What Do We Know and What Do We Do Now?

November 08, 2016

We know that there are a multitude of issues with simply entering authorizations onto the WaMS system and having authorizations successfully processed in VaMMIS; We know that the majority of the issues seem to be a direct consequence of the “system” being created without input from a significant segment of the end users, no end user testing prior to the “go live” date and a significant change to the plan for use which occurred after the limited training of one person in each CSB; We know that there are issues with approving “new authorizations” which have come up because of annual plan dates between 1 September and 1 December which are varied based upon the service and any changes which may have or may have been reported to have been because of changes to the regulations – these include conflicting views of “semi-predictable events,” new categories for some therapeutic consult, pressure to utilize new services whether they meet the needs of the individual or not, renewing sponsored residential plans, or receiving exceptional rates, which are no longer authorized; We know that there have been claims issues for a variety of reasons in addition to those listed above including the lack of any “SIS Tier” having been entered in VaMMIS for thousands on individuals when billing began under the new codes in September; We know that the CSBs are struggling with the integration of the DD enrollees into the larger system due to the wait list priorities not being assigned by DBHDS and the severe limitations of WaMS which have required double data entry in some cases which are inefficient and leach case management time that could better be spent in favor of individuals and families ; We know that there are many interpretations of almost everything leading to many directions and few answers and that only 50 slots were allocated for each of the five training sessions planned for next week which were sold out within 24 hours and no plans were in place to add either sessions or slots! We also know that the temporary H2022 authorizations which migrated from IDOLS to WaMS to honor the commitment made by the Administration that providers would continue to get paid expired on 31 October and there are a significant number of those authorizations which are waiting approval in WaMS; We know that we requested an extension of the authorization and/or an arrangement for payment without an approved authorization and both have been denied for what are legitimate reasons by DMAS; DMAS did approve an extension of the “grace” period to allow authorizations to be entered – when they can be entered – backdated to 1 September, but that does not allow claims to be paid until the authorization is actually approved;

So Now What?

We have received a response from DMAS to a recent query; the response included their justification for not including the kind of stakeholder input and testing which we believe would have made the WaMS implementation much smoother – whether it is valid or not is immaterial as we are where we are now and can only move forward; the response does acknowledge the large number of authorizations currently in queue and the steps being taken by DBHDS to monitor the flow and make adjustments as needed. They are also, as you know, doing training and will issue additional guidance; we may believe that the attention to the issues is late in coming, but it now seems to be important and we are grateful for that.  It is critical that providers communicate with us about any issues which continue to cause billing problems so that we can continue to track the primary concerns.