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

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