Frequently Asked Questions About GO (Global Options for Long-Term Care) and the Waiver Consolidation

 Billing/Payment
 Eligibility/Enrollment
 PCA, HBSC, Homemaker
 Transferring Between AL and Community
 Care Manager Administration
 Forms, Record Keeping, Documentation
 Adding, Revising Services
 Provider Relation
 Contact List
 Miscellaneous

Billing/Payment

1. Is there a $200 first month, care management fee for cases transitioning to Global Options?
   
   No, there is not a $200 first month care management fee for cases that are automatically transitioned to GO.  The transition is seamless and the Plan of Care remains the same until the reevaluation so there is no service to justify the initial first month care management fee.
   
   
2. If a Care Management Site has a Provider Number and Procedure Code to bill for CCPED Care Management and a separate Provider Number and Procedure Code to bill for ECO Care Management, what should it use to bill for Care Management for GO?
   
   The Care Management Site may bill either the Provider number and Procedure Code for CCPED or the Provider number and Procedure Code for ECO and the claims will automatically “map” to GO for payment.
   
   
3. Will the State recoup monies (Medicaid dollars) spent for a Waiver participant, as they can with a person on Medicaid in a nursing facility?
   
   The regulations indicate that the State can recoup monies spent for Waiver services for those beneficiaries who were 55 years of age or older at the time they received services in the same way that they may be recouped for Medicaid recipients. For more information about this topic, please contact your County Welfare Association to request a copy of Medicaid Communication No. 02-14 and the publication “Estate Recovery – What You Should Know” Publication.
   
   
4. Will Care Management rates be increased?
   
   There is no plan to increase Care Management rates at this time.
   
   
5. Has the billing for Care Management changed?
   
   The process and reimbursement have not changed.
   
   

Eligibility/Enrollment

1. We understand that clients in Class B licensed residences cannot be NH LOC according to DCA, would they be eligible for GO?
   
   DACS added Class B Boarding Homes to the list of residences where a GO participant could live largely because of the individuals that lived on their own in such a residence, but needed assistance with Activities of Daily Living. According to DCA, if a home serves more than one person unrelated to the proprietor, it must get a Boarding Home License. (Adult Family Care homes are exempt from this regulation.) The Class B Boarding Home License is valid for a boarding house that offers no financial services and no personal services other than meals, other food services, and laundry. Class B Boarding Homes are designed for individuals who can live independently or independently with services.
   
   
2. Who will do the actual enrollment forms for GO?
   
   Because we want their Medicaid to start right away, we are hoping it will be OCCO at the time of their clinical approval.
   (1) The State has determined that it should be the Community Choice Counselor or County Assessor (in ADRC Counties), who completes the CP-5, Notice of Program Enrollment, and sends it to the CWA for those that are Medicaid Only with copies to the participant, contact person, Care Management Site, AL/AFC provider and OCCO file. The Care Manager, should complete the CP-23, Notice of Program Disenrollment, and send to the CWA for those that are Medicaid Only (not on SSI) with copies to the participant, contact person, participant’s file, and OCCO file. (2) Please note that it is not the goal of GO to get Medicaid for a person ASAP. Medicaid coverage is a result of Waiver enrollment and not an end in itself. It is never acceptable to enroll a person in GO just because they need health insurance.
   
   
3. All clients in the community waiver will be GO – is it still code 32?
   
   All participants currently enrolled in CCPED, ECO, and AL will be GO, still Special Program Code 32. The CWAs do not need to change any screens.
   
   
4. How do we refer to a person enrolled in GO? Is it client, consumer, participant, recipient or beneficiary?
   
   The term used in the Waiver amendment to consolidate the three Waivers is participant; that is the term that DACS will be using to identify one enrolled in GO.
   
   
5. Does a person still have to be in a Nursing Facility for 21 days before being referred to GO?
   
   A person must be in a Nursing Facility for 21 days and have an Interdisciplinary Team Meeting to be discharged onto GO. A participant may also be enrolled in GO from the community.
   
   
6. Do you need a PAS for Nursing Home Placement/GO?
   
   Yes.
   
