Retainer Payments-Appendix K Waiver Amendment-Frequently Asked Questions (FAQs)

Question:How should providers prove they received money from the Small Business Administration (SBA) or Paycheck Protection Program (PPP)?

Answer:An attestation for any loans or monies received during the public health emergency (PHE) is included in the required Form 950K1 and Form 950K2. Proof must be maintained by the provider in case of an audit or review. Providers who received PPP loans thatexceeded their revenue for the last full quarter prior to the public health emergency are not eligible for retainer payments.

Question:Will any additional funding be provided for personal protective equipment (PPE)?

Answer:At this time, no additional funding is being provided for PPE.

Question:If a provider closed due to low census can they request a retainer payment?  What if a provider closed after Jan. 1,2020?

Answer:No. To be approved for retainer payments, providers must have been enrolled with the South Carolina Department of Health and Human Services (SCDHHS) as of Jan. 1, 2020, and remain in good standing with SCDHHS. Good standing means a provider who is in an active status with SCDHHS and is not on suspension.

Question:What if a provider has already let staff go due to low census?  

Answer:SCDHHS will require an attestation from the provider that it will not lay off staff and will maintain wages at existing levels to receive retainer payments. Previous layoffs prior to the retainer payment request are not part of the required attestation.

Question:What happens if the provider does not agree with the amount they are awarded?

Answer:The acceptance of retainer payments is strictly voluntary. Providers do not have to receive retainer payments.

Question:Which services are available for retainer payments?

Answer:Adult Day Health Care, Adult Day Health Care Nursing, Attendant Care,  Personal Care I and II,  Agency Companion, Respite, Nursing (Registered Nurse (RN), Licensed Practical Nurse (LPN), Medicaid Nursing, Children’s Private Duty Nursing), Day Activity, Career Preparation, Community Services, Support Center Services, Group Employment, Individual Employment. These are the only services that were approved for retainer payments by the Centers for Medicare and Medicaid Services (CMS).

Question:How can providers  tell how much money Medicaid has reimbursed my agency?

Answer: Providers can run a claims activity report in Phoenix and/or review theremittance advice in the Webtool. 

Question: How will this work for Adult Day Health Care (ADHC) providers that render services on Saturdays?

Answer: ADHC falls under service group one. This service group is to report their usual and customary revenue received for each service over a six-week period, as well as actual revenue received for those services provided during the periods of March 16 to April 24, 2020; April 27 to June 5, 2020; and, June 8 to July 17, 2020.

Question: Will this provide reimbursement for ADHC transportation?

Answer:No. ADHC transportation was not included in the approved request.

Question: For ADHC services, there are some authorizations on my remittance advice with procedure code LTC10.  This is not listed on the Appendix K – will it count?

Answer: No. Only revenue received under the approved procedure code S5102 will be considered for retainer payments. If you are receiving revenue under the LTC10 procedure code, please contact the Provider Oversight, Support and Education Team via email at: waiverclaims@scdhhs.gov .

Question: Will this provide reimbursement for Veterans Affairs (VA) or other type of payment clients?

Answer: No. Retainer payments are based upon the average payment amount made to providers from SCDHHS.

Question: We are a multi-state provider. Are the revenue figures used to complete the attestation form strictly revenue related to our South Carolina operations?

Answer: Only the revenue generated from SCDHHS Medicaid payments for the specified South Carolina Medicaid services are applicable.

Question: How will this work if we owe SCDHHS funds?

Answer:  SCDHHS will evaluate each situation in which a provider has an outstanding balance due to SCDHHS. In certain circumstances, the retainer payment may be applied as a credit against the outstanding amount due.

Question: For Group 1 providers, the actual revenue for the services provided in the designated periods is a six-week period; however, the form requires usual and customary revenue to be listed as an average monthly amount. It appears the comparison is not an equal date range.

Answer: SCDHHS will conduct a comparison analysis of usual and customary revenue and actual revenue for the designated periods that utilizes a weekly average to account for the six-week periods for Group 1.

Question: Will retainer payments be calculated for each service distinctly or as an aggregate for all services?

Answer: Each service will be evaluated individually for retainer payment eligibility and amounts.  The provider will be paid in individual adjustments for each waiver and each service.

Question:. Is procedure code S5170 included to add to 950K2?

Answer: No. Procedure code S5170 is not approved for retainer payments.

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