates from Patch.

RELATED: Watch NJ Nursing Home Ex-Employee Talk About ‘Makeshift Morgue’

In the Lester Holt broadcast, interviewer Stephanie Gosk spoke about the outcome of the federal inspections at Andover Subacute after the 2020 incident, which later changed its name, referring back to NBC News’ own 2019 investigation into Schwartz’s company.

Find out what’s happening in Hopatcong-Sparta with free, real-time updates from Patch.

Schwartz’s Skyline reportedly once had a stake in the Andover facilities, with his son Louis still one of the owners, NBC News reported in its exposé below:

 
 

The Allegations From Arkansas

Arkansas’ Attorney General Leslie Rutledge said authorities are looking for Schwartz after a 44-month investigation into his company Skyline nursing homes, who Rutledge said received $3.6 million in 2018 from overbilled Medicaid payments for eight facilities that he owns in Arkansas.

According to a recent news release from Rutledge’s office, Schwartz’s company ballooned its billings to more than $6.2 million by filing bogus cost reports, statements and other documents, which resulted in an overpayment to his company of more than $3.6 million from Arkansas’ Medicaid Program.

Rutledge said Schwartz was also charged with attempting to evade taxes by taking out over $2 million in income taxes from his Arkansas employees’ paychecks between July 2017 and March 2018, without forwarding those tax withholdings to the State of Arkansas.

He additionally took in “tens of millions of dollars in gross income,” from his facilities in 2018 and 2019, for which he never filed tax returns, according to Rutledge.

“These charges come after a 44-month-long investigation into Skyline’s wrongdoings, and I will not sit idly by while anyone defrauds the State and Federal government out of millions of dollars to line their own pockets,” Rutledge said. “It’s important for Arkansans to know if they suspect Medicaid fraud, they should immediately contact my office.”

Her office referred the case to the Attorney General’s Office by the Office of Medicaid Inspector General, following a joint investigation with the HHS OIG- Office of Investigation, Nebraska Medicaid Fraud and Patient Abuse Unit, Kansas MFCU, Maryland MFCU and South Dakota MFCU.

Local Response To Allegations Against Schwartz

Members of Sussex County’s Board of County Commissioners responded to the news about the Arkansas warrant for Schwartz on Wednesday, stating they plan to draft a letter to New Jersey’s Acting Attorney General Andrew J. Bruck for an update on the state’s investigation into Andover Subacute, which the commissioners plan to present at their next public meeting.

According to a news release from the commissioners, they say that Governor Phil Murphy’s administration continues to stonewall Open Public Records Act requests that Sussex County’s attorney first submitted in May 2020.

RELATED: Still No Answers In Case Of NJ ‘Makeshift Morgue’ Nursing Home

The County Commissioners additionally say that “a yearlong investigation by the New Jersey Attorney General into Andover Subacute and other nursing homes has produced no news.”

A special public question that was on Sussex County ballots in the Nov. 2 General election, overwhelmingly had more than 34,000 votes or 82 percent of voters choosing “yes” for a deeper probe into the COVID-19 deaths in New Jersey’s nursing home, as well as further release of information related to New Jersey’s handling of nursing homes during the pandemic.

RELATED: Sussex Co. Ballot Question Calls For COVID-19 Nursing Home Probe

The commissioners say that the news about Schwartz thrusts into the spotlight the “poor management of the nursing homes in the run-up to Governor Phil Murphy’s Executive Order 103 that forced many substandard, long-term care facilities to accept COVID patients.”

“The fact that state officials were responsible for the licensing and oversight of these facilities only heightens the need for transparency and full disclosure,” wrote Samantha Gabriele, a spokesperson on behalf of the commissioners.

“The County Commissioners have cooperated fully with the state investigation, including allowing interviewing of staff members, all emails and correspondences; and emails to the state Health Department in response to what was happening at the nursing home,” said Commissioner Herb Yardley.

He called the cooperation from the state “one-sided,” indicating that rather than having an investigation conducted by the Attorney General, who Murphy appointed, it should be performed by special counsel.

“It’s been more than a year and we still have not heard anything about this investigation or how the policies, decisions and oversight directed at our nursing homes resulted in tragedy,” Commissioner Anthony Fasano said. “Transparency and accountability are so desperately needed and so noticeably missing.”

