Provider Update: August 13, 2018
To: All ADvantage Providers
Subject: ADvantage and State Plane Personal Care Rate Increases
The Medicaid Services Unit is pleased to announce the approval of rate increases by the Centers for Medicare and Medicaid (CMS) and Oklahoma Health Care Authority (OHCA).
The table below shows the current rate and the new rate for each service impacted which will be effective retroactively to July 1, 2018. All rates are per unit unless otherwise indicated by an asterisk (*). State Plan services are included in these rates as indicated below; however, the State Plan Skilled Nursing rate is still in the approval process. The pending new rate and effective date for State Plan Skilled Nursing will be provided to you as soon as that information becomes available.
| Service | Service Code |
Current Rate |
New Rate |
| State Plan Personal Care | T1019 | $3.78 | $4.05 |
| State Plan Skilled Nursing | T1001 | $54.00 | pending |
| ADvantage Personal Care | T1019 | $3.78 | $4.05 |
| Respite - In Home | T1005 | $3.78 | $4.05 |
| Respite - In Home Extended | S9125 | $160.77 | $168.80* |
| Advanced Supportive/Restorative | T1019-TF | $4.07 | $4.35 |
| CM Standard | T1016 | $13.75 | $14.70 |
| Transitional CM Standard | T1016-U3 | $13.75 | $14.70 |
| CM Very Rural | T1016-TN | $19.69 | $21.05 |
| Transitional CM Very Rural | T1016-TN-U3 | $19.69 | $21.05 |
| Adult Day Health | S5100-U1 | $1.88 | $2.00 |
| Adult Day Health - Therapies | S5105-TG | $10.00 | $11.25 |
| Adult Day Health - Personal Care | S5105 | $7.50 | $7.95 |
| Hospice | S9126 | $119.10 | $123.80* |
| Registered Nurse - Home Health Setting | G0299 | $13.50 | $15.00 |
| Registered Nurse - Extended State Plan | G0299-TF | $13.50 | $15.00 |
| LPN - Home Health Setting | G0300 | $13.50 | $14.00 |
| LPN - Extended State Plan | G0300-TF | $13.50 | $14.00 |
| RN Assessment/Evaluation | T1002 | $13.50 | $15.00 |
| Assisted Living - Standard | T2031 | $44.01 | $47.10* |
| Assisted Living - Intermediate | T2031-TF | $59.40 | $63.55* |
| Assisted Living - High | T2031-TG | $83.09 | $88.90* |
| Home Delivered Meals | S5170 | $4.88 | $5.15 |
| Personal Services Assistant | S5125 | $3.20 | $3.42 |
| Advanced Personal Services Assistant | S5125-TF | $3.84 | $4.11 |
| Optional/Budget Expense | T2025 | $0.97 | $1.04 |
As you know, the current Waiver Management Information System (WMIS) is being replaced by the Harmony WMIS system. This replacement is on-target to go-live on August 27, 2018. During the conversion of information from the old system to Harmony, the new rates reflected in the table will be implemented. All impacted prior authorizations will reflect the new rate backdated to the effective date (July 1, 2018).
Due to the effective date of Harmony go-live, managing the conversion in the existing WMIS system is prohibitive. The effective date to begin billing at the new rate is August 27, 2018. To receive the new rate on any claims already filed with dates of service between July 1, 2018 and August 26, 2018, the claim must be voided and rebilled.
*Reminder: Claim processing through Harmony does not begin until October 1, 2018.
If you have any questions regarding the information provided above, please feel free to contact us via SmarterMail at: aauproviderquestion@aau.okdhs.org
