UPDATE Weekly

A final compromise has been reached by the House and Senate to reform North Carolina’s Medicaid program. The long debated legislation creates a shared system of fully capitated arrangements with Prepaid Health Plans (PHPS). PHPs can be either commercial managed care plans (CPs) or provider led plans (PLEs).

Important provisions include;

• When fully implemented, there will be three state-wide contracts and up to ten regional contracts.
• Requires DHHS to submit an 1115 waiver to CMS no later than June 1, 2016.
• All capitated contracts will begin 18 months after waiver is approved.
• Capitated PHP contracts shall cover all beneficiaries, except recipients who are dually eligible for Medicaid and Medicare.
• All Medicaid services are included, except for dental services and behavioral health (LMEs) for four years.
• Pharmacy services are included in the capitated rates.
• Provider assessments and other supplemental payment programs remain.
• Medical Loss Ratio (MLR) of 88%
• All contracts must offer benefits at least at the existing levels.
• Creates a new Division of Health Benefits within DHHS.
• Creates a separate Legislative Oversight Committee for Medicaid.
• Maintains contracts with Community Care of North Carolina until capitated contracts have been awarded.
• Division of Health Benefits must develop a long-term strategy to cover dual eligibles.
• Dual Eligibles Advisory Committee is established and must report findings by January 1, 2017.
• Risk adjusted cost growth must be two percentage points below national Medicaid spending as determined by CMS through the Office of the Actuary.
• PHPs may not exclude providers from their networks, except for quality reasons or refusal to accept network rates.

HB372 is a framework for creating a fully capitated, risk based, Medicaid program in North Carolina. It is likely to take up to three years or more before the first contract is awarded.

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A Blueprint for a Fall Prevention Program presented by Sue Ann Guildermann on September 30th, 2015 in Greensboro is sold out! We will not be able to accommodate any on-site registrations. If you registered for this seminar and are not able to attend, please e-mail karenl@nchcfa.org, as soon as possible, so a substitution can be made. We hope to have Sue Ann Guildermann back again soon for those not able to attend!

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The NCHCFA Annual Convention and Trade Show will be held February 21-24, 2016 at the Sheraton Four Seasons Hotel/Koury Convention Center in Greensboro, NC! Brochures outlining specific program information will be available in December.

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The ICD-10-CM/PCS Frequently Asked Questions Web page has answers to your questions about:

• Claims processing and billing
• Coding
• General Equivalence Mappings (GEMs)
• National Coverage Determinations (NCDs)
• Local Coverage Determinations (LCDs)

Visit the ICD-10 Medicare Fee-For-Service Provider Resources Web page for a complete list of Medicare Learning Network educational materials.

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Jurisdiction M (formerly Jurisdiction 11) Medicare will soon begin making automated calls to providers in an effort to increase timely responses to eligible outstanding overpayments.

An automated courtesy call will be made when the debt remains open and ages to 67 days old. This call will be a reminder to any provider who has not responded either with payment in full, by submitting an appeal, or by submitting a request for an extended repayment schedule, to a first demand letter.

These calls will provide basic information about the pending overpayment, including the date of the first demand letter and the outstanding balance.

To avoid further collection action, providers can submit payment electronically using On-line Provider Services on the Palmetto GBA Web site, submit a check to the address listed on the demand letter, submit a request for an extended repayment schedule, or file an appeal in accordance with the rights provided to you in the demand letter.

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100 Essential Forms for Long-Term Care provides convenient access to a compilation of essential long-term care forms that offer easy-to-understand descriptions of implementation processes and timing, and can be used as-is or customized to meet the particular needs of nursing home staff.

The updated content found in this new edition will help long-term care facilities stay compliant with recent regulatory changes and ensure quality resident care is always provided. This valuable resource contains 100 of the most commonly utilized forms in long-term care facilities, including:

• Clinical assessment forms
• Survey readiness assessments
• Documentation forms
• MDS tools
• Regulatory forms
• Accountability reports
• Quality Assessment and Performance Improvement (QAPI) forms

This comprehensive book will help long-term care providers:

• Gain immediate access to the most essential, commonly used long-term care forms
• Enhance the efficiency of staff procedures
• Improve documentation accuracy
• Address documentation needs and concerns for every department

To order, visit http://www.AHCApublications.org or call (800) 321-0343.

Product #8357
AHCA MEMBERS $149.00

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If you missed the Upcoming Hospice Regulations seminar, the notebook/presentation is now available for purchase. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org. The cost is $25 plus tax and shipping.

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How Is Society Coping With the Growing Elderly Population?

http://www.huffingtonpost.com/scott-de-buitleir/how-is-society-coping-with-the-growing-elderly-population_b_7931144.html

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When Albert Einstein died, his final words died with him. The nurse at his side did not understand German.

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