DMAS Announces Delay in Patient Pay Claiming Changes

In the February 25th CareConnection, we alerted you to a change in the way the Department of Medical Assistance Services (DMAS) would process patient pay adjustments under Medicaid for long term care recipients.  Subsequent to that article, we were told by each of the three Medicare/Medicaid Plans (MMPs) operating under the Commonwealth Coordinated Care (CCC) program that they intended to follow the new patient pay methodology that was outlined by DMAS for the fee-for-service program.

This week, we were alerted by DMAS that the implementation of the patient pay changes for the fee-for-service program has been delayed due to “multiple provider coordination concerns for HCBS providers, especially for ID/DD/DS members.” DMAS further stated:  “The Department is delaying changes to patient pay processing for claims submitted by long term care providers described in the memo published February 24, 2015.  Providers should continue to submit patient pay on claims.  The Department intends to implement the changes outlined in the February 24 memo, possibly with modifications, as soon as practicable and will publish a new memo at that time (emphasis added).”

Regarding CCC, it appears at least two of the three MMPs (Humana and Anthem) are already utilizing a report from DMAS for the actual patient pay applied on any given claim, as opposed to the amount entered by the facility.  It is not entirely clear when Virginia Premier will begin doing so.  However, all three MMPs report that regardless of the procedural change, the inclusion of a patient pay amount on the claim from the provider will not trigger any edit in processing (it will simply be ignored).  As such, we are suggesting you continue to submit the patient pay on all Medicaid claims per normal practice, at least until the changes from DMAS, and any MMP changes, settle out.