{"id":2023,"date":"2017-11-22T09:59:34","date_gmt":"2017-11-22T09:59:34","guid":{"rendered":"http:\/\/www.ltccs.com\/?p=2023"},"modified":"2022-03-25T19:23:54","modified_gmt":"2022-03-25T19:23:54","slug":"ltc-consulting-lens-5-letter-word-shaking-pa","status":"publish","type":"post","link":"https:\/\/ltcally.com\/articles\/ltc-consulting-lens-5-letter-word-shaking-pa\/","title":{"rendered":"LTC Consulting Lens: The 5 letter word shaking up PA"},"content":{"rendered":"<p>This is a another great clip from our Vlog!<\/p>\n<p>Find out about the MLTSS changes in Pennsylvania from LTC Consulting\u2019s very own Steve Shain.<\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/jPP1r7VqQHU\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Stay informed with LTC&#8217;s outlook on the Healthcare business world, our AR collections, receivables financing and collection of receivables processes. News, upcoming changes, and policy updates. A great way to keep on the pulse of our industry, without searching further than YouTube.<\/p>\n<p>Subscribe to our <a href=\"https:\/\/www.youtube.com\/channel\/UCIRoQos5SAdPaBSCVHRVJWg\/videos\">You Tube Channel<\/a> so you don&#8217;t miss the next one! <a href=\"https:\/\/www.ltcally.com\/contact\">Get in touch with us about a free evaluation!<\/a><\/p>\n<p><em>Transcript:<\/p>\n<p>Steve Shain: Hi, welcome back. Today I\u2019d like to talk more about the Pennsylvania rollout of MLTSS beginning in January 2018, right around the corner for the more rural areas and then January 2019 and January 2020 for the more urban areas. MLTSS as you know stands for Medicaid\u2019s little trick saving shekels, right? That\u2019s what they try to do, they try to save money. No, it really stands for Managed Long-Term Services and Supports. The insurance companies that are participating are Amerihealth, PA Health and Wellness and UPMC. The eligibility process \u2013 the same as \u2013 it\u2019s basically going to be the same as Medicaid. The application process \u2013 basically gonna be the same as Medicaid, same forms submitted. Billing process \u2013 the basics can be the same as well. There\u2019s gonna be a little bit of a difference when somebody\u2019s pending Medicaid in regards to their coverage, which will be Medicaid at first and then the insurance company, but overall not much is changing. So what really are you gonna see as a difference? Well, aside for a slower cash flow and a more unpredictable cash flow, probably you\u2019re gonna see a more frequent denials on your claims and a more fragmented process from the insurance companies, especially in the beginning while they\u2019re trying to figure things out. A couple of differences between each of these insurers that is worth noting; No. 1 is that the insurance are not requiring the custodial authorization for coverage similar to what a managed care usually would require. Amerihealth is the only one that\u2019s asking for an authorization but they\u2019re gonna be the ones that are going to be covering that process. They\u2019re not gonna put that burden on the facility to make sure that authorization is in place. In contrast to maybe New Jersey for example, where all of the managed MLTSS insurers do require a custodial authorization be obtained by the facility. Another interesting difference is that the other insurance are giving basically a lock-in of your Medicaid rate for the last 4 quarters, and that goes to the extent of the contract. PA Health and Wellness is giving an option; either you can get your rate similar to those other insurers or you can base it off of CMI, your case mix index. So obviously if you feel your CMI is going to be going up or has been on a trend to go up, you probably want a contract with them on that structure that way your rate has a better chance of being higher, if on the other hand you feel that your CMI is not that awesome, you want to lock in your rate as per the last four quarters of your Medicaid rate in order to make sure that you\u2019re getting decent reimbursement. I also wanted to point out if any of you are going to be at the AJAS conference in February, February 13, I will be there speaking on managed care for everybody at the conference. Would love to see there, if you\u2019re going to be there awesome, if you\u2019re not going to be there and you\u2019d like to ask me questions about managed care or about this specific thing, MLTSS, please reach out. If you\u2019d like to talk to your organization, please reach out, I\u2019ve been happy to talk to you if it helps I\u2019m there. Thank you so much for listening take care.<\/em><\/p>\n<p><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This is a another great clip from our Vlog! Find out about the MLTSS changes in Pennsylvania from LTC Consulting\u2019s very own Steve Shain. Stay informed with LTC&#8217;s outlook on the Healthcare business world, our AR collections, receivables financing and collection of receivables processes. News, upcoming changes, and policy updates. A great way to keep <a href=\"https:\/\/ltcally.com\/articles\/ltc-consulting-lens-5-letter-word-shaking-pa\/\" class=\"more-link\">&#8230;<span class=\"screen-reader-text\">  LTC Consulting Lens: The 5 letter word shaking up PA<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[23],"tags":[],"class_list":["post-2023","post","type-post","status-publish","format-standard","hentry","category-videos"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>LTC Consulting Lens: The 5 letter word shaking up PA | Articles | LTC Ally<\/title>\n<meta name=\"description\" content=\"This is a another great clip from our Vlog! 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