The AAP has long been working with Pennsylvania Department of Human Services (DHS) Fee For Service, Division of Managed Care, and Office of Long Term Living to determine when; and for what services, Skilled Nursing Facilities (SNF) are responsible for payment of medical transportation. Since October, 1983 the Department of Public Welfare, now DHS, has informed us via several iterations of a SNF Bulletin that “all non-emergency transportation of MA patients is the financial responsibility of the SNF where they reside”. Over the years many changes to coverages have changed the delivery of medical transportation and the payment structures for the various delivery models. As it turns out, SNF ARE responsible for Medicare Cost Sharing for dual eligible SNF residents under specific circumstances.
The clarification in this bulletin resulted in many unanswered questions so we reached out to Page, Wolfberg & Wirth for their opinion.
In addition, the Eligibility Determination is performed at the County Assistance Office level and can take months to complete. It often is approved with retroactivity to the application date. As Providers, you must make constant attempts to verify/validate Medical Assistance or dual eligibility coverage. The AAP urges you to keep in constant contact with your SNFs to maintain awareness of their “Presumptive MA” patient processes so that you are able to capture payment from the appropriate source as timely as possible.
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