Seniors and People with Disabilities
Action Request
Transmittal
Cathy Cooper Number: SPD-AR-08-026
Authorized Signature Issue Date: 4/14/2008
Topic: Long Term Care Due Date:
Subject:
SPD Contract RN Program Provider Rate Increase Effective July 1,2008 that Impacts the Total Dollar Amounts for Services that are Prior Authorized for RN Providers
Applies to (check all that apply):
All DHS employees County Mental Health Directors Area Agencies on Aging Health Services
Children, Adults and Families Seniors and People with Disabilities County DD Program Managers Other (please specify):
Action Required: Beginning immediately, the local offices must increase the total
dollar amount on all prior authorization (PA) requests for Contract RN (CRN) services by 3.5%. For existing PAs the local offices do not need to adjust the total dollar amount unless contacted by the CRN.
Reason for Action: Seniors and People with Disabilities Contract RNs will receive a
3.5% rate increase effective July 1, 2008. This increase reflects a 1.4% medical inflation rate and a 2.1% cost of living adjustment.
To minimize the number of PAs requiring adjustments the total dollars on any new PAs issued for CRN services must be increased by 3.5%. The local offices do not need to determine how many units may be provided on or after July 1, 2008 just calculate the total by the 3.5%. Additionally, there is no need for the local offices to determine what existing PAs need adjustments. The CRNs will receive a letter instructing them to review their existing PAs that have an end date after July 1, 2008 to determine if they need to contact the local office requesting an adjustment to the remaining dollars on the PA.
Attached is a SPD Contract RN Program New Unit Rate Table for local office use only that demonstrates the July 1, 2008 unit rates for each procedure code and how to factor the adjustments. The CRNs will receive a new table reflecting the new July 1, 2008 rates.
Field/Stakeholder review: Yes No
If yes, reviewed by:
If you have any questions about this action request, contact:
Contact(s): Gretchen Koch Thompson
Phone: 503-945-6484 Fax: 503-378-8966
E-mail: [email protected]
FOR LOCAL OFFICE USE ONLY
Seniors and People with Disabilities Contract RN Program Rates Table Effective July 1, 2008 SPD Contract RN Program Procedure Codes July 1, 2008 Unit Rate
Units per Date of Service
T2024
Initial Assessment & Client Health Support Plan
$141.55 Unit = per diem
1 Unit 96151 Reassessment $8.85 Unit = 15 minutes 1 to 12 Units 99347 Monitoring Visit $8.85 Unit = 15 minutes 1 to 12 Units S5115 Delegation/Teaching Non-Family $8.85 Unit = 15 minutes 1 to 12 Units S5110 Teaching Family $8.85 Unit = 15 minutes 1 to 12 Units S9123 RN Services Direct Care $35.40 Unit = 1 hour 1 Unit
EXAMPLE: The following table illustrates an adjustment being made to a
Contract RN PA request with a service end date on or after July 1, 2008.
Procedure Code Total Units $ Amount
S5115 Delegation/Teaching Non-Family 20 171.00
S5110 Teaching Family 20 171.00
99347 Monitoring Visit 24 205.20
TOTALS 64 $ 547.2
$547.20 (requested total at old unit rate) X .035 (% rate increase) = $19.52 (to be added to requested PA total)
$547.20 + $19.52 = $566.72 is the adjusted total dollar amount.
Oregon
Department of Human Services Theodore R. Kulongoski, Governor Seniors and People with Disabilities500 Summer Street NE, E13
Salem, OR 97301-1074 (503) 945-5832 1-800-232-3020
Fax (503) 378-8966 Date: April 11, 2008
To: All Contract RNs
From: Gretchen Thompson
CRN Program Coordinator Subject: Rate Increase Effective July 1, 2008
The Seniors and People with Disabilities Contract RN (CRN) Program will receive a 3.5% rate increase effective July 1, 2008. This increase reflects a 1.4% medical inflation rate and a 2.1% cost of living adjustment.
Local Offices will adjust all new requests for prior authorization (PA) by
3.5%.
The local office will adjust existing PAs with an end date after July 1, 2008 upon notification from the CRN that a PA(s) requires a dollar adjustment.
The CRN is responsible for determining if it is necessary to adjust the
dollar amount on existing PAs. Only PAs with a service end date after July 1, 2008 need to be adjusted.
Once the CRN has determined that there is a need to adjust an existing PA the CRN needs to provide the local office with a copy of the original request that includes the PA number and date range. The CRN must indicate at the top of the page that an adjustment for the dollar amount is needed. This must be turned into the local office no later then June 6, 2008. The local office needs time to make any necessary adjustments.
Assisting People to Become Independent, Healthy and Safe
An Equal Opportunity Employer SPD 1350 (02/03)
Failure to provide the local office with the necessary PA information by June 6, 2008 could result in your claims being processed with an incorrect payment(s) for services provided on or after July 1, 2008.
Billing for services provided on or after July 1, 2008 the CRN must list the
new rate when submitting a CMS 1500 for service(s) provided on or after July 1, 2008.
If a CMS 1500 is submitted for service(s) provided on or after July 1, 2008 with the old rate the payment will be at the old rate. It this occurs the CRN must submit an adjustment for the balance.
The new rates can only be billed for services provided on or after July 1, 2008
If you have any questions please contact me through the CRN e-mail address at [email protected]. Responses to questions that may assist others will be sent to all CRNs.
Attached is an updated SPD Contract RN Program Rate Table that reflects
Seniors and People with Disabilities Contract RN Program New Unit Rate Table
Effective July 1, 2008
SPD Contract RN Program Procedure Codes
July 1, 2008 Unit Rate
Units per Date of Service
T2024
Initial Assessment & Client Health Support Plan
$141.55 Unit = per diem
1 Unit 96151 Reassessment $8.85 Unit = 15 minutes 1 to 12 Units 99347 Monitoring Visit $8.85 Unit = 15 minutes 1 to 12 Units S5115 Delegation/Teaching Non-Family $8.85 Unit = 15 minutes 1 to 12 Units S5110 Teaching Family $8.85 Unit = 15 minutes 1 to 12 Units S9123 RN Services Direct Care $35.40 Unit = 1 hour 1 Unit
The above rates will be effective for services provided on or after July 1, 2008.
