Posted on Leave a comment

Medicaid Acronym of the Day – NCHS

The National Center for Health Statistics (NCHS) is a principal agency of the U.S. Federal Statistical System which provides statistical information to guide actions and policies to improve the health of the American people.

NCHS is housed within the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services (HHS). It is headquartered at University Town Center in Hyattsville, Maryland, just outside Washington, D.C. In 1960, the National Office of Vital Statistics and the National Health Survey merged to form the National Center for Health Statistics (NCHS). NCHS is one of 13 principal statistical agencies in the federal government. The Center has been located in a number of organizations within the Department of Health and Human Services (HHS), and since 1987 has been part of the Centers for Disease Control and Prevention (CDC).

NCHS collects data with surveys, from other agencies and U.S. states, from administrative sources, and from partnerships with private health partners. NCHS collects data from birth and death records, medical records, interview surveys, and through direct physical examinations and laboratory testing. These diverse sources give perspectives to help understand the U.S. population’s health, health outcomes, and influences on health.

Further reading

https://www.cdc.gov/nchs/index.htm

Posted on Leave a comment

Medicaid Acronym of the Day – NCCI

The National Correct Coding Initiative (NCCI) is a CMS program designed to prevent improper payment of procedures that should not be submitted together. There are two categories of edits:

Physician Edits: these code pair edits apply to physicians, non-physician practitioners, and Ambulatory Surgery Centers
Hospital Outpatient Prospective Payment System Edits (Outpatient Edits): these edits apply to the following types of bills: Hospitals (12X and 13X), Skilled Nursing Facilities (22X and 23X), Home Health Agencies Part B (34X), Outpatient Physical Therapy and Speech Language Pathology Providers (74X), and Comprehensive Outpatient Rehabilitation Facilities (75X).

Both the physician and outpatient edits can be split into two further code pair categories:

Column1/Column2 Code Pairs: these code pairs were created to identify unbundled services. The name is derived from the fact that the code pairs are separated into two columns; Column 1 contains the most comprehensive code, and Column 2 contains component services already covered by that more-comprehensive code.

These code pairs are further categorized into two sets:

Modifier: the appropriate use of a modifier allows these code pair to be reported together. In most cases, the -59 modifier is used, although there are other acceptable modifiers. These modifiers must be supported by documentation in the medical record.

No Modifiers: these code pairs should never be reported together, regardless of modifiers.

Mutually Exclusive Code Pairs (MEC): these code pairs should not be reported together because they are mutually exclusive of each other.
NCCI code pairs must match on member, provider, and date of service. CMS maintains tables of code pair edits and updates these tables on a quarterly basis.

Further reading

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

Posted on Leave a comment

Medicaid Acronym of the Day – NCANDS

The National Child Abuse and Neglect Data System (NCANDS) is a voluntary data collection system that gathers information from all 50 states, the District of Columbia, and Puerto Rico about reports of child abuse and neglect. NCANDS was established in response to the Child Abuse Prevention and Treatment Act of 1988. The data are used to examine trends in child abuse and neglect across the country, and key findings are published in our Child Welfare Outcomes Reports to Congress and annual Child Maltreatment reports.

Further reading

https://www.acf.hhs.gov/cb/research-data-technology/reporting-systems/ncands

Posted on Leave a comment

Medicaid Acronym of the Day – NASUAD

The National Association of States United for Aging and Disabilities (NASUAD) was founded in 1964 under the name National Association of State Units on Aging (NASUA). In 2010, the organization changed its name to NASUAD in an effort to formally recognize the work that the state agencies were undertaking in the field of disability policy and advocacy. Today, NASUAD represents the nation’s 56 state and territorial agencies on aging and disabilities and supports visionary state leadership, the advancement of state systems innovation and the articulation of national policies that support home and community based services for older adults and individuals with disabilities.

Further reading

http://www.nasuad.org/

Posted on

Medicaid Industry Who’s Who Series: John Tote

Medicaid Who’s Who: John Tote – Vice President of Behavioral Health Solutions with Mostly Medicaid

  1.  Which segment of the industry are you currently involved?

A: ‘Behavioral’ Health, which includes mental health, intellectual and developmental disabilities (IDD), substance use disorder (SUD), and integrated care

2. How many years have you been in the Medicaid industry?

A:  I have been working in and around Medicaid funded services for 32 years

 3.  What is your focus/passion? (Industry related or not)

A:   I always have seen and always will see myself as an advocate…that’s where my passion lies…seeing people progress as they define, want, and need that in their own lives…

 4.  What is the top item on your “bucket list?”

A: Professionally to see ‘total person’ care a true reality in the healthcare field…personally, to play golf at Augusta National…both would be heavenly!

 5.  What do you enjoy doing most with your personal time?

A: As you might have guessed from the last answer, when I have time I love to golf…but I also love music, bicycling, working in the yard, and enjoying a great red wine with my terrific wife and friends!

