Long Term Service and Support Providers (LTSS) Rate Enhancement Methodology

Posted 17 Febrero 2012 by admin & filed under newsroom, Provider News.

Effective 3/1/2012, Superior will begin to reimburse Providers the Attendant Care Rate Enhanced payment at the same participation level as they are assigned by DADs (Levels 1 – 23).  Superior will include the appropriate amount within the fee schedules for the codes included in the enhancement program (PAS & DAHS) to reflect the Providers participation level and will continued to be paid at the time of claim payment.  Providers who are enrolled and subsequently do not continue participation in DADs, the level will remain the same throughout the duration of their participation in the Superior program.  All Providers who participate in and receive enhanced payments, performance measures will be reviewed annually to determine continued participation. Those who request enrollment including all current Participating Providers will receive notice of approval/denial of participation by Superior and level of participation.  All Providers will be required to demonstrate enrollment and in good standing with the DADs program, if applicable.

Assisted Living Facilities who currently participate and receive Attendant Care rate enhanced payments, there will be no changes in the current reimbursement levels or methodology.

For initial enrollment into the STAR+PLUS Attendant Care Enhanced Payments program, Superior will only allow those providers that are currently participating in the DADs Attendant Compensation Rate Enhancements to participate.  This will extend only through the initial year of the program for the new STAR+PLUS Service Areas in Hidalgo & Lubbock.  Annually, Superior will send notice to Provider’s allowing to request enrollment & all current participating providers will receive an affidavit to complete and return to Superior indicating the Provider applied the enhancement funds to the compensation for direct care staff.  Each Provider’s compliance with the attendant compensation spending requirement for the reporting period will be monitored on an annual basis via the submission of the affidavit.  Compensation may include increased hourly rates, bonuses, paid holidays or additional benefits such as employer paid insurance.  In addition, providers may be audited on an as-needed basis to ensure financial records support the pass through of the enhanced funds.  Enhanced payments could potentially be recouped for those Providers who fail to pass the funds to their direct care staff.

Please ensure any claims billed with DOS 3/1/2012 forward include the amounts tied to their appropriate rate enhancement level.  As a reminder, any claims billed the lesser amount of the contracted amount, the claim will pay up to the billed charges.

I am currently reimbursed at level 20 under Superior, but DADs I am reimbursed at level 23. Which level will Superior pay after 3/1?

If I currently participate with Superior and receive rate enhancement, do I need to notify Superior the level I have with DADs?

Do I need to bill a separate line on my claim for rate enhancement?

Are there any reports we need to send to Superior for rate enhancement?

What is the process to appeal if Attendant Rate Enhancement payments were not paid or were paid at the incorrect rate?