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Certified Physical Therapy Assistant Licensure Update
Per Arizona Administrative Code (AAC) R4-24 et seq., effective 6/30/07, Certified Physical Therapy Assistants (PTAs) no longer need to be in the same immediate area as the Supervising Physical Therapist (PT). The PTAs are able to claim for the physical therapy services provided to the student by using the supervising PT’s National Provider ID (NPI) number. It is essential that the PTAs meet all of the certification requirements listed in AAC R4-24-207 and R4-24-303, Arizona Revised Statutes (ARS) 32-2001 and 32-2022, and are under the general supervision of the PT. .
Under ARS 32-2001, a PTA “means a person who meets the requirements of this chapter for certification and who performs physical therapy procedures and related tasks that have been selected and delegated by the supervising Physical Therapist.” And “"General Supervision" means that the supervising physical therapist is on call and is readily available via telecommunications when the Physical Therapist assistant is providing treatment interventions.”
According to ARS 32-2022, under the qualifications for licensure and certification, it states:
D. An applicant for certification as a Physical Therapist Assistant shall meet the following requirements:
1. Be of good moral character.
2. Complete the application process.
3. Be a graduate of a physical therapist assistant education program accredited by an agency approved by the board.
4. Have successfully passed the national examination approved by the board.
5. Have successfully passed a jurisprudence examination that tests the applicant's knowledge of board statutes and rules.
School districts that have been appropriately documenting PTA services, including clinical notes, may begin billing immediately, back to 6/30/07, for PTAs who are under the general supervision of PTs, using the PT’s NPI. (This is similar to the arrangement for Certified Occupational Therapy Assistants (COTAs) and Occupational Therapists (OTs).) All claims must meet the timely filing requirements, i.e., they must be billed within 6 months of the date of service.
Please note that PTAs are not Health Aides and cannot claim using the Health Aide CPT codes. This new ruling allows greater flexibility for billing certified PTA services using the physical therapy CPT codes only, as long as the Supervising PT is registered with AHCCCS and has their NPI.
In addition, PTAs must adhere to documentation requirements that are identified in AAC R4-24-303. Some of those requirements that need to be part of the medical record are:
- The name and license number of the supervising physical therapist;
- The name of the patient to whom the selected treatment intervention is provided;
- The date on which the selected treatment intervention is provided;
- The selected treatment intervention provided; and
- Whether the physical therapist assistant consulted with the supervising physical therapist during the course of the selected treatment intervention and if so, the subject of the consultation and any decision made.
You are encouraged to review the State Statute and Administrative Code, and discuss the new regulations with your contracted PT to thoroughly understand the requirements for both the PT and PTA under their licensure.
Contact your MAXIMUS Account Manager if you have any questions.
Fall Regional Information Session
MAXIMUS AZ Project would like to thank the following school districts for hosting the Fall Regional Information Sessions: Higley Unified School District, Pendergast Elementary School District and Vail Unified School District. If you were unable to attend the recent Fall 2007 Regional Information Session held around the State of Arizona, please click here for the presentation material.
MAC Coordinator Training Sites and Dates Released
MAXIMUS is pleased to announce the locations and dates for the September 2007 MAC Coordinator and Train the Trainer Sessions. The attachment provides the dates, times, and locations of the training sessions. If you would like to attend the training sessions please submit your RSVP no later than 5:00 PM on Wednesday, September 5, 2007 either via fax at (480) 829-0701 or via e-mail at azmac@maximus.com. Due to limited space, please limit your registration to no more than three (3) representatives per LEA.
MAXIMUS and AHCCCS have developed an additional method for AHCCCS Providers who have not registered their NPI number with AHCCCS to do so. They may complete this form and mail to AHCCCS Provider Registration, P.O. Box 25500, Mail Drop 8100, Phoenix, AZ 85002. Please check with your MAXIMUS Account Manager to verify if your NPI number has been properly registered. Please note that you may only report one AHCCCS Provider per form.
NEWS FLASH!! NPI UPDATE!! HELPFUL HINTS!!
CMS has allowed an extension beyond 5/23/07 for using NPI that they call an "enforcement delay". AHCCCS will allow an extension, but MAXIMUS must write a contingency plan, stating when we will cutoff the use of the AHCCCS ID for those providers requiring NPI (all except Health Aides and Transportation.) We anticipate the new cutoff date to be November 7, 2007 with a dual use period beginning July 11.
