Tuesday Does Come Once a Week!

May 05, 2020

Updates for today include:
  • We can expect the Memo describing the details of the CMS approved “retainer” payments for Day Services to be available by early next week.  It will include details on the authority to provide Day Support in a different location.
  • In order to streamline the necessary system changes and steps that a provider will have to take to receive the “retainer payment;” DMAS is considering the following:
    • To ensure that the total billing will not exceed the amount already budgeted for the services, DMAS has calculated the average percentage of authorized units that were actually billed using July-December 2019 as the base period.  It worked out to be approximately 65%.
    • Rather than make each provider calculate 65% of each individual’s authorization, they are planning to allow all authorized units to be billed at 65% of the rate (and the VaMMIS system will do the calculation!).  This also allows for a provider to more easily bill for the units remaining in the authorization if they are able to actually provide a few hours of service (which, of course, would be billed at 100% of the rate.)  Details to be forthcoming in the Memo.
  • Other news is on the Federal level – one of the last bits to be operationalized in the CARES Act, is the methodolgy to distribute the funding designated specifically for Medicaid providers.   ANCOR has been working with the staff at HHS to develop a methodology, preferably one that does not require passing the funds through the state Medicaid  offices.
  • This past week, each Medicaid agency was directed to provide detailed information about every Medicaid provider, whether paid FFS or through Managed Care.  That information (total billing across all services for CY2018 and CY2019, along with details which identify the provider) would theoretically be sufficient to allow a direct payment.  There is a lot we do not know – how much, and how soon being the two most obvious questions.  We do know that the data is due to CMS by close of business today.
We are also beginning to think about how we will transition services as we approach the “new normal” described earlier today in the Governor’s press release.  Just like moving into “pandemic mode” was not a one step affair, and is not a one size fits all; moving out, especially as it will be a phased approach, will not be either.