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Washoe County Department of Social Services Health Care Assistance Program The Health Care Assistance Program (HCAP) reimburses medical and institutional facilities for eligible participants who do not qualify for Federal, State or community programs. Washoe County HCAP Approved Providers Renown Regional Medical Center-Tax ID #: 88-0213754 Renown South Meadows Hospital-Tax ID #:46-0517825 Saint Mary’s Regional Medical Center-Tax ID #:45-4989022 Northern Nevada Medical Center-Tax ID #:88-0159958 Outpatient Clinic Renown Health Care Center- Tax ID #: 88-0213754 Medical Miscellaneous Providers Remsa-Tax ID # 88-0175774 See Addendum A for complete list Acadian Rehab Inc-Tax ID # 88-0254192 Accellence Home Health-Tax ID # 94-3325112 Better Breathing-Nevada, LLC-Tax ID # 90-0197492 KCI USA Inc-Tax ID # 74-2152396 Lincare-Tax ID # 59-2852900 & 59-3493196 Neurodevelopmental Neurodiagnostic/ Sleep Disorder Center-Tax ID # 88-0200884 Preferred Home Care-Tax ID # 86-0898663 Renown Home Care-Tax ID # 88-0213754 St. Mary’s Home Care-Tax ID # 45-4989022 Hospitals Eligible Services Service Ambulance Hospital Inpatient Care (Includes Inpatient Rehab) Outpatient Care Outpatient Facility Charges including: Coverage Notes Transports to facility from private residence or public site. Transports from: Healthcare Center to hospital Jail infirmary to hospital NNAMHS to hospital Triage Center to hospital Note: Transports from acute facility to acute facility are not covered. Example: Renown Regional Medical Center to Renown South Meadows would not be covered. (See Definitions) Medicaid bed day rates paid for the admission timeframe minus the discharge date. Cardiac Rehab-Phase I & Phase II (See Definitions) Cardiac Stress Test Chemotherapy / Radiation Therapy Diabetic Shoes Durable Medical Equipment (See Definitions) Emergency Room Facility (emergent only) Home Health Care (See Definitions) Hospice Care Hyperbaric Chamber Oxygen Treatment Influenza Vaccinations Infusion Therapy Laboratory Testing (pathology professional fees are a non-covered service) Mammogram – Diagnostic Only (See Prior Authorization section) 1 of 13 Effective 9/1/13 Non-Formulary Drugs (See Prior Authorization section) Occupational Therapy (24 in a calendar year, 25th visit requires Prior Authorization) Observation (first 48 hours only) Oxygen – 8 canisters per month (See Prior Authorization section) Physical Therapy (24 in a calendar year, 25th visit requires Prior Authorization) Pneumonia Vaccinations Prescriptions dispensed by an approved hospital clinic or facility. Radiology Services- (See Prior Authorizations section) Same-Day-Surgery Sleep Studies/CPAP Titrating (See Definitions) Speech Therapy (24 in a calendar year, 25th visit requires Prior Authorization) Substance Abuse Treatment (See Prior Authorization section) Treatment received in an approved hospital clinic or facility Wound Therapy (24 in a calendar year, 25th visit requires Prior Authorization) Prior Authorization Requirements Unless expressly stated otherwise, all services requiring Prior Authorization must meet Nevada Medicaid requirements Service Cardiac Rehabilitation Authorization Information Phase I & Phase II (See Definitions) Note: Phase III is not covered. Cardiac Stress Test Durable Medical Equipment All Prosthetics Home Health Care Hospice Care Hyperbaric Chamber Oxygen Treatment Mammogram-Diagnostic Only Non-Formulary Drugs Oxygen Physical/Occupational/Speech Therapy Radiology Services Rehabilitation Inpatient Facility Sleep Studies / CPAP Titrating Substance Abuse Treatment (outpatient) Wound Therapy Charges greater than $1000. Items available through local non-profit organizations (Care Chest) are not eligible. Charges greater than $1000 Women – Diagnostic only and must meet the following criteria: • Provide proof of denial from Access to Healthcare Network (AHN) for Medicaid Breast and Cervical Cancer Program and Susan G. Komen grant funds. Men - No authorization required. Prior Authorization Request may only be sent if drug was prescribed by a Specialist and the Pharmacist has signed off that there is not an equivalent available on the HCAP Formulary. Prior Authorization Requests should be sent to the Washoe County HCAP Program Coordinator. Up to 8 canisters per month In excess of 24 visits in a calendar year PET Scans / CT Scans / MRI / MRA Services must be approved by WCSS as an exception In excess of 24 visits in a calendar year 2 of 13 Effective 9/1/13 Exclusions- Non-Covered Services 1. Alcohol and/or detoxification. 2. Ambulance transports from acute facility to acute facility. Example: Renown Regional Medical Center to Renown South Meadows Hospital. 