STATE OF WASHINGTON



center31912900STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services Division18859501943100HCS MANAGEMENT BULLETIN00HCS MANAGEMENT BULLETINPO Box 45600, Olympia, WA 98504-5600H20-072– ProcedureAugust 17, 2020TO:Home and Community Services (HCS) Division Regional Administrators Area Agency on Aging (AAA) DirectorsDevelopmental Disabilities Administration (DDA) Regional Administrators FROM:Bea Rector, Director, Home and Community Services DivisionDebbie Roberts, Deputy Assistant Secretary, Developmental Disabilities Administration SUBJECT:Retainer Payments for specific Medicaid Service Providers-- Assisted Living Facilities (ALFs), Enhanced Services Facilities (ESFs), and Adult Family Homes (AFHs) during the COVID-19 public health emergencyPURPOSE:To notify the field about temporary changes to the retainer payments that may be paid during the COVID-19 pandemicBACKGROUND:On February 29, 2020, Governor Inslee declared a state of emergency in response to the COVID-19 outbreak, directing state agencies to use all resources necessary to prepare for and respond to the outbreak. The Department of Social and Health Services (DSHS) has received approval to pay retainer payments to specific Community First Choice (CFC) and 1915(c) waiver providers from the Centers for Medicare and Medicaid Services (CMS) under an 1115 demonstration waiver to address the COVID-19 public health emergency. WHAT’S NEW, CHANGED, OR CLARIFIED:In light of the unprecedented emergency circumstances associated with the COVID-19 pandemic, CMS has granted the ability to authorize up to three retainer payment episodes of thirty consecutive days when certain conditions are met. HCS and DDA will be allowing up to three episodes of temporary retainer payments (maximum of 30 consecutive days each) to ALFs (all contract types), ESFs, and AFHs (all contract types) due to specific COVID-19 related circumstances described in the Action section of this MB. Retainer payments are payments to providers made in lieu of normal payment for services when the provider is prevented from delivering services for one of the reasons detailed in the action section below. ACTION:By mid-August, changes will be made to Provider One to allow additional retainer payments to be authorized.From July 1, 2020 and until September 30, 2020, ALFs (all contract types), ESFs, and AFHs (all contract types), may be authorized a second or third pandemic-related retainer payment when:The ALF, ESF, or AFH was prevented from providing services to a Medicaid client due to the provider temporarily closing in response to local, state, federal, or medical requirements or orders; orThe ALF, ESF, or AFH was prevented from providing services to a Medicaid resident due to the client temporarily leaving the facility because of a positive or suspected COVID-19 diagnosis; ANDAdditionally, in order to receive a retainer payment the following requirements must also apply:The Medicaid resident is likely to return to the ALF, AFH, or ESF; andThe ALF, AFH, or ESF holds the Medicaid resident's bed or unit for the period the retainer payment is paid; andThe facility provided care to the resident at some point during the public health emergency and prior to needing the retainer payment. ANDThe ALF, ESF, or AFH provider signs, enters the date that the terms are true for them, and returns a Retainer Payment Attestation to the case manager agreeing to the CMS terms (attached).When one of the two scenarios listed in paragraph A applies; the provider agrees to the requirements included in paragraph B; and the provider enters the date the CMS terms are true for them, signs, and returns a Retainer Payment Attestation in paragraph C; use the pandemic-related retainer payment service code SA687,U1 to authorize up to three thirty day episodes of a retainer payments. Retainer payments are to be paid at 70% of the current daily rate. Send the attestation form to the appropriate staff in your office to download into ACD. For audit purposes, attestations must be downloaded into ACD on the Contract Detail page under the Document Mgmt tab. Only one attestation is needed per provider contract. If staff are able to verify in ACD that a signed attestation has been completed and the date, a second attestation does not need to be signed. With this new CMS approval, the 30 day authorization episodes can be successive and do not require care to be provided between them. They do, however, require the provider to agree to the CMS conditions listed in the Attestation form (attached). Please note: Additional retainer payments may go back to July 1, 2020 but must not be authorized before the date the provider enters on the attestation form. Do not authorize for another 30 day period until the signed Attestation is received from the provider showing the date and provider’s agreement to the terms.Three 30-day retainer payments is the maximum number of retainer payments a provider may receive from March 1, 2020 through September 30, 2020. A 30-day retainer payment does not have to be used all at once so a resident that is out for 15 days and returns has 15 days remaining on the 30-day retainer payment. In total, a retainer payment must not be paid for more than 90 days.When calculating 70% of the resident’s daily rate, do not include the new COVID-19 rate add-on for the resident’s care for each day the resident is absent from the facility. A spreadsheet to calculate 70% of the current daily rate is attached to this MB. Providers must not claim a retainer payment for any Medicaid resident on the same date for which a service is provided. Claiming a retainer payment while also claiming for the provision of care to a resident will result in an overpayment. Case Managers should not process an overpayment for retainer payments at this time. Further instruction on completing overpayments for pandemic-related retainer payments will be provided at a later date. For hospitalizations or short stays in skilled nursing facilities for reasons other than the two listed in this MB, use the existing bed hold policy and rates. The existing bed hold and social leave policy have not changed. RELATED REFERENCES:ATTACHMENT(S): \s \sCONTACT(S):Natalie Lehl, Residential Policy Program Manager(360) 725-2370natalie.lehl@dshs. Sandy Spiegelberg, Residential Support Waiver Program Manager(360) 725-2576sandra.speigelberg@dshs. Kelly Hampton, DDA State Plan Residential Unit Manager(360) 407-1514Kelly.hampton@dshs. ................
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