MEDICAID CONSOLIDATED SERVICES UPDATE-8/24/09

Effective for dates of service starting August 1, 2009 a skilled nursing facility (SNF) will be required to pay for the following:
 
 
 Oxygen
    -Concentrators and tanks
    -Repairs and Maintenence 

 Custom Wheelchairs
    -Parts and accessories
    -Repairs
 
 Transportation
    -Ambulette
    -Ambulance co-pay when Medicaid is the coinsurer

 Some over the counter medications

 Licensed Therapy
    -Medicaid only residents
    -Medicare B co-pay when Medicaid is the coinsurer

To compensate facilities for these new expenses, each provider will receive an add-on of $3.91 to their calculated Medicaid. Additionally, ODJFS is not anticipating having rates calculated until mid-September and does not plan to retroactively (back rates until the October vender.

The breakout by ODJFS of the $3.91 is as follows:
 
 
 Oxygen $.33
 
 Wheelchairs $.66
 
 Transportation $1.14

 OTC medications $.03
 
 Therapy $1.75

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008.  The Act is retroactive to July 1, 2008 and allows outpatient therapy service providers to submit the KX modifiers on claims that meet the exception criteria for therapy services through December 31, 2009.  The limit on incurred therapy expenses is $1810 for Occupational Therapy services per calendar year and $1810 combined for Physical and Speech Therapy services per calendar year.  Services billed beyond this limit must meet exception criteria to allow use of the KX modifier.