   
7. Are you eligible for GO if you receive SSI?
   
   Yes, but only if there is an assessed need for two Waiver Services. If a person’s only service needs were for State Plan Services, he or she would not qualify for GO.
   
   
8. Does a Medicaid application need to be completed to transfer a person to NH Placement before they are eligible for GO?
   
   The State does not use PA-3L (PR-1) to verify Medicaid eligibility, but Medicaid eligibility does need to be verified before a person can be considered for GO.
   
   
9. Some counties have a CAP Wait List. May these individuals now be enrolled in GO?
   
   Yes, there is no longer a Wait List and individuals waiting for CCPED or CAP may be enrolled in GO.
   
   
10. Does a person on the GO waiver, who went into a nursing facility, need to stay 21 days and have an IDT before being discharged?
    
    For new persons, never enrolled in a Medicaid Waiver, they need to be in a Nursing Facility for 21 days and have an Interdisciplinary Team Meeting to be discharged onto GO.
    
    A person who is currently on the GO waiver and has entered a nursing facility who has not had a change in their functional abilities does not need to remain in the facility for 21 or have an IDT before discharge.

A person who is currently on the GO waiver and has entered a nursing facility and had a change in their functional abilities does not need to remain for 21 days, but a modified IDT will be needed.

The modified IDT will involve the Community Choice Counselor (CCC) and the care manager. The modified IDT meeting shall discuss the functional changes that have occurred and what service changes are needed in the Plan of Care to address these changes. Either the CCC or the care manager can initiate the meeting. The modified IDT meeting may occur via telephone. The care manager will be responsible for advising the participant about the changes, for incorporating the changes into the POC and for obtaining, if needed, the necessary signatures as per the POC Instructions.

PCA, HBSC, Homemaker

1. Should we stop using the term “Homemaker” for folks on JACC (Jersey Assistance for Community Caregiving) and use Home-Based Supportive Care?
   
   Yes. For consistency, the term Home-Based Supportive Care will be universally used (except of course for PCA or CHHA).
   
   
2. If a participant cannot get weekend service from one agency, can they receive PCA from two agencies? What happens to a participant who is currently using two agencies? Will he or she have to choose by their anniversary date?
   
   Services are to be rendered according to assessed need. Two agencies may be used as long as they are either PCA Agencies or both HBSC Agencies, and the need for same is documented. You could not use both a PCA Agency and a HBSC Agency to deliver services to the same participant.
   
   
3. I understand that a participant must chose between Home-Based Supportive Care and PCA Services and only have one service. What about Participant-Employed Providers (PEPs), can the participant receive this service on top of getting HBSC or PCA services? How many PEP hours can a participant receive?
   
   PEP is a provider type for HBSC. Therefore, it may not be combined with PCA services. The participant must choose between HBSC and PCA. The number of hours received is determined by assessed need and availability of services in the geographical area.
   
   
4. Can a participant receive PCA Services and Home-Based Supportive Care?
   
   No, it is not allowed to receive PCA Services and Home-Based Supportive Care. A participant must choose one or the other.
   
   
5. Can a participant receive PCA Services and Adult Day Health Services?
   
   Yes, if there is an assessed need for both, and the participant is eligible for ADHS.
   
   
6. What is the reimbursement for Home-Based Supportive Care?
   
   Home-Based Supportive Care provided by an Agency that is licensed as a Health Care Service Firm and that is accredited by one of the four Accreditation bodies is reimbursed at $15.50 an hour on weekdays and $17.00 an hour on week-ends and holidays. If the agency is licensed, but not accredited or only provides IADL services, it is reimbursed at the rate of $15.40 per hour.
   
   
7. Can a Homemaker Agency provide both Personal Care and IADLs for the same participant under GO?
   
   Yes, if the agency is licensed as a Health Care Service Firm and the services have been authorized according to assessed need.
   
   
8. Will an agency that used to provide homemaker service for us still be paid $15.50? Do we still need an RN assessment (as you know, we don’t need that for HBSC)?
   
   Yes, those agencies still need an RN assessment. The criteria for providers are unchanged.
   
   
9. Can a waiver participant get HBSC from an agency and have a PEP? Can they get PCA and have a PEP?
   
   No, PEP is a change in provider types, not a change is service options. PEP is still a HBSC service.
   
