January 2014 Medicaid Update

07 Feb 2014

The New York State Department of Health Office of Health Insurance Programs has released their January 2014 Medicaid Update which has valuable information for all healthcare providers. Some highlights from the newsletter:

Medicaid Evidence-Based Dossier Review Process Underway

The New York State Department of Health has established a new process regarding decisions for Medicaid benefits. Part of this process is the “Medicaid Evidence-Based Review Process” for which the department of health began accepting dossiers on December 1st, 2013. The package is available on the NYS website. Services that have uncertain value, such as high cost with a lower cost alternative, high risk, etc will be subject to the Dossier process.

Transition of Nursing Home Benefit and Population into Managed Care

Starting March 1st, all recipients in the NY Metropolitan area in need of a long term placement in a qualified nursing facility will be required to join either a Medicaid managed plan or a Managed Long Term Care Plan. The rest of NY will be transitioning in September 2014 – December 2014. After the transition period is over, the nursing homes and managed care organizations will negotiate reimbursement rates.

Request for Medicaid Provider Documentation

For the first time since 2011, New York will participate in a federal program designed to measure improper payments in Medicaid programs. The requests will begin in March 2014.

IRS Form 1099s

CSC, a contractor for the NYSDOH, will be issuing 1099s for payments by January 31, 2014. The 1099s are based on the date of the check, not when they are released to providers. Due to the two week lag between check date and when they are given to providers, the 1099 will not match the sum of all the payments received in 2013.

Primary Care Rate Increase Attestation Deadline

The deadline in order to attest for the need for a retroactive payment of PCRI from January 1, 2013 forward was originally August 1, 2013. Providers needed to provide the documents prior to this date in order to receive a retroactive payment. After consulting with CMS, NYS has decided to allow physicians to re-attest and change their qualifying effective date.

Medicaid Requires ALL Billing providers to register for EFT and electronic remittance advice

Any provider who has not registered for EFT and electronic remittance will not be able to re-certify their ETIN, which when it expires the providers claims will be rejected and not paid.

The full bulletin can be found here:

We at Cerini and Associates are committed to being a trusted business partner and advisor to your healthcare practice. If you have any questions on how the information above will affect your practice, please do not hesitate to contact us.