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Virginia Health Care Association | Virginia Center for Assisted Living

Important Reminders about Medicaid $20 Per Day Add-On

Important Reminders about Medicaid $20 Per Day Add-On

Earlier this week we communicated that DMAS finalized the guidance and templates and that the roster billing process for the per diem add-on had gone live.  Banking information was requested from nursing facilities for EFT set-up at the managed care organizations (MCOs) by April 29 and rosters for the March 12-31 period were requested by tomorrow, May 1. Submitters that meet those deadlines should  receive payments by May 15. If you do not meet one or both of those deadlines, submit the information as soon as you can, but understand that payment may not be made by May 15.

Subsequent to the finalization of the guidance, several questions have come up requiring clarification:

  1. Use the DMAS-approved spreadsheet template do not modify it or convert it to a different format (like a PDF) (NB: The Fee-for-Service spreadsheet includes hospice tabs; the MCO spreadsheet should be used to create individual MCO submissions.)
  2. Use a separate spreadsheet for each payer (FFS and a unique one for each of the MCOs); copy the FFS address on each of the MCO submissions.
  3. Do not password protect the spreadsheet, but send the email encrypted due to PHI. If you do not have your own encryption solution, email each payer and ask them to send you an encrypted email to which you can reply with your submission (within their encryption service). This may require you to set up a password but will allow you to use their system going forward.
  4. Double check the Medicaid ID numbers for accuracy.
  5. The number of days should follow billing rules–do not include the discharge date.
  6. Hospice: In addition to the previous guidance, the NPI on the FFS hospice tabs is for the hospice NPI.
  7. Specialized Care: If you also provide specialized care (a distinct Medicaid service – only a handful do this), we have asked whether or not those should be reported on a separate tab or within the NF days. We have no gotten an answer as of this article. We are suggesting you do one of two things:
    1. Just report them on the same tab as NF days and understand that you may need to re-submit or provide additional distinguishing information after the fact.
    2. Hold the specialized care days from the March span and include them on your April dates submission due by May 8 as hopefully DMAS will provide the answer by then.
  8. PACE: If you have residents who are enrolled in PACE, we do not yet know if they are included for the add-on (we have asked). We are suggesting that you should not include them on your FFS submission (nor the MCOs) until DMAS answers the question. We do suggest you examine you contract with the PACE organization(s) to determine if your contract ties your reimbursement to the prevailing Medicaid rate; if so, the PACE organization may already be obligated to pay you the additional $20 per day. We continue to wait for DMAS guidance on PACE

If you have additional questions, please email Steve Ford.