Resources & Links

Housing Roundtable Information

February 21 Meeting Notes (PDF file)

Protecting Residents from Financial Exploitation

The Consumer Financial Protection Bureau has published a new brochure titled Protecting residents from financial exploitation: A manual for assisted living and nursing providers. The Bureau’s Office for Older Americans is the only federal office dedicated to the financial health of Americans age 62 and over. The manual, directed to nursing home and assisted living providers, is intended to help staff protect residents from financial exploitation through prevention and early intervention. Download the brochure. (PDF file)

Logisticare Policy with respect to transportation services for dialysis in light of the CMS implementation (in December 2014) of the prior authorization pilot program for Medicare funded transport for dialysis

The CMS prior authorization pilot has led to denials under Medicare Part B. Logisticare is trying to work with providers and with CMS to ensure appropriate, timely transport. Please read the information below carefully, share it with appropriate staff involved in arranging transport, and also please let us know if you have any questions or concerns by emailing Theresa Edelstein at tedelstein@leadingagenj.org

With the implementation of the CMS pilot program for reoccurring stretcher trips, the following amendments will be made to the current process:

If the trip meets the safety standards required for Medicare coverage, and a physician involved in the treatment of the client certifies medical necessity, the trip may be approved for Medicaid coverage of stretcher transportation while the transportation provider/client appeal the Medicare decision. Any client who does not meet these criteria shall be offered the appropriate level of service to ensure they continue to receive necessary medical services.

When a provider/member calls to reserve a BLS trip for a repetitive service, such as dialysis, for a dually eligible member and claims that either Medicare has denied their claim or a transportation provider is refusing to accept the transport under Medicare, schedule reservation for 2 weeks of courtesy trips and have the requesting party forward the following documentation to LogistiCare’s Medical Director for review: (fax # 877-457-3316)
A copy of non-affirmed letter/denial (letter must have the member’s name and date of birth)
A completed MNF (medical necessity form) with specific information/diagnosis. (i.e. Stroke is not a sufficient description/diagnosis. Must describe the neurological deficit)

Note: All un-affirmed claims will have a unique tracking number (UTN) be sure to request and enter this UTN in the rider notes

If the un-affirmed/denial letter is indicating an administrative error, then the standing order should be entered with an expiration date of 30 days and will be subject to re-certification every 30 days until a final decision is received from Medicare regarding the prior authorization. When assigning these standing orders to a transportation provider, it must be communicated that they are responsible for submitting/re-submitting a prior-authorization for reoccurring trip or face recovery of funds for the Medicare eligible services. It is also the responsibility of the Transportation provider to notify LogistiCare when an approval is received.

If the un-affirmed letter/denial is indicating that the member’s condition does not require a BLS level of service, LogistiCare will either downgrade the member to a lower level of service (based on the MNF) or accept the transport as BLS with the following conditions:

(The highlighted reasons are the 3 that CMS requires for a BLS transport. All 3 must be met.)
Unable to get up from bed without assistance
Unable to ambulate, and
Unable to sit in a chair (including a wheelchair)
prevent injury to the client
the client must remain immobile secondary to a fracture or other medical condition, or
The client is bed-confined and unable to sit up safely during transport.

All standings for dually eligible members who have a BLS level of service will be subject to recertification every 6 months.

Digital Talking Books and Braille Library Services Available

A collaborative effort between the NJ Department of Health and the NJ State Library is making digital talking books and braille library services available, at no charge, to residents of licensed health care providers and those living at home being serviced by our licensed home heath agencies. The goal of this project is to enhance the quality of life of those no longer able to reap the pleasures of books due to vision challenges. Click here for more information. (PDF file)

Click here for Individual Application (PDF file)
Click here for Service Deposit Application (PDF file)

Implementation of Qualified Income Trusts (aka Miller Trusts)

The New Jersey Division of Medical Assistance and Health Services of the Department of Human Services has confirmed implementation of qualified income trusts effective Dec. 1, 2014. To assist providers in their work with consumers, NJHA and LeadingAge NJ had co-sponsored a webinar (Oct. 8) on the implementation of qualified income trusts.A recording of the webinar, including the handouts, is now available for purchase at

http://www.njha.com/education/brochure/?id=564

This webinar will provide your organization with a good understanding of what qualified income trusts are, how they will affect your organization, how you can work with residents and families in establishing their trusts, and how New Jersey intends to provide resources and carry out the implementation. Faculty for the webinar was Brian Rath, Esq., Buchanan Ingersoll Rooney, P.C., and Meghan Davey, Chief of Operations, Division of Medical Assistance and Health Services, Department of Human Services.

Disposal of Controlled Substances

On September 9, the US Drug Enforcement Agency issued its final rule related to the disposal of controlled substances. Click here (PDF file) for the DEA’s fact sheet for long term care

Expansion of Certified Medication Aide Program in Assisted Living

As of January 2013, the Department of Health will accept a waiver request from providers to expand the role of the Certified Medication Aide. If granted the approved waiver request will allow the registered professional nurse (RN) to delegate to certified medication aides (CMAs), the administration of injectable medications (other than the previously approved insulin) via disposable, integrated, mechanical, medication delivery devices that are prefilled by the manufacturer (commonly known as “pens”). Click here (PDF file) for complete information. Click here for the application for waiver form CN-28. If you have any questions or require additional information, contact Pamela Gendlek, Program Manager, Assessment & Survey at 609-633-8981 or pamela.gendlek@doh.state.nj.us

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