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Medicaid Managed Care Concept Paper - Therapists Not Included

DHHS Medicaid issued a managed care concept paper,Prepaid Health Plan Network Adequacy and Accessibility Standardsrecently to consider standards for perspectives of beneficiaries, plans and providers on what each defines as an “adequate and accessible” network. The proposed network does not include physical therapists, occupational therapists, respiratory therapists or speech/language pathologists.


NCPTA will be advocating for the inclusion of therapists in theAppendix B: Providers Subject to Specialty Care Access Standards. We are encouraging members to also comment on these standards. Comments can be emailed to Medicaid, through March 29, 2018, attransformation@dhhs.nc.gov.

 
NCPTA Officials Attend Medicaid Opioid Stakeholders Meeting

The Medicaid Outpatient Specialized Therapies Stakeholder Committee held  a committee meeting on February 1 to discuss adult therapy services. Flo Moses, Director for Payor Relations and Liz Reeser, Payor Relations Committee member attended the meeting on behalf of  NCPTA .Medicaid’s Outpatient Specialized Therapies staff have been charged with developing policy recommendations to address the opioid crisis. Due to the complicated clinical coverage policy for therapy services for adults the group was asked to make new recommendations for therapy services for adults. 


The results of  a survey on services for adults was presented. Overwhelming the survey respondents felt that adults should be asked to be charged a co-pay for therapy and that 2 visits a month were optimum rather than 1 visit per month. The goals are to simplify the policy to make it easier for providers, reviewers, recipients and Division of Medical Assistance (DMA) staff and to support the mandates from the Department of Health and Human Services (DHHS). 

T
wo proposals were presented and agreed upon:

  1. Visits: 24 visits per year or 30 visits per year, as well as, 1 evaluation per year for PT, OT , ST. Both proposals will be sent to Fiscal Research for each proposals fiscal impact which could be $15 million or higher and require a legislative budget appropriation.

  2. Co-pays: $3 as suggested by the stakeholders or $4 as proposed by DMA to be consistent with CMS policy. Both proposals will also need to be submitted to CMS for review and approval. The stakeholders will be kept informed as the proposals proceed.