To facilitate LEAs and providers getting their required NPI, MAXIMUS has posted simplified instructions for both on this website (see Program News below from January 26, 2007 for the links).
WHEN YOU SUBMIT YOUR NPI TO AHCCCS
- Remember to include your name and AHCCCS ID, regardless of the method you choose to notify them - fax, e-mail, letter, etc.
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If the LEA submits on behalf of a provider, the name and AHCCCS ID of the individual provider must be clearly noted
If the school district submits on behalf of many providers on a form other than the confirmation received from NPPES, the form must be signed by an authorized signer on record with AHCCCS (talk to your account manager to find out who is authorized to sign, per AHCCCS, and update your records)
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Submitting NPI to your Biller does not ensure that it is on file with AHCCCS; you must take that next step and send it to AHCCCS for their records
Only claims submitted with NPI on file at AHCCCS will be paid after the final cutoff date of 11/7/07.
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ALL CLAIMS BILLED AFTER THAT NOVEMBER CUTOFF DATE REQUIRE NPI, REGARDLESS OF DATE OF SERVICE!!!
Since AHCCCS now requires newly registering providers to get their NPI first, it is critical that all providers get their NPI as soon as possible. The new providers then put their NPI on the registration packet where indicated to register with AHCCCS as an eligible provider and to get their AHCCCS Provider ID. (Only Health Aide and Transportation claims will not require the use of NPI. They still must register with AHCCCS and get an AHCCCS Provider ID.)
GET NPI FIRST
Beginning March 1, 2007 providers newly registering with AHCCCS must apply for
and receive their National Provider ID (NPI) first.
The provider must then include the NPI on their registration paperwork to AHCCCS.
Also, there is not much time left for providers (Individual) and LEAs (Organizational) already registered
with AHCCCS to apply for and receive their NPI number, report them to AHCCCS, have AHCCCS enter the NPI
number to their computer and be ready for billing claims by May 23, 2007.
To assist individual providers to get their Individual NPI numbers, here are some simplified instructions.
To assist LEAs with getting their Organizational NPI numbers, here are some
simplified instructions
to get your organizational NPI number.
MAC Coordinator Training Sites and Dates Released
MAXIMUS is pleased to announce the locations and dates for the February 2007 MAC Coordinator and Train the Trainer Sessions.
The attachment provides the dates, times, and locations of the training sessions. If you would like to attend the training sessions please submit
your RSVP no later than 5:00 PM on Wednesday February 7, 2007 either via fax at (480) 829-0701 or via e-mail at
azmac@maximus.com.
Due to limited space, please limit your registration to no more than three (3) representatives per LEA.
Visions Finance Training Offered
The MAXIMUS AZ office will be hosting web conference training to answer finance questions
related to the Q4 2006 Cost Financial Data. We have also added new Visions 2.5 and Enterprise Training courses.
This is a MUST Attend if you have VISIONS!
The teleconference training will be held on January 17 and January 18, 2007.
MAXIMUS has helped large LEAs cut the processing time down from days to hours.
If you use another software and need assistance, please contact your Account Manager.
If you would like to participant in the training, please send an email to azmac@maximus.com
no later than Tuesday, January 16, 2007 to receive the link and call in information.
WebMAC Frequently Asked Questions Released
These are the Q & A's that MAXIMUS has been adding to the newsletters, plus a few extra. Please take a look at them to see what types of questions MAXIMUS has been receiving from LEAs regarding WebMAC.
If you have questions that are not addressed in the FAQ's sheet
, please send them to me so that MAXIMUS can get the answers and add them so that everyone has the questions and answers.
Clarification of the Health Aide Claims
Recently an array of misinformation has
been distributed implying that AHCCCS/MAXIMUS was not processing
Health Aide claims for July through September 2006. This is not the case.
Please read the memo
from AHCCCS addressing the misinformation provided to LEAs.
Q2 2006 DSC Certification of Match Letters are coming to LEAs.
The Direct Service Claiming (DSC) Program has recently sent out the Q2 2006 Match Certification Letters.
