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From the Commissioner--April 2013 Medicaid Report



Nancy V. Atkins, R.N., M.S.N., N.P.-B.C.


The Bureau for Medical Services (BMS)has several new initiatives underway all of which are designed to provide our fellow West Virginians with the best services possible. 

Health Home for Individuals with Chronic Conditions
Over the past year, BMS staff and a group of stakeholders have been designing a Health Home Program for people with bipolar disorder and who have or at risk of having hepatitis B or C. During the pilot phase, we are focusing on a six county area that includes: Cabell, Wayne, Putnam, Kanawha, Raleigh and Mercer. We anticipate submitting a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS) within the next few months. More information on the Health Home initiative can be found on this website. 

Money Follows the Person and Rebalancing Demonstration Grant
Take Me Home, West Virginia is a five year demonstration grant from CMS which assists Medicaid members who are in long-term care facilities return to their communities. By participating in this project West Virginia is taking another step in meeting the mandate of the U.S. Supreme Court Olmstead Decision which says states must “administer services in the most integrated setting appropriate to meet the needs of individuals with disabilities.”

The Take Me Home Program began accepting referrals at the end of February 2013. To date, there have been more than 55 people determined eligible for Take Me Home services. The first two Take Me Home participant’s transitioned from a nursing facility to the community on April 5.

Medicaid members, their family, advocates or long-term care facility staff may make a referral to the Take Me Home Program by calling (866) 987-2372. 

Enhanced Primary Care Payments
The Affordable Care Act (ACA) requires that Medicaid reimburse eligible primary care providers at parity with Medicare rates in 2013 and 2014 for certain evaluation and management (E&M) and vaccination codes beginning with January 1, 2013 dates of service (42 CFR 447.400(a)).

Prior to receiving the enhanced rate, eligible physicians and advanced practice registered nurses (APRNs) must self-attest. Physician assistants (PAs) are not required to complete a self-attestation form, but instead should be listed in the appropriate section of their supervising physician’s self-attestation form. Eligible services provided by all advanced practice clinicians providing services within their state scope of practice under the supervision of an eligible physician will be eligible for higher payment. 

Physicians must first attest to a specialty designation of family medicine, general internal medicine, pediatric medicine, or subspecialties as defined by the following recognized boards: 

  • The American Board of Physician Specialties (ABPS),
  • The American Osteopathic Association (AOA),
  • The American Board of Medical Specialties (ABMS).     

APRNs must attest that they are under the supervision of, or have a collaborative relationship with, a qualifying physician.  

BMS has submitted a State Plan Amendment to CMS and once it is approved more information will be available on this website.

Provider Re-Enrollment/Revalidation
All WV Medicaid providers must be re-enrolled by the end of 2015. We plan to start the re-enrollment process this summer. Re-enrollment will be phased in by provider type/risk level. The first phase will be physicians. The Phase schedule will be placed on the Molina web portal and banner pages. Providers will have 60 days from the state date to re-enroll.

ICD-10
Providers and Payers must be compliant with the new ICD-10 requirements by October 2014. CMS recently released guides for providers and payers. These guides can be found at: http://www.cms.gov/Medicare/Coding/ICD10

Please check the BMS website for additional updates as they become available.