FLORIDA UPDATES EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER - PowerPoint PPT Presentation

FLORIDA UPDATES EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER HOMETOWN HEALTH

ALL PROVIDERS MUST TAKE ACTION BY JULY 1, 2016 TO AVOID PAYMENT ADJUSTMENTS Due by July 1, 2016 for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs). APPLICATIONS AND INSTRUCTIONS • instructions • application • Payment Adjustments & Hardship Information webpage • EHR Incentive Programs’ FAQs page Please note: CAHs should use the form specific for the CAH hardship exceptions related to an EHR reporting period in 2015. CAHs that have already submitted a form for 2015 are not required to resubmit.

DIAGNOSIS RELATED GROUP (DRG) HOSPITAL INPATIENT RATES: NEW LOGIC EFFECTIVE 07/1/2016 New DRG parameters to FY 2016-17 are age policy adjustors that apply to neonatal and pediatric services based on the level of severity of the DRG: Severity Level I 1.00 Severity Level 2 1.52 Severity Level 3 1.80 Severity Level 4 2.00 Also, a migration to Version 33 APR-DRGs will occur for claims processed on and after 6/24/2016. This change will be implemented retroactively and will assign Version 33 APR- DRGs to all claims with date of admission on and after 10/1/2015 and processed on and after 6/24/2016.

REGISTER FOR AMD GLOBAL TELEMEDICINE EMAIL UPDATES Click here for registration information June issue includes: Telemedicine Ideas, Answers and Insights • Featured Use Cases • Updates from AMD • Best Practice Tip of the Month •

PROPOSED CHANGES TO THE PAYMENT ERROR RATE MEASUREMENT AND MEDICAID ELIGIBILITY QUALITY CONTROL PROGRAMS IN RESPONSE TO THE AFFORDABLE CARE ACT (CMS-6068-P) Proposed Changes to the PERM Program: Review Period: The PERM program will review Medicaid and CHIP payments made by states July through June of a given year. Eligibility Review Responsibility: A federal contractor will conduct PERM eligibility reviews with support from each state. Eligibility Universe: The PERM program will conduct eligibility reviews (in addition to medical and data processing reviews) on FFS and managed care payments sampled for the PERM program. The eligibility review will be conducted on the beneficiary associated with the sampled claim. Under the current rule, states create separate universes of eligible individuals that are sampled for eligibility review. Federal Improper Payments: Improper payments will be cited if the federal share amount is incorrect (even if the total computable amount is correct). Under the current rule, improper payments are only cited on the total computable amount (i.e., federal share + state share).

Continued… Sample Sizes: A national sample size will be calculated to meet national Medicaid and CHIP improper payment rate precision requirements. The national s ample size will then be distributed across states to maximize precision at the state level, and state-specific sample sizes would be based on factors such as each state’s expenditures and previous improper payment rate. Corrective Action: States will continue to implement Corrective Action Plans (CAPs) for all errors and deficiencies; however, there will be more stringent requirements added for states that have consecutive PERM eligibility improper payment rates over the 3% national standard established under section 1903(u) of the Social Security Act (the Act). Payment Reductions/Disallowances: Potential payment reductions/disallowances under section 1903(u) of the Act will be applicable for eligibility reviews conducted during PERM years in cases where a state’s eligibility improper payment rate exceeds 3%. CMS will only pursue disallowances if a state does not demonstrate a good faith effort to meet the national standard, which is defined as meeting PERM CAP and MEQC pilot requirements.

FloridaHealthFinder.gov Webinar Friday, June 24, 2016 at 10:00 a.m. ET https://attendee.gotowebinar.com/register/486382530 0803017476 In order to access the audio portion of the webinar: Dial (Toll-Free) 1-866-901-6455 Attendee Access Code: 566-430-730 Audio PIN: Shown on your screen after joining the webinar

The MMA Waiver amendment meetings During the meetings, the Agency will provide a description of the amendment request; and time for public comments. Please visit: http://ahca.myflorida.com/medicaid/Policy_and_Quality/Policy/federal_authorities/feder al_waivers/mma_fed_auth_amend_waiver_2016-06.shtml Tuesday, July 5, 2016 from 2:00 p.m. – 3:00 p.m. Mary Grizzle Building, 11351 Ulmerton Road Largo, Fl. 33778 Conference Line: 1 877 299.4502 Participant Code: 985 653 67# Wednesday, July 6, 2016 from 10:30 a.m. – 11:30 a.m. Agency for Health Care Administration, 400 W Robinson St, Suite S309 Conference Room S309D Orlando, FL 32801 Conference Line: 1 877 809 7263 Participant Code: 835 393 65#

WHERE TO GET DRAFT DOCUMENTS, MEDICAID FORMS & HEARING DRAFTS? http://ahca.myflorida.com/Medicaid/review/index.shtml

STARK LAW UPDATE GAFP.org New Stark Exceptions: • Assistance to compensate a non-physician practitioner • Timeshare arrangements Modifications to existing stark law exceptions, polies, definitions and other changes: • Writing Requirement • Term Requirement • Signature requirement $ Temporary Noncompliance • Holdover Arrangements • Definition of Remuneration • Georgraphic Area Served by FQHCs and RHCs

PRESTIGE May 2016 Communication – Prestige Looks to Ensure Accurate Encounter Data “In the near future, Prestige will ask you to assist us in ensuring that all diagnosis codes that affect patient care, treatment or management are coded and reported via claim submission. Look for more information in the coming weeks .” -Prestige May 2016 Communication - Target pharmacy no longer in Prestige pharmacy network “As of July 20, 2016, Target pharmacy will no longer be in the Prestige Health Choice (Prestige) pharmacy network. If you currently direct members to Target to fill their prescription medications, you will need to pick a new pharmacy .”

STAYWELL/WELLCARE: MONTHLY WEBINARS Encounters Overview Last Tuesday of every month, 10 a.m.-11 a.m. ET Navigating the Provider Portal Last Monday of every month, 2 p.m.-3 p.m. ET How to Join AT&T TeleConference Services Meeting Number: 8665905055 Passcode: 3729889

WEBINAR INFORMATION HomeTown Health Florida Medicaid Information: http://hthu.net/florida/