Authors Posts by Sarah Eyster

Sarah Eyster

Ms. Eyster represents the association at state-level meetings and serves as staff liaison to the Mental Health Committee. She is responsible for member communication of, and the analysis of, Department of Human Services and other key policy decisions.

The Department of Human Services (DHS) is now implementing a new simplified process called the Elderly/Disabled Simplified Application Process (ESAP) for the Supplemental Nutrition Assistance Program (SNAP), commonly referred to as the food stamp program. The federally approved process simplifies the SNAP application and recertification process for older Pennsylvanians and individuals with a disability who have no earned income.

“The new simplified process will help ensure that some of the most vulnerable Pennsylvanians have easier access to the SNAP benefits that are critical to their health and well-being,” said DHS Secretary Ted Dallas. “Through enhanced data matches and other steps, the ESAP process helps these Pennsylvanians overcome barriers such as limited mobility and lack of access to the internet and helps realize the governor’s vision of a government that works.”

ESAP is available to households that meet all of the following criteria:

  • Every member in the household is at least 60 years old, has a disability, or both;
  • No member of the household has earned income; and
  • For SNAP eligibility, a household includes only individuals who live under one roof and who purchase and prepare meals together.

Through the use of data verification, DHS will be able to reduce the current application from 24 pages to a simplified two-page application. In addition to the simplified application process, ESAP households will now have a 36-month certification period, as opposed to the current 12-month recertification period.

“This initiative, part of Governor Wolf’s larger forthcoming statewide hunger plan, will increase SNAP participation by reducing barriers to participation and providing people with easier access to nutrition,” said Dallas.

“Hunger among seniors is a growing concern, and SNAP is a critical piece of the social safety net enabling older Pennsylvanians to access healthy and nutritious foods,” said Department of Aging Secretary Teresa Osborne. “DHS’ successful pursuit of a streamlined and simplified SNAP eligibility process will benefit seniors throughout the commonwealth, and highlights the positive results that occur when agencies work together to provide people with easier access to services and programs that have the capacity to improve their quality of life.”

On September 29, 2015, Governor Wolf brought together leaders from nonprofit anti-hunger organizations, the food industry, and government to discuss food security in Pennsylvania and signed Executive Order 2015-12, which created the Governor’s Food Security Partnership. To apply for SNAP using the ESAP form, visit the COMPASS web page. For more information on SNAP benefits visit the DHS website.

RCPA has been contacted by providers having difficulty with the revalidation process. After contacting the Office of Medical Assistance Programs (OMAP), the following tips and pointers were offered to ease and speed up the revalidation process. After mailing 80,000 reminder letters, the 800 number for assistance was unable to be manned properly; this has been corrected and providers are urged to contact the state next week.

You must ensure that the provider has reviewed and included the items in the application that are on the provider checklist at the end of the application (such as social security card, provider license, corporation papers, etc.). Most of the applications are sent back because the provider did not send a copy of a license, social security card, or corporation’s papers, or they send W-9s when the instructions say not to.

Providers often do not send the additional requirements for that provider type or specialty. Each provider type has additional requirements to what is on the checklist at the end of the application. Many providers fill out the application and submit it – then OMAP must send it back because the provider did not review, understand, or submit the additional requirements. For example:

Additional Required Documents for Provider Type 08 (CLINIC):
The following documents and supporting information are required by the Bureau of Fee-For-Service Programs to enroll your facility as a provider:

  • Completed provider enrollment application;
  • Signed outpatient provider agreement;
  • Copy of document generated by the Federal IRS that shows both name and tax ID of entity applying for enrollment;
  • A copy of the corporation papers issued by the Department of State Corporation Bureau;
  • Completed “Ownership or Control Interest” form;
  • Peer support services addendum (for Specialty 076 only);
  • Out-of-state providers – proof of home state Medicaid participation;
  • A statement signed by the medical director (licensed physician enrolled with PA Medicaid) indicating their affiliation with the clinic;
  • A copy of the medical director’s license; and
  • The medical director’s 13-digit PROMISe provider number.

For Specialties 558 and 808 through 811, include the service description denoting approval by the Bureau of Children’s Behavioral Health Services, Office of Mental Health & Substance Abuse Services (OMHSAS). Contact the Bureau at 717-705-8289 for additional information or requirements.

Often applications are received where the address of the facility license does not match the address on the provider application for enrollment or revalidation.