3. Any medication not included on the Health Care Assistance Program Formulary without prior authorization. 4. Clients with private insurance, Medi-Cal, Medicaid, or other State/Federal medical programs if the program pays for the cost of medical treatment in Washoe County. 5. Behavioral Health/Mental Health 6. Dental, Vision or Audiology Services. 7. Dialysis-outpatient services covered under Emergency Medicaid for individuals with End Stage Renal Disease. 8. Experimental surgery. Experimental surgery is any surgical procedure not funded by Medicare or Medicaid. 9. Family Planning services which may include education, counseling, physical examinations; or birth control devices, supplies or surgeries. 10. Hyperactive disorders of children. 11. Immunizations with the exception of pneumonia or influenza vaccinations. 12. Medical Care for eligible veterans. 13. Medical examinations or evaluations not related to specific complaints of illness including examinations for sports, employment and health screening. 14. Out-of-State care without prior authorization. 15. Over the counter items. 16. Pre natal services. 17. Preventative/Routine Services. 18. Private Physicians and/or Professional Fees. 19. Psychiatric care including sedative, hypnotic, psychotropic medications or other psychiatric medications; and inpatient or outpatient psychotherapy. 20. Tests or treatment for sexually transmitted diseases provided by the Washoe County Health Department. Emergency Medicaid Requirement Section 9406 of P.L. 99-509 authorizes Medicaid in emergency situations to non-citizens. Emergency Medicaid only coverage is for non-citizens who meet eligibility requirements for Temporary Assistance for Needy Families or Medicaid with the exception of citizenship status. The Health Care Assistance Program will not pay emergency room visits for persons who could be eligible for Emergency Medicaid. Ambulance transports or inpatient hospital admissions require proof of denial from Emergency Medicaid for non-emergent service prior to HCAP payment. The Health Care Assistance Program will not pay for outpatient dialysis for individuals with End Stage Renal Disease who could be eligible for Emergency Medicaid for citizens or non-citizens. 3 of 13 Effective 9/1/13 DEFINITIONS Ambulance: Professional ground or air ambulance service: (1) when necessary to transport a Covered Person from the place where he/she is injured or stricken by a Sickness to the nearest Hospital where treatment can be given, (2) from Nevada Adult Mental Health Services facility to nearest Hospital where treatment can be given (3) from incarceration facility to nearest Hospital where treatment can be given. Ambulatory Surgical Center (Same Day Surgery): Any public or private establishment which complies with all licensing and other legal requirements and is operating lawfully in the jurisdiction where it is located; has an organized medical staff of Physicians, with permanent facilities that are equipped and operated primarily for the purpose of performing surgical procedures; provides continuous Physician services and registered professional nursing services whenever a patient is in the facility; and does not provide services or other accommodations for patients to stay overnight. Cardiac Rehab: A monitored exercise program directed at restoring both physiological and psychological wellbeing to individuals with heart disease and only for patients who have one of the following: documented diagnosis of acute myocardial infarction within the preceding 12 months had coronary bypass surgery have stable angina pectoris had heart valve repair/replacement had percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting had a heart or heart-lung transplant Note: Phase I and II are considered medically necessary. Phase I refers to inpatient cardiac rehabilitation services. Phase II, cardiac rehabilitation, is a comprehensive, long-term program including medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. Phase II refers to outpatient, medicallysupervised programs that are typically initiated one to three weeks after hospital discharge and provide appropriate electrocardiographic monitoring. Phase III refers to maintenance programs without physician supervision and monitoring and does not meet criteria for coverage. Chemotherapy/Radiation Therapy: Services performed in hospital setting only. Supplies related to the administration of chemical agents in the treatment or control of a sickness. Covered Recipient: In accordance with federal and state regulations, eligibility of the individual