New Jersey Department of Human Services Division of

New Jersey Department of Human Services Division of Medical Assistance and Health Services (DMAHS) Managed Health Care Update June 2016 1

Overview of Topics • • Managed Long Term Services and Support (MLTSS) Update Provider Resources – Website information – e-MEVS display – Cost Share Overview 2

MLTSS Update • Managed Long Term Services Supports – Any Willing Provider – Existing SCNF FFS members 3

March 2016 LTC Headlines 37. 9% of the NJ Family. Care LTC Population is in Home and Community Based Services* Prior Month = 37. 5%; Start of Program = 28. 9% Nursing Facility Population** Down by Over 1, 000 Since the July 2014 Implementation of MLTSS * Methodology used to calculate completion factor for claims lag in the ‘NF FFS Other’ category (which primarily consists of medically needy and rehab recipients) has been recalculated as of December 2015 to account for changes in claims lag; this population was being under-estimated. ** Nursing Facility Population includes all MLTSS recipients and all FFS recipients (grandfathered, medically needy, etc. ) physically residing in a nursing facility during the reporting month.

Long Term Care Recipients Summary – March 2016 Total Long Term Care Recipients* 46, 891 Managed Long Term Support & Services (MLTSS) 24, 910 Fee For Service (FFS/Managed Care Exemption) 21, 100 MLTSS HCBS MLTSS Assisted Living MLTSS HCBS/AL (unable to differentiate) MLTSS NF MLTSS Upper SCNF MLTSS Lower SCNF FFS pending MLTSS (SPC 60 -64) FFS Nursing Facility (SPC 65) FFS SCNF Upper (SPC 66) FFS SCNF Lower (SPC 67) FFS NF – Other (Oct 2015)** PACE Source: NJ DMAHS Shared Data Warehouse Regular MMX Eligibility Summary Universe, accessed 4/14/2016. Notes: Information shown includes any person who was considered LTC at any point in a given month and includes individuals with Capitation Codes 79399, 89399, 78199, 88199, 78399, 88399, 78499 & 88499, Special Program Codes 03, 05, 06, 17, 32, 60 -67, Category of Service Code 07, or MC Plan Codes 220 -223 (PACE). * ‘FFS NF – Other is derived based on the prior month’s population with a completion factor (CF) included to estimate the impact of nursing facility claims not yet received. Historically, 90. 76% of long term care nursing facility claims and encounters are received one month after the end of a given service month. ** Includes Medically Needy (PSC 170, 180, 270, 280, 340 -370, 570&580) recipients residing in nursing facilities and individuals in all other program status codes that are not within special program codes 60 -67 or capitation codes 79399, 89399, 78199, 88199, 78399, 88399, 78499 & 88499. 13, 450 3, 163 10 8, 177 72 38 625 15, 542 215 146 4, 572 881

Managed Care –Behavioral Health Update • Behavioral Health Homes (BHH) currently in Mercer and Bergen Counties • BHHs coming online 4/1/2016 for Atlantic, Cape May and Monmouth Counties • MCOs manage behavioral health services for the MLTSS and DDD members 6

Managed Care –Behavioral Health Update – July 2016: • New Medicaid and state only rates for adult behavioral health services provided in the community • “True up” of the benefit so that individuals in Title XIX plans will receive the same benefit as individuals in the ABP plan that includes a substance use disorder benefit. • State only SUD contracts move to FFS – January 2017 • State only mental health contracts move to FFS – Next Steps • Move to managed behavioral health services 7

Provider Resources • Provider Resources (see handout) – Website information • DHS Site • MCO Website – e-MEVS display 8

DHS Website Information The link below will provide connection to individual MCO sites. http: //www. state. nj. us/humanservices/dmahs/info/resources/hmo/ • Contact phone number for Member and Provider Relations is listed • Link for MCO Member Manual is posted • Provider Manual and Quick Reference Guides (see handout) • Human Services website - MLTSS: http: //www. state. nj. us/humanservices/dmahs/home/mltss_resources. html • Provider Frequently Asked Questions (FAQ) posted • Provider Education Power. Points 9

Molina Website Information • Molina –NJMMIS website: http: //www. njmmis. com • Medicaid Newsletters • • • Pre-Admission Screening (PAS) Screen Action Code 2 Volume 26 Number 2 Managed Long Term Services and Support Volume 25 Number 11 Patient Pay Liability (PPL) and Provider-Collected Cost Share Volume 25 Number 1 • e-MEVS- Member Eligibility- login required 10

NJ Family. Care Cost Share Patient Pay Liability (PPL) County Welfare Agency (CWA) Calculates Cost share PR- 1 Nursing Facility PR-2 Assisted Living PR-3 Currently paper forms are HCBS in private home used – cost share is paid directly to state 11

Cost Share Process • County Welfare Agency (CWA)calculates cost share annually and/or when member change living arrangement for custodial care • Cost Share (PPL) Amount recorded in state electronic system • MCO receive weekly file from State with PR amounts for individuals enrolled with their MCO • Cost Share deducted from MCO monthly capitation for enrolled members • MCO deducts cost share from the Provider payment 12

Suggestions to Address Questions Regarding Cost Share • Facilities should notify CWA when they have admission or discharge • Confirm that member has a current cost share calculation- required annually • Contact CWA if cost share update is needed • Confirm amount deducted from MCO claim is consistent with amount provided by CWA • If there is a discrepancy in CWA amount and MCO claims deduction e-mail detail to mahs. provider-inquiries@dhs. state. nj. us 13

Update to e-MEVS display 2016 For LTC and Assisted Living Providers - Effective Friday, May 6, 2016, Nursing Facility and Assisted Living Facility providers will receive patient responsibility (PR) data as part of a e. MEVS response on the NJMMIS website. The PR data is being provided as information only and represents the member’s net income. As this PR information doesn’t include consideration of a member’s maximum patient payment liability, providers are required to use only the PR 1 or PR 2 copy, which are received by mail from the State, as the official record of a member’s cost share. 14

e-MEVS Display • Users access e. MEVS by selecting Login 15

e-MEVS Login Enter your secure Username and Password 16

e-MEVS search criteria Select the search method Date Format must include slashes 01/01/2006 17

e-MEVS Display Information • Medicaid Eligibility Data – Termination Date –displayed if members eligibility scheduled to term month eligibility is verified – Termination Code Descriptions • MCO Name –Begin Date • Special Program Code • Eligible Services • Medicare Part A-Data • TPL Information • PPL Information for NF and AL Provider 18

Sample e-MEVS Display (Part 1) Eligibility display includes description of termination reason. The MCO information will be displayed if member is enrolled in an MCO 19

Sample e-MEVS Display (Part 2) Special Program Data specifies MLTSS Eligibility **** TPL Coverage **** 20

Sample e-MEVS Display (Part 3) PR 1/PR 2 Indicator Available Income Begin Date PR 2 $841. 77 01/01/2015 $810. 10 07/01/2014 TPL Coverage PR 2 **** 21

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