New Jersey Takes Action to Modify Medicaid Program for COVID-19

 

New Jersey’s Medicaid program normally has a lot of rules and red tape.  Some of the rules relate to who meets the level of care for Long Term Services and Supports (LTSS) and some relate to financial eligibility.  All of these rules require travel and manpower to implement that may not be available during this pandemic emergency.
Federal Medicaid law has a type of waiver of Medicaid rules for emergencies, like COVID-19, or before that, Superstorm Sandy.  These are called 1135 waivers, and they can be obtained much more quickly than other types of Medicaid waivers.Waivers were just granted making it easier for certain individuals to get the care they need through the Medicaid program. Two provisions particularly stand out.  First, if a person is approved for the MLTSS Home and Community-Based Services Program (formerly known as Global Options) and wants to hire her own privately-selected employee as her “Care Provider,” “Provisional provider enrollment” can be granted  if certain information for the employee is given, assuming there will be regular enrollment after the emergency is over.  This may be useful for family member providers or volunteers helping families ride out quarantine.

Second, the necessity to have a PAS completed before a Medicaid-eligible person is admitted to a nursing home. Pre-Admission Screenings are now waived for 30 days for new admits, and are not required for facility to facility transfers.

Our state Medicaid director, in a letter dated March 19th, asked for such waiver authority to modify or suspend certain normal Medicaid rules retroactive to March 1st, such as:

  • Suspending Prior Authorization requirements
  • Waiving Pre-Admission Screenings as a requirement for nursing home placement (these are done by state nurses physically visiting applicants at their facilities)
  • Letting a nursing home get Medicaid payment even if they are providing services in an alternate facility due to an evacuation.
  • Making it easier for family members to serve as Medicaid-paid personal care assistants
  • Relaxing rules for filing deadlines for fair hearings
  • Allowing more Telehealth and telephonic reimbursement by Medicaid

Monday, CMS replied to Director Jacobs, clarifying that the nationwide 1135 will allow for most of these requests but that some require state plan amendments:

  • Prior authorization is a function of the state plan and will require an amendment but previous prior authorizations can be extended due to the emergency
  • Pre-Admission Screenings are waived for 30 days for new admits, and are not required for facility to facility transfers
  • MCO decision fair hearing appeals will get 120 days to be filed if it happens within the emergency period
  • Expanding eligible providers to include Medicare providers who may not have been Medicaid enrolled for the duration of the emergency
  • Provisional provider enrollment if certain information for an employee (like a family member) is given, assuming there will be regular enrollment after the emergency is over
  • Medicaid will be able to pay facilities even if they have to move residents to alternative settings during the emergency.

We strive to stay as informed as possible on Medicaid Eligibility and Medicaid benefits so that we can best guide our clients who need senior care urgently.  We will continue to ask questions and monitor the day-by-day and hour-by-hour developments during this health care crisis.

Call us for advice about Medicaid eligibility, spend-down plans, applications and appeals ……………………732-382-6070

3-night stay requirement waived for Medicare Part A subacute benefits

Medicare Part A covers post-hospitalization, subacute skilled care and rehabilitation benefits for individuals who were admitted to the hospital and remained as inpatients for at least three overnights. Upon discharge to a subacute facility with a need for ongoing skilled nursing or rehabilitative services, Medicare would cover up to 100 days of treatment including the room & board costs, subject to co-payments and deductibles. In other posts, we have written about some of the issues that would come up for patients receiving such benefits.

In light of the exigencies caused by COVID-19 and the urgent need to transfer patients from hospitals to subacute rehabilitation facilities, Medicare has waived the three-overnight requirement for people in the hospital to get to subacute rehab. There have been demonstration projects around the country for several years involving waivers of the 3-day stay requirement. Medicare 3 day waiver. The March 13th announcement by the CMS Administrator specifies that ” Therefore, SNF care without a 3-day inpatient hospital stay will be covered for beneficiaries who experience dislocations or are otherwise affected by the emergency, such as those who are (1) evacuated from a nursing home in the emergency area, (2) discharged from a hospital (in the emergency or receiving locations) in order to provide care to more seriously ill patients, or (3) need SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the emergency. In addition, we will recognize special circumstances for certain beneficiaries who, prior to the current emergency, had either begun or were ready to begin the process of ending their spell of illness after utilizing all of their available SNF benefit days.” CMS’ 2020 SNF secn 1812f waiver

The patient and their advocate will need to be proactive as always in working with the physician and the SNF assessing staff to develop a treatment plan that provides the fullest possible range of services to meet the needs of the patients. Keep in mind that “failure to progress” is not the sole criteria for continued Medicare coverage for subacute care. However there is an increasing trend by Medicare insurance intermediaries to pressure the facilities to terminate coverage after just a few weeks. What do advocates need to do? Be vigilant, be vocal, be aware. Make sure that the patient you are assisting has signed HIPPA releases to enable you to access their protected health information and talk with the personnel on the team. Be vigilant, be vocal, be there.

