That is my understanding as well. I believe it was the CMS Provider Call on 8/21 that reiterated that it was up to the discretion of the Med Adv payer whether or not they adopt PDGM.

Our issue is if Med Adv payers do not adopt PDGM, how will we generate a PPS HIPPS code after 1/1/20 with OASIS D1 assessments that only generate PDGM HIPPS codes?

I’m crossing my fingers that the Med Adv plans will adopt PDGM, but I’m not seeing anything from anyone anywhere about it and its making me nervous!

Kori Meyer

Biller | Pathways to Achievement, Inc

114 S 20th Ave W Suite A | Duluth MN 55806

218.623.7106 | Fax 218.491.7185

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Jane Vujovich
Sent: Thursday, September 19, 2019 10:22 AM
To: billers@list.mnhomecare.org
Subject: RE: Medicare Advantage payers and PDGM

My understanding is that for now PDGM is only for FFS and I will dig for the reference on this.

Jane Vujovich | Regional Director - South

Office: 651-388-1010 | Fax: 651-388-1178 | Cell: 612-616-7935

120 Hedin Avenue, Suite 101

Red Wing, MN 55066

Hopkins Office: 952-935-3515

1011 1^st Street South, Suite 315, Hopkins, MN 55343

Email: janevujovich@accracare.org | Website: www.accracare.org

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From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Karen Peterson
Sent: Thursday, September 19, 2019 10:05 AM
To: billers@list.mnhomecare.org
Subject: RE: Medicare Advantage payers and PDGM

This is a really good question and I hope several of you are able to chime in with your experiences. This was brought up at the recent Home Care Policy Summit I attended a couple of weeks ago – they didn’t have any answers to share, just that we should each, in our respective states, learn what will happen with our Medicare Advantage Plans.

Your responses to Kori’s question will help me figure out how to proceed!!

Thanks in advance –

Karen Peterson

Regulatory Affairs and Advocacy Manager

Minnesota HomeCare Association

2550 University Ave. W., Ste. 350 S | St. Paul, MN 55114-1900

Direct: 651.659.1457 | Main: 651.635.0607

Toll-free: 866.607.0607 | Fax: 651.635.0043

www.mnhomecare.org | kpeterson@mnhomecare.org

Mission: MHCA represents and supports Minnesota home care providers committed to high quality home care services.

Vision: MHCA will shape the home care landscape to improve and sustain quality home care services.

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Kori Meyer
Sent: Thursday, September 19, 2019 9:46 AM
To: 'billers@list.mnhomecare.org' <billers@list.mnhomecare.org>
Subject: Medicare Advantage payers and PDGM

Has anyone seen anything from any of the Medicare Advantage payers regarding a decision to adopt PDGM? Or not adopt?

Our software is not going to support PPS HIPPS code OASIS D assessments once OASIS D1 PDGM HIPPS codes are implemented unless we can point to specific payers that will still require PPS HIPPS codes after 010120. I have not had any luck contacting individual payers (BCBS MSHO, Humana, Aetna, UnitedHealthcare), and am wondering if anyone else has had better luck and gotten some specific answers?

Thanks in advance!

Kori Meyer

Biller | Pathways to Achievement, Inc

114 S 20th Ave W Suite A | Duluth MN 55806

218.623.7106 | Fax 218.491.7185

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