is dependent upon the approval of the Washoe County Social Services Health Care Assistance Program. The following is a list of CDS benefit plans and benefit codes: Plan/Benefit Code MEDA/WA- Approved for services and reimbursement under the Washoe County Social Services Health Care Assistance Program (HCAP) MEDP/WP-Approved for services under HCAP, but denied for reimbursement due to pending Medicaid MEXA/XA-Approved for services and reimbursement under HCAP for a specific, identified service and timeframe MEXP/XP-Approved for service under HCAP for a specific, identified service and timeframe, but denied for reimbursement due to pending Medicaid MEEM/WM-Approved for service and reimbursement under HCAP for services other than Emergency Medicaid MEDD/WD-Denied for services and reimbursement under HCAP due to Medicaid eligibility. NOCOV/XX-No coverage under HCAP, Medicaid, or other Government Entity Covered Provider: Any practitioner of the healing arts who: is licensed and regulated by a state or federal agency and is acting within the scope of his or her license; or in the absence of licensing requirements, is certified by the appropriate regulatory agency or professional association; 4 of 13 Effective 9/1/13 DEFINITIONS, continued including, but not limited to a/an: Certified Registered Nurse Anesthetist (CRNA) Licensed Practical Nurse (LPN) Occupational Therapist (OTR) Physical Therapist (PT or RPT) Registered Nurse (RN) Respiratory Therapist Speech Pathologist A "Covered Provider" will also include the following when appropriately-licensed and providing services which are covered by the Plan: facilities as are defined herein including, but not limited to, Hospitals, Ambulatory Surgical Facilities, hemodialysis and Outpatient clinics under the direction of a Physician (MD); ambulance companies. Dialysis: Covered under Emergency Medicaid for individuals with End Stage Renal Disease. Diabetic Shoes: Diabetic shoes, fitting, and Modification (HCPC A5500 – A5507, A5512 – A5513) Durable Medical Equipment: Rental of durable medical equipment (but not to exceed the fair market purchase price) or purchase of such equipment where only purchase is permitted or where purchase is more cost-effective due to a long-term need for the equipment. Such equipment must be prescribed by a Physician and required for therapeutic use in treatment of an active Sickness or Accidental Injury. The decision to rent or purchase equipment shall be at the discretion of Washoe County Social Services. Excess charges for deluxe equipment or devices will not be covered. Repair of purchased equipment will be covered when necessary to maintain its usability. Replacement of durable medical equipment will be covered only if: (1) needed due to a change in the patient’s physical condition, or (2), it is likely to cost less to buy a replacement than to repair existing equipment or rent like equipment. Durable Medical equipment includes, but it not limited to oxygen, nebulizers, and concentrators. Emergency Room Care: “Emergency medical condition” or “emergency” is defined as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a lay person, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: Serious jeopardy to the health of the individual or, the case of a pregnant woman, the health of the woman or her unborn child, Serious impairment to bodily functions; or Serious dysfunction of any bodily organ or part. Home Health Care: Services provided by a Registered Nurse, Speech Therapist , Occupational Therapist or Physical Therapist Services and supplies which are furnished to an eligible Person who is confined at home and is under the active medical supervision of the Physician ordering home health care and who is treating the condition for which that care is needed. Home health care services and supplies must be consistent with the patient’s health condition, degree of disability and medical needs. Home health care services and/or supplies must be provided and billed by a Home Health Care Agency. Covered home health care services and supplies include: Services of physical, occupational and speech therapists; Necessary medical supplies provided by the Home Health Care Agency. Services of a registered nurse (RN) 5 of 13 Effective 9/1/13 DEFINITIONS, continued Hospice Care Services: Nursing services, physician services, and drugs and biologicals must be routinely available on a 24-hour basis; all other covered services must be available on a 24-hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for the palliation and management of terminal illness and related conditions and provide these services in a manner consistent