ADHC, AIDS ADHC, TBDOT Questions and Answers

Tuberculosis Directly Observed Therapy benefit transition to Medicaid Managed Care August 1, 2013

QUESTION RESPONSE
Q: Why do the DOT Revenue codes provided differ from the revenue codes provided in the MMCOR COS definitions? No TB revenue codes were provided. There may be confusion of revenue codes with Px codes or rate codes.
Q: What are some of the issues that plans should be aware of for the transition of the TB DOT benefit transition? what were the reasons for keeping this in FFS? Plans need to be aware that the service is provided under the authority of the local government and must be rembursed if provided by the LPHU or designated site (NYC). The Plan will pay the FFS rate if it does not have a contract with an appropriate provider. The rate does not include TB frugs, which are also the responsibility of the plan. Plans may amend contracts or enter into new contracts for these services.
Q: What were the reasons for keeping this in FFS? It was decided to require the Medicaid FFS rate for all members (new and old) receiving services at AID ADHC 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.
Q: Is the TB DOT rate for services provided in home, clinic, or in office setting? The rates are applicable regardless on the setting.
Q: Will the DOT providers bill just once a week even thought they're providing daily etc? Yes, the rate is a weekly rate regardless of the frequency of treatment (daily, twice a week, or three times a week).
Q: Are plans required to contract with each county or can we just pay FFS rates as non-par. The plans may amend existing contracts or enter into new contracts for TB DOT service providers.
Q: Are all members currently enrolled in FFS required to switch to a MCO and if so is there a deadline for them to switch? A FFS Medicaid consumer in receipt of TB DOT will continue to receive that service FFS and will not be required to enroll in a plan. The Mainstream managed care benefit package now includes the service for its enrollees. For MMC enrollees, the TB DOT services provider will be paid by the plan.
Q: With regard to reporting TB related carve in services on MMCOR and MEDS, the HCPCS code (HCPCS - H0033) provided in the previous carve in presentation are not exclusive to TB therapy. Will the reporting category of service guide be updated to include logic for TB therapy ? We suggested they use the U1 modifier with H0033 to indicate that the service is TB DOT.
Q: Can we still bill FFS if the TBDOT date of service is before August 1? Yes, the date of service will dictate if payment is FFS or if the plan is responsible.
Q: can we still bill FFS if the TBDOT date of service is before August 1? Yes, the service is not included in the benefit package until August 1.