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Additional Safeguards Session Law 2013-306 Revised Payment Adjustment Plan

Additional Safeguards Session Law 2013-306 Revised Payment Adjustment Plan. Personal Care Services State Plan Amendment 13-009 August 20, 2014 Revised version of webinar presented on July 2nd & 9th titled Personal Care Services (PCS) Recoupment/Repayment Plan.

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Additional Safeguards Session Law 2013-306 Revised Payment Adjustment Plan

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  1. Additional SafeguardsSession Law 2013-306Revised Payment Adjustment Plan Personal Care ServicesState Plan Amendment 13-009 August 20, 2014 Revised version of webinar presented on July 2nd & 9th titled Personal Care Services (PCS) Recoupment/Repayment Plan

  2. Session Law 2013-306House Bill 492 Purpose: Direct the Department of Health and Human Services (DHHS) to adjust Medicaid Personal Care Services (PCS) to provide additional safeguards for qualified individuals. • Approved 18th day of July, 2013

  3. Provider Rates & Reimbursement • With the approval of SPA 13-009 (HB492) by CMS, the reimbursement rate from October 1, 2013 through December 31, 2013 is $3.58 per 15 minutes ($14.32 per hour). The rate prior to October 1, 2013 was $3.88 per 15 minutes or ($15.52 per hour). • To comply with the Shared Savings plan enacted by N.C. Session Law 2013-360, DMA applied the 3% reduction on January 1, 2014 to the current rate of $3.88 per 15 minutes ($15.52 per hour) which equated to $3.76 per 15 minutes ($15.04 per hour). • The reimbursement rate from January 1, 2014 will now be $3.47 per 15 minutes ($13.88 per hour). This equates to $3.58 per 15 minutes reimbursement rate less the 3% reduction.

  4. Provider Rates & Reimbursement

  5. Revised Payment Adjustment Plan • Systematic Payment Adjustments will begin with the September 9 check write and will continue through April 2015 beginning with claims with Dates of Service from October 1, 2013 through May 22, 2014 [1]Check-write calendar for calendar year 2015 is not available. Dates for 2015 adjustments will be confirmed once available.

  6. Notification of Payment Adjustment • PCS providers will receive a letter stating the estimated total payment adjustment amount prior to the September 9th check write.   • All amounts owed to DMA that are not satisfied within 30 days from the Systematic Payment Adjustment Begin Date will incur penalty and interest.

  7. Payment Adjustment by Setting of Service: Calculating Adjustment from SPA • Payment amounts are then recalculated for the period using the reduced rates. The difference between the actuals and this amount represent adjustment to DMA. • The table below shows calculated adjustment resulting from the implementation of the SPA by Type and Setting, across the impact period (October 2013 to date) • Source data: • Actual hours provided by James Campbell on 5/24/2014 • Estimated hours provided by Talbatha Myatt on 6/3/2014 • Rate obtained from PCS SPA presentation posted on DMA website

  8. Average Monthly Payout vs. Gross Adjusment by Setting of Service • Source data: • Actual hours provided by James Campbell on 5/24/2014 • Estimated hours provided by Talbatha Myatt on 6/3/2014 • Rate obtained from PCS SPA presentation posted on DMA website

  9. Gross Adjustment Histogram • 80% of providers will owe less than $15,000 • Approximately 60% will owe less than $5,000 • Source data: • Actual hours provided by James Campbell on 5/24/2014 • Estimated hours provided by Talbatha Myatt on 6/3/2014 • Rate obtained from PCS SPA presentation posted on DMA website

  10. Estimate Your Adjusted Payment • The Payment Adjustment Calculator will provide a rough estimate of the adjustment, not the exact amount. • The Payment Adjustment Calculator is available on the PCS Webpage: http://www.ncdhhs.gov/dma/pcs/pas.html

  11. Manual Provider Repayment Option • Providers can pay the balance owed to DMA at any point in the adjustment process by sending a check to the lockbox address listed below. Miscellaneous Medicaid Payments PO Box 602885 Charlotte, NC 28260-2885

  12. Manual Provider Repayment Option • Please note that you can only have one check per NPI/Payer otherwise those funds will not be able to be posted correctly. • Payments will be posted to your accounts more quickly by including the accounts receivable page from the remittance advice statement with the payment.

  13. Resources DMA will continue to host monthly stakeholder meetings and update the PCS webpage with current information. Contact the DMA PCS program at 919-855-4340 or email: PCS_Program_Questions@dhhs.nc.gov Contact the DMA Finance Section at 919-814-0060

  14. Personal Care Services Contacts Beneficiaries and Providers who have questions about the additional safeguards allowed by N.C. Session Law 2013-306 and the implementation of additional hours may contact: • The DMA PCS Program at 919-855-4340 or email: PCS_Program_Questions@dhhs.nc.gov • Liberty Healthcare-NC, Call Center at 855-740-1400 or 919-322-5944; Independent Assessment Email:NCIASupport@LibertyHealth.com for questions.

  15. Resources

  16. Frequently Asked Questions (FAQ) Questions submitted through the chat box will be posted in the FAQ section on DMA’s Website following the August 20, 2014 Webinar http://www.ncdhhs.gov/dma/pcs/pas.html

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