with accepted standards of practice. Bereavement counseling must be provided. The following services are included in the hospice reimbursement when consistent with the plan of care. The services must be provided in accordance with recognized professional standards of practice. a. Nursing Services b. Medical Social Services c. Physician Services d. Counseling Services e. Medical Appliances, Supplies and Pharmaceutical f. Home Health Aide, Personal Care Aide and Homemaker Services g. Physical Therapy, Occupational Therapy, Respiratory Therapy and Speech-Language Pathology Services Level of Care (LOC) a. Routine Home Care b. Continuous Home Care c. Inpatient Care (Respite or General): Hyperbaric Oxygen Therapy (HBOT): Therapy in which a recipient breathes 100% oxygen intermittently while the pressure of the treatment chamber is increased to a point higher than sea level pressure (i.e.,>1 atm abs.). Breathing 100% oxygen at 1 atm of pressure or exposing isolated parts of the body does not constitute HBOT; the recipient must receive the oxygen by inhalation within a pressurized chamber. Mammogram: Diagnostic mammograms for men and women are not restricted to age. Women over the age of 40 and who possess a valid social security number must provide proof of denial for services from Access to Healthcare Network (AHN). Programs available through AHN include Women’s Health Connection (WHC) and the Medicaid Breast and Cervical Program. Medical Supplies: Medical supplies such as ostomy, catheter, wound, surgical dressings, and related supplies. Occupational Therapy: Short-term active, progressive Occupational Therapy performed by a licensed or duly qualified therapist as ordered by a Physician. Services that are restorative in nature and designed to significantly improve, develop or restore physical functions lost or impaired as a result of a disease, or injury and only if there is a reasonable expectation that occupational therapy will achieve measurable improvement in the patient’s condition in a reasonable and predictable amount of time. Over-the-Counter Items: Supplies that can be obtained without a Physician’s prescription are not covered. Physical Therapy: Short-term active, progressive Physical Therapy performed by a licensed or duly qualified therapist as ordered by a Physician. Services that are related to an injury, illness, or disease and the diagnosis are consistent with physical therapy treatment. There must be reasonable expectation that the services will produce significant improvement in the patient’s condition. Documentation, when requested, must support physical therapy services that contain progress reports, a diagnosis to support the level of care provided, medical necessity of the care provided, the patient’s progress toward meeting the goals of the therapy and the results achieved during the physical therapy services. Prescription Drugs: Drugs and medicines which are dispensed and administered to a Covered Person. Coverage for pharmacy purchases is provided through Catalyst RX. See the Prescription Drugs section for additional information. 6 of 13 Effective 9/1/13 DEFINITIONS, continued Radiology Services: Services that are considered to be reasonable and necessary for the diagnosis and treatment of a specific illness, symptom, complaint, or injury or to improve the functioning of a malformed body part. Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), Magnetic Resonance Spectroscopy (MRS), or Positron Emission Tomography (PET) scans. Always use other modalities or less expensive tests such as CT, Ultrasound,or standard X-ray, etc., when they will achieve the required results. Rehabilitation Inpatient Facility: Inpatient hospital services are services ordinarily furnished in a hospital for the care and treatment of an inpatient under the direction of a physician. Sleep Studies, Polysomnography, multiple sleep latency test (MSLT)-Medically necessary testing in a certified sleep disorder clinic. These facilities in which certain conditions are diagnosed through the study of sleep are either affiliated with a hospital or are under the direction and control of physicians. Coverage will be based upon the following: a licensed physician or other licensed professionals working within the scope of their practice must request the appropriate test. the need for diagnostic testing is confirmed by medical evidence, e.g., patient history, physician examination and other laboratory type tests. diagnostic testing that is duplicative of previous testing done by the attending physician to the extent the results are still pertinent is not covered. diagnostic Testing Facilities for