Make sure that the ownership and disclosure forms disclose at least one managing agent or person in charge. Many come in with no information and are returned to the provider.

Here is a link to a Q and A document regarding the ownership and control section of the application that may be helpful.

Anything related to the Behavioral Health HealthChoices counties – Managed Care Organizations should be directed to OMHSAS. Likewise, they continue to remind the BH-MCOs, if the provider is a state plan provider, they should be instructed to contact the appropriate program office for clarification/assistance to assure providers are being given the correct information.

RCPA wants to know about your experience with revalidation in Pennsylvania. Members may email Sarah Eyster with information. RCPA will continue to work closely with the licensing bodies to ensure timely review of programs in need of revalidation.

The conversion from ICD 9/DSM 4-TR to ICD 10/DSM 5 has come and gone. Many RCPA members are reporting claims denials for billing codes related to the Schizophrenia NOS and PTSD NOS. The reason is that the DSM 5 only offers the Schizophrenia NOS code but the ICD 10 offers seven other choices for Schizophrenia and similarly for PTSD. Clinicians are using the DSM 5 for documentation and choosing the available option; however, when converted to ICD 10 for billing and payment, the person does not meet the criteria for Schizophrenia NOS – therefore, CMS is denying payment. And if you think you are out of the woods in the substance abuse arena, think again; those problems are forthcoming.

RCPA is pleased to offer this webinar: DSM 5/ICD 10 Troubles: Understanding and Rectifying Revenue Problems, by Lisette Wright of Behavioral Health Solutions, P.A. Wright is author of the published curriculum ICD-10 and DSM-5: Coding, Documentation and Clinical Diagnostic Criteria Training, and has trained close to 13,000 clinicians across the country. Her soon-to-be-published graduate level test is titled Coding and Documentation Compliance for the ICD and DSM: A Comprehensive Guide for Clinicians, Routledge, late fall 2016.

Wednesday, June 1, 2:00 – 3:30 pm
Member Registration: $25
Non-Member Registration: $40
Register here no later than Monday, May 30, 2016

RCPA will host its annual conference at the Hershey Lodge on September 27–30, 2016. At this large-scale, statewide event, the RCPA board of directors wants to continue the important tradition of recognizing individuals and organizations/facilities for their dedication and commitment to service. The following award categories have been created for this event and recognition:

  1. RCPA Innovation Award. Presented to an individual or organization in recognition of significant innovation. Examples include cross-systems integration, physical/behavioral health integration, and implementation of new technologies. Up to three awards may be given in any year.
  2. Exemplary Service to RCPA Award. Presented to an individual or organization/facility that has shown a strong commitment and dedication in service to the association, its members, and related issues.
  3. Legislative Leadership Award. Presented to an individual who has shown significant leadership and commitment to government affairs and legislative issues, on behalf of RCPA and its members.
  4. Community Leadership Award. Presented to an individual in recognition of extending service and knowledge to the community at large, and efforts in helping the community understand the needs of individuals served by RCPA members. This can be for specific or short-term significant acts, or to recognize a career-long body of work.
  5. Lifetime Achievement Award. Presented to an individual in honor of his/her significant, consistent, and enduring contribution throughout his/her career in support and furthering of the field.

At this time, RCPA is accepting nominations through an open solicitation of members (e.g., designated contact person, CEOs/executive directors, staff) and RCPA committees. Members may nominate one or more individuals/organizations in one or more categories. Nominations will be reviewed by a sub-group of the board of directors to make recommendations for final selection and approval by the full board.

Include the name/organization (if applicable) of the nominee, the award category, and a statement about why you believe the individual/organization should be honored. Nominations should be made by Monday, May 16. Please send nominations to Cindy Lloyd.

Award recipients are not limited to RCPA members and every award may not be presented annually. Please join the association in continuing this tradition and in offering nominations for those who deserve recognition for their significant contributions.

SAMHSA and the Centers for Medicare & Medicaid Services (CMS) invite you to join a presentation of the final rule on mental health and substance use disorder parity for Medicaid and CHIP, to be held on Thursday, April 14, 1:00 – 2:00 pm.

This rule implements the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) for 23 million beneficiaries enrolled in Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and the Children’s Health Insurance Program (CHIP), ensuring that benefits for mental health and substance use disorder treatments and services are offered on equal footing with medical and surgical benefits. This presentation will include a discussion of the application of parity to Medicaid and CHIP programs, key changes from the Notice of Proposed Rulemaking, and answers to frequently asked questions.