   
10. Can you attend Adult Day Health Services and receive home-based supportive care simultaneously?
    
    Yes, if the participant has assessed needs for both, and as long as the services are not duplicated. Please remember that ADHS has its own eligibility criteria, and they must be met in order for a participant to attend.
    

Waiver/State Plan Service

1. What is considered a waiver service? Does it include transportation?
   
   A Waiver service is; a service that is not offered in the Medicaid State Plan, or it is offered in the Medicaid State Plan, but is not offered in the needed amount, duration or frequency or provide the type of service that the participant requires. Transportation is both a Waiver Service as well as a service available through the Medicaid State Plan. Transportation for medical (dialysis treatment, physician appointments, etc.) purposes is a Medicaid State Plan service; transportation for non-medical reasons, such as to religious services, shopping, errands, is a Waiver Service.

   The other Waiver services included in GO are: Adult Family Care, Assisted Living/Comprehensive Personal Care Home, Assisted Living Program in Subsidized Housing, Attendant Care, Care Management, Caregiver/Participant Training, Chore Services, Community Transition Services, Environmental Accessibility Adaptations, Home-Based Supportive Care, Home-Delivered Meals, Personal Emergency Response System (PERS), Respite Care, Social Adult Day Care, Specialized Medical Equipment and Supplies, Transitional Care Management, and Transportation.

   The Division of Aging and Community Services will supply Care Managers with a thorough description of each Waiver Service, any limitations/exclusions, standards, and considerations for authorizing it for a participant. This information will also be available on the Department of Health and Senior Services Website, under the Provider heading.

   In addition, participants are eligible for all Medicaid State Plan services except for Medicaid Hospice.
   
   

2. What is the maximum number of days for Social Adult Day Care for GO enrollees? Is five days okay, based on assessed need, as long as the service falls within the $2,841 monthly cost cap?
   
   The maximum number of days for Social Adult Day Care for GO enrollees is five, based on assessed need. B) However, ALP and AFC participants are limited to 3 days, with Care Manager authorization.
   
   
3. Clarify the two services that a GO participant needs: CM plus one or CM plus two? What is the frequency of delivery?
   
   Waiver participants need at least two Waiver Services to be eligible for GO. This would generally be CM plus at least one other service. Frequency of delivery must be at least monthly
   
   
4. How many Waiver Services must a participant receive to remain eligible for GO? If a participant receives Care Management and only Adult Day Health Services or Care Management and Medical Transportation, is he or she eligible for GO?
   
   A participant must receive two Waiver Services monthly to remain eligible for GO. ADHS and Medical Transportation are Medicaid State Plan Services, which, in combination with Care Management would not qualify the person for GO. A participant must receive at least Care Management and one other Waiver service. Please note, however, that Current Waiver participants, who receive only one Waiver service, may remain on GO until they are re-evaluated. At that point, there may be an assessed need for a second Waiver service or, if not, the participant should be disenrolled from GO.)
   
   
5. Is it permissible to enroll a person in GO because they need Environmental Accessibility Adaptation (EAA) and no other services?
   
   No, EAA is not a service that would be received monthly.
   
   
6. Will GO cover stair glides/stair chairs?
   
   Yes, as long as it is in response to an assessed need.
   
   
7. Are we going to receive a list of services in writing for ourselves and for our participants? We currently have such a list for CCPED, review it with the participants, have them sign it and keep it in the chart.
   
   Yes. DACS is updating the service definitions, limitations/exclusions, standards, and considerations for authorizing each service. From that, you can develop a list of GO services to review with your participants, have them sign, and keep in participant’s file.
   
   
8. Since Adult Day Health Services is included in the monthly cap and the Care Manager authorizes the number of days, monitors the service by communicating with the center staff, and visits the participants at the center, why can’t it count as a Waiver Service?
   
   ADHS is a State Plan Service that has its own eligibility criteria.
   
   
9. Please clarify what services are covered by the State and what the Waiver covers?
   
   Please see attached lists.
   
   
10. Does GO cover Meals-on-Wheels? If so, please explain.
    
    Services for GO are based on the participant’s assessed need. If the participant needs Meals on Wheels, they can be provided.
    