Sleep Disorders may be covered even in the absence of direct supervision by a physician, however, a trained qualified attendant must be present to assess and monitor the patient. A licensed physician must review and sign reports. Diagnostic testing is covered only if the recipient has symptoms or complaints of one of the conditions: Morbid obesity Pickwickian Syndrome Cataplexy and narcolepsy Various Insomnia’s Obstructive Sleep Apnea (OSA) requires documentation of at least 30 episodes of apnea, each lasting a minimum of 10 seconds, and hypopnea with oxygen saturation levels below 85% during 6-7 hours of recorded sleep. Polysomnography is distinguished from sleep studies by the inclusion of sleep staging. The following are included: EEG; Electro-oculography (EOG); and EMG Additional parameters of sleep which may be monitored include: EKG; Airflow; Ventilation and respiratory effort; Gas exchange by oximetry, transcutaneour monitoring, or end tidal gas analysis; Extremity muscle activity, motor activity-movement; Extended EEG monitoring; Penile tumescence; Gastro esophageal reflux; Continuous blood pressure monitoring; Snoring; and Body positions, etc. 7 of 13 Effective 9/1/13 DEFINITIONS, continued For a study to be reported as a polysomnogram, sleep must be recorded and staged. Adult testing includes a half night with continuous positive airway pressure (CPAP). Testing for children (0-12) must be reviewed and scored by physician to determine need for follow-up with CPAP. Prior authorization may be included for this age group in the initial authorization. Multiple Sleep Latency studies are covered only if the symptoms or complaints suggest a diagnosis for Narcolepsy. Speech Therapy: Short-term active, progressive Speech Therapy performed by a licensed or duly qualified therapist as ordered by a Physician. Speech Therapy to restore speech to a person who has lost existing speech function as a result of disease, injury or surgery, such as seizure disorder, CVA or stroke, otitis media, brain injury, hearing loss, Parkinson’s disease and paralysis of the vocal cord or larynx, carcinoma of the larynx, trachea, pharynx, lip, head, neck, and dysphasia. NOTE: Speech Therapy is not covered for non-organic/functional speech and language disorders such as lisping, stuttering and stammering, or speech and language problems that result from non-curable developmental disorders such as, developmental delay, mental retardation, Down’s Syndrome. Maintenance therapy is not covered. Maintenance therapy begins when the therapeutic goals of a treatment plan have been met and no further functional progress is expected. Substance Abuse Treatment:Substance abuse treatment (methadone and suboxone opioid therapy) as approved by the Washoe County Department of Social Services Health Care Assistance Program. Services include oral medication, evaluation and management, lab drug and TB tests, and diagnostic psychiatric evaluation. Wound Therapy: Restore or ameliorate functional limitations that are the result of an illness or injury which can respond or improve as a result of the prescribed therapy treatment plan in a reasonable, predictable period of time. It must be rendered according to the written orders of the physician, physician’s assistant or an advanced practitioner of nursing (APN) and be directly related to the active treatment regimen designed by the therapist and approved by the professional who wrote the order. PRESCRIPTION DRUG PROGRAM The Prescription Drug Program is provided through a separate agreement with Catamaran Rx, a Pharmacy Benefit Manager (PBM). Catamaran RX administers Point of Service (POS) claims This section provides a summary of the prescription drug coverage through Catamaran Rx. Catamaran Rx (888) 869-4600 www.catalystrx.com There is a 30 day supply limit on prescriptions. Currently the rules for refills at the Renown Health Care Clinic (HCC) Pharmacy are: 1. If the refill is within the thirty (30) days of the last dispensing date, there is a two (2) day rule for a controlled substance (i.e. the 30 day limit is on a Sunday the client may refill on the Friday before or 2 days early) 2. Five (5) days for a non-controlled substance (i.e. the 30 day limit is on a Sunday, so the script would not be eligible for refill until Wednesday of the following week). 3. The date of the refill reverts to the dispensing date or the clock starts ticking on the refill date for the next 30 days. Claims must be billed within six (6) months from the date of service (dispensing) or ninety (90) days from the authorization date. To obtain updated information regarding the Formulary list, covered and non covered drugs, and helpful information on generic equivalent drugs, contact Catamaran RX Customer Service at (888) 869-4600. 