Provider update: April 8, 2020
To:All Assisted Living Providers and Assisted Living Case Managers
Subject:Assisted Living Tiers During Pandemic
Date:April 8, 2020
Per the Appendix K approved by CMS for Emergency Preparedness, all tiers for Assisted Living (AL) Members will be changed to ‘Tier III-T2031TG High’ through the end of the calendar year. This means that all Members currently at ‘Tier I-T2031 Standard’ or ‘Tier II-T2031TF Intermediate’ will be raised to Tier III for dates of service 03/01/2020-12/31/2020.
In order to complete this, all AL authorizations currently in Harmony for Members at Tier I and II will be revised by MSU to end 02/29/2020.New authorizations of Tier III will be placed for dates 03/01/2020 through the Member’s service plan end date (not to exceed 12/31/2020). Case Managers can begin adding Tier III to service plans for all AL Members going forward for dates through 12/31/2020. Authorizations beginning 01/01/2021 will be added for the Member’s previously assessed tier rate.
If billing for services of Members at Tier I and II has already been completed for dates in March/April 2020, billing will need to be voided so the Members’ authorizations can be updated and retransmitted. This will allow the AL to rebill at the higher tier rate for those dates of service. If the AL chooses not to void billing, MSU will end the authorization for the last date of service billed and begin the new authorization for the following day.The last date of service billed will need to be communicated to MSU by the AL.
If billing has not taken place for March/April, or when all needed billing has been voided for March/April, please notify MSU so the authorizations can be updated. The AL should refrain from billing for services until the Member’s authorization has been updated and transmitted in Harmony to prevent billing errors.
MSU has identified this as a priority project and will have multiple staff assisting to ensure quick turnaround time for the AL providers. These authorization revisions need to be coordinated closely.We are asking that all correspondence be sent through the PQ chapter in Harmony using Type: AL Question.
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