We have also posted the Certification of Matching Funds worksheet to assist LEAs to determine if the quarterly matching requirement has been met.
You can get the worksheet by clicking here
or find it in the Downloads Area.
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Background |
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MAXIMUS was
founded in 1975 with a corporate mission of "Helping Government
Serve the People®," and today we are the largest firm in the nation
devoted to providing services to government agencies, including School-Based Medicaid programs. We understand the issues that face
state and local governments and education agencies, and work closely
with our client agencies to strengthen and improve their programs,
operations, systems, and financing.
MAXIMUS has a proven approach to administrative and direct
service claiming in schools, delivering both administrative and direct
service claiming in eleven states. MAXIMUS is currently providing
Medicaid services for more than 900 school
districts.
MAXIMUS is proud to administer the Medicaid Direct Service
Claiming (DSC) program and the Medicaid Administrative Claim
program (MAC) for the state of Arizona. These two school-based
programs assist participating school districts; charter schools and
the Arizona School for the Deaf and Blind (ASDB), referred
to as a Local Education Agency (LEA), by reimbursing them for
Medicaid covered services provided to eligible and qualified students.
The purpose of the MAC program is to allow LEAs to receive
reimbursement for Medicaid administrative outreach activities that
are done routinely within the school setting.
The Centers for Medicare and Medicaid Services
(CMS) is the
federal agency that oversees these two school-based programs. Locally,
these programs are overseen by Arizona Health Care Cost Containment
System (AHCCCS). The purpose of the DSC program is to allow
LEAs to receive reimbursement for Medicaid covered medical services
provided to Title XIX-eligible students.
The program requirements for both programs are a blended result of
federal laws and requirements from CMS, state laws and program
requirements from AHCCCS, and MAXIMUS. Significant changes
in either program will typically require some level of approval from
all three levels (CMS, AHCCCS and MAXIMUS). In 2003, CMS required
that a LEA participating in the MAC program must also claim
in the DSC program. A LEA can, however, participate in the DSC program
alone. |
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AHCCCS is Arizona's Medicaid program that
was developed as a result of Title XIX of the Social Security Act.
While AHCCCS also administers other state and federal health care
programs, only Title XIX members are eligible for the DSC program.
This handbook provides the information necessary to successfully participate
in the DSC program. AHCCCS policies relating to the DSC program can
be accessed on their website at http://www.ahcccs.state.az.us
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MAXIMUS was awarded a contract by AHCCCS to act as a third
party administrator for the DSC and MAC programs in November 2003.
Our contract effective date was January 1, 2004. MAXIMUS
provides a full spectrum of services under this contract including:
- Providing the necessary training required to prepare all LEAs
to participate in the program.
- Processing claims through the AHCCCS system.
- Providing the Information Services (IS) system required to administer
this program.
- The MAXIMUS data processing system houses
the program membership, contracted providers and needed reference
materials. It receives claims, processes them and forwards them
to AHCCCS for final approval. Payment is then distributed
to each LEA or their biller, accompanied by a remittance advice
that identifies the claims paid and the amount, as well as listing
any denials and the reason codes.
- Conducting periodic compliance reviews of participating LEAs.
During the reviews, staff will assess all documentation related
to the program, including provider records and student records.
MAXIMUS works closely with all participants throughout this
process to ensure compliance with all AHCCCS and CMS
requirements.
These programs are administered at MAXIMUS in Tempe, Arizona,
by a staff that is dedicated to this program. LEA Account Managers
are assigned to the individual LEAs and are available to answer
questions, help resolve problems, modify the contracted provider
list and perform other related support services.
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| States |
# of Participating
School Districts |
Net Medicaid
Revenue
Recoveries to Date |
| Arizona |
286 |
$65,900,000 |
| California |
1 |
$7,500,000 |
| Florida |
21 |
$69,500,000 |
| Kansas |
304 |
$95,000,000 |
| Kentucky |
139 |
$1,700,000 |
| Mississippi |
152 |
$3,500,000 |
| Missouri |
340 |
$86,632,000 |
| Montana |
1 |
$2,000,000 |
| Neveda |
1 |
$18,600,000 |
| New
Mexico |
18 |
New
Project |
| South
Carolina |
17 |
$32,100,000 |
| Total |
877 |
$208,432,000
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