    
11. Are clients still eligible for 30 days a year of nursing home respite under GO? If so, is this covered by the state or the waiver?
    
    Yes, participants are still eligible for 30 days a year of nursing home respite under GO. However, Waiver services must be delivered monthly to be considered one of the two required Waiver Services for eligibility.
    
    
12. If a participant only wants medical day care, what should the care manager do?
    
    A Person seeking only ADHS is ineligible for the Waiver. ADHS is a State-Plan service. Participants must receive at least two Waiver Services in order to be eligible for the Waiver.
    
    
13. Will GO cover dentists, hearing aids, and eyeglasses?
    
    Yes. These are State Plan Services, so a GO participant has access to the services.
    
    
14. Do ALP participants receive ADHS?
    
    No. ALP participants may not attend ADHS. They may use Social Adult Day Care, up to three days a week, if there is an assessed need for those services, and authorized by the Care Manager.
    
    
15. If GO participant has one Respite/EAA (1x only services), are they still eligible for GO or do they have to have an ongoing service?
    
    No, they are not eligible for GO unless they use two Waiver services at least monthly.
    
    
16. Can a client have 5 days of Adult Day Health Services a week if prior authorized by OCCO and they are still within the spending guide for GO?
    
    Yes, services are based on assessed need.
    
    
17. Since former CCPED participants are now eligible for State Plan Services, may they receive medical supplies such as diapers before their re-evaluations?
    
    Yes, former CCPED participants may receive Special Medical Equipment and Supplies covered by the Medicaid State Plan before a re-evaluation.
    
    
18. What if a person is on Hospice in the Community, can he or she enroll in GO?
    
    A person on Hospice in the Community should not enroll in GO. The person should be encouraged to enroll in Medicaid Hospice.
    
    
19. Can a participant receive Medicare Hospice Care and GO/PEP services?
    
    (1) If a person is on Medicare Hospice in the Community, he or she should not be enrolled in GO. (2) If the person is enrolled in GO and does not have a PEP, he or she should be encouraged to disenroll from GO and opt for Medicaid Hospice. However, if this would cause extreme hardship (could not have same aide or hours would be changed), then, on a case by case basis, we could consider combining Medicare Hospice and GO. (3) If the person is enrolled in GO and has a PEP and now is in need of Medicare Hospice, he or she could remain on GO and receive Medicare Hospice. The PEP services may continue when the participant is receiving Medicare Hospice.
    
    
20. Home Health is a State Plan Service. May a participant receive both Certified Home Health Aides and Home-Based Supportive Care at the same time?
    
    Certified Home Health Aide services are used when professional nursing or therapy are part of the participant’s Plan of Care. If professional nursing, or R.N. monitoring of the participant’s condition is prescribed for twice-a-month visits or more, or if the participant’s medical condition is unstable, home health aide services are recommended by the attending physician. When physical therapy, occupational therapy or other therapies are part of the Plan of Care, a certified home health aide is selected. Under these conditions, a participant may have both a certified home health aide and a home-based supportive care worker. However, the home-based supportive care hours should be adjusted because the certified home health aide may provide personal care assistance, prepare and serve meals, and launder participant’s clothing and linens. The Home Health reimbursement rates are based on a methodology determined by the Office of Financial Support in the Division of Medical Assistance and Health Services and exceed the reimbursement for Home-Based Supportive Care. Please note that if the Care Manager contacts a Home Health Agency specifically for Home-Based Supportive Care, the provider will be reimbursed at the rate of $15.50 per hour on weekdays and $17.00 an hour on weekends and holidays.
    
    
21. Can Respite be provided for a PEP?
    
    No, GO will only pay for Respite for an unpaid caregiver/worker.
    
    
22. Are there Funeral Benefits for GO participants?
    
    Waiver participants may be eligible for Funeral Benefits, according to N.J.A.C. 10:90-8.2. In order to determine where a participant qualifies, you should contact the County Welfare Agency and they will make the determination whether someone is eligible.
    

