Liberty Healthcare PCS Provider Training October 2017

Leading Today Empowering Tomorrow

Welcome

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8:00-9:00 am Registration

9:00-9:15 am Welcome and Introductions Lyneka Judkins-Executive Director; Liberty Healthcare

9:15-9:40 am PCS Updates Jill Elliott – Director of Operations; Liberty Healthcare

9:40-10:00 am Program Integrity Updates Pat Meyer – Office of Compliance/Program Integrity

10:00 – 10:40 am Top PCS Provider Resources Denise Hobson – Director of Clinical Services; Liberty Healthcare

10:40 - 11:00 am Break

11:00 -11:30 am QiReport Lyneka Judkins-Executive Director; Liberty Healthcare with Peer to Peer Discussion

11:30 – 12:30 pm Q&A Session

Meeting Agenda

PCS Updates

Jill Elliott - Director of Operations, Liberty

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Effective 08/01/2017

Clinical Coverage Policy 3L - Subsection 5.5

Retroactive Prior Approval for PCS amended which allows retroactive period for prior approvals for PCS from 10 days to 30 days.

POLICY UPDATE

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POLICY UPDATE

•Rate Increase from $3.47 to $3.88

•Retroactive to August 1, 2017

•Pending SPA submission and CMS approval

•Rate Increase to $3.90

•Effective January 1, 2018

•Session Law 2017-257

•Pending SPA submission and CMS approval

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What does this mean?

• DMA has authorized retroactive prior approval for PCS requests received on or after August 1, 2017.

• Retroactive prior approval will only be applied to initial requests for PCS.

• The retroactive effective date for authorization will be the request date on the Request for Independent Assessment for Personal Care Services 3051 form, provided the date is not more than 30 calendar days from the date that the Independent Assessment Entity (IAE), Liberty Healthcare, received the completed request form.

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What does this mean?

• If the request is received by Liberty Healthcare more than 30 calendar days from the request date on the request form, the authorization will be effective the date Liberty Healthcare received the form.

• If the initial request is missing information, the received date will not be effective until the correct information is provided to process the referral.

• If a beneficiary requesting admission to an Adult Care Home, Licensed under G.S. 131D-2.4, has not received a screening through the Pre-admission Screening and Resident Review (PASRR) program, retroactive prior approval does not apply. PCS authorization will be made effective the date beneficiary receives their PASRR.

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PA Effective Dates

Example 1:

Example 2:

Request Date 8/1/17

IAE Received Date 8/26/17

Effective Date 8/1/17

Request Date 8/1/17

IAE Received Date 9/12/17

Effective Date 9/12/17

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Forms, Forms, and more Forms

Important Forms • PCS Training Attestation

Form-3085 • Quality Improvement

Form-3136

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PCS Training Attestation Form DMA 3085

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PCS Training Attestation Form DMA 3085

Who is required to submit this form?

Any provider servicing or who plans to service a beneficiary that receives additional hours mandated by N.C. Session Law 2013-306.

NOTE: Providers who are non-compliant

with submission of the DMA 3085 are

subject to audit by Program Integrity.

DMA will begin an internal audit of DMA

3085 training attestation submission in

2017.

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PCS Training Attestation Form DMA 3085

N.C. Session Law 2013-306 Providers serving beneficiaries seeking additional hours of PCS due to Alzheimer’s or other Memory Care complications are required to have caregivers with training or experience in caring for individuals who have a degenerative disease characterized by irreversible memory dysfunction that attacks the brain and results in impaired memory, thinking, and behavior, including gradual memory loss, impaired judgment, disorientation, personality change, difficulty learning, and the loss of language skills.

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PCS Training Attestation Form DMA 3085

Submitting the 3085 Form to DMA

Complete the DMA-3085 and submit by email, or U.S. mail as noted below along with any required materials as noted on the form.

Email: DMA.PCSTraining@lists.ncmail.net

Mail to: NC DMA Home & Community Care

2501 Mail Service Center

Raleigh, NC 27699-2501

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3136 Quality Improvement Attestation Form

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3136 Quality Improvement Attestation Form Key Points

Required to be submitted to DMA by December 31st each year;

There is no standard regarding the format of the required documents;

All documents are not required to be submitted to DMA, just the 3136 QI Attestation Form.

Providers who are non-compliant with submission of the DMA 3136 are subject to audit by Program Integrity. DMA will begin an internal audit of DMA 3136 quality attestation submission in 2017.

