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STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICES
Aging and Long-Term Support AdministrationHome and Community Services Division
PO Box 45600, Olympia, WA 98504-5600
H15-002 - ProceduresJanuary 7, 2015
TO: Area Agency on Aging (AAA) DirectorsDevelopmental Disabilities Administration (DDA) Regional AdministratorsHome and Community Services (HCS) Regional Administrators
FROM: Bea Rector, Director, HCS DivisionDon Clintsman, Deputy Assistant Secretary, DDA
SUBJECT: Contracts for Medical Services
PURPOSE: To inform staff that all providers of medical services are required to have a Core Provider Agreement (CPA) with Health Care Authority (HCA) prior to being paid for LTC/DD services.
BACKGROUND: Historically, DSHS has contracted with medical providers who may or may not also hold a CPA with HCA and be deemed a Medicaid provider.
With the consolidation of the payments into the ProviderOne (P1) payment system, all DSHS social service medical providers will also need to be qualified as a Medicaid provider and obtain a CPA through HCA.
A P1 project team is currently working with an identified list of providers, who held a DSHS signed medical service contract on September 1, 2014, to inform our current medical providers that a CPA is required to be in place prior to implementation of “Phase 2 go-live”.
WHAT’S NEW, CHANGED, ORCLARIFIED
All medical providers need to have a CPA with HCA.
In order to be payable, each contractor needs to have the same taxonomy in their current DSHS contract and the P1 system.
The following medical services will be impacted by this change:1. Psychiatric, 2. Psychological,3. Nursing,4. Occupational Therapy, 5. Physical Therapy, 6. Speech Therapy,7. Communication Therapy,8. Certified Dietician Nutritionist and Durable Medical
Equipment.
ACTION: Effective immediately, HCS/AAA/DDA contract staff are required to do the following:
1. For Current Medical Contractors. Verify that the contractor has a CPA and that the
EIN/SSN matches the ACD contractor profile. https://fortress.wa.gov/hca/p1findaprovider
If the contractor has a CPA and the EIN/SSN match in both systems, no further action is required.
If the contractor has a CPA but the EIN/SSN does not match, the contract staffs are to work with the contractor to resolve the discrepancy. See issue resolve in SIT room located at http://adsaweb.dshs.wa.gov/providerone/SIT.htm.
If the contractor does not have a CPA, HCS/AAA/DDA contract staff shall determine:a) If the contractor indeed received the CPA application
from HCA. * If so, are they in the process of obtaining a CPA. * If not, send them a copy of the HCA Provider Application to complete and return to you.b) Determine where the contractor’s CPA application is in
the HCA process, and/orc) If the contractor has decided not to go through with the
requirements to obtain a CPA, let them know that we will not able to contract with them and a termination for convenience of their current contract will be requested.
2. For New Medical Contractors. Determine if the contractor has a CPA and make note of
the EIN/SSN attached to the ProviderOne number. https://fortress.wa.gov/hca/p1findaprovider
If the contractor has a CPA, HCS/AAA/DDA contract staff can start the normal contracting process, using the same EIN/SSN you noted above.
If the contractor does not have a CPA, inform them that they will have to secure a CPA with HCA.
a) If the contractor wants to continue with the contracting process, send them the attached HCA Provider Application, along with a pre-approved cover letter, background check form, etc. NOTE: the Provider Application will only replace the DSHS “Contractor Intake Form” and “Medicaid Provider Disclosure Statement.”
b) Instruct the provider to complete and return the application to you.
c) If they have questions about the HCA Provider Application, they need to call the HCA number listed on the packet. All other questions you would answer as usual.
When returned, use the HCA Provider Application in place
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of our DSHS “Contractor Intake Form” and “Medicaid Provider Disclosure Statement” forms.
Input the information into the ACD and create the contract as usual, making note of the taxonomy you select on the contract document.
You may continue with the contract process through signature of your contract however the medical provider WILL NOT be payable in the ProviderOne system until the HCA CPA process is complete.
After the contract is signed, verify the taxonomy on the first page of the HCA Provider Application packet to the taxonomy you selected when you created the contract and submit your entire (DSHS and HCA information) packet to HCA for processing. Note: the packet needs to include the W9 and copy of liability Insurance. Submit the packet to your Key Contract Coordinator.
This should help to streamline the process for our providers and ensure the CPA is processed with the correct taxonomy.
ATTACHMENT(S):
CONTACT(S): Christy HoosierMS. [email protected]
April HassettMS. [email protected]
Melissa DiebertMS. [email protected]
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