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Nursing Home Transition
Peggy Morningstar, Esquire, CPA, CFE Chief Financial Officer and Nicole White, Aging Services Specialist
1 1/18/2017
Nursing Home Transition Peggy Morningstar, Esquire, CPA, CFE Chief - - PowerPoint PPT Presentation
Nursing Home Transition Peggy Morningstar, Esquire, CPA, CFE Chief Financial Officer and Nicole White, Aging Services Specialist 1/18/2017 1 Click to add footer text Agenda Introduction Billing Documentation DocuShare
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Peggy Morningstar, Esquire, CPA, CFE Chief Financial Officer and Nicole White, Aging Services Specialist
1 1/18/2017
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Nursing Home Transition Fund (SNHTF)
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Purpose of this presentation: To cover the new billing process effective Dec. 1, 2016: Two Billing Tracks:
documented in SAMs and paid through W7337
documented in SAMS and paid monthly in the same format currently paid
Three Main Changes:
management through a waiver or program
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Waiver (PROMISe code W7337):
1. Independence 2. OBRA
Nonwaiver (OLTL monthly billing process):
through an OLTL or PDA program. This may include individuals receiving person centered counseling, Apprise counseling or individuals private paying for services due to income or assets.
emergency response system (PERS) or home delivered meals (HDM)
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NHT care enrollments entered NHT care November 30th 2016 enrollments entered and prior will follow December 1st forward the previous NHT billing process December 1st 2016 will follow the new NHT billing process
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SAMS as a Service Delivery once it is determined that an individual
Service Coordination regional rates
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ERIE CRAWFORD WARREN MERCER BUTLER
ALLEGHENY WASHINGTON GREENE FAYETTE INDIANA CLARION
FOREST MCKEAN ELK CLEARFIELD
SOMERSET BEDFORD BLAIR
POTTER CENTRE CLINTON LYCOMING TIOGA UNION
PERRY FRANKLIN ADAMS YORK
NORTHUMBERLAND MONTOUR COLUMBIA
SULLIVAN
BRADFORD
WAYNE
PIKE LUZERNE
CARBON MONROE SCHUYLKILL
LANCASTER
CHESTER
BERKS
LEHIGH
BUCKS NORTHAMPTON DELAWARE
PHILADELPHIA
Region 2 $20.21 Region 3 $18.78 Region 1 $18.49 Region 4 $21.47 1/18/2017 8
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rate) NHT01 are based on quarter ¼ hr increments. Ex: 1 hr=4 units, 4 hrs =16 units, 8 hrs=32 units
approved
to 480 units
circumstances when formal services have not yet begun to prevent reinstitutionalization (must be documented in SAMS journal notes)
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NHT Billing Structure for OLTL and PDA Programs with Service Coordination or Care Management
Coordination or Care Management may bill:
NHT 01 as part of the record, documenting time spent, units provided, and when the units of service were provided. This becomes part of the supporting documentation for services rendered.
include NHT01NHT02B
480 may be requested
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NHT Billing Structure for OLTL and PDA Programs with Service Coordination or Care Management
Management include:
this is considered a duplication of service.
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NHT Billing StructureWaiver (W7337)
will occur when:
Upon this review it will be determined which entered service deliveries will be paid monthly (NHT 01), or direction will be provided to the NHTCA to bill entered units under W7337 through the Waiver Individual Service Plan (ISP) and paid through PROMISe.
Coordination Services please refer to MA Bulletin 59-16-09 Nursing Home Transition Program Changes.
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Programs not providing Service Coordination/Care Management
private pay individuals in a nursing facility
emergency response system (PERS) or home delivered meals (HDM)
service from OLTL or PDA that involves Service Coordination or Care Management
and will be paid monthly for services posted in SAMS.
completed in person as part of a face to face visit
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will be transitioning into the LIFE program are billed monthly as NHT 01.
participants
eligible to bill for NHT Post Transition Gap Coverage (NHT02B)
eligible for NHT03,04,05
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individual is entering, payment will only occur when:
successful Service Delivery must have:
Outreach Form. If the form is not completed in its entirety (based on skip patterns) this will appear on an error report.
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Enrollment beginning December 1st.
services related to NHT (including SNHTF) are entered into SAMS. This pertains to the new billing process and the existing billing process (NHT0105).
