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MSM Chapter 200, Hospital Services Public Workshop The purpose of this workshop is to seek public comment on and discuss Chapter 200: current proposed.

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Presentation on theme: "MSM Chapter 200, Hospital Services Public Workshop The purpose of this workshop is to seek public comment on and discuss Chapter 200: current proposed."— Presentation transcript:

1 MSM Chapter 200, Hospital Services Public Workshop The purpose of this workshop is to seek public comment on and discuss Chapter 200: current proposed revisions plans to restructure sections of the Chapter 200 where revision, modification, or clarification of information is suggested.

2 Current MSM Chapter 200 Revisions  Removal of billing and QIO-like vendor PA process language from Chapter 200. Information already specified in Billing Guides or the Billing Manual  Removal of language already in other MSM Chapters  Removal of Specific NRS Citation Reference None of these revisions constitute a chang e in policy.

3 Removal of Specific Citation Number From NRS 449 Reference Specific Citation Number Removed Nevada Revised Statutes (NRS) (Classification of Hospitals in Nevada) Page 1 of section 201 Current Reference Nevada Revised Statutes (NRS) 449 (Classification of Hospitals) Page 1 of section 201

4 Removal of Billing Language from MSM Chapter 200 Language Removed  Entry of a prior authorization (PA) number on a claim Page 1, Section  RTC covered services - recipients under 21 years old Page 5, Section A 2 f 10 Language in PT 11 or PT 12 Billing Guide Page 4, PT 11 Billing Guide Page 49, Chapter 400, 403.8

5 Removal of QIO- like Vendor Process Language Language Removed from MSM Chapter 200 PA timeframes for newborns without a Medicaid number until after the date of birth Page 6, Section A 2 g 2 Language in the Billing Manual or a Billing Guide Page 4, PT 11 Billing Guide & Page24, Billing Manual

6 Sentences Relocation Without Modification Language moved from: QIO-like vendor LOC and Length of Stay Determinations Page 8, A 2 h 3 a Language moved to: Page 7, Section 203.1A 2 h

7 Removal of Process Language from MSM Chapter 200  Retrospective Review – Submission of additional documentation Page 8, Section A 2 h 2  Notification of Admission Authorization request timelines for retroeligible recipients Page 8, Section A 2 h 2 a 1-2 Language in the Billing Manual or a Billing Guide Page 2, PT 11 Billing Guide Page 2, PT 11 Billing Guide, Page 24 & 25, Billing Manual & Page 2, MSM Chapter 100, Section a Language Removed

8 Removal of Process Language from MSM Chapter 200 Language Removed  Timelines for submission of additional clinical information & provider determination notification Page 9, Section 203.1A 2 h 3 b-d Language in the Billing Manual or a Billing Guide Page 2, PT 11 Billing Guide & Page 25, Billing Manual

9 Removal of Language Already in Other MSM Chapters Language Removed :  Prior Resources heading and language Page 13, 203.1A 4  Patient Liability Page 14, 203.1B 1 b 6 Language Already Stated at: MSM Chapter100, Sections 104 and (pages 1, 3 & 4 of section 104) Page 68, MSM Chapter 400, Section B 11

10 Removal of Billing Language from MSM Chapter 200 Language Removed Billing of non-emergent use of the ER Page 28, Section 203.4B 2 Language in PT 11 or PT 12 Billing Guide Page 3, PT 12 Billing Guide

11 Chapter 200 Revision Any questions or comments?

12 Plans to Restructure Chapter 200 Questions: What is the purpose? How will this be accomplished? Answers: Facilitate easier access to specific policies & policy development Chapter 200 will have an over- arching policy regarding inpatient & outpatient hospital and free standing facility Coverage and Limitation, Authorization Requirements and Provider Responsibilities.

13 Attachments Policy language regarding the following topics will be removed from within Chapter 200 & will be added as Attachments: Inpatient: Sterilization Administrative Days Medical Rehabilitation Specialty Hospital Long Term Acute Care Specialty Hospital Swing beds Outpatient: Ambulatory Surgical Centers End Stage Renal Dialysis Observation Emergency room Free Standing Facilities: Birth Centers

14 Attachments Questions What is the Attachment format? Answers Policy # Title Effective date Description Policy Authorization or Prior Authorization Coverage and Limitations Covered Services Noncovered Services Provider Responsibilities (specific to that service)

15 Attachments Questions Will policy intent be changed as information is moved to Attachments? Answers Many Attachments will not have changes in policy intent. Examples include: Language modification for clarity (e.g. Administrative Days, LTAC, Swing beds) Incorrect information will be corrected (e.g. reference to > in the ASC policy will be deleted.) Addition of language to better define service parameters, such as when a service is or is not covered (e.g. Observation and ER services)

16 Attachments Questions Will policy intent be changed in these attachments? Answers Some Attachments will contain changes in policy intent. Examples include: New policy related to Birth Centers – expanding Medicaid ‘s covered services. Medical Rehabilitation- change the three hours of therapy a day requirement to three hours of therapy a day at least five days a week or at least 15 hours within a seven day period. (This change will benefit both recipients and providers.)

17 Chapter 200 Revisions/Restructuring Question: How will this process be Implemented ? Answer  Every 1 to 3 months, a Public Workshop notice will be posted announcing the topics to be discussed.  In the workshop, proposed language regarding the revision, will be discussed. Suggestions, comments and/or concerns will be discussed as part of a collaborate process.

18 Chapter 200 Revisions Question What policies are currently being proposed for discussion in the next Public Workshop? Answer Sterilization & Administrative Days

19 Chapter 200- Future Revisions Are there specific policy sections that you want to see revised first? Sterilization Administrative Days Ambulatory Surgical Centers End Stage Renal Dialysis Medical Rehabilitation Specialty Hospital Long Term Acute Care Specialty Hospital Swing beds Observation Emergency Overarching policy: Coverage and Limitations, Authorizations, Provider Responsibilities

20 Chapter 200- Future Revisions 1.Questions/ concerns 2. Suggestions/ recommendations

21 Chapter 200 Revisions Contact Information: Carol Tilstra, Inpatient/ Outpatient Hospital Supervisor Phone number: address: Renee Necas, Inpatient Hospital Specialist Phone number: address:

22 Important Websites  https://dhcfp.nv.gov https://dhcfp.nv.gov In the DHCFP Index box Choose Medicaid Manuals NV Medicaid Service Manuals …. Choose HPES DHCFP and Policy Provider Portal Providers Billing Information tab Prior Authorization tab ….  DHCFP and Policy Provider Portal

23 Important Websites To find Public Hearings/ Public Workshops information go to https://dhcfp.nv.gov In the DHCFP Index box Choose Public Notices Scroll down under Public Notices to find the Public Hearing & Public Workshop notification The date, time, and location of the meeting is specified. There is also an agenda and attachment link. An agenda gives a brief general description of a proposed revisions or topic being discussed. An attachment provides proposed language.


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