 6. Who is your favorite historical figure and why? 

A:  Abraham Lincoln…despite incredible challenges-where he was from, health issues, etc.-he devoted himself passionately to causes that mattered.  He also worked-or tried to-with those that disagreed with him…in so doing, yes, he built better coalitions, but he also learned from their thinking and that made him a better listener and more able to achieve great things for those he sought to serve.

7.  What is your favorite junk food?

A: Pizza…but is that really ‘junk’ food?  Not sure about that!…

 8.  Of what accomplishment are you most proud?

A: Being part of a wonderful coalition myself that saw innovative Medicaid policies, ironically enough, passed in North Carolina for those with significant disabilities.

 9. For what one thing do you wish you could get a mulligan?

A: There have been many things that I would have liked and wanted to go differently, of course, but those ‘loses’ have been important in my growth personally and professionally…the only mulligans that I would take are those times when something I did had a negative impact on someone else…those are the things I would do over…

 10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 

A: There will be many areas of Medicaid, both nationally and at the state level, that impact millions of people…there always are…but for me, 2 major areas of concern will be the state of ‘behavioral’ and integrated care as so many changes occur and what that means for individuals being served by Medicaid funded programs…and, secondly, also how Medicaid is and will be viewed as we go into mid-term elections.  Medicaid is often misrepresented for what it is…and what it is not…but there is also very little general understanding of how Medicaid as a health care funding source is also a major economic driver at the community level-especially in more rural areas oftentimes.  This needs to be a more substantial part of the overall Medicaid discussion and conversation.  If we can move away from the ‘politics’ of Medicaid-even a small bit-and cast a truthful eye towards it, Medicaid could take on a much more significant role throughout our healthcare system and in many of our communities. 

 

Posted on Leave a comment

Medicaid Acronym of the Day – NADAC

National Average Drug Acquisition Cost Survey – The NADAC survey process focuses on retail community pharmacy drug ingredient costs. The survey collects acquisition costs for covered outpatient drugs purchased by retail community pharmacies, which include invoice purchase prices from independent and chain retail community pharmacies.

Included in the Survey of Retail Prices, in addition to a survey of the cost pharmacies incur to purchase drugs, CMS collects information on consumer prices for the purchase of drugs. This survey focuses on the collection of retail community pharmacy prices charged to consumers and the calculation of consumer unit drug prices.

Further reading

https://www.medicaid.gov/medicaid-chip-program-information/by-topics/prescription-drugs/ful-nadac-downloads/nadacmethodology.pdf

Posted on Leave a comment

Medicaid Acronym of the Day – CALT

Collaborative Application Lifecycle Tool – The CALT is a collaborative tool that creates a centralized repository for storing, collaborating on and sharing deliverables and artifacts from IT projects in support of Medicaid administration and establishment of Exchanges. CMS recently deployed the CALT on a secure cloud computing environment.

Within the CALT, CMS has created the Medicaid State Collaborative Community to allow States the opportunity to leverage, share, and collaborate on Medicaid information technology (IT) systems development projects and to submit artifacts to the CALT for review and approval as required by the systems development lifecycle (SDLC) process. CMS established CALT as a centralized platform and provides its features and functions to all users – regardless of geographic location. CALT collaboration features allow States to manage systems development activities related to planning, developing, testing, implementing, and maintaining numerous Medicaid/Exchange IT software/system applications, and to communicate their progress and innovative ideas with other States. States can also share best practices and post documents such as MITA State Self-Assessments. Through the use of CALT, CMS will provide States with timely feedback and direct support for systems development projects.

Further reading

https://calt.cms.gov/sf/sfmain/do/home

Posted on Leave a comment

Medicaid Acronym of the Day – TEFT

Testing Experience and Functional Tools – In March 2014, CMS awarded TEFT grants to nine states to test quality measurement tools and demonstrate e-health in Medicaid community-based long term services and supports (CB-LTSS). The grant program, spanning four years through March 2018, is designed to field test an experience of care survey and a set of functional assessment items, demonstrate personal health records, and create a standard electronic LTSS plan.

Further reading

https://www.medicaid.gov/medicaid/ltss/teft-program/index.html

Posted on Leave a comment

Medicaid Acronym of the Day – PASRR

Preadmission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care. PASRR requires that 1) all applicants to a Medicaid-certified nursing facility be evaluated for mental illness and/or intellectual disability; 2) be offered the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings); and 3) receive the services they need in those settings. The PASRR Technical Assistance Center provides information in a variety of formats available from the link below, and offers free individual consultation to any state agency involved with PASRR, from simple questions to intensive on-site review and program design.

Further reading

https://www.medicaid.gov/medicaid/ltss/institutional/pasrr/index.html