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Oct 17
Adult Day Waiver Service Changes- Delayed

To:                  DODD County Boards, DODD Waiver Providers

 

From:               Lori Horvath, Deputy Director

 

Date:                October 17, 2016

 

Subject:          Adult Day Waiver Service Changes- Delayed

 

 

DODD received notice that the Centers for Medicare and Medicaid Services (CMS) will be issuing a formal Request for Additional Information (RAI) regarding the proposed changes to the adult day, money management, and SELF waiver servicesAs a result of the formal RAI, the proposed changes will not be effective November 1, 2016 and a new implementation date is pending.

 

Services being delayed include:

 

  • Rate modifications for adult day services, including implementation of the behavior add-on, medical add-on, and the new community integration add-on Availability of Group Employment Supports, Individual Employment Supports, and Career Planning services
  • Availability of Money Management services
  • Budget limitation increases
  • Community inclusion- personal care hour units change to fifteen minute units and removal of service limitations

 

It is important that County Boards stop authorizing the new services (Career Planning, Individual Employment Supports, Group Employment Supports, Money Management, and the Community Integration code attached to Adult Day Support and Vocational Habilitation) until further notice.

 

Since the Career Planning and Money Management services will not be available November 1, 2016, boards must ensure that alternative providers are in place to meet the needs of individuals who expected to receive Career Planning and/or Money ManagementIn addition, boards will need to remove these services from the cost projection tool (CPT) and payment authorization for waiver services (PAWS).

 

It is not necessary for boards to immediately remove Individual Employment Supports or Group Employment Supports from individuals PAWS.  Providers will be able to be paid for employment-related services authorized on the PAWS by submitting claims using the existing Supported Employment Community, Supported Employment – Enclave, and/or Integrated Employment procedure codes.


In addition, no immediate action is required for the behavior, medical or community integration add-ons.  An edit is in place within the Medicaid Billing System that will prevent payment of the add-ons for day services.

 

It is important to note that boards will be required to remove the proposed services from CPT/PAWS and replace them with existing day services whenever making any changes to a persons authorization.  For example, boards will need to remove Individual Employment Supports, Group Employment Supports, or the Community Integration add-on in order to finalize/authorize a CPT/PAWS for dates of service after 11/1/16.

 

PLEASE NOTE: Day service combo code billing will still be eliminated on November 1, 2016. An outline for all changes that will occur November 1, 2016 is below:

 

Elimination of the Adult Day/ Vocational Habilitation Combo codes

 

Through the person-centered planning process, the team will identify the type and amount of each service to be authorized.  For individuals that require a blend of Adult Day Support and Vocational Habilitation, the county board may use either the distinct service codes or use the combo code in the cost projection tool.  Providers must always use the code that reflects the specific service delivered and will no longer bill using the combo code.

 

Effective November 1, 2016 the Adult Day/ Vocational Habilitation Combo codes will no longer be a billable service (AXD, AXF, FXD, FXF, SXD, SXF).  Services must be billed to reflect the specific service provided; either Adult Day or Vocational Habilitation.

 

 

  • The Adult Day daily codes and the Vocational Habilitation daily codes must be used if that service is provided in the period of 5-7 hours (defined day).
  • The service specific fifteen-minute unit code may be used to bill when the individual receives less than 5 or more than 7 hours of the service that day or when Adult Day services and Vocational Habilitation services are delivered on the same day.

 

DODD providers

 

 

Service

 

End dated

billing code

on 10/31/16

 

Active

billing

code after

11/1/16

 

Adult Day/Voc Hab Combo Daily

I/O, LV1, SELF

 

AXD, FXD, SXD

 

 

Adult Day/Voc Hab Combo – 15 Minute

I/O, LV1, SELF

 

AXF, FXF, SXF

 

 

Adult Day Support Daily

I/O, LV1, SELF

 

 

ADS, FDS, SDS

 

Adult Day Support – 15 minute

I/O, LV1, SELF

 

 

ADF, FDF, SDF


 

 

Vocational Habilitation Daily

I/O, LV1, SELF

 

 

AVH, FVH, SVD

 

Vocational Habilitation 15 Minute

I/O, LV1, SELF

 

 

AVF, FVF, SVF

 

 

Provided Through Contract With Providers Certified by the Ohio Department of Aging

 

 

Service

 

NO changes to the below codes

 

Contracted Adult Day SupportDaily

I/O, LV1, SELF

 

AGD, FGD, SGD

 

Contracted Adult Day Support 15 minute

I/O, LV1, SELF

 

AGF, FGF, SGF

 

We plan to use this time for ongoing planning, preparation, and training for the proposed services to better support individuals with intellectual and developmental disabilities and their families in Ohio.

 

If you have questions, please contact the DODD Support Center at 1-800-617-6733. Thank you.


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