Understanding Changes in Medicaid Policies for BRS Webinar
Join the upcoming BRS Webinar on April 15, 2025, for insights into Medicaid policy changes affecting Behavior Rehabilitation Services. Topics include provider documentation, transitioning to MMIS for prior authorization, and billing rate studies. Discover why these changes are happening and how to implement them effectively.
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Presentation Transcript
BRS Webinar Behavior Rehabilitation Services April 15, 2025
Presenter Amy Gordin, Medicaid Policy Analyst 2
Topics to be Covered Provider Documentation Transition to MMIS for Prior Auth. & Billing Rate Study For Each Topic What is the change? Why is it happening? What's the process for implementing the change? 3
What is the Change? Providers There is no change 5
What is the Change? People requesting prior authorizations and ROIs review memo All BRS requests for children not in the legal custody of Oregon Department of Human Services or Oregon Youth Authority must include a release of information (ROI) signed by the guardian, or by the child if aged 18 or older. OHA will process all requests based on the information received. The LPHA will use the documentation provided with the request to determine medical necessity and medical appropriateness for BRS. If information is missing or insufficient to make a medical necessity and medical appropriateness determination, OHA may deny the request. OHA expects BRS providers to share information to support these requests as required by OAR 410-170-0030(3)(e). OHA will share any compliance issues with the agency program analyst for the specific BRS program. 6
Why is it Happening These changes will ensure BRS compliance with state and federal requirements and align with what is expected from other residential facilities in Oregon 7
Whats the Process for Implementing the Change Memo will be sent ahead of time Forms have been updated Requests will be considered completed upon receipt 8
What is the Change? Per CMS requirements OHA must have prior authorization and billing for BRS program transition to the Medicaid Management Information System (MMIS) for children eligible for OHP. 10
Why is it Happening It is a requirement from CMS and part of our ongoing efforts to align the BRS program with state and federal Medicaid requirements. 11
Whats the Process for Implementing the Change PA through MMIS System configurations Training for those who request BRS authorizations Process of submitting the request may look different depending on the state agency the provider contracts with - ODHS/OYA: state staff - OHA county providers Documentation standards are the same for all agencies Gives provider opportunity to look up PA details in MMIS 12
Whats the Process for Implementing the Change Billing through MMIS: PA process must be complete first For providers not currently billing through MMIS, OHA in collaboration with ODHS/OYA will hold future meetings to obtain provider feedback as we design the system configurations 13
Whats the Process for Implementing the Change Rule changes: OHA in collaboration with ODHS/OYA have restarted rule revisions and will offer future provider and member engagement prior to the RAC. 14
Rate Study 15
What is the Change? Need procedure codes and rates for purposes of BRS expansion to in-home services and to all eligible members. Re-evaluating how aftercare is billed. 16
Why is it Happening Expansion: refer to kick off meeting and SOW for more info 17
Whats the Process for Implementing the Change TBD 18
Questions? 19
Additional Information BHMC@oha.oregon.gov OHA BRS Webpage Dialogue with collaborators and partners, including families and members, helps us center equity. Thank you for your ongoing participation, and for providing us with the partnership and insights that help us better serve Oregon s communities. Thank you
