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:: NAHC Report
NAHC Report: Issue# 2319, 11/20/2013
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
UPDATE: Palmetto to Conduct Hospice-specific Prepay Probe Review
South Carolina Signs Memorandum of Understanding with CMS - Becoming the Eighth State to Adopt Medicare-Medicaid Dual Eligibles Initiative
For Your Information: 2013 NAHC Annual Meeting Certificates for Attendees are Now Available Online
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UPDATE: Palmetto to Conduct Hospice-specific Prepay Probe Review

As reported in the November 1, 2013 NAHC Report, Palmetto GBA notified providers that it will perform a service-specific prepay probe review on hospice claims with non-cancer diagnoses, billed with place of service Skilled Nursing Facility, HCPCS code Q5004.

The Q5004 location code is used when a hospice beneficiary is residing in a skilled nursing facility and the facility staff is providing skilled care to the patient, i.e. hospice general inpatient level of care.

Palmetto has identified 13 providers with a large number of beneficiaries receiving hospice services billed with the Q5004 location code. In accordance with CMS requirements, the service-specific probe will encompass 100 claims from these 13 identified providers. This is a prospective review. Based on the results, Palmetto may or may not initiate further probes/edits for these providers and/or other hospice providers.

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2013 NAHC Annual Meeting Certificates for Attendees are Now Available Online

The 2013 NAHC Annual Meeting certificates are now available online and ready to download for participants and attendees to this year’s Annual Meeting.

Please click here to download your certificate.

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South Carolina Signs Memorandum of Understanding with CMS - Becoming the Eighth State to Adopt Medicare-Medicaid Dual Eligibles Initiative
The National Council on Medicaid Home Care – a NAHC Affiliate – Issues In-Depth Issue Brief on the South Carolina Program

On October 25, 2013, the Centers for Medicare and Medicaid Services (CMS) and the South Carolina Department of Health and Human Services (SCDHHS) signed a Memorandum of Understanding (MOU) establishing the Medicare-Medicaid Alignment Initiative (MMAI) in South Carolina (the Demonstration). South Carolina is now the eighth state to implement the MMAI, after Massachusetts, Washington, Ohio, Illinois, California, Virginia, and New York.

Fifteen other states have active proposals submitted to CMS. The MMAI is a joint federal and state project that seeks to improve care and reduce costs associated with beneficiaries eligible for both Medicare and Medicaid, or “dual eligibles.” Minnesota has signed a dual eligibles demonstration independent of the MMAI.

In South Carolina, the Demonstration is called the Health Connections Prime program. It functions to enroll dual eligibles into managed care plans called Coordinated and Integrated Care Organizations (CICOs), and provide long-term care services and supports (LTSS). Starting no earlier than July 1, 2014, the Demonstration will eventually coordinate care to approximately 54,000 dual eligibles and encompass all counties of the state.

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