Budget and Accounting

Q:         How can I determine how this change may affect my revenue?

A:         Providers can identify the number of Medicaid and PAC enrolled individuals by checking the eligibility status of individuals on the Eligibility Verification System (EVS) (see question related to EVS).  A provider may assess how many individuals they serve may be Medicaid or PAC eligible, but not enrolled by looking at the income of individuals they serve reported through their intake process.  A provider can assess the services that they provide to these PAC and Medicaid clients and determine their possible revenue by looking at the new Medicaid fee schedule (see question related to how much a provider will be paid). 

Q:        How do I account for services that the MCO will not reimburse for a Medicaid or PAC covered individual?

A:        MCOs are not required to cover some treatment services.  These include residential services for adults or halfway house services.   Providers should continue to bill their grant for non-Medicaid covered services provided to PAC or Medicaid enrolled individuals that meet ASAM criteria for that level of care.   If an MCO denies a Medicaid-covered service as not meeting the ASAM criteria for the level of care requested, it is up to the jurisdiction whether the services may be billed to the grant.   In Baltimore City, bSAS has advised that the service should not be billed to the bSAS grant.