Questions or comments about this story? Have a local news tip? Contact me at: jennifer.miller@patch.com.

Clipped from: https://patch.com/new-jersey/hopatcong-sparta/3-6m-medicaid-fraud-allegations-tied-ex-nj-nursing-home-owner

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NV/HCBS- Nevada leveraging federal funds for home care workers

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[ MM Curator Summary]: Home care workers can get a one-time $500 payment.

 
 

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.

 
 

Nevada Medicaid is leveraging an opportunity through the federal American Rescue Plan Act to offer $500 supplemental payments to Medicaid home care workers who have been on the front lines of the pandemic.

“Nevada is indebted to this critical workforce that quietly helps people stay in their homes every day,” said Governor Steve Sisolak. “Home care workers left their own homes and cared for our elderly and Nevadans with disabilities so that they didn’t have to leave home. This opportunity is one way to give back.”

Home care workers were first informed of this opportunity late last year, and the application period is open until January 14.

The $500 supplemental payment is available to home care workers who have maintained their employment with an agency since Nov. 1, 2021. Medicaid providers offering home care services may apply on behalf of employees until January 14, 2022. Participation is voluntary. The application and qualifications can be found at https://dhcfp.nv.gov/Pgms/LTSS/AmericanRescuePlan/

Nevada has more than 13,000 home care workers, predominately women and disproportionately minorities, who help older Nevadans and persons with physical or intellectual disabilities with daily tasks to remain independent in their homes.

Nevada Medicaid offers free or low-cost health insurance for working Nevadans, people who have lost their jobs or have become too sick to work. The program supports low-income families, children, seniors, and people with disabilities and offers financial protection against bankruptcy for families who are struck by unexpected illness. Nevada Medicaid makes health care possible in many urban and rural communities. Sign up today for Nevada Medicaid email alerts. Apply for Nevada Medicaid at Access Nevada or call 1-800-992-0900. If you are not eligible for Medicaid, subsidies and tax credits for health insurance costs are offered through NevadaHealthLink.com (1-800-547-2927).

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Clipped from: https://gov.nv.gov/News/Press/2022/Nevada_leveraging_federal_funds_for_home_care_workers/

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CMS Says Children’s COVID-19 Vaccine Counseling Visits Covered by Medicaid

 
 

 
 

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[ MM Curator Summary]: CMS will now require COVID vaccination counseling as part of the EPSDT program.

 
 

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.

 
 

On Dec. 2, the Centers for Medicare & Medicaid Services (CMS) announced that Medicaid programs must cover COVID-19 vaccine counseling visits provided to children as part of the Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This action is part of the Biden-Harris administration’s winter plan to respond to COVID-19 amid the emergence of a new variant of concern, omicron.

COVID-19 vaccine counseling visits will fall under COVID-19 vaccine administration, and as such will be federally matched at 100% under the American Rescue Plan Act. The law was enacted in March 2021 and provides a 100% federal match for COVID-19 vaccines and vaccine administration during the public health emergency and for one year after the end of the emergency. Read more about the American Rescue Plan Act’s health-related provisions in this previous blog post.

Medicaid programs will also be required to cover stand-alone vaccine counseling visits, federally matched at the regular match rate, for all pediatric vaccines under the EPSDT benefit.

 
 

Clipped from: https://achi.net/newsroom/cms-says-childrens-covid-19-vaccine-counseling-visits-covered-by-medicaid/

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Medicaid DSH cuts nixed from Build Back Better Act

 
 

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[ MM Curator Summary]: Dems were unable to punish hospitals in non-expansion states with DSH cuts.

 
 

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.

 
 

After receiving pushback from hospitals, the Senate scrapped plans to cut Medicaid disproportionate share hospital payments in 12 states from its version of President Joe Biden’s $1.7 trillion social spending package.

Under the House-passed Build Back Better Act, the 12 states that haven’t expanded their Medicaid programs faced a 12.5 percent reduction in Medicaid DSH allotments. The AHA said the cuts could be as much as $4.7 billion over 10 years. Under the House version, if a state chooses to discontinue its Medicaid expansion, its DSH allotments would be reduced as well.  

In early November, eight healthcare organizations argued that reductions in DSH allotments would be an “additional hardship for hospitals” in states that didn’t expand Medicaid and would “make it difficult for hospitals in those states to continue to serve their patients and their communities.”

