AL Provider Webinar

NJ DoAS PresentationJuly 10, 2014

MLTSS OCCO AL Questions

• Do we continue to follow the same procedures to notify OCCO when a resident is in spend down?

• What happens to the tracking form for transfers/discharges etc? Does it have to be done? If so, in what format and sent to whom?

• Explain how the cost share process will work and who is responsible for telling the provider and when. Then, how will the mco adjust the payment?

Claim Questions

• What place of service and HCPCS codes are used?

• Are ID qualifiers used and if so, which ones?• Do we put the amount of the cost share on the

1500 ?• Do we use the Medicaid # or the MCO

insurance ID # on the 1500?• Will the MCO’s have a sample claim form filled

in on their websites?

Where to find answers

• At the DHS website there is a link to Managed Long Term Services and Supports(MLTSS)

• URL for MLTSS Information;– http://www.state.nj.us/humanservices/dmahs/ho

me/mltss.html

• URL for MLTSS Information for Providers and Consumers– http://www.state.nj.us/humanservices/dmahs/ho

me/mltss_resources.html

Examples of Provider Information

• On the provider site you will find useful information. Such as;– Provider Education Sessions– Frequently Asked Questions (FAQS) for Providers– The “crosswalk” for billing codes from previous

waivers to MLTSS services– Copy of the CMS 1500 form used for billing MLTSS

services

Resources for Providers is found about half way down the page:

Changes for Cost Share• County Welfare Agencies (CWA) or Board of Social Services

(BSS) will be responsible for completing, reviewing and updating Patient Pay Liability Worksheet (PR-2) (formerly Cost Share).

• Patient Pay Liability (PPL) Worksheets (PR-2) are updated annually and reviewed/revised as necessary, but at least every twelve months.

• Assisted Living and Adult Family Care service providers will receive a reduced payment from the participant’s Managed Care Organization (MCO) equal to the amount of the individual’s Patient Pay Liability. MLTSS participants are responsible to pay the provider the Patient Pay Liability calculated by the County Welfare Agency (CWA) or Board of Social Services (BSS), in addition to any Room and Board charge.

• CWA/BSS workers are to inform the participant of the amount the participant is responsible for paying (Room & Board and Cost Share) to the Assisted Living Facility (ALR and CPCH)/Adult Family Care Sponsor Agency.

• CWA/BSSs are to give the original Patient Pay Liability (PR-2) to the Facility/Agency as advisement of the amount that is owed to the provider directly from the participant and copies to the participant and, if requested, the authorized representative/guardian. A new PR-2 is given to each party every time it is reviewed/revised or at the time of financial redetermination.

SSI and Patient Pay

• SSI residents will not be seen by the CWA/BSS• The facility will need to send a client tracking

form to the DoAS for us to complete the PR-2 form and document if a Patient Pay Liability is appropriate.

• Facilities can fax the client tracking form to 609-631-4678, Attention: Mary Rose

SSI and State Supplement

• SSI beneficiaries sometimes do not have enough income to pay the room and board rate and have a PNA.

• The state has an agreement with the Social Security Administration that the person can request a state supplement to provide the minimum income for living in an AL facility.

• The facility should assist the participant to call the local SSA office as soon as possible to “lock-in” their start date for the supplement.

• The resident needs to be present when SSA is called or SSA will not accept the request without verbal approval from the resident.

• It takes about three (3) months for the resident to see the increase in their SS check.

• This is the same process that was used under GO.

Numbers for MLTSSMLTSS @ MCOs

Amerigroup - Janet Sweeney - 732-623-5819.Horizon - MLTSS Member Service Reps - 1-844-444-4410

United Health Care - Renee Reed - 1-848-200-3570WellCare - Susan Ruddiman - 973-274-2178

To Change your NJ FamilyCare MCO - 1-866-472-5338

To enroll in PACE - 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048)or

NJ State Health Insurance Assistance Program - 1-800-792-8820

General QuestionsNJ FamilyCare Helpline – 1-800-356-1561

Questions about MLTSS for consumers1-866-854-1596

DoAS Managed Long Term Services and Supports

ATLANTIC, BURLINGTON, CAPE MAY, GLOUCESTER, SALEMSilvia Laboy-Villa 609-588-3406

BERGEN, CAMDEN, OCEANKevin Murphy 609-588-7220

ESSEX, MORRIS, SOMERSET, SUSSEX, WARRENJean Cochrane 609-588-7258

HUNTERDON, MERCER, MIDDLESEX, MONMOUTH, PASSAIC, UNIONLeslie Alvarez 609-588-7685

Jean King, Technical Assistant (609) 588-6566Fax Number (609) 588-7683