December 27, 2017
Providers of DD Waiver Services (and the individuals who receive the services) continue to receive letters which “authorize” DD Waiver services not covered by CCCPlus. Virginia Premier seems to be the greatest offender, but other plans have made the same mistake. In some cases the letters are:
- for dates of service which have passed, or nearly passed,
- are not copied to the Case Manager,
- for billing codes without the appropriate modifier,
- for authorization periods which do not correspond to the PCP planning cycle, and
- for far fewer units than would be required (76 units of group home residential to cover a three month period)!
Remember that DD Waiver Services are excluded from CCCPlus and you may need to reassure a nervous family that the letters are not relevant. You can verify that the Service Authorization which controls your services/billing is still in effect by confirming it through the Medicaid WebPortal (do not verify through WaMS as that, too, in this case is irrelevant!). Our experience is that calling to have the letter withdrawn is time consuming and ineffective. At this point, our advice is to ignore the letter and hope that eventually CCCPlus plans sort it out internally!
DMAS is aware and is working diligently to try to reinforce with the Health Plans that they need to be more aware of the exclusion for DD Waiver services.