NJACP along with the other provider associations participated in DDD’s leadership meeting on July 24. The following was discussed:
Meghan Davey, Director of Medicaid Services, reported the Comprehensive Waiver expired on June 30, and CMS issued a 30-day extension. She is hoping for approval by the end of the month. With the change in administration, Ms. Davey reported CMS seems to be more flexible. She noted that the waiver includes a pilot for individuals with a dual diagnosis, however, they cannot provide details regarding the pilot or if it will continue should mental health services move to the Department of Health.
Liz Shea noted CCW will be moved into the Comprehensive Waiver and that will occur with a one-day flip. With approval of the Comprehensive Waiver, authority will switch from the 1915(c) to the 1115(i) which is the Comp Waiver. There will be no need for DDD to request approval from CMS for amendments to the CCW as the amendments are already in the Comprehensive Waiver. Upon approval of the Comp Waiver, DDD will have thirty days to notify consumers that there has been a change in authority.
-Documentation and Audits
Discussion took place regarding provider concerns with documentation. Tom Baffutto asked Meghan Davey if Medicaid had a “cheat sheet” for documentation. Both Liz Shea and Meghan Davey noted there are absolutely no guarantees or full-proof language that will protect a provider from an OIG audit. Jenn Joyce referred everyone to the service definitions. Providers can reference billing in the CMS regulations. Jenn Joyce noted that if documentation is consistent with definitions, and what is in the Manual, then that should provide some comfort. Mercadien has visited some providers to review their documentation. (NJACP will be inviting Mercadien to participate in the upcoming Medicaid Boot Camp to discuss documentation and what they are finding with IDD providers.)
-Support Coordination and Employment Goals
Concern regarding Support Coordination was raised, specifically, many providers are receiving only one goal and it is employment related—no other goals. DDD will be talking to Support Coordinators to ensure they understand that there needs to be more goals, not just those related to employment. If it is determined by the agency that an employment goal is not feasible and other goals must be created, then a discussion should take place with the specific Support Coordinator. If problems continue, DDD should be notified.
-NJ CAT Reassessments
Liz Shea noted she heard rumors that DDD will not approve requests for reassessments. She indicated this is not true and that the process for such a request is still in place. When a request is made, there are a series of questions that are asked to determine if a reassessment will be conducted. On the CCW side, DDD will not consider a reassessment until the individual is ready to flip into fee-for-service (FFS). Valerie Sellers asked if data were available reflecting the number of reassessments that have been requested and the number that have been approved. Carol Jones of DDD indicated she will gather that information.
Providers of day programs should work with parents/guardians for reassessments, but not submit a request absent the involvement of the parents/guardians. Darlene Yannetta shared that 200 NJCATs have yet to be completed. Providers that have not yet received tiering information for those being served should reach out to the family or residential service provider.
One provider indicated that she is telling parents/guardians that they must submit the NJCAT by the end of July or they will be terminated from a program as of September 1. If the parents/guardians have submitted the assessment via email and it is pending, DDD will not take action. It was noted that there is a backlog of requests for the NJCAT to be transcribed into Spanish.
Liz Shea noted that the NJCAT will be reviewed as she knows that some changes need to occur. For example, it does not capture information regarding seizures nor does it capture mental health issues. It was suggested that additional follow up questions be added to the tool. Liz Shea and Jenn Joyce recognize parents are not always completing the tool correctly; however, there is a webinar that can be accessed that explains how the NJCAT should be completed.
Concerns regarding Logisticare were raised, specifically, they’re arriving late to pick up clients for appointments, they are leaving people behind and they are telling clients they cannot accommodate a wheelchair. Meghan Davey noted that the percentage of complaints is small but they should be raised. In addition, Medicaid will be strengthening the RFP to address some of these issues. It was raised that there are real problems with Logisticare. They are showing up late so people are missing doctor appts., leaving people behind, etc. Ms. Davey will bring Logisticare in to talk about these types of complaints and will have providers join in the discussion.
The issue of delays in approval of Medicaid applications was raised. Some delays are attributed to Molina while others are attributed to DDD. Anyone that is experiencing a problem with their application being processed/approved should contact Wendy Yesko or Rachel Jameson.
Laura Williams from the ARC of Ocean County said that if a provider is adding a service, all of the secondary location pages do not have to be added; only what you are changing is what should be added—do not complete the application again.
-Size of Day Programs
Liz Shea noted there is no rule regarding the size a day program can be; however, there is great concern with programs that appear to be extremely large. Recently it came to Ms. Shea’s attention that some programs are huge, resulting in problems. It may be okay if people are coming and going (in and out of the building) so it’s not consistently at an enormous number. If the day program facility is not a large building, and the program has a great number of people remaining there all day, a problem could exist. Ms. Shea will be making unannounced visits to some of the larger programs, and if it appears that the size is compromising how the program is being run, then a discussion will take place as to possible remedies, i.e., reducing the size of the program, opening a second program, increasing staff. If Ms. Shea believes consumers are at risk, the program will be shut down. There are currently nine programs that she will be examining.
HMFA-Supportive Housing Connection
A presentation was given regarding the Supportive Housing Connection and the role it will play in securing or assisting with housing. It was noted that policy regarding housing takes place on the DDD side, while the actual process takes place on the Supportive Housing Connection side. See attached presentation. Some additional notes:
- Two portals have been created; one is for landlords and one is for providers. The portal will allow providers to see information; for example, the status of documents being processed. Another example is that a provider will receive notice that a document has been received. The document can be uploaded to SHC. Verification that it was received by SHC can be checked via the portal. Payment information can also be accessed. An inspection piece is being developed, and by November 1, subsidies will be reflected in the portal.
- DHS licensed setting, there is an inspection by DHS Office of Licensing.
- Housing inspections are based on HUD quality standards. SHC will pick up inspections for unlicensed housing.
- Gilson Software Solutions has been contracted to provide inspection scheduling services for unlicensed facilities.
- As of the end of June 2017, there were about 3600 registered through SHC.
More information can be found via the attached presentation as well as through a Webinar on SHC’s website re: the www.njshc.gov under the heading of training. To get SHC emails: http://bit.ly/njhmfaemail