Transferring Between AL and Community

1. What is the process for switching a person on GO from Assisted Living Program to just home care, PERS, ADHS, etc?
   
   If the ALP participant is categorically eligible for Medicaid in the community, e.g., is on SSI or New Jersey Care, and not requesting waiver services under GO, he or she can be disenrolled from GO by signing a withdrawal form, which is sent to the Regional OCCO. If the participant is not categorically eligible for Medicaid in the community, he or she may remain on GO with a different service package, assuming that the person remains eligible and requests at least two waiver services. In this instance, the participant should sign a withdrawal form, which is sent to ALP provider and OCCO. The Care Manager should retain a copy of the form in the participant’s file. The participant should also sign a CP-6, Choice of Care Form, to confirm that he or she has had freedom to choose the desired service.
   
   
2. How do we handle the transition of a GO participant from home to an Assisted Living Facility? Will they need a new PAS from OCCO? When do these assessments get done – will the participant get the opportunity to sign off that this is what they want?
   
   If a GO participant chooses to move into an Assisted Living Facility that will accept him or her on the Waiver, it is permissible. The participant does NOT need a new PAS from OCCO. He or she should notify his or her Care Manager of the desire to move. The participant should sign a CP-6, to indicate that the move to the facility is his or her choice. A copy of the signed CP-6 should be sent to OCCO so it will be aware of the change of address. A copy of the signed CP-6 must be sent to the CWA for those participants that are Medicaid Only (not on SSI). Previous providers should be notified of the change. The facility must be reminded to send the Client Tracking Form to OCCO to confirm the date of admission. That will be the date the facility may start billing for AL reimbursement.
   

Care Manager Administration

1. What is the recommended Caseload for GO?
   
   The recommended Caseload for a GO Care Manager is 70.
   
   
2. How will new GO cases be assigned?
   
   The Regional Offices of Community Choice Options will continue to assign the new GO cases at this time.
   
   
3. Do County Welfare Agencies (CWAs) know that GO will replace CCPED, CAP and AL Waivers?
   
   Yes, they are aware of the consolidation. Language for a Medicaid Communication (MED COMM ) has been drafted and sent to Medicaid for distribution.
   
   
4. What are the criteria for Care Managers?
   
   The criteria for Care Managers are being updated by a workgroup and will be shared with you once they are finalized.
   

Forms, Record Keeping, Documentation

1. Will Care Managers be entering participants into the HCBS database solely for the purpose of their profile unless it is a service that is being provided by a nontraditional Medicaid provider?
   
   No. A Care Manager is required to enter the participant profile on the HCBS database only if the participant needs a service that will be delivered by a non-traditional provider. This provider is reimbursed by Public Partnerships LLC (PPL) ONLY when it can compare the provider’s invoice with the ISA (Individual Service Agreement. A Care Manager can ONLY enter an ISA if there is a participant profile on the database.
   
   
2. Do we need to do a Service Cost Record on all GO participants now and does that include the Assisted Living GO participants? Is this necessary with all ISAs in the HCBS or billed direct to Unisys?
   
   (1) A Service Cost Record is required for all GO participants, except those residing in an Assisted Living Residence or Comprehensive Personal Care Home. All Waiver services, as well as PCA and ADHS costs, must be tracked. (2) The Service Cost Record is the baseline document that the Care Manager uses to compare services authorized with services actually delivered.
   
   
3. Can the Adult Day Health Services (ADHS) Office fax Care Managers the approval form they send to the ADHS provider?
   
   No. The ADHS Office never sees the approval letter that Unisys generates. The ADHS Office enters the approval for payment into Unisys and the provider, as well as the participant, receives the approval letter. It is mailed to the participant’s home address from Unisys.
   
   
4. Please clarify: When are ISAs needed for supplies (depends, ensure) and/or equipment (PERS, walkers, canes)?
   
   The Care Manager should first contact the Medical Assistance Customer Center (MACC) Office to determine whether the supplies are covered by State Plan Services. An ISA will be needed for a supply or equipment that Medicaid will not pay for as a State Plan Service.
   
   
5. When do you use an ISA? For what services is an ISA needed?
   
   ISAs are used for services delivered by non-traditional providers. Non-traditional providers are those that are not enrolled in Medicaid and therefore cannot bill Unisys directly.
   
