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Provider Update: November 26, 2019

To: ADvantage Case Management and Home Care Providers

Subject: Unit Rate Adjustments Spreadsheets

On October 1, 2019, several ADvantage services received a 4% rate increase resulting in a break in service authorizations.  The services most at risk of experiencing a negative impact from the break in lines were those having annual units.  To proactively offset this negative impact the Medicaid Services Unit (MSU) used program logic to apply a "buffer" in units on both sides of the split authorization.

The intent of the buffered lines was that: 1) providers would not be negatively impacted as authorized units on each side of the split would exceed the monthly average unit amount (based on 175 units/plan year), and 2) as lines would exceed the average monthly unit allowance, MSU staff would not have to manually adjust units using a spreadsheet process.

Even with this prior planning, the MSU has received multiple requests from providers to adjust units, i.e., pulling unused units from the line after the split and applying those units to the line before the split.  Therefore, we will begin adjusting units as requested by providers according to the following process:

  1. All authorizations worked by MSU staff will be appropriately adjusted to reflect a total of 175 units for the Member's service plan year per current authorization practice.  For example:
CURRENT UNITS ending on 9/30/19 line CURRENT UNITS beginning
on 10/1/19 line
TO BE MOVED from 10/1 Line to 9/30 line
Final Adjusted Units
for line ending 9/30/2019
Final Adjusted Units
for line
Total Units
for Year
75 120 11 86 89 175
  1. Unitadjustment spreadsheets will be accepted from each provider branch once only.
    1. One branch per each Excel spreadsheet. Please do not submit multiple branches on one spreadsheet.
  2. Unit adjustment spreadsheets are due by close of business 12/31/2019.
  3. Unit adjustment spreadsheets are to be submitted for all requests to move units, whether large or small.
  4. Unit adjustment spreadsheets must be attached to a Note in the PQ Chapter.
    1. Note type = Claims Issue
  5. The attached Unit Adjustment Worksheet must be used for all submissions.  No other Excel documents or modifications to the attached document will be accepted.
  6. If adjustments are needed for services other than Case Management, please submit a separate spreadsheet for each service type and clarify in the header under provider name the service type being submitted.

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

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