Tags Posts tagged with "MA"


The Office of Long-Term Living (OLTL) has updated the Home and Community-Based Services (HCBS) Medical Assistance (MA) Fee Schedule. The updates reflect the fee schedule rates for Personal Assistance Services (PAS) procedure codes W1793, W1793 TT, W1792, and W1792 TU in the referenced Pennsylvania Bulletin below.

The updated OLTL HCBS MA Fee Schedule (effective January 1, 2022) may be found here. The new rates for the OBRA Waiver and Act 150 Program were announced in the Pennsylvania Bulletin on November 6, 2021, in the Volume 51, Number 45 issue and can be found here.

Questions related to this update should be directed to the OLTL Provider Inquiry Line at 800-932-0939, option 2, Monday–Friday between 9:00 am–12:00 pm and 1:00 pm–4:00 pm.

Photo by Markus Winkler on Unsplash

The Medical Assistance (MA) Bulletin posted on 10-22-2021 applies to all providers that render personal care services (PCS) to beneficiaries in the fee-for-service (FFS) delivery system, including Agency with Choice and Vendor Fiscal/Employer Agent financial management services organizations that provide PCS to MA participants who are enrolled in an Office of Developmental Program or Office of Long-Term Living waiver, the Act 150 Program, or a Community HealthChoices managed care organization.

The purpose of the bulletin is to:

  • Advise providers of updates to certain error status codes (ESC) for PCS subject to electronic visit verification (EVV), effective for claims received on and after October 22, 2021; and
  • Advise providers of an updated Provider Assistance Center (PAC) contact e-mail for their use.

Providers rendering PCS in the managed care delivery system should address any questions regarding ESCs for PCS subject to EVV with the applicable managed care organization.

The Department of Human Services has been working in collaboration with Managed Care Organizations (MCOs), county oversight organizations, and RCPA regarding the concerns and challenges with implementing federal Ordering, Referring and Prescribing (ORP) requirements by the January 1, 2018 deadline. The Department of Human Services has informed RCPA of the following:

  • The ORP requirements for Fee-for-Service continue to apply; i.e., allORP practitioners must be enrolled in the Pennsylvania Medical Assistance (MA) Program or the rendering provider will not be paid.
  • In the HealthChoices managed care delivery system, if a rendering network provider submits a claim to an MCO with the National Provider Identifier (NPI) information that results in edits identifying that the non-networkORP is not enrolled in MA, the claim can be paid. However, if the non-MA enrolled ORP has a high volume of claims, the MCO will work with the network provider and non-MA enrolled ORP to have them enroll in MA or work to transition the member to an enrolled MA provider.

Contact your contracting BH-MCO for additional information.

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The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2018 updates to the Quality Payment Program (QPP) via a final rule with comment period.

Established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the QPP has the goal to incentivize physicians and other eligible clinicians by rewarding value and outcomes through either the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

Some of the provisions contained in the final rule include:

  • Weighting the MIPS cost performance category to 10 percent of total MIPS final score, and the Quality performance category to 50 percent;
  • Raising the MIPS performance threshold to 15 points in Year 2 (from 3 points in the transition year);
  • Awarding up to 5 bonus points on MIPS final score for treatment of complex patients;
  • Adding 5 bonus points to the MIPS final scores of small practices;
  • Adding Virtual Groups as a participation option for MIPS;
  • Issuing an interim final rule with comment period for extreme and uncontrollable circumstances where clinicians can be automatically exempt from these categories in the transition year without submitting a hardship exception application if they have been affected by the hurricanes that occurred during the 2017 MIPS performance period;
  • Providing more detail on how eligible clinicians participating in selected APMs (known as MIPS APMs) will be assessed under the APM scoring standard; and
  • Creating additional flexibilities to allow clinicians to be successful under the All Payer Combination Option, which will be available beginning in performance year 2019.

The final rule will be published in the November 16, 2017 Federal Register, with comments due by January 1, 2018.

Additional information is available in a fact sheet and an Executive Summary document. In addition, CMS will conduct an overview webinar on Tuesday, November 14, 2017, from 1:00 pm to 2:30 pm. To participate in this webinar, registration is required.

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The Department of Human Services (DHS) published a notice that will appear in tomorrow’s Pennsylvania Bulletin that they intend to make a supplemental payment in fiscal year (FY) 2017/2018 to certain special rehabilitation facilities (SRFs) that have high Medical Assistance (MA) and total facility occupancy levels. An SRF is one that specializes in providing services and care to adults who have a neurological/neuromuscular diagnosis and condition, as well as severe functional limitations. Because of the complex needs of these individuals, SRF’s typically incur staffing and specialized medical equipment costs that are very high. Additionally, SRF’s with high MA and total facility occupancy levels are dependent on MA payments to continue to operate. To help offset the higher costs incurred by these SRFs while they reconfigure to home and community-based services, DHS intends to make a supplemental payment to these facilities to assure that the unique services they provide continue to be available to MA beneficiaries.

To qualify for an MA dependency payment the following requirements must be met:

  • Be classified as an SRF as of the cost report end date.
  • Have MA occupancy greater than or equal to 94% as reported on Schedule A, Column A, Line 5 of the cost report.
  • Have an overall nursing facility occupancy greater than or equal to 95% as reported on Schedule A, Column A, Line 4 of the cost report.
  • Have at least 200 MA certified nursing facility beds as of the cost report end date.

DHS will accept comments on this notice for thirty days following publication. Comments should be sent to: Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, PO Box 8025, Harrisburg, PA 17105-8025.