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3136 Quality Improvement Attestation Form

What are the requirements for the PCS Provider regarding an Internal Quality Improvement Program?

Develop, and update at least quarterly, an organizational Quality Improvement Plan or set of quality improvement policies and procedures that describe the PCS CQI program and activities;

Implement an organizational CQI Program designed to identify and correct quality of care and quality of service problems;

Conduct at least annually a written beneficiary PCS satisfaction survey for beneficiaries and their legally responsible person;

Maintain complete records of all CQI activities and results.

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3136 Quality Improvement Attestation Form

Submitting the 3136 Form to DMA

Complete the DMA-3136 form and submit by email or U.S. mail as noted below.

Email: DMA.PCSQualityImprovement@lists.ncmail.net

Mail to: NC DMA Home & Community Care

2501 Mail Service Center

Raleigh, NC 27699-2501

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Location of Forms

All forms with instructions can be found in the following locations:

1. Liberty website: http://nc-pcs.com/Medicaid-PCS-forms/

2. N.C. Division of Medical Assistance (DMA) PCS webpage under “Forms.”

http://www2.ncdhhs.gov/dma/pcs/pas.html

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Turning 21 Process

• When a Medicaid beneficiary turns 21, they are no longer eligible for EPSDT and must be reassessed as an adult.

• Effective July 1, 2017, Personal Care Services (PCS) beneficiaries receiving PCS under EPSDT will be required to submit a new DMA 3051 prior to the date of their 21st birthday. The DMA 3051 form must be completed by the beneficiary’s primary care physician or the practitioner providing care for the medical, physical, or cognitive condition causing the functional limitation.

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Turning 21 Process

• Ninety days prior to the beneficiaries 21st birthday, PCS beneficiaries or their legal representative will be notified of this requirement and receive a letter stating that on the beneficiary’s 21st birthday, they will no longer be eligible for PCS under EPSDT.

• Once the DMA 3051 is received and processed, Liberty Healthcare will work with beneficiaries to schedule an assessment in the 10 days following the date of the 21st birthday.

• If the new request for assessment is not received by the beneficiary’s 21st birthday, authorization for PCS will end on the beneficiary’s 21st birthday.

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Turning 21 Process

Process Overview

90 days prior to 21st birthday

Turning 21 Notification and blank DMA 3051 mailed to beneficiary & uploaded

to Provider Portal in QiReport

Liberty will call beneficiary if New Request is not received within 30 days

of 21st birthday.

New Request received & processed the day after the 21st birthday

Liberty to conduct assessment within 10 days following 21st birthday.

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PASRR UPDATES

•DMA is awaiting guidance from DMH around the revision of the ACH PASRR.

•Revision will likely not take effect until mid-summer 2018.

•Additional information will be available in the coming months.

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Delinquent Service Plans

• Outstanding service plans continue to be an ongoing issue.

• On average there are over 300 service plans that are greater than 30 days past due each month.

• Clinical Coverage Policy 3L, section 6.1.4, Providers shall develop an online PCS service plan through the Provider Interface. The PCS service plan must be developed and validated within seven (7) business days of the Provider accepting the IAE referral (section 6.1.4 (i))

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Delinquent Service Plans

Proposed Plan

• Providers who have outstanding service plans greater than 30 days will receive a notification reminding them of requirements and they must complete service plan within 7 days.

• Failure to comply with Clinical Policy 3L may result in referral to OCPI and face-to-face meetings with DMA.

• If continued non-compliance exists beyond the DMA meeting, Provider is at risk for PA void.

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Mediation and Appeals (M&A) Process Overview

PCS beneficiaries have the legal right to due process.

Beneficiaries who have received a denial, reduction, termination, or suspension of PCS must receive written notice of the adverse decision and have the opportunity for a fair hearing.

Liberty sends all adverse decision notifications via USPS Priority Mail; this mail is tracked for delivery, but does not require a signature.

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M&A Process Overview

Adverse decision letter mailed to beneficiary

Beneficiary completes formal hearing request form and mails to OAH

OAH stamps as filed, assigns docket #, and sends to Mediation

Network

Mediation Network contacts beneficiary in regards to scheduling a

mediation

If agrees to a mediation, Mediation

Network sends request to Liberty to schedule

Liberty schedules mediation with

beneficiary/designated representative

Mediation is held with beneficiary/designated

representative, Mediator, and LHC

M&A RN

Mediation is held and resolution received or beneficiary elects to

move to impasse

OAH schedules formal hearing, formal hearing held, and final decision

is made

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M&A Process Overview

Filing the Appeal

If the beneficiary decides to appeal, the beneficiary or their legal representative must sign and date the appeal request form and send it to the Office of Administrative Hearings (OAH) within 30 days of the date the notice was mailed.