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2016 OLD WAY AFTER DEC. 1, 2016
NHT 01 MFP – NHT Care Enrollment NHT 01 – NHT Care Enrollment NHT 02 – NHT Care Enrollment NHT 02A and B – NHT Care Enrollment NHT 03 – Aging Waiver Care NHT 03 – NHT Care Enrollment Enrollment NHT 04 – Aging Waiver Care NHT 04 – NHT Care Enrollment Enrollment NHT 05 – Aging Waiver Care NHT 05 – NHT Care Enrollment Enrollment
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Transition
NHT 01 MFP – NHT Care Enrollment NHT 02 – NHT Care Enrollment NHT 03 – Aging Waiver Care Enrollment NHT 04 – NHT Care Enrollment NHT 05 – NHT Care Enrollment
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unit details calendar.
daily unit details calendar.
details calendar.
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Non Billable Services or Time
hold for up to 180 days. It is the Service Coordination Entities responsibility to address the individual’s needs as this was taken into consideration when the Service Coordination rate (W1011) was developed. DHS website:
http://www.dhs.pa.gov/provider/longtermcareprov/index. htm under “Billing” attachment B page 5
http://www.dhs.state.pa.us/cs/groups/webcontent/documents/bul letin_admin/p_033878.pdf
– Housing – Home Adaptations – Increase in services through the ISP process – Obtaining Specialized Medical Equipment (SME) – Addressing any other barrier that may arise that would prevent the individual from returning to the community and resuming Waiver services – Developing the ISP
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for the completion of a Care Management Instrument (CMI) for Waiver eligible participants. This is completed by the Independent Enrollment Broker (IEB).
that occur after the date of transition.
time.
to a specific individual (e.g. general meetings, conferences, etc).
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through SAMS journal notes is essential for NHT participants.
historical record of the participants transitional activity.
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document in the journal note area of SAMS the services you are providing and the decisions you are making regarding the participants you are working with.
whom, why and what the results are.
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the following situations:
reasoning behind the cancellation.
within a 180 day period.
the following:
safe discharge.
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contacts must be in-person face-to-face).
living plan,” which should include but not be limited to needed waiver services, mental health or substance abuse counseling and services.
Office of Developmental Programs (ODP), Office of Mental Health and Substance Abuse Services (OMHSAS), or PA Department of Aging (PDA) programs, services or programs provided by Office of Income Maintenance (OIM) or charitable community
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“front” monies for completion prior to transition).
The Community Living Plan serves as a way to communicate with the selected Service Coordination agency (SCE) the specific community services the individual will need and which have been
journal note “Community Living Plan.”
nht@pa.gov) to get approval ahead of time.
and how the risks are being addressed or mitigated.
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Proper documentation of standards and practices ensures the accuracy and legitimacy that services are provided in accordance with NHT program requirements and procedures.
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Instruction folder.
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tabs may be added in the future to distinguish Waiver vs NonWaiver participants.
1) All payables entered and processed during the month (NHT Services MM/YYYY), 2) Errors not processed (Items to be Corrected), 3) Errors/exceptions reviewed by NHT staff with approval/disapproval (Errors), and 4) Summary.
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environment is located at https://www.dpwds.st ate.pa.us/ . The URL uses SSL so it must start with https:// and not http://.
user name (1) and password (2) provided to you by OLTL
Managed (3)
3 1 2
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After Signing in click on the OLTL folder.
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Next click on NHT Payables folder.
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Click on your agency
be able to see your provider(s) folders and the General Instructions folder. Please notify OLTL via the RA mailbox (RA-PWOLTLDOCUSHARE@pa.gov) if you can see more or less.
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Your report is here with designated month and year.
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The report is readonly.
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reset, you will need to contact Account Administration by calling (800) 2815340.
password reset so you are prompted when it is about to
about to expire. If you are unable to login for any reason, it is likely because your password is incorrect or has expired.