NJ DMAHS announces initiatives to protect the most vulnerable

The State of New Jersey Department of Human Services has announced some initiatives designed to help assure continuity of care, access to medicine and nutrition assistance, for individuals who are dependent on programs such as SNAP, group homes, charity medical care, MLTSS home care and services in certain DDD-funded programs. As always, the real test will be in the details for how these initiatives will be administered, but many of the ideas sound great. Some of the efforts  that were announced through a press release on the 18th are these:

“Cash, Shelter and Food Assistance

  • Automatically extending for 60 days WorkFirst New Jersey cash assistance to individuals whose case is up for renewal in March or April;
  • Extending all Emergency Assistance cases through April 30;
  • Deeming the current state of emergency as a good cause exemption for the work requirements in WorkFirst New Jersey and SNAP and suspending all adverse actions for non-compliance;

“NJ FamilyCare/Medicaid

  • Covering COVID-19 testing, visits for testing, and testing-related services at no cost;
  • Waiving costs for COVID-19 testing, visits for testing, and testing-related services in the Children’s Health Insurance Program (CHIP);
  • Covering 90-day supplies of prescriptions for maintenance medications and early refills of prescriptions in Medicaid and CHIP; and
  • Directing hospitals to waive cost sharing for uninsured individuals who are eligible for charity care for medically necessary testing and testing-related services for the COVID-19 virus.

Supporting Older Residents

  • Mobilizing nurse care managers at Medicaid health plans to call high risk populations to identify and address their critical needs including supplies such as durable medical equipment and food;
  • Allowing older residents receiving prescription drugs through Medicaid or the state prescription drug assistance program (PAAD and Senior Gold) to refill their prescriptions early and receive 90-day supplies of   maintenance medications;
  • Working with our county partners to ensure that those receiving home-delivered meals continue to have access to food;

“For those receiving DDD services, 

  • Temporarily closing congregate day programs for individuals with intellectual and developmental disabilities and supporting this transition;
  • Providing flexibility to families to quickly hire workers and working closely with program providers and direct support professionals during the closure; ……. “

Tremendous partnership efforts will be needed across all sectors of government and society to take care of our most vulnerable citizens at this difficult time. Hopefully the DHS will focus on flexibility and practicality, minimize red tape and streamline the steps it takes to accomplish these laudable goals.

 

Call us for help with your urgent elder care problems ………… 732-382-6070

COVID-19 Testing available for Medicare beneficiaries

Medicare Part B generally covers medically necessary outpatient testing for beneficiaries. CMS has recently advised that if testing is ordered by the patient’s physician and the test is performed on or after February 4, 2020, it will be a covered service under Medicare Part B. Read more here.

The Centers for Medicare and Medicaid Services is issuing fact sheets and alerts that address corona virus-related concerns raised by Medicare beneficiaries as well as health care providers. Some of them are: guidance to home health care providers — anyone who hires a home care provider might want to study this and share it with their employee — expanded tele-health services to enable people to contact professionals for advice by phone; and specific guidance for specific health care settings such as nursing homes or dialysis centers. 

The Center for Medicare Advocacy (CMA) is an excellent source for updates about Medicare and for advocacy on legal problems with Medicare coverage that are encountered by enrollees. Another great source of help can be found at your local SHIP office — the State Health Insurance Assistance Program (SHIP).

Call us for help with your elder care law problems …… 732-382-6070

Restrictions related to Covid-19 particularly impact elders and people with disabilities

Everything is happening so fast it’s making our heads spin. The frail, dependent aged and disabled people in our communities are having a tough time of it. Starting today, Social Security Offices are only accepting telephone contacts and online contacts. COVID – 19 SSA press release     Health care providers are overwhelmed. County welfare offices are urging people to do their business on-line and avoid coming into the offices. Based on the CDC guidelines – click HERE — nursing facilities are barring the door except for end-of-life situations, and preventing concerned family members from entering the facility to oversee the care being provided. There are inadequate quantities of protective gear for the staff members who are caring for nursing home residents or patients who need home health care. Staffing levels are being affected. Under proposed regulations by the federal government, nursing homes will be able to cut their infectious disease staffs in  the interest of “less regulation.” What will this mean for the safety of the residents, in terms of infection control, potential bedsores, fall prevention and more?

Meanwhile, applications for crucial government benefits must be processed and new applications continue to flow in. County offices that are processing MLTSS/medicaid applications still expect people to produce missing documents in ten days under threat of a denial of eligibilityThe paperwork requirements for certain programs is staggering. The Centers for Medicare and Medicaid Services issued CMS FAQs that enable States to to address some current issues raised by this crisis. CMS covd-19-faqs-20200312 Clearly there’s a need for the Division of Medical Assistance and Health Services (DMAHS) to exercise its muscle and  ease certain requirements as an accommodation to the present emergency. I’m not talking about the core standards for eligibility, but rather, the reams of paper documentation that are required to prove eligibility for MLTSS/medicaid. The State could direct the counties to ease up on the short deadlines they give to the applicants to submit requested verifications. The State could direct the counties to accept reasonable explanations that show the impossibility of complying with a request. For example. if the applicant is mentally incapacitated and house-bound, and the Agent under Power of Attorney has contracted the corona virus or is quarantined, it may be utterly impossible to obtain some requested bank records or to produce proof about some transaction happened several years ago.

So many issues need to be urgently addressed so that people in need of benefits will not be denied due to inability to meet administrative requirements. And there needs to be a way to assure those who watch over their loved ones in nursing facilities to still be able to perform that crucial role.

We are here to help with your family’s elder law crises …… call for consultation 732-382-6070