   
6. Do we have to track all services on the HCBS website?
   
   The only services that are/ must be tracked on the HCBS website are those that are paid by non-traditional providers (those that are not enrolled as Medicaid providers and must bill through PPL).
   
   
7. If a participant is in a nursing home and is not ever expected to return home, does the Care Manager need to keep care management open for the three months?
   
   No, if you are aware that the person is not expected to ever return home, notify OCCO that the GO participant has been re-admitted to the NF, and is not expected to return home. An OCCO Community Choice Counselor will either do an in-person assessment or review the previous PAS and make the Track change as necessary.
   

Adding, Revising Services

1. If we have already noted an item or service on the Plan of Care as an unmet need, and now with GO, the need can be met, shouldn’t we just complete the provider details, rather than do a new Plan of Care? Also, if an item/service is not listed as an unmet need and does exist as a need, do we addendum the Level of Care, initiate a new anniversary date with a new Plan of Care? How should this be addressed?
   
   The reevaluation should be revised when it is due, unless there is an acute change in the medical or caregiver status. Acute change means a physical or mental change that significantly affects a participant’s functional abilities. Acute change in caregiver status means that a caregiver is ill, hospitalized, incapacitated, in a nursing home or otherwise unable to provide the level of care that he or she provided in the past.
   
   An unmet need should be added to the POC on the re-evaluation anniversary.
   
   
2. Participants/families demand 40 hours of home care services. How should a Care Manager Respond? Will we be given parameters?
   
   The demands of the families/participants, although sometimes convincing, are not the criteria for accessing services. Services are based on assessment of need, not want. DACS is in the process of developing a tool that will help Care Managers to set parameters for the home care services.
   
   
3. How does a Care Manager increase PEP hours?
   
   All services are determined according to assessed need.
   
   
4. Is HBSC limited to 40 hours a week? We have someone with 42 hours – which is still under the $2,481. Is the goal to stay under the allowable cap or will there be service limits as we had in the past for CAP?
   
   Services are provided according to assessed need. It is the goal of Care Management to be fiscally responsible, while still providing appropriate services to the participant. DACS is in the process of developing a Home Care Assessment tool to assist Care Managers to determine the appropriate home care hours per week of service needed by the participant.
   
   
5. In reviewing the GO handout a question was asked about “transitional care management” as a service mentioned under Assisted Living – can we get a description of this including who is providing it and what is the code to be billed? Can this be used to bill for the IDT meeting whether or not the individual is discharged?
   
   Transitional Care Management is a service that will assist individual who are in a nursing facility or sub-acute unit of a hospital or nursing facility to gain access to GO services. It also may be used if a GO person is readmitted to the NF, when the Care Manager has contacted the GO participant and NF social worker during the first two months of admission and visited the GO participant and NF social worker during month three to ascertain the person’s progress to return to the community, plan services for the discharge, AND the GO participant returns to the community. (2) A chart with the list of codes to be used in billing is included with this list of FAQs. (3) A Care Manager may not bill for Transitional Care Management when the person is not discharged to the Waiver. (4) DACS is updating the Service Definitions for all Waiver Services that were distributed in August 2008. They will give in-depth definitions, address service limitations/exclusions and standards, and also provide issues to consider when authorizing a service.
   
   
6. We realize the goal is to not add services until the reevaluation on cases transitioning to Global Options, but what about PEPs who are only currently getting paid up to 25 hours when they are providing so many more hours. They have just been waiting for the waiver consolidation to get paid the additional hours. All are struggling as they have quit jobs to care for loved ones. Can their hours be increased? And what about other cases that have needed additional services and we have just been waiting for consolidation to be able to add them? Clients are under the impression that now we can finally add those services as they are getting the letter regarding consolidation.
   
   (1) The hours for the PEPs should not be increased until the reevaluation unless there is an acute change in the person’s condition or in that of a caregiver. We realize that many PEPs are providing care in excess of 25 hours a week or even 40 hours, but it is not the intent of the program to cover the cost of all the family members/friends do for one another. (2) We understand that there are people who have been waiting for the consolidation in order to receive additional services. All of the letters addressed this situation and state that the Plans of Care may be changed, as necessary, when he or she meets with his or her Care Manager for the annual reevaluation.
   

