Provider Update: January 23, 2020

To:                  All ADvantage and SPPC Providers

Subject:Reminders to Provider Agencies

Leap Year –

To keep all services plans within the 365 day certification timeframe with regards to leap year, just remember that Plans beginning 3/1/2020 forward will go back to using an end date of 1 day prior to the current plan start date +1 year.  

*Example 3/2/2020 to 3/1/2021

As a reminder plan dates should follow right after each other. There should not be a gap or an overlap in dates on the plan dates.

Planned Services –

To enable easier identification of change requests to Members' planned services (also known as addendums) in Harmony, we want to remind agencies that the following options are available in the SPA Review dropdown menu (for providers only) for use as follows:

End Service (Provider Use Only):

Use this option on the Planned Services page when requesting to end authorized service line(s). The status will be updated to 'Service Ended' when your request has been processed by MSU.

New Request (Provider Use Only):

Use this option on the Planned Services page when adding new service line(s) to the service plan.  The status will be updated when the request has been reviewed by MSU.

*Use of these options help to reduce turnaround times for plan reviews. 

Plan Information –

In an effort to ensure review requests are systematically routed to the right place, the Plan Status for Member's services needing review/authorization must always be set to SPA Review.  This includes plans requesting CD-PASS authorization.  This action supports faster service authorization and also allows for timely redetermination of medical eligibility prior to the end of the certification period.  Routing of service plans to the various review teams is completed internally by MSU-AA staff.  (see image below)

Please also be advised that the last two boxes that appear when setting a Plan Status to SPA Review should only be utilized when submitting an addendum or a response to a condition.  The answers to these two questions impacts notifications sent to MSU-AA. (see image below)

Reassessments –

All Member Reassessments are to be completed 60 to 30 calendar days prior to the end date of the current service plan.  While up to 60 calendar days are allowed, reassessments must be submitted to MSU-AA no less than 30 calendar days before the current plan expires.

*Please send any questions or concerns regarding this information through the Harmony PQ chapter.