Although the DSH cuts were scrapped, the Senate version keeps a provision to limit federal payments in states that didn’t expand Medicaid for a separate uncompensated care pool.

 
 

Clipped from: https://www.beckershospitalreview.com/finance/medicaid-dsh-cuts-nixed-from-build-back-better-act.html

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Biden Administration To Expand Vaccine Education For Medicare, Medicaid As Omicron Hits U.S.

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[ MM Curator Summary]: CMS Administrator Lasure thinks members don’t know enough about their vaccine options.

 
 

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.

 
 

 
 

Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure.

Forbes

Chiquita Brooks-LaSure, who leads the federal Centers for Medicare and Medicaid Services (CMS), says her office will double down on vaccine education for seniors and low-income Americans as the country continues to battle the Covid-19 pandemic and the latest omicron variant. 

“We are really trying to make sure that everyone knows what is available to them,” Brooks-LaSure told the Forbes Healthcare Summit on Thursday. Her remarks coincided with the Biden-Harris Administration announcing a series of new actions to combat the pandemic, including tightened travel rules and requiring insurers to reimburse at-home Covid testing, a day after the first U.S. omicron case was detected in California.

While more time is needed to study and determine whether this new variant poses greater risk of severe disease or death, the Biden Administration’s position in recent weeks has been to encourage all adults to get a Covid-19 vaccine booster shot, especially for older or vulnerable people. 

Brooks-LaSure said she will be sending a letter to the 63 million people in the Medicare program “telling them to get boosted” and alerting them to where Covid-19 booster shots are available within their communities. This is the first time in four years that the agency has sent out a mass letter to all Medicare recipients, according to the White House. The CDC reports that 99.9% of percent of Americans aged 65 and over have gotten at least one dose, while 86.3% are fully vaccinated. Around 21 million seniors, or 44.7% of the 65 and older population, have received a booster shot. 

CMS will also focus on outreach to low-income Americans in the Medicaid program by providing federal matching funds and requiring states to reimburse Covid-19 vaccine counseling sessions “in which healthcare providers talk to families about the importance of kids’ vaccination” for the duration of the pandemic. 

“We’re requiring states to pay for vaccine education,” said Brooks-LaSure. One of the main reasons is trusted relationships with healthcare providers, be it doctors, nurses or community health workers, are one of the ways to move the needle when it comes to vaccine hesitancy. This also means reaching people where they live and work. “Whether it’s through churches, through [federally qualified health centers], through so many of the organizations that people trust, they want to hear from their friends and their neighbors about why they got vaccinated,” she said. 

“This effort of education is something that I hope we take with us,” Brooks-LaSure added. “Developing these relationships between providers and people in their communities is something that we can use to strengthen our healthcare system more broadly.”

 
 

Clipped from: https://www.forbes.com/sites/katiejennings/2021/12/02/biden-administration-to-expand-vaccine-education-for-medicare-medicaid-as-omicron-hits-us/?sh=32baff475b8d

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Medicaid contractor stops trying to recoup payments from mental health providers

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[ MM Curator Summary]: Colorado will no longer recoup payments from providers who say they submitted them correctly in the first place.

 
 

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 announcement came two days after The Colorado Sun reported that mental health providers would no longer accept Medicaid patients because of the debacle.

 
 

 
 

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)

Colorado mental health therapists will no longer have to pay back money they received for seeing Medicaid patients after a state contractor that had threatened to “recoup” the payments reversed course Wednesday. 

Mental health counselors at practices in eight Front Range counties received emails from Colorado Community Health Alliance — the contractor that processes their Medicaid claims — notifying them it was “stopping the current recoupment project.” This comes after the health alliance sent letters asking therapists to return thousands of dollars in payments they had already received, a financial debacle blamed on a software error.  

This week’s reversal by the state contractor came after reports in The Colorado Sun and 9News exposing the claims fiasco. Several mental health counselors and therapists working in small group practices told The Sun they would no longer accept Medicaid patients because of the paperwork headache and the latest fight with the state contractor. 

TODAY’S UNDERWRITER

For some, the reversal is too little, too late.