8 of 13 Effective 9/1/13 .ELIGIBILITY Washoe County Department of Social Services Health Care Assistance Program (HCAP) determines recipient eligibility. Eligibility is determined on a month to month basis. Providers must always verify recipient eligibility prior to providing services. VERIFYING ELIGIBILITY Eligible Recipients will be identified by the following benefit plan and benefit codes: Plan/Benefit Code MEDA/WA- Approved for services and reimbursement under the Washoe County Social Services Health Care Assistance Program (HCAP) MEDP/WP-Approved for services under HCAP, but denied for reimbursement due to pending Medicaid MEXA/XA-Approved for services and reimbursement under HCAP for a specific, identified service and timeframe MEXP/XP-Approved for service under HCAP for a specific, identified service and timeframe, but denied for reimbursement due to pending Medicaid MEEM/WM-Approved for service and reimbursement under HCAP for services other than Emergency Medicaid MEDD/WD-Denied for services and reimbursement under HCAP due to Medicaid eligibility. NOCOV/XX-No coverage under HCAP, Medicaid, or other Government Entity It is important to verify a recipient’s eligibility before providing services. Eligibility can be verified through the CDS web portal at https://secure.cdsgrouphealth.com/. You may log on 24 hours a day, 7 days a week using any Internet-ready computer. To obtain access, new users must register on the Provider Web Portal at https://secure.cdsgrouphealth.com/. CDS will verify you are authorized for access. Once this is complete, you will be notified via mail or email with your password to begin using the system. For questions or assistance, contact CDS’ Customer Service Department at (775) 352-6900 or (800) 455-4236 Monday thru Friday 8:00 am to 5:00 pm Pacific Standard Time. Or by email at [email protected] PRIOR AUTHORIZATIONS Prior Authorization is required for most services. For a list of services refer to the Prior Authorization Requirements section. For prior authorization questions, forms, or requirements, contact: CDS Group Health Customer Service Department (775) 352-6900 or (800) 455-4236 Ways to request prior authorization Paper Requests: Services can be requested by obtaining the Prior Authorization Request form, which can be found on the CDS website @ www.cdsgrouphealth.com under the ‘Member/Provider’ section. Requests may be faxed or mailed and must include documentation supporting medical necessity. The prior authorization fax number for all services is: (775) 352-6992. 9 of 13 Effective 9/1/13 PRIOR AUTHORIZATIONS, continued The mailing address is: CDS Group Health PO Box 50190 Sparks, NV 89435-0190 Attn: Medical Management Prior Authorization Turnaround Time Requirements: Pre Service Urgent – 72 hours Non Urgent–15 Calendar Days Post Service 30 Calendar Days Review / Notification completion times from receipt of request Incomplete Requests: If additional information is necessary to make a determination notification will be sent by fax. You have five (5) business days to submit the requested information or the request will be denied for insufficient information. Requests for Modification: All requests to modify a previously approved request must be submitted in writing (e.g. CPT code, date of service, number of units). Any modifications must be approved before the scheduled service date. Approved Requests: When a request has been approved, CDS Medical Management department will provide written confirmation, sent via fax to the provider(s). Approved requests are assigned an 11-digit authorization number, CPT/HCPCS code, and a service date range. Approved requests are only valid for specific service(s), and date(s) shown. CLAIMS AND APPEALS PROCEDURES Filing a Claim: Claims may be submitted electronically to CDS Group Health for processing by utilizing: Payer ID Number: 88022 Timely Filing: Claims must be received within one hundred eighty (180) days from the date of service(s) or ninety (90) days from the date of Medicaid eligibility denial. Inaccurate, Illegible or Incomplete Claims: If a claim is denied or returned (e.g., illegible or incomplete claims), you are not given an additional 180 or 90 days to resubmit. Timely filing is always based on date of service or date of eligibility denial. Claim Appeals: Providers have the right to appeal an adverse determination. Appeals must be post marked no later than thirty (30) calendar days from the date of the original decision. If the appeal is rejected for incomplete