WV BUREAU FOR MEDICAL SERVICES 2014 FALL PROVIDER WORKSHOPS Ed Dolly, DHHR Chief Information Officer Jon Cain, MIS Director of Integrated Systems Management Tanya Cyrus, RN, BMS Director of Policy Administrative Services Meghan Shears, Manager, WV CARES Nicole Becnel, Manager, BerryDunn October 27 - Martinsburg, WV October 28 – Morgantown, WV October 29 – Beckley, WV October 30 – Charleston, WV
Medicaid Expansion As of September 20, 2014, approximately 148,611 have enrolled in Medicaid as a result of the expansion: 42% are between 19 and 34 years of age 37% are between 35 and 50 years of age 20% are between 51 and 64 years of age Less than 1% fall outside of these age ranges Approximately 54% of the new enrollees are female and 46% are male. Approximately 28% (513,481) of West Virginia’s population is now covered by Medicaid. About 41% of these individuals are receiving services through Mountain Health Trust, the State’s Managed Care Program. 1
Medicaid Expansion July 9, 2014 - according to an article in the Charleston Daily Mail WV has seen the biggest drop in adult uninsured rate and has the most new Medicaid enrollees per capita than any other state that expanded Medicaid. WV now has the sixth-lowest uninsured rate in the country. As of April 30, 2014, expenditures for the expansion population were over $225 million. The three highest expenditure categories were: Outpatient Hospital Services $35.3 million Prescription Drugs $47.4 million Inpatient Hospital $38.6 million 2
Medically Frail Update Definition (42CFR § 440.315): Individual having a chronic substance use disorder, serious and complex medical condition, or a physical, behavioral, intellectual, or developmental disorder that requires additional care. A member can self-identify at any time during their eligibility period. Claims Reprocessing Update 3
Enhanced Primary Care Payments Provision under the Affordable Care Act (42 CFR 447.400(a)) Required that Medicaid reimburse eligible primary care providers at parity with Medicare rates in 2013 and 2014 for certain evaluation and management (E&M) and vaccination codes beginning with January 1, 2013 dates of service Enhanced payments expire on December 31, 2014. There will be a second review required of provider compliance during CY 2015, which will examine provider participation in CY 2014. 4
Hospital Based Presumptive Eligibility (HBPE) Currently, 37 hospitals participate in the HBPE program. Hospitals must meet two performance measures in order to continue participation in the program: 75% of the individuals who are determined presumptively eligible must complete a full Medicaid application and Of those who complete a full Medicaid application, 50% of them must be approved for Medicaid coverage. September 12, 2014 - 5,384 people have been determined presumptively eligible for Medicaid and 2,246 of them have become fully eligible for Medicaid. To keep informed about the progress of Medicaid expansion check the Medicaid expansion section at http://www.dhhr.wv.gov/bms/Pages/MedicaidExpansion.aspx on the BMS website. 5
BMS Policy and Program Updates Drug Screening Policy Coverage changes delayed until 2015 CPT codes evaluated Take Me Home, WV Expanding network of Transition Navigator provider agencies ADW and TBI agencies For more information, go to program’s website at http://www.dhhr.wv.gov/bms/MFP/ Home and Community Based Waivers Renewal applications to be submitted to CMS December 2014 Quality Program CMS Adult Quality Measures Medical Record Requests Delayed - Pending CMS Response 6
BMS Health Homes Program WV Health Homes Launched July 1, 2014 Medicaid members with bipolar disease who have or are at risk of having Hepatitis B or C Must be receiving services from provider in Cabell, Kanawha, Mercer, Putnam, Raleigh or Wayne counties Health Home Providers must offer team approach to assist member with Managing medical conditions and medications Understanding medical tests and results Remembering medical appointments Other health care needs 7
BMS Health Homes Program Currently eight (8) BMS-approved Health Home Providers: Cabin Creek Health Systems FMRS Health Systems Marshall Health Prestera Center for Mental Health Process Strategies Southern Highlands Community Health Center WV Health Right WomenCare, Inc. (FamilyCare) Additional Health Home Program information is available on the Bureau for Medical Services website: www.dhhr.wv.gov/bms/ or the APS Healthcare-WV website: www.apshealthcare.com/wv Questions/concerns contact APS Healthcare at 304-343-9663 or 1-800-461-0655. 8
New Hospice Rule BMS will follow new Federal Rule, effective October 1, 2014 Final Rule Implements changes to coding guidelines for diagnosis reporting on Hospice claims Specifies that Alzheimer’s, Dementia, and “adult failure to thrive” diagnoses cannot serve as the sole/primary determinant for Hospice services Located in August 22, 2014, Federal Register page 50498, item #4: “Coding Guidelines for Hospice Claims Reporting” http://www.gpo.gov/fdsys/pkg/FR-2014-08-22/pdf/2014-18506.pdf APS has attached message to all Hospice submissions with a sole/primary diagnosis of Alzheimer’s/Dementia or adult failure to thrive indicating that an additional primary diagnosis for prior authorization of Hospice services is required. Some providers have begun submitting the additional information on their submissions and are now compliant with the new rule. 9
ICD-10 Compliance Date – October 1, 2015 Changes to MMIS completed BMS Policy Remediation to be completed by January 1, 2015 Policies to be released using current process Draft policy posted to BMS website 30-day Public Comment Period Internal testing – CMS Level I is 90% Completed External testing - to begin 1 st Quarter 2015 Provider Readiness Surveys will continue For more information: Molina’s website under “ICD - 10 Transition” link Molina Biweekly Webinars www.cms.gov/icd10 10
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