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CMS
Announces 2003 Conversion Factor Increase
Legislation
enacted by Congress in February will result in an approximate 1.6%
increase in the Medicare allowable beginning with March 1 care
provision. This
legislation provides CMS the authority to revise past errors in
estimates used to establish annual payment updates, resulting in a
1.6 percent increase in payments for this year, as opposed to the
previously announced 4.4 percent decrease. More information on this
change is available on CMS’ Web site at: www.cms.gov/regulations.
The 1.6 percent increase applies to the conversion factor
alone. The 2003 physician fee schedule made modifications to
numerous physician work and practice expense relative value units
that will further modify payments for specific services. ACT is
currently waiting for the fee schedule to be released so we can see
how our services are paid.
Health
Insurance Portability and Accountability Act Updates
ACT
Medical Group, PA is meeting timelines of HIPAA compliance.
In our upcoming Annual Meeting, staff will be focusing on
HIPAA Privacy and Security standards and how they will comply as an
ACT employee.
HIPAA
Administrative Simplification Compliance Deadlines
October
15, 2002 – Deadline to submit a compliance extension form for
Electronic Health Care Transactions and Code Sets.
ACT has filed an extension to allow time for our Software Vendors
to complete compliance
October
16, 2002 - Electronic Health Care Transactions and Code Sets
- all covered entities except those who filed for an extension and
are not a small health plan.
ACT has filed an extension to allow time for our Software Vendors
to complete compliance
April
14, 2003- Privacy - all covered entities except small health
plans.
ACT is making final preparations and will be providing staff
training on March 29, 2003
April
16, 2003 – Electronic
Health Care Transactions and Code Sets - all covered entities must
have started software and systems testing.
see
below
October
16, 2003- Electronic Health Care Transactions and Code Sets -
all covered entities that filed for an extension and small health
plans.
ACT has filed an extension to allow time for our Software Vendors
to complete compliance
April
14, 2004-
Privacy - small health plans.
ACT will be compliant in 2003
July
30, 2004
Employer
Identifier Standard - all covered entities except small health
plans.
August
1, 2005
Employer
Identifier Standard - small health plans.
The
final Rule adopting HIPAA standards for the security of electronic
health information was published in the Federal Register on February
20, 2003. This final rule specifies a series of administrative,
technical, and physical security procedures for covered entities to
use to assure the confidentiality of electronic protected health
information. The standards are delineated into either required or
addressable implementation specifications.
Final
Rule adopting changes to the HIPAA Electronic Transactions and Code
Set Standards was published in the Federal Register on February 20,
2003. This final rule modifies a number of the electronic
transactions and code sets adopted as national standards under HIPAA,
and eliminates the NDC code set as the standard for all providers
except retail pharmacies. It does not adopt a standard reporting
drugs and biologics on non-retail pharmacy transactions.
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Progress in State Reform of the
Mental Health Care System
Mental
health centers are currently under North Carolina mandate to close
as direct service providers. Area
Programs have been joining with other Area Programs that are
geographically appropriate and that provide value in order to form
Local Management Entities. The
function of these LME’s is to build the community network of
resources for mental health center current clients and to oversee
the care to ensure quality services to the community.
Mental Health Centers have expressed concern over current and
future patients they feel will not fit the target population for
service- the SPMI (Severe and Persistently Mentally Ill) population.
Individuals who cannot be labeled SPMI cannot gain access to
State funds for continued care.
For those non-SPMI individuals without healthcare insurance
and who are indigent, this means the LME will have to find free
community care. Many
fear these resources will be difficult, if not impossible, to find.
At
the same time, private providers who would like to be a resource and
could potentially expand services to cover the need continue to
battle with inconsistencies between Medicare and Medicaid policy for
private providers. Inconsistencies
lead to denial of billing and lack of much needed revenues to
provide care for the disabled, elderly and indigent populations.
Lack of adequate funding for “paid” services makes it
extremely difficult for providers to extend their time to provide
probono (free) care. Additionally,
current law places private providers in a potential payback
situation to Medicare for providing probono care.
Nursing
facilities throughout NC are currently bidding for 80 psych beds
being closed at state institutions. These beds will be granted in 20 closed unit bed increments
in the East, West and Central regions of NC.
These facilities must propose whether to use currently
certified beds or to apply for additional beds and must ensure
correct facility layout to meet the need as well as correct
staffing.
The
Division of Mental Health has charged Local Management Entities with
creation of Geropsych Specialty Teams to care for geriatric
individuals being released from state institutions and for those
persons who are at risk for return to the institution due to
instability. Proposals
were to be submitted to the Division in March.
Many LME’s are choosing to outsource this work.
ACT is proud to be a considered provider for this work. The team’s would include consumer specific services such as
therapy, psychosocial activities, clinical assessments/ evaluations
and case management as well as generic technical assistance such as
staff training, creating community links and working with state
hospitals who have geriatric expertise in maximizing supports to
clients.
Happy
ACT Anniversary!
v
Bryan
Patterson, PhD celebrating 5
years with ACT March
1
v
Erinn Moore
celebrating 5
years with ACT as of March
1
v
Michael
Lefaive, NP celebrating 1
year with ACT as of March 4
v
Robert
Zozus, PhD celebrating 3
years with ACT as of March
20
v
Jennifer
Benton, NP celebrating 1
year with ACT as of April
1
v
Jeff
Crawford, PhD celebrating 3
years with ACT as of April
10
v
Craig
Iversen, PhD celebrating 3
years with ACT as of April
13
v
Les
Heller celebrating 2
years with ACT as of April
16
v
Ronny
Wright, PsyD celebrating 1
year with ACT as of April
29
Happy
Birthday!
v
Karen
Fulwood, NP March 3
v
Gretchen
Belovicz, PhD March 9
v
Chris
Norris, PhD March 11
v
Barry A
Moore, MD
March 21
v
Jeff
Crawford March 22
v
Roderick
Lilly, PhD April 6
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