information, there is no extension to the original 30 calendar days. How to File: All appeals must be submitted in writing and include the following information: • • • • • • • • A cover letter or statement indicating the reason for the appeal Reason for the appeal Provider name and Tax ID # Recipient name and ID # Date(s) of service Procedure code(s) Contact Information for the individual filing the appeal Documentation to support the issue, e.g., prior authorization, physician’s notes, ER reports 10 of 13 Effective 9/1/13 • A copy of the original Explanation of Benefits (EOB) showing the denial CLAIMS AND APPEALS PROCEDURES, continued Mailing Address: CDS Group Health Attention: Appeals P.O. Box 50190 Sparks, NV 89435-0190 Or Via Fax: (775) 352-7266 Determination: CDS Group Health will render a decision within sixty (60) days of receipt of the appeal and will notify, in writing, of the findings. Washoe County Social Services Health Care Assistance Program has one (1) level of Appeal. HIPAA The HIPAA Privacy Rule (Standards for Privacy of Individually Identifiable Health Information) (3) provides the first national standards for protecting the privacy of health information. The Privacy Rule regulates how certain entities, called covered entities, use and disclose certain individually identifiable health information, called protected health information (PHI). PHI is individually identifiable health information that is transmitted or maintained in any form or medium (e.g., electronic, paper, or oral), but excludes certain educational records and employment records Protected Health Information The Privacy Rule protects certain information that covered entities use and disclose. This information is called protected health information (PHI), which is generally individually identifiable health information that is transmitted by, or maintained in, electronic media or any other form or medium. This information must relate to 1) the past, present, or future physical or mental health, or condition of an individual; 2) provision of health care to an individual; or 3) payment for the provision of health care to an individual. If the information identifies or provides a reasonable basis to believe it can be used to identify an individual, it is considered individually identifiable health information. 11 of 13 Effective 9/1/13 Addendum A PROVIDER LIST FOR WASHOE COUNTY SOCIAL SERVICES HEALTH CARE ASSISTANCE PROGRAM TAX ID # 88-0213754 Renown Regional Medical Center 850 Harvard Way N12 Reno NV 89502 TAX ID # 59-2852900 & 59-3493196 Lincare PO Box 22950 Tucson AZ 85734 TAX ID # 45-4989022 Prime Health (aka: Saint Mary's Regional) 235 West 6th Street Reno NV 89503-4548 TAX ID # 88-0200884 Washoe Sleep Disorder Center 75 Pringle Way Ste 701 Reno NV 89502-1472 TAX ID # 23-2537015 Northern Nevada Medical Center 2375 E Prater Way Sparks NV 89434 TAX ID # 86-0898663 Preferred Home Care PO Box 40700 Mesa AZ 85274-0700 TAX ID # 46-0517825 Renown South Meadows 10101 Double R Blvd Reno NV 89521 TAX ID # 88-0213754 Renown Home Care 780 Kuenzli Ste 200 Reno NV 89502 TAX ID # 94-3325112 Accellence Home Medical 35 North Edison Way #37 Reno NV 89502 TAX ID # 45-4989022 Saint Mary’s Home Care Services 18653 Wedge Parkway Reno NV 89511 TAX ID # 90-0197492 Better Breathing-Nevada, LLC 434 South Rock Blvd Sparks NV 89431 TAX ID # 45-4717291 Ability Prosthetics & Orthotics 309 Kirman Ave Ste A Reno NV 89502 TAX ID # 74-2152396 KCI USA Inc PO Box 203084 Houston TX 77216-3084 TAX ID # 88-0175774 Remsa 450 Edison Way Reno NV 89502 TAX ID # 88-0254192 Acadian Rehab Inc 175 South Park St Reno NV 89502 TAX ID # 88-0113741 Reno Radiological Associates PO Box 39000 Dept 34548 San Francisco CA 94139 TAX ID # 26-3558729 Davita (Sparks Dialysis, So Meadows Dialysis, Reno Dialysis, Sierra Rose Dialysis) PO Box 8500-8326 Philadelphia, PA 19178-8326 TAX ID # 88-0113741 Renown Vista 910 Vista Blvd Sparks NV 89502 775-982-5585 12 of 13 Effective 9/1/13 TAX ID # 26-1565558 Millenium Laboratories, Inc 16981 Via Tazon San Diego, CA 92127 TAX ID # 65-0127483 DVA Laboratory Services PO Box 281226 Atlanta, GA 30384-1226 TAX ID # 59-3205549 Total Renal Laboratories Lock Box 100244 Atlanta, GA 30384-0244 TAX ID # 94-6004062-001 Incline Village Community Hospital PO Box 60901 Truckee, CA 96160-9001 TAX ID # 86-0808230 Vista Care Hospice a Gentiva Co. PO Box 847949 Dallas, TX 75284 TAX ID # 95-2667855 Hanger Prosthetics & Orthotics 961 Matley Lane Reno, NV 89502-2100 TAX ID #88-0291454 Continuum Rehab Agency 3700 Grant Drive Reno, NV 89509 TAX ID # 88-0402361 Life Change Center 1755 Sullivan Lane Sparks, NV 89431 13 of 13 Effective 9/1/13