MLTSS Updates from DMAHS Meeting

January 29, 2018

On Monday, January 29, NJHA, HCANJ and LeadingAge NJ met with the Division of Medical Assistance and Health Services (DMAHS) and the Division of Aging Services (DoAS) regarding a host of outstanding topics. Below are key highlights from the discussion:

  • Authorization Issues – The MCOs are still required to submit to DMAHS a complete description of their authorization process, including how they communicate with providers concerning authorizations. This is particularly important for continuity of care situations when a client/resident changes health plans. DMAHS is working on a policy memo and/or FAQ concerning continuity of care that would be distributed to the MCOs and to providers. The associations will ask the MCOs to focus on these topics at the upcoming Medicaid Managed Care conference on March 6 at NJHA.
  • Cost Share Collection – DMAHS previewed an updated FAQ on cost-share with the associations. Additional tweaks are needed to fully address the concerns of providers and to ensure that MCOs, providers and DMAHS are all working from the same understanding of the regulatory and policy requirements.
  • Hospice Room and Board – DMAHS will discuss internally the production of the hospice NF room and board rate file for hospice providers and MCOs, including the issue of what date is used for the implementation of the NF rates. With respect to hospice room and board amounts outstanding from prior periods, each MCO is addressing this individually with their hospice providers.
  • MLTSS Report Card – This summer, DMAHS intends to release a fully interactive data analytics web site that will include some of the items the associations recommended for an MLTSS MCO report card. The MLTSS Steering Committee will review the remaining items on the associations’ list of recommendations and align them with the transparency requirements under the federal Medicaid managed care regulations. The data analytics site will continue to be enhanced in 2018 and 2019.
  • AWQP Webinar – Feedback on the first AWQP webinar was very positive. Two more dates (2/1 and 2/7) are being offered. Thereafter, a recording will be available to providers.
  • Retroactive Date for COB/EOB guidance – Jan. 2015 is the date the COB/EOB guidance took effect because prior to that date there was a bypass letter in effect.
  • Redetermination issues – One county seems to be continuing to include termination dates in the redet system for Medicaid. Kathy Martin will be addressing this with the counties.
  • Certificate of Need Calls for SCNF Beds – DMAHS expects that any new SCNF providers that come into the market as a result of the DOH CN call for new beds will be considered under the existing AWP system, assuming the beds come into operation while AWP is still in effect.

Feel free to contact James McCracken or Theresa Edelstein if you have any questions.