Action Request Transmittal

Transcription

1 Seniors and People with Disabilities Action Request Transmittal Cathy Cooper Number: SPD-AR Authorized Signature Issue Date: 4/14/2008 Topic: Long Term Care Due Date: Subject: SPD Contract RN Program Provider Rate Increase Effective July 1,2008 that Impacts the Total Dollar Amounts for Services that are Prior Authorized for RN Providers Applies to (check all that apply): All DHS employees Area Agencies on Aging Children, Adults and Families County DD Program Managers County Mental Health Directors Health Services Seniors and People with Disabilities Other (please specify): Action Required: Beginning immediately, the local offices must increase the total dollar amount on all prior authorization (PA) requests for Contract RN (CRN) services by 3.5%. For existing PAs the local offices do not need to adjust the total dollar amount unless contacted by the CRN. Reason for Action: Seniors and People with Disabilities Contract RNs will receive a 3.5% rate increase effective July 1, This increase reflects a 1.4% medical inflation rate and a 2.1% cost of living adjustment. To minimize the number of PAs requiring adjustments the total dollars on any new PAs issued for CRN services must be increased by 3.5%. The local offices do not need to determine how many units may be provided on or after July 1, 2008 just calculate the total by the 3.5%. Additionally, there is no need for the local offices to determine what existing PAs need adjustments. The CRNs will receive a letter instructing them to review their existing PAs that have an end date after July 1, 2008 to determine if they need to contact the local office requesting an adjustment to the remaining dollars on the PA. Attached is a SPD Contract RN Program New Unit Rate Table for local office use only that demonstrates the July 1, 2008 unit rates for each procedure code and how to factor the adjustments. The CRNs will receive a new table reflecting the new July 1, 2008 rates. DHS 0078 (02/04)

2 Field/Stakeholder review: Yes No If yes, reviewed by: If you have any questions about this action request, contact: Contact(s): Gretchen Koch Thompson Phone: Fax: DHS 0078 (02/04)

3 FOR LOCAL OFFICE USE ONLY Seniors and People with Disabilities Contract RN Program Rates Table Effective July 1, 2008 SPD Contract RN Program Procedure Codes T2024 Initial Assessment & Client Health Support Plan Reassessment Monitoring Visit S5115 Delegation/Teaching Non-Family S5110 Teaching Family S9123 RN Services Direct Care July 1, 2008 Unit Rate $ Unit = per diem $35.40 Unit = 1 hour Units per Date of Service EXAMPLE: The following table illustrates an adjustment being made to a Contract RN PA request with a service end date on or after July 1, Procedure Code Total Units $ Amount S5115 Delegation/Teaching Non-Family S5110 Teaching Family Monitoring Visit TOTALS 64 $ $ (requested total at old unit rate) X.035 (% rate increase) = $19.52 (to be added to requested PA total) $ $19.52 = $ is the adjusted total dollar amount. Seniors and People with Disabilities Contract RN Program Revised April 2008

4 Oregon Theodore R. Kulongoski, Governor Date: April 11, 2008 Department of Human Services Seniors and People with Disabilities 500 Summer Street NE, E13 Salem, OR (503) Fax (503) To: From: All Contract RNs Gretchen Thompson CRN Program Coordinator Subject: Rate Increase Effective July 1, 2008 The Seniors and People with Disabilities Contract RN (CRN) Program will receive a 3.5% rate increase effective July 1, This increase reflects a 1.4% medical inflation rate and a 2.1% cost of living adjustment. Local Offices will adjust all new requests for prior authorization (PA) by 3.5%. The local office will adjust existing PAs with an end date after July 1, 2008 upon notification from the CRN that a PA(s) requires a dollar adjustment. The CRN is responsible for determining if it is necessary to adjust the dollar amount on existing PAs. Only PAs with a service end date after July 1, 2008 need to be adjusted. Once the CRN has determined that there is a need to adjust an existing PA the CRN needs to provide the local office with a copy of the original request that includes the PA number and date range. The CRN must indicate at the top of the page that an adjustment for the dollar amount is needed. This must be turned into the local office no later then June 6, The local office needs time to make any necessary adjustments. SPD 1350 (02/03) Assisting People to Become Independent, Healthy and Safe An Equal Opportunity Employer

5 Failure to provide the local office with the necessary PA information by June 6, 2008 could result in your claims being processed with an incorrect payment(s) for services provided on or after July 1, Billing for services provided on or after July 1, 2008 the CRN must list the new rate when submitting a CMS 1500 for service(s) provided on or after July 1, If a CMS 1500 is submitted for service(s) provided on or after July 1, 2008 with the old rate the payment will be at the old rate. It this occurs the CRN must submit an adjustment for the balance. The new rates can only be billed for services provided on or after July 1, 2008 If you have any questions please contact me through the CRN address at [email protected]. Responses to questions that may assist others will be sent to all CRNs. Attached is an updated SPD Contract RN Program Rate Table that reflects the new rates for services provided on or after July 1, 2008.

6 Seniors and People with Disabilities Contract RN Program New Unit Rate Table Effective July 1, 2008 SPD Contract RN Program Procedure Codes T2024 Initial Assessment & Client Health Support Plan Reassessment Monitoring Visit S5115 Delegation/Teaching Non-Family S5110 Teaching Family S9123 RN Services Direct Care July 1, 2008 Unit Rate $ Unit = per diem $35.40 Unit = 1 hour Units per Date of Service The above rates will be effective for services provided on or after July 1, Seniors and People with Disabilities Contract RN Program Revised April 2008