Carla D’Agostino-Vigil, one of the only specialists in obsessive-compulsive disorder who accepted Medicaid in Colorado, was among those who decided she would no longer see Medicaid patients because of the latest hassle. While she welcomed the health alliance’s announcement, D’Agostino-Vigil said Wednesday she had no plans to change her mind about accepting Medicaid clients. 

“I am cautiously optimistic this will result in a timely correction,” said D’Agostino-Vigil, who runs Ignite Counseling in Westminster. 

The licensed counselor already was suffering from a 20% rate cut for Medicaid patients that the health alliance put in place in January 2020. And D’Agostino-Vigil is still in the midst of an unrelated dispute with the health alliance over claims that were denied due to an alliance software issue, she said. 

Therapists who already paid a recoupment fee to the health alliance will get a refund, the alliance said.

The recoupment letters, copies of which were reviewed by The Sun, told providers they had 60 days to return the money or Colorado Community Health Alliance could withhold future payments. The health alliance, which is owned by insurance giant Anthem, is essentially the middle man between the providers and the state Medicaid department and is responsible for processing claims and dispensing payment. 

The therapists were not overpaid — they were asked to return money for services they provided during prior years because claims were missing a provider identification number. 

 
 

 

Mental health professionals said they included the provider identification number on their claims. It was the computer system used by the health alliance that scrubbed the identification numbers — required by state and federal law — from its claims. The contractor realized the mistake in July 2019 and fixed its software system in October 2020, said spokeswoman Colleen Daywalt. Mental health providers have been warned of the issue via email and in meetings since March 2020, but many said they were caught off guard when they received the recoupment notifications requesting payment this fall. 

Colorado Community Health Alliance is the payer for 1,175 behavioral health providers in Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park and Teller counties. About 200 providers who did not resubmit claims received the recoupment letters, which asked for amounts up to $18,000.

The health alliance said Wednesday that it was taking back the recoupment action “in light of recent feedback from behavioral health practices.” 

Instead of requiring therapists to pay up or resubmit claims, the health alliance is making plans to contact each counseling practice to retrieve the needed provider identification numbers, Daywalt said in an email to The Sun. “We plan to work with providers to collect the data to ensure we have proper documentation without requiring the providers to resubmit the claims,” she said. 

TODAY’S UNDERWRITER

She said the alliance is “dedicated to ensuring access” to mental health care in Colorado, noting there are now 3,514 practitioners in the network.

The billing issue comes as Colorado has tried to expand the number of mental health professionals who accept Medicaid, a government insurance program for low-income residents and those with disabilities. The Colorado Department of Health Care Policy and Financing, which runs the Medicaid program and contracts with the health alliance to disperse payments to the providers, said the number of providers statewide taking Medicaid reached 8,371 in June, compared with 6,029 in April 2020.

The department said Wednesday that it was pleased the state and its contractor “identified an easier way” to collect the required claim information. The process “was never intended to be about recouping payments from providers but rather to have accurate and compliant claims,” department spokesman Marc Williams said in an email to The Sun.

“While 84% of providers were able to comply with the claim data request during the 20-plus months of time provided, we understand that this issue presented a heavier administrative burden for the remainder of the providers.”

Williams added that the resolution “enables all our behavioral health providers to continue to deliver care to our Medicaid members — especially during this time of increased demand for such services due to the impacts of COVID-19.”

TODAY’S UNDERWRITER

Christia Young, a Brighton therapist who received a recoupment notice for $7,200, was skeptical that the announcement meant things with the alliance would improve. 

“It’s good news, but I already paid an attorney, drafted a letter, and spent a large chunk of my time faxing them all of the corrected claims,” said Young, who sees patients with chronic suicidal thoughts at Badass Therapy. “It also doesn’t fix all of the other issues providers have with them. I already had so many issues with billing prior to this.”

Young has stopped taking Medicaid patients through the health alliance. 

“My Medicaid clients are some of my favorites to work with,” she said. “It has been heartbreaking to have to prioritize my mental health and financial well-being because it is so difficult to work with Medicaid.” 

 
 

Clipped from: https://coloradosun.com/2021/12/02/medicaid-mental-health-claims-2/

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IL- Rate Increases to the Medicaid Fee Schedule (Dental)

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

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State pushes back timeline for Medicaid bonuses; group home providers eye long-term solutions

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/

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Some Colorado therapists will no longer take Medicaid patients

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. 

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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. 

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“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/