AL Provider Webinar
NJ DoAS Presentation
July 10, 2014
MLTSS OCCO AL Questions
• Do we continue to follow the same procedures to
notify OCCO when a resident is in spend down?
• What happens to the tracking form for
transfers/discharges etc? Does it have to be
done? If so, in what format and sent to whom?
• Explain how the cost share process will work and
who is responsible for telling the provider and
when. Then, how will the mco adjust the
payment?
Claim Questions
• What place of service and HCPCS codes are
used?
• Are ID qualifiers used and if so, which ones?
• Do we put the amount of the cost share on
the 1500 ?
• Do we use the Medicaid # or the MCO
insurance ID # on the 1500?
• Will the MCO’s have a sample claim form filled
in on their websites?
Where to find answers
• At the DHS website there is a link to Managed
Long Term Services and Supports(MLTSS)
• URL for MLTSS Information;
– http://www.state.nj.us/humanservices/dmahs/ho
me/mltss.html
• URL for MLTSS Information for Providers and
Consumers
– http://www.state.nj.us/humanservices/dmahs/ho
me/mltss_resources.html
Examples of Provider Information
• On the provider site you will find useful
information. Such as;
– Provider Education Sessions
– Frequently Asked Questions (FAQS) for Providers
– The “crosswalk” for billing codes from previous
waivers to MLTSS services
– Copy of the CMS 1500 form used for billing MLTSS
services
Resources for Providers is found about half way down
the page:
Changes for Cost Share
• County Welfare Agencies (CWA) or Board of Social Services
(BSS) will be responsible for completing, reviewing and
updating Patient Pay Liability Worksheet (PR-2) (formerly
Cost Share).
• Patient Pay Liability (PPL) Worksheets (PR-2) are updated
annually and reviewed/revised as necessary, but at least
every twelve months.
• Assisted Living and Adult Family Care service providers will
receive a reduced payment from the participant’s Managed
Care Organization (MCO) equal to the amount of the
individual’s Patient Pay Liability. MLTSS participants are
responsible to pay the provider the Patient Pay Liability
calculated by the County Welfare Agency (CWA) or Board of
Social Services (BSS), in addition to any Room and Board
charge.
• CWA/BSS workers are to inform the participant of the
amount the participant is responsible for paying (Room &
Board and Cost Share) to the Assisted Living Facility (ALR
and CPCH)/Adult Family Care Sponsor Agency.
• CWA/BSSs are to give the original Patient Pay Liability (PR2) to the Facility/Agency as advisement of the amount that
is owed to the provider directly from the participant and
copies to the participant and, if requested, the authorized
representative/guardian. A new PR-2 is given to each party
every time it is reviewed/revised or at the time of financial
redetermination.
SSI and Patient Pay
• SSI residents will not be seen by the CWA/BSS
• The facility will need to send a client tracking
form to the DoAS for us to complete the PR-2
form and document if a Patient Pay Liability is
appropriate.
• Facilities can fax the client tracking form to
609-631-4678, Attention: Mary Rose
SSI and State Supplement
• SSI beneficiaries sometimes do not have
enough income to pay the room and board
rate and have a PNA.
• The state has an agreement with the Social
Security Administration that the person can
request a state supplement to provide the
minimum income for living in an AL facility.
• The facility should assist the participant to call
the local SSA office as soon as possible to
“lock-in” their start date for the supplement.
• The resident needs to be present when SSA is
called or SSA will not accept the request
without verbal approval from the resident.
• It takes about three (3) months for the
resident to see the increase in their SS check.
• This is the same process that was used under
GO.
Numbers for MLTSS
MLTSS @ MCOs
Amerigroup - Janet Sweeney - 732-623-5819.
Horizon - MLTSS Member Service Reps - 1-844-444-4410
United Health Care - Renee Reed - 1-848-200-3570
WellCare - Susan Ruddiman - 973-274-2178
To Change your NJ FamilyCare MCO - 1-866-472-5338
To enroll in PACE - 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048)
or
NJ State Health Insurance Assistance Program - 1-800-792-8820
General Questions
NJ FamilyCare Helpline – 1-800-356-1561
Questions about MLTSS for consumers
1-866-854-1596
DoAS Managed Long Term
Services and Supports
ATLANTIC, BURLINGTON, CAPE MAY, GLOUCESTER, SALEM
Silvia Laboy-Villa 609-588-3406
BERGEN, CAMDEN, OCEAN
Kevin Murphy
609-588-7220
ESSEX, MORRIS, SOMERSET, SUSSEX, WARREN
Jean Cochrane 609-588-7258
HUNTERDON, MERCER, MIDDLESEX, MONMOUTH, PASSAIC, UNION
Leslie Alvarez
609-588-7685
Jean King, Technical Assistant (609) 588-6566
Fax Number (609) 588-7683