DMAS has asked VHCA-VCAL to relay a series of updates on the Medicaid $20 per day add-on. The updates address the May Fee-for-Service (FFS) rosters, information on how DMAS processes FFS rosters, and a reminder about nursing facility residents in hospice. 

May FFS Rosters

Based on the DMAS guidance on the $20 per day add-on, we understood May rosters would be due by June 12 (the Friday at the end of the first full week of the following month), with payment processed two weeks later, June 26, which is the last Friday of June. Because the state’s fiscal year ends June 30, DMAS does not process any payments the last Friday of June.  Because of this, DMAS is advising that NFs get the May FFS rosters to DMAS no later than Friday June 5, for payment to process by June 19.  If you are unable to meet the June 5 submission date, the payment for May FFS invoices will not be processed to payment by DMAS until July 24, or a month later than otherwise (see next topic below). 

CCC plus plans do not have the same fiscal year-end constraints.  We recommend you send your CCC Plus rosters as early as you can, but there is no indication payment would be delayed as significantly as FFS if the June 5 submission date is missed.  MCOs have approximately two weeks from receipt to process rosters to payment. 

One Processing Date Per Month for FFS Rosters

DMAS has indicated that each month, there will only be one payment cycle for the $20 add-on payment for the FFS rosters. Therefore, if you miss the submission date for the monthly roster, that month’s FFS roster will not process to payment until the following month’s cycle. Missing a FFS submission date does not mean you will not get paid for that month’s roster, but it does mean payment will be delayed approximately one month. For those providers with high FFS volume, this clarification from DMAS may be significant to your submission plans. 

Reminder:  NF Residents in Hospice

DMAS informed VHCA-VCAL that some NFs are incorrectly including CCC Plus hospice residents on the hospice tabs of the FFS roster spreadsheet. Please remember that if the hospice resident is in the CCC Plus program, their days should be included on the specific MCO’s roster along with every other NF resident participating with that MCO. 

The hospice tabs on the FFS roster are only for FFS NF residents in hospice. For FFS NF residents in hospice, they should not be included with the other NF residents, rather, they should be included on a separate hospice tab for each hospice company – this separate tab reporting only applies to FFS hospice residents on the FFS rosters.