NOTE: Providers may not file appeals on the behalf of the beneficiary. Providers may be listed as the representative on the appeal request form and may assist in filing the appeal.

The OAH may be contacted to validate that the appeal request has been received and the date it was received.

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M&A Process Overview

Beneficiaries are not required to participate in mediation. The beneficiary may choose instead to request that the case go straight to hearing before an Administrative Law Judge.

If the beneficiary does wish to participate in mediation in an effort to resolve the appeal, the mediation session must be completed within 25 calendar days of the date that OAH received the beneficiary’s Request for Hearing form.

For example, if OAH received the beneficiary’s Request for Hearing form on June 1, the mediation process should be completed by June 26.

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Maintenance of Service (MOS)

MOS vs No MOS

Appeal filed < 30 days of adverse decision letter = MOS

No break in service hours if filed < 10 days

Break in service hours if filed days 11 - 30

Appeal filed > 31 days of adverse decision letter = no MOS

Reduced hours effective (if applicable)

New admission denial = 0 MOS

NOTE: MOS ends upon the issuance resolution of the appeal at OAH.

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MOS Service Plan (SP)

Is a MOS SP required?

Yes. No MOS SP = no PA generation

Can a MOS SP be done online?

Yes, if assessment hours = MOS hours

Manual MOS SP needed if MOS hours do not match assessment hours

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M&A: New Requests (NR)

What if an appeal is received after a NR is entered/processed/scheduled?

Appeal takes precedence

Appeal will be entered and NR workflow terminated

Can a NR be entered/processed if appeal is active?

No, not until the appeal is resolved/closed

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M&A: COS and ROM Assessments

Change of Status (COS) assessments during appeal

Will not be released and hours not discussed

Will be released only if hours are accepted as part of resolution

Result of Mediation (ROM) assessments

AG’s office will notify beneficiary/representative of outcome

Released only if hours are accepted as part of resolution

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M&A: Change of Provider (COP) Requests

New Provider will be sent a referral request but will not be provided a copy of the assessment;

Provider should do a manual SP for the MOS hours; and

Provider will need to do another manual SP for settled hours if different than the MOS hours.

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Questions about M&A

Beneficiaries and/or providers may reach out to Liberty, DMA, or the Office of Administrative Hearings (OAH) at any time during the pendency of an Appeal with questions.

Liberty Contact – 1-855-740-1400 or 919-322-5944

DMA Contact – 919-855-4360 or PCS_Program_Questions@dhhs.nc.gov

OAH- 919-431-3000

Program Integrity Updates Pat Meyer – Office of Compliance/Program Integrity, DHHS

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Program Integrity Updates

Office of Compliance and Program Integrity staff presented updates during the face-to-face regional trainings.

Their PowerPoint Presentation slides will be available on DMA’s website for review at a later date.

For specific questions, please see OCPI Nurse Supervisor Patricia Meyer’s contact information on the next slide.

Patricia Meyer RN,BC CPIP

Nurse Supervisor, OCPI Medical Review

919-814-0170

Pat.meyer@dhhs.nc.gov

OCPI |October 2017 37

Contact Information

Top PCS Provider Resources Denise Hobson – Director of Clinical Services, Liberty

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Powerful Tips for PCS Providers

Knowledge of available resources

Keeping up to date with requirements

Educate staff of resource locations

Get involved as a stakeholder

Attend provider training, webinars, and conferences

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Top PCS Provider Resources

Websites

www.nc-pcs.com

www.qireport.net

www.dma.ncdhhs.gov

www.nctracks.nc.gov

Trainings

Manuals

Always stay connected…….

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Liberty Healthcare of NC: Home Page

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Liberty Healthcare of NC: Home Page

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Liberty Healthcare of NC: Training

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Liberty Healthcare of NC: Training

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Liberty Healthcare of NC: Manuals

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QI Report: Provider Portal

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QI Report: Provider Portal

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DMA Website: Provider Resources

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DMA Website: Provider Resources

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DMA Website: Provider Resources

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Reach Out for Assistance

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Summary

Knowledge is power……

Find the resources

Use the resources

Share the resources

Educate staff with the resources

Provider

resource

BREAK

Leading Today, Empowering Tomorrow

QiReport

Lyneka Judkins – Executive Director, Liberty

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What can I do with QiReport?

