LeadingAge NY Meets with DOH on Home Care Billing and CHHA Rebasing
LeadingAge New York met with the Department of Health (DOH) and other home care associations on uniform billing codes for home care under contract with managed care, and Cerrtified Home Health Agencies (CHHAs) Episodic Payment System (EPS) rebasing.
Uniform Billing Codes
As we reported earlier, the final budget included a provision that required the use of standards billing codes for claims submitted to Medicaid managed care plans and MLTC plans for Home and Community-based Services (HCBS), fiscal intermediaries for Consumer Directed Personal Assistance Programs (CDPAPs) and nursing homes. The provision for uniform billing codes was advocated by members of the HCBS workgroup and supported by LeadingAge NY.
The outcome of the meetings is to arrive at a consensus on one or two sets of codes that could be used by home care under contract with plans. The home care associations will be asking members for the codes that they presently use.
LeadingAge NY will keep home care and managed care members informed of the latest developments. Please note this provision has to be in place by January 2016.
CHHA EPS Rebasing
LeadingAge NY and DOH also addressed concerns regarding the impact of the CHHA EPS rebasing. The EPS legislation, a result of Medicaid Redesign Team (MRT) Initiative #5, requires that the CHHA episodic rates be rebased no less than every three years.
As we reported in our state budget analysis, the authority for CHHA EPS was extended until March 31, 2019. The State's fiscal plan for 2015-16 reflects an anticipated $30 million of savings due to EPS rebasing.
Last week LeadingAge NY and other home care associations met with DOH to review and discuss the rebasing calculations and next steps. DOH indicated that the Division of Budget has approved a reduction of 12 percent to the existing EPS rates retroactive to April 1, 2015 until a full rebasing of rates goes into effect Oct. 1, 15. The State estimates that a 12 percent reduction to current rates would result in a payment cut to providers totalling approximately $30 million on an annualized basis. CHHA members should see this reduction sometime in June of July.
However, DOH plans to replace this 12 percent cut to current rates by a full rebasing, that would not only reduce the base price but would also re-weigh each of the 108 payment groups and alter the grouper, effective Oct. 1, 2015. They are seeking the necessary approval from the Division of the Budget for the full rebasing and plan to issue a Dear Administrator Letter with a complete description of the changes once approved.
LeadingAge NY is concerned that the fully rabased rates will have a negative impact well above 12 percent, and is working with DOH and other policymakers to lessen the negative impact of rebasing on members.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871 or Darius Kirstein, dkirstein@leadingageny.org, 518-867-8383