Provider update: April 15, 2020
To: All ADvantage Home Care Providers
Subject: Home Care Process Changes related to COVID-19 Emergency Plan
Date: April 15, 2020
The Human Services Department has been working with our state and federal partners to initiate emergency plans to support our provider network as we go through this difficult time together. Please see below for a summary of those changes specific to your service types.
Pandemic Tracking Reminder
- On March 26, a bulletin was sent to providers requiring pandemic reporting by Home Care and Case Management providers be submitted every Wednesday. There are still providers not in compliance.
- The bulletin and guidance for completing the report can be found at this location.
MSU Audit Process Change
- All Audit processes are modified to only include electronic data contained in the Harmony system.
Personal Care Services (PCS)
- Beginning immediately, please use:
- Activity Code 63 – 'Pandemic Related Telehealth' when entering a web claim in Authenticare to capture electronic member/nurse interactions (phone calls, video chat, etc.) usually completed in the home; and
- Activity Code 62 – 'Retainer Payment' when entering a web claim in Authenticare to capture billing for retainer payments for members unable to receive PCS due to the pandemic.
- The ADvantage Eligible Provider Exemption process is waived for the period of the emergency, allowing legal guardians, powers of attorney, and spouses to provide PCS to Members.
- Rule does not apply to State Plan Personal Care (SPPC) Members.
- Training of personal care attendants may be completed electronically.
- For family member paid-caregivers with existing knowledge of how to assist Members, formal electronic agency training may be completed within 10 days of the first billed date of service.
- The requirement for in-home training for Advanced Supportive/Restorative (ASR) assistants is waived. Training, which may be completed electronically, may be completed in another setting unless there are specific needs warranting the training in the Member's home.
- If training is completed in the Member's home, the training must be conducted in accordance with HIPAA requirements.
- The requirement for annual in-service training for AS/R assistants is also waived.
- When a Personal Care Assistant (PCA) terminates employment in good standing and is later rehired by the same agency, new hire paperwork must be completed only if the PCA has been separated for more than 90 days.
- For new plans, reassessment plans and service increases, PCS may be provided once the Planned Service line and Identified Needs have been entered and in advance of the authorization being applied. However, no billing can occur until the PA is transmitted to OHCA and available in AuthentiCare.
- When essential to the needs of the Member, ADvantage PCS may be provided in the hospital setting to assist with communication, intensive personal care needs, behavioral stabilization, or other supports the hospital is unable to provide, not to exceed 30 days.
- Retainer payments are allowed for PCS for ADvantage Members who are unable to receive services due to the COVID-19 pandemic. Retainer payments are not allowed for SPPC Members.
- Payments are claimed per Member when the Member is not able to receive the service due to COVID-19, e.g., Member refuses due to being in a high risk category, Member refuses due to fear of infection by exposure to the PCA, etc.
- Payments are not allowed because the provider is unable to provide the service.
- Retainer payments may not exceed seven (7) days of authorized services.
- Retainer payments may not be claimed for any dates the Member is hospitalized, as this would constitute duplicate billing.
- When billing for retainer payments, please make a note in the web claim in AuthentiCare as follows:
- Include the dates for which the retainer payments are being claimed and the specific reason the Member is not able to participate in PCS.
- For SPPC Members, no service plan changes will be accepted that result in a reduction of services to the Member unless requested by the Member.
- Update to signature requirements for SPPC:
- We are aware that some Home Care nurses may not have access to printers or scanners. In these cases, the nurse should document the Member's agreement with the service plan in a Plan Note using "Pandemic" as justification.
- Please complete required SPPC Documents (Nurse Evaluation, SPPC Service Planning Document) in Harmony, which will capture the date of the activity.
- For new plans, the personal care (T1019) line will be conditionally authorized for up to 120 days.
- Formally signed SPPC Signature Page that indicates the date the meeting occurred will be required to remove the condition.
- All electronic interactions with Members must be completed in accordance HIPAA requirements.
As always, we appreciate the support you provide to our Members.
If you have questions on the content of this bulletin, please submit a Provider Question with an Inquiry type of COVID-19 Question / Issue.
AGING SERVICES | MEDICAID SERVICES UNIT
ADvantage Administration | State Plan Personal Care
Office: 918-933-4900 | CareLine: 800-435-4711