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(NHT0105):
details calendar, and
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StytesG H 1 Nursing Home Transition Services Report Consumers in S AMS Service Deliveries Entered or Updated For the Time Period: 71 112014 To 713112014 Effective Date: 81
512014PSA_ID Provider SSN Client ID Consumer Name Service Service Date Units Items to be 2 Corrected 16 Union-Snyder Agency on Aging, Inc. NHT0512 Month 07/1 4/2014 0.25 Partial Units 3 Entered 14 32 Berks County Alea Agency on Aging NHT01MFP
07101/2014 0.50 Partial Units Entered 32 Berks County Alea Agency on Aging NHT02Transition 07/03 /2014 0.50 Partial Units 5 Entered 03 Office of Human Services, Inc. (Cameron/Elk/McKe) NHT01NonMFP 07/23/2014 0.50 Partial Units 6 Entered 43 Experience Inc. AAA (Warren/Forest) NHT04 ~ Month InCommunity Contact July 2014 1.00 No Daily Detail 7 25 York County AAA NHT04 ~ Month InCommunity Contact July 2014 1.00 No Daily Detail 8 OLTL Voices for lndependence0004 NHT04 ~ Month lnCommunrty Contact July 2014 1.00 No Daily Detail 9 31 Philadelphia Corporation for Aging NHT01 -MFP Transition Coordination July 2014 1.00 No Daily Detail 10 OLTL
A bi l~iesin Motion0001 NHT03 3 Month InCommunity Contact October 201 4 1.00 No Daily Detail 11 29 Bucks County AAA NHT04 ~ Month InCommunity Contact July 2014 1.00 No Daily Detail 12 OLTL Voices for lndependence0004 NHT03 3 Month InCommunity Contact July 2014 1.00 No Daily Detail 13 OLTL Voices for lndependence0004 NHT04 ~ Month InCommunity Contact June 2014 1.00 No Daily Detail 14 08 Tri-County Patrio ts for Independent Living NHT01 -Non·MFP Transition Coordination June 2014 1.00 No Daily Detail 15 OLTL Voices for lndependence-0004 NHT01 -MFP Transition Coordination June 2014 1.00 No Daily Detail 16 23 Dauphin County AAA NHT04 ~ Month InCommunity Contact January 2014 1.00 No Daily Detail 17 43 Experience Inc. AAA (Warren/Forest) NHT05 12 Month InCommunity Contact July 2014 1.00 No Daily Detail 18 OLTL Northeast Center for Independent Living0003 NHT05 12 Month InCommunity Contact June 2014 1.00 No Daily Detail 19 44 Voices for lndependence--0004 NHT02 Transition Complete June 2014 1.00 No Daily Detail 20 31 Philadelphia Corporation for Aging NHT02 Transition Complete July 2014 1.00 No Daily Detail
2148 Monroe County A.AA. NHT02 Transition Complete June 201 4 1.00 No Daily Detail
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50 Butler County AAA NHT04 ~ Month InCommunity Contact November 2013 1.00 No Daily Detail 23 31 Philadelphia Corporation for Aging NHT01 -MFP Transition Coordination July 2014 1.00 No Daily Detail 24
_ J~ 3Experience Inc. AAA (Warren/Forest) NHT01 NonMFP Transition Coordination April 2014 4.00 No Daily Detail
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exception may be requested and approved for up to 480 units with justification and documentation.
enter units above the daily cap of 32 units, NHT staff will disapprove all units and give you an opportunity to reenter up to 32 units per day, unless justification and documentation has been provided.
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without care management services before the allowable timeframes after transition will cause an error:
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NHT staff review errors and approve them upon you contacting NHT staff with documentation and justification. An essential part of the NHT staff review process includes checking journal entries about issues that would justify payments for services outside the normal caps and timeframes.
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deliveries should:
that the provider must correct,
review by OLTL staff in order for payment to
funding or require the PROMISe W7337 code.
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service entries.
process.
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NHT Payables Timeline (example)
July Payables Report is run - OLTL review Payables Report with errors posted
July August September October Providers enter service deliveries using dates on calendar OLTL staff review complete process
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calendar in July 1 – 31.
services entered July 1 – 31.
potential errors by August 15.
September 15 unless they are Waiver eligible.
October 31. Payment should be received close to this same time.
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authorization from the OLTL NHT Team. Requests may be sent to ratransitionfunding@pa.gov using the Funding Request form.
transition Services (CTS):
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permitted $4,000.
such as ACT 150, LIFE, Options, or CSP.
have been exhausted.
contingent upon funds being made available by the Pennsylvania Department of Aging.
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Plan in SAMS and should list what is being requested as a service in the NHT Care Plan.
care plan should be modified to reflect actual costs. If the actual amount spent is MORE than authorized, an amended request should be sent to ratransitionfunding@pa.gov.
the NHT Care Enrollment.
in the service plan, a service order, and a service delivery.
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reports will be placed into each agency’s DocuShare folders.
allocation amount (should be: SD ≤ SO ≤ SA)
service allocation, or both
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appear on the next quarter’s payable report.
reviewed by OLTL staff.
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planners on consumers with scheduled discharge date
participant
independently in the community
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community resources
members for qualifying for services (e.g. Medicaid, food stamps, home adaptations, etc.)
required documentation
related to support the NHT initiative
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providers need to make corrections in SAMS:
they will be processed in a subsequent report.
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