Provider Agencies utilize QiRePort to do the following:

• Receive service referrals and accept/reject them electronically

• Manage servicing beneficiaries' accounts, including access to historical assessments and PA’s

• Submit Discharges

• Submit Service Plans

• Submit Change of Status Requests

• Upload the Beneficiary Consent Form

• Manage servicing territories

• Update/Correct Modifiers

• Update NPI association

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How do I access QiRePort?

1. Have a registered NCID. For more information on NCID, visit https://www.ncid.its.state.nc.us/

2. Complete a Provider Registration Form and submit to Viebridge, Inc. via the following: Fax: 919-301-0765 Email: support@qireport.net Mail To: 8130 Boone BLVD, STE 350, Vienna, VA 22182 A registration form can be obtained by visiting https://www.qireport.net

3. Log in!

Important: Registration is now required for all PCS Providers.

Registration and Access Requires 3 Steps:

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Home Page

• Get up-to-date news regarding PCS under the announcements section

• Access to Training Videos/Webinars under the Training Resources Section

• Ask system related questions directly to Viebridge, Inc.

• Ask policy related questions directly to DMA

• Access Liberty Healthcare of North Carolina’s web page for detailed information regarding PCS

• Access ‘Frequently Asked Questions’ about the provider portal and PCS

The Home Page allows you to do the following:

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Home Page

Functionality on the Home Page:

Providers are able to View training resources Ask Viebridge questions Ask DMA questions

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Referrals

Access to all beneficiary information and account management can be found under the ‘Referrals’ tab

Click the ‘Referrals’ tab to access beneficiary information

Access links are located in the left side toolbar

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Referrals for Review

• This page displays the list of beneficiaries who have selected your agency as a provider of choice and Liberty has submitted a request for services on their behalf. From this page you can:

• Review the beneficiary’s demographic information

• See the total amount of approved PCS hours

• Review the completed PCS assessment

• Accept/Reject a beneficiary for services

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Referrals for Review

Click here to access a copy of the assessment

Hours awarded is displayed here

Provider should select a response to request by selecting the appropriate response decision

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Referral Info – Accepted (last 1 year)

Accepted (last 1 year), continued

Displays notification type Click active link to access notifications

See total hrs

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Referral Info – Accepted (last 1 year)

• This page displays the list of beneficiaries who have been accepted by your agency to provide PCS. From this page you can:

• Access notifications regarding the status of PCS for a beneficiary

• Review current approved hour totals

• Access historical assessments

• Review demographic information

• Access the beneficiary summary page

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Referral Info – Accepted (last 1 year) Select a beneficiary to access the Beneficiary Summary page

Displays assessment type Click date to access assessment

Displays total hours

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Referral Info – Denials (last 6 months)

• This page displays almost identical to the ‘Accepted (last 1 year)’ page. The ‘Denials’ page provides a list of beneficiaries who have been accepted by the provider agency but since denied PCS. From this page you can:

• Access notifications regarding the denial of PCS for a beneficiary

• Review current approved hour totals

• Access historical assessments

• Review demographic information

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Accepted and Active Recipients

The ‘Search Recipients’ link allows you to search for a particular beneficiary and access the following:

• Review demographic information

• Review the request entry entered by the IAE

• Review current approved hour totals

• Access historical assessments

Search Recipients/Recipient Summary:

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Accepted and Active Recipients

Recipient Summary, continued

Can review request entries entered by the IAE

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Beneficiary Profile

• The beneficiary profile is used to store and maintain key information about a beneficiary in a single location.

• The profile uses information collected from the assessment and NC Tracks

• Providers may update and add information to the profile record including current contact information and current diagnosis codes.

• LHC Coordinators may reference the information in the profile in order to obtain the most up to date information.

What is the Beneficiary Profile?

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Beneficiary Profile

Once you have searched for a beneficiary, you will want to click ‘Beneficiary Profile’ from the left index bar in order to access their profile.

How to access the Beneficiary Profile

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Beneficiary Profile

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Supporting Docs

Once you have searched for a beneficiary, you will want to click ‘Supporting Docs’ from the left index bar in order to access documents that have been uploaded to the beneficiary’s account or to upload a new document.

To upload a new document, you will click ‘Add’, locate the document from your computer, and upload.

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Supporting Docs

• Providers are required to upload all signed service plans to Supporting Docs.

• If a provider is unable to complete a service plan in QiReport- they must upload a copy of the manually generated service plan to Supporting Docs.

