Summary of Policy Changes Since the June 10, 2013 Webinar

  • Summary is also available in Portable Document Format (PDF, 9KB)

Please note, the following policy changes have been made since the webinar was held on the new benefits transitioning into managed care.

  1. It was decided to require the Medicaid FFS rate for all members (new and old) receiving services at AADHCs and ADHCs during the transition year. This means if plans have contracts with different rates, they will still be required to pay the Medicaid FFS during the transition year.

  2. For new cases, it has been decided to allow the contracted ADHCs and AADHCs to conduct the assessment (RAI) during the transition period. Since it is a per diem, the providers will be given up to 2 visits to complete the RAI. Plans must cover the 2 visits even if they do not authorize for placement.

  3. For cases in care, plans will be required to use the most recent assessment completed, unless there are changes to the person's condition, to determine treatment plan after the 90 day period. This information must be shared with the plan to develop or approve the treatment plan.

  4. The FFS rates for AADHC does include transportation. Plans will be required to pay the rate inclusive of transportation for the transition year. After the transition year, plans will negotiate rates exclusive of transportation and transportation will be covered FFS.

  5. Lastly, the date for the implementation of the new benefits (TB, ADHC and AADHC) has been extended to August 1, 2013.