AHS Launches Phase 2 of the Medicaid Retainer Program
As of April 27, 2020, the Vermont Agency of Services (AHS) is implementing a second phase of Medicaid retainer payments called the “COVID-19-specific Sustained Monthly Retainer Payment Program.” Interested eligible practices need to opt-in to the program, and will continue to receive fee-for-service reimbursement as well as the retainer payments. The advanced payments are based on the practice’s average monthly Medicaid fee-for-service reimbursement, less the total value of Medicaid fee-for-service claims received by the practice in the previous month. DVHA plans to run the program for the months of May and June, after which AHS will determine whether to extend it. Practices wishing to opt in for May will have to complete the opt-in form by May 5th. DVHA has provided specific conditions that each practice must meet in order to receive the funds and has specified that up to 10 percent of these payments may be recouped no sooner than six months after the conclusion of the State of Emergency. The recoupment amount for each provider will be calculated based on provider, provider type, regional, and/or system-level performance on the access to care and financial impact metrics that DVHA has established. For more information please read the guidance documents below:
COVID-19-specific Sustained Monthly Retainer Payments Cover Letter and Process
Online Opt-In Form for the Vermont Medicaid COVID-19-specific Sustained Monthly Retainer Program
Frequently Asked Questions (FAQs) - COVID-19-specific Medicaid Retainer
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BCBSVT to Open Codes for All Virtual Well Child Visits
As of Monday, BCBSVT has agreed to reverse a policy it had in place restricting reimbursement for virtual well-child care to children only over age 2 and will now cover virtual well-child care for all children regardless of age. This change will be retroactive. This change is due to advocacy led by the AAPVT Chapter in coordination with the Vermont Academy of Family Physicians and the Vermont Medical Society. AAP reminds all pediatric clinicians about following AAP guidelines for well visits during this time and in the future:
- Well-child care should occur in person whenever possible.
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- Where community circumstances require pediatricians to limit in-person well visits:
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- Clinicians are encouraged to prioritize in-person newborn care, and well visits and immunization of infants and young children (through 24 months of age) whenever possible.
- Well visits for children may be conducted through telehealth, recognizing that some elements of the well exam should be completed in clinic once community circumstances allow. These elements include, at a minimum: the comprehensive physical exam; office testing, including laboratory testing; hearing, vision, and oral health screening; fluoride varnish; and immunizations.
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CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program
On Monday, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B providers effective immediately. The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs and in light of the $175 billion recently appropriated for healthcare provider relief payments through the Provider Relief Fund, which is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. The Accelerated and Advance Payment (AAP) Programs were loans and not grants. Click for an updated fact sheet on the Accelerated and Advance Payment Programs.
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Latest CARES Act Funding - All Practices Must Submit Revenue Info
Last week, the Department of Health and Human Services (HHS) announced that it will begin distributing the second wave of funds from the $100 billion appropriated to hospitals and other healthcare providers impacted by the coronavirus response. Starting on April 24, a portion of providers were automatically sent an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file will need to submit their revenue information to the General Distribution Portal 
for additional general distribution funds. Initially some states and specialties thought that physicians must also submit cost reports, but the AMA verified with HHS that this is not the case. Physicians, however, do need to submit their revenue information so that it can be verified via the General Distribution Portal . The portal is now open. The customer service line confirmed anyone who has a Billing TIN (including a pediatric or obstetric practice) who lost revenue in March and/or can estimate lost revenue in April due to the COVID-19 crisis, should be filling out this portal. Please see further FAQ and guidance from the AMA and the following HHS FAQs.
Additional Funding Related to Treatment of the Uninsured
A portion of the $100 billion Provider Relief Fund will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured. Physicians are eligible for this funding. Every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the program and will be reimbursed at Medicare rates, subject to available funding. Steps will involve: enrolling as a provider participant, checking patient eligibility and benefits, submitting patient information, submitting claims, and receiving payment via direct deposit. Providers can register for the program on April 27, 2020, and begin submitting claims in early May 2020. For more information, visit coviduninsuredclaim.hrsa.gov.