• Providers may upload any other medical or personal information pertaining to the beneficiary to supporting docs.

• LHC can view all information uploaded to supporting docs.

*Supporting documents do not transfer with a beneficiary when they request a change of provider.

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Service Plan

The service plan became effective June 10, 2015. Each time a provider accepts a referral for new or existing beneficiary, a service plan must be completed. A service plan will need to be completed after each of the following:

New admission assessments

Annual assessments

COS assessments

COP requests

MOS notifications

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Completing a Service Plan

Note: Provider have 7 business days after acceptance to complete and submit the service plan.

To view new or in process service plans

To access a beneficiary’s service plan a provider will… • Select the ‘Plan’ tab at the top of their screen • Next they will select ‘In Process Plans’ from the left index bar to view all service plans

awaiting completion

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Completing a Service Plan

This is where provider enters the shifts to calculate the daily hours.

Weekly hours are already divided by 4.35

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Completing a Service Plan

Providers must ensure the frequency listed matches the number of days selected for each task.

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Completing a Service Plan

Before submitting service plan provider needs to select if the service plan is completed.

Once complete, select save to submit the service plan

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Service Plan revision

Accessing a completed Service Plan

• Go to the “Plan” tab and perform a search for the beneficiary. • Click on the beneficiary’s name to display their Beneficiary Summary • IHC- select “Beneficiary Service Plan List” found on left index of the QiReport • ACH- select “Plan List” found on the left index of the QiReport

Select ‘Plan’ to access service plans

Click here to access completed service plans for a beneficiary

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Service Plan revision

Providers will click on the plan start date to access the service plan.

Once you select ‘Beneficiary Service Plan List’, a list of completed service plans will populate, click the date of the service plan you wish to access.

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Service Plan revision

Revising a Completed Service Plan Click on ‘Revise Service Plan’ to make changes to the Service Plan. A revision date will need to be entered to indicate when the changes will be effective.

NOTE: Changes in days of service can be made and which days a task will be completed, but frequency must still match what has been indicated in the assessment.

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Service Plans Outside of QiReport

• A PCS Provider will need to create a Service Plan outside of the system in the following cases:

• EPSDT Temporary Summer Hour Change – A SP should be manually drafted for the temporary time frame of hour change.

• In the case of a settlement and the hours awarded are different than what is reflected on the assessment.

• Expedited Assessments – A manual SP will need to reflect the temporary hour award.

• A COP was processed, but the assessment was not provided to the provider due to an active appeal.

NOTE: All manually drafted service plans must be uploaded to supporting docs. in the provider portal.

Exceptions

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Change of Status Requests

The ‘Change of Status (COS) Request’ link allows the provider to submit an electronic COS request form directly to the IAE as well as access historical requests submitted and review the status of approval.

NOTE: Physician attestation cannot be submitted through the provider portal.

Review historical requests and the approval status

Click the ‘Add’ button to submit a new request. Complete the request form and hit ‘save’.

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Discharges

In accordance of Clinical Policy 3L, providers are expected to discharge a beneficiary no longer under their care, within 7 days. Discharge submission can be completed electronically through the provider portal.

Enter the discharge date, most appropriate reason and hit ‘save’ to submit discharge to IAE

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Billing Modifier Change – ACH Only

For ACH facilities, the ability to manage modifier codes for each beneficiary is available in the provider portal. After selecting the appropriate beneficiary, select the ‘Billing Modifier Change’ link.

Select appropriate modifier here and hit ‘save’.

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Provider Number Change

If a provider has multiple locations or manages multiple NPIs, they have the ability to match the associated NPI to their serviced beneficiary under the ‘Provider Number Change’ link.

Select the appropriate NPI and the effective date and hit ‘Save’.

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Counties Served – IHC Only

Every beneficiary is provided a ‘Random Provider List’ during the time of assessment. This list only includes providers who have indicated they service the county the beneficiary resides in. The ‘Counties Served’ link allows providers to identify the counties they serve.

Indicates how many counties currently serving

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Counties Served – IHC Only

After selecting your provider agency name, a page will display listing all individual counties. This page allows you to delete or add counties as appropriate.

List of counties currently indicated as serving

Add a new county here

Edit effective date or remove county through ‘edit’ option

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Additional Questions?

For any additional questions regarding the use of QiRePort, please contact

Viebridge at

888-705-0970.

11/15/2017

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Question and Answer Session

Liberty Healthcare PCS Provider Training October 2017

Leading Today, Empowering Tomorrow