Provider Relation

1. We understand that transition from homemaker to Home-Based Supportive Care (HBSC) is a seamless transition. A lot of the agencies that are listed on the HCBS system as homemaker are not listed as approved for HCBS. We cannot do the ISAs unless they are added to the system as a provider for this service.
   
   Providers in the HCBS database will automatically be switched to allow them to provider services and bill as a HBSC agency. The HCBS database will allow for claims for homemaker services to track to the right payment amount.
   
   
2. Some providers have asked: “Will current participants that are getting homemaker services and want to do PCA have to have Prior Authorization by January 1, 2009 or will they be grandfathered in and given time to get the PCA approval?”
   
   They will continue to get Homemaker services, which will be known as Home-Based Supportive Care until they have Prior Authorization for PCA. Remember, this is the participant’s choice and not that of the Provider Agency.
   
   
3. Are the providers getting anything in writing to let them know of the “homemaker” change and how to bill for Global Options?
   
   The Remittance Advice that accompanies Unisys payments, starting December 26, 2008, will include a message for providers of all services, about the Waiver consolidation and its seamless transition for providers and participants.
   
   Providers will continue to bill as they always have. If they were a Homemaker provider prior to GO, they will continue to bill through the same fiscal agent (Unisys for Waiver and PPL for JACC), for the same service and at the same rate. The implementation of GO should be seamless to them, too.
   

Contact List

1. Is there a list of medical and social day cares?
   
   ADHS providers as well as those for Assisted Living Facilities, Comprehensive Personal Care Homes, Assisted Living Programs, and Adult Family Care Sponsor Agencies can be found on the Division of Health Facilities Evaluation and Licensure website at: http://www.state.nj.us/health/healthfacilities/search.shtml. Lists of Social Adult Day Cares, Home-Based Supportive Care Agencies that bill Medicaid directly, and Home Health Agencies will be available on the Department’s website in the near future.
   
   
2. How do we get a list of HBSC Agencies and how do we get a list of PCA Agencies?
   
   A list of licensed HBSC that bill through PPL is available on the HCBS website. A list of PCA Agencies is available by contacting the Division of Disability Services, Office of Home and Community Services (OHCS) at 609-292-4800. These PCA agencies are also eligible to deliver Home-Based Supportive Care. A list of Home Health Agencies can be found at http://www.state.nj.us/health/healthfacilities/search/ac.shtml. Once at the site, check “home health” for search.
   

Miscellaneous

1. Since participants’ expenses will come from the Global Budget starting January 1, 2009, will the remaining dollars allocated in July 2008 be diverted to other programs?
   
   For State Fiscal Year (SFY) 2009, Treasury consolidated ECO and CCPED waiver allocations into a single budget known as Global Budget (Options) for LTC. The combined budgets (CCPED, AL/AFC, CAP and GO) total $149,634,000. Under the newly approved Global Options for LTC Waiver, 11,600 unduplicated individuals in Federal Fiscal Year (FY) 2008 can be served statewide.
   
   The Division will be monitoring both allocations and enrollment to ensure that expenditures and the number of participants are within the approved allocations/numbers. The county Liaisons will be working with Care Coordinators to address any current waiting lists.
   
   
2. Now that Medicaid will be covering the 20% of hospital and doctor bills not covered by Medicare, should we advise our clients to drop their secondary assurance?
   
   No. Care Managers should never give this advice. You may inform participants that they will now have Medicaid coverage for medical expenses, but participants should be referred to specialists in Financial matters for these types of questions.
   
   
3. What is the maximum co-pay amount a GO participant should pay for prescription (if any)? If they are paying and should not be – who do we contact to remedy situation?
   
   Waiver participants are considered "dually eligible” for Medicare Part D. They do not have a deductible but the State of NJ pays the Medicare Part D co-pay as part of the State wrap around. However, if the person refuses Part D enrollment because he or she has a prescription/health benefit through an employer plan that requires the person to not enroll in part D, the benefit plan may require him or her to pay a co-pay or have a deductible. B) If there are problems, please contact the PAAD Office at 1-800-792-9745.