Provider Update: December 26, 2018
To: Home Care Provider Agencies
Subject:Important Information Regarding State Plan Personal Care
State Plan Personal Care (SPPC) has some process variances that are necessary because of the systems used to manage the SPPC program. Below are some explanations of a few of these variances.
- Prior to Harmony, units were listed as monthly in the SPPC management system. In Harmony, they will be shown as weekly (like ADvantage). There are still some units from the conversion that may be showing a monthly frequency, causing some confusion. Please do not alter any of these lines.
- SPPC requires an end of year process that closes existing authorizations effective 12/31 and opens new authorizations effective 1/1. We are currently working to get the new authorizations in both Harmony and EVV for 2019. We are aware some of the service lines in Harmony are not yet broken out for the 1/1 begin date and are working to correct this. No PQ is necessary.
- Prior to Harmony, SPPC authorizations had a letter at the end of the PA to make it unique for each month in the EVV system. The Harmony PA does not include the letter. This has caused several instances where, when there has been a change to the existing T1019 line in Harmony, it has resulted in the creation of a new PA in the EVV system. We are working with the vendor to correct this issue.
- Currently T1001 is a "placeholder" in the Harmony system. Adding the T1001 line creates the record for the member in EVV, however the number of visits listed on the plan is not tied to billing at this time. A maximum of five (5) T1001 nurse visits are allowed per 12 month period, so if Harmony is not showing the correct number of units the agency may still provide the service and bill without requesting a plan correction.
For start of care, annual reviews, and anytime a change in personal care services (T1019) is needed, the Home Care nurse is responsible to:
- Complete the Nurse Evaluation;
- Complete the SPPC Planning Document; and
- Add/Adjust the T1019 (personal care) planned services line, as appropriate.
For the six month monitoring visit, only the Nurse Evaluation form is required if no change in personal care services is needed.