Winter 2012 
  In This Issue:

Provider Directory Validation Survey Begins

Upcoming Medical Record Audits for 2012


Claims Corner

Medicare and Medicaid Benefit Changes for 2012

Emblem Behavioral Health Services Program Underway

More Information on ICD-10

Good Notices for our Medical Manual on Religio-Cultural Competence

Behind the Scenes


Introducing Patient Health Profiles

Adolescent Immunizations

Vaccines For Children

Flu: It’s Not Too Late to Vaccinate

Medication Safety and Adherence

Health and Wellness Programs

Clinical Corner

News&Notes Archive

Medicare and Medicaid Benefit Changes for 2012

Medicare Changes
On January 1, 2012, we introduced changes to our Medicare programs and policies. Among these changes is a reduction in the maximum out-of-pocket expenses for which a member is responsible. We also introduced an annual wellness exam benefit that aligns with Medicare's initial "Welcome to Medicare" physical exam.

Medicaid Changes
As of January 1, 2012, the transportation benefit for both Medicaid managed-care and Family Health Plus (FHPlus) enrollees in Westchester County changed. In addition, personal emergency response systems (PERS) were added to the Medicaid managed care benefit package.

Transportation Carve-Out for Medicaid/FHPlus Members in Westchester
EmblemHealth no longer covers nonemergency transportation services for our Westchester County Medicaid and FHPlus members or emergency transportation for Westchester County Medicaid members.

  • Medicaid: emergency and nonemergency medical transportation is now covered by regular Medicaid.
  • Family Health Plus: nonemergency medical transportation is now covered by regular Medicaid.

The change in nonemergency transportation coverage means that network practitioners no longer need to reimburse HIP Medicaid and FHPlus members enrolled in Westchester County for the cost of transportation to and from their medical appointments. Nonemergency medical transportation includes personal vehicle, bus, taxi, ambulette and public transportation.

To arrange nonemergency transportation, you or your patient should call Medical Answering Services (MAS) at 1-866-883-7865. If possible, call MAS at least three days before the medical appointment. Please provide the appointment date, time and address, the name of the doctor the appointment is with and the patient's Medicaid Client Identification Number (CIN). The CIN is the same as the ID number on the front of the member's ID card minus the first alpha character and 01 suffix.

To arrange emergency transportation for both Medicaid and FHPlus members in Westchester County, please call 911. Ambulance providers bill FFS Medicaid for Medicaid members and HIP for FHPlus members.

If you have any questions, please call MAS at 1-866-883-7865.

Personal Emergency Response Systems (PERS)
PERS are now covered by HIP and not by regular Medicaid. We will give prior approval for PERS services as part of the Personal Care Services (PCS) home assessment. PERS is available only to members receiving home health and/or personal care services.

PERS services are the provision and maintenance of electronic communication equipment in the patient's home. When activated, this equipment signals a monitoring agency that immediately notifies the emergency response organizations previously specified by the patient.

We have contracted with the following vendors to provide PERS services:

  • American Medical Alert Corp (NYC and Westchester)
  • Lifeline Systems (service area wide)
  • Valued Relationships, Inc. (service area wide)

Our service area for Medicaid includes the five boroughs of New York City and Nassau, Suffolk and Westchester counties.

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