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Mar 19
Add-On Incentivizes Training, Longevity

This is a guidance memo from the Ohio Department of Developmental Disabilities. To print this memo, select "CTRL" and "P" on your keyboard.

*Updated Mar. 16, 2018

On July 1, 2018, the Ohio Department of Developmental Disabilities will begin offering an incentive for experienced direct care staff who have also completed approved training, pending Centers for Medicare and Medicaid Services (CMS) approval.

The initiative is a response to the needs voiced by stakeholders to address a shortage of direct service providers felt across the state. The requirements for receiving the additional reimbursement were designed to have minimal administrative impact while empowering direct service providers to advance professional goals.

Upon CMS approval, independent providers and agency direct support staff interested in obtaining the add-on rate must meet all of the following conditions in order to be eligible for the proposed add-on rate

  • Two years' full time equivalent experience in providing direct support to people with developmental disabilities; experience may be accumulated over any period of time and include part time hours

  • Completion of 60 hours of applicable training

Training applicable toward 60 hours needed for the add-on

  • Completion of Ohio DS PATHS Certificate of Initial Proficiency or Certificate of Advanced Proficiency, regardless of when it was completed, or

  • 60 training hours of courses accredited by the National Alliance of Direct Support Professionals offered through Relias and/or Direct Course College of Direct Support

Courses must be completed after Jan. 1, 2012, and fall within the past five consecutive calendar years from the date the last course was completed.

Courses that are not applicable toward 60 hours of training for the add-on rate include

  • any courses that were a part of the provider's eight-hour initial direct support provider training,

  • any courses that are taken as to meet annual training requirements,

  • the requirements of rule 5123:2-17-02 (MUI),

  • the rights of individuals set forth in sections 5123.62 to 5123.64,

  • and the role and responsibilities with regard to services, including person-centered planning, community integration, self-determination, and self-advocacy, (5123:2-2-01).

Free courses

DODD has made web-based courses through Direct Course available free of charge.  Independent providers or employees of agencies may create accounts and log in on any device with an internet connection to take courses.

Instructions on creating an account, logging in, and taking the free courses are available at dodd.ohio.gov/training.

Approval for Add-On

Direct service providers will track the hours of applicable training they have completed.

Direct service providers working as employees of a provider agency will provide their employer with certificates as proof of successfully completed training once they have completed 60 hours of applicable training.

  • The employer will review a transcript of completed courses or course certificates and verify two years of work experience, after which the employer can bill for that direct care provider's hours of HPC using a billing code that will reimburse the provider at a higher rate.

  • Agency providers will be required to maintain verification of each direct service provider's related experience and training for whom the add-on is billed.

Once they have completed 60 hours of applicable training, independent providers will be required to submit the forms developed by DODD for verification of experience and training requirements, along with transcripts and/or certificates indicating the number of hours and courses completed.  After DODD reviews the documentation and confirms the requirements have been met, the independent provider will receive notification that he/she is eligible to bill hours of HPC using a billing code that will reimburse at the add-on rate.

No re-certification is required to maintain the add-on rate. Once obtained, the provider remains eligible indefinitely.

Billing the Add-On

The cost of the add-on would not be attributed to the person's ODDP range or waiver budget limitation. County boards will continue to project units of HPC but do not project the number of units to which the add-on will apply.

Providers bill new HPC "Q" codes contained in the appendix to the HPC rule.

Provider will add the $0.39 add-on amount to the input rate of the claim per qualified staff member. When a multi-staff billing code is used, Agency providers enter the number of qualified staff who meet the criteria for the add on in the staff size billing field.

1 Staff

Individual Options Waiver

AQC

Add $0.39 to rate

Level One Waiver

FQC

2 Staff

Individual Options Waiver

AQW

Add $0.39 per qualified staff to rate; and

Enter number of qualified staff in "staff size"

Level One Waiver

FQW

3 Staff

Individual Options Waiver

AQX

Level One Waiver

FQX

4 Staff

Individual Options Waiver

AQY

Level One Waiver

FQY

5 Staff

Individual Options Waiver

AQZ

Level One Waiver

FQZ

 

Examples

Independent provider who is qualified for the add on serving 1 person on the IO waiver in Clark county: the regular HPC rate for independent providers is $4.36/unit. The provider adds $0.39 to the unit input rate and bills AQC at $4.75/unit.

Agency provider has 1 staff who is qualified for the add on serving 1 individual on the IO waiver in Clark county: the regular HPC rate for agency providers is $5.04/unit. The provider adds $0.39 to the unit input rate and bills AQC at $5.43/unit.

Agency provider has 2 staff who are both qualified for the add on serving 4 individuals on the IO waiver in Clark county: the regular HPC rate for 2 staff serving 4 individuals is $10.80/unit. The provider bills AQW at $11.58/unit and the agency enters "2" in the staff size field to indicate that both staff are qualified for the competency add on.

Agency provider has 2 staff serving 4 individuals on the IO waiver in Clark county, 1 staff who is qualified for the add on and 1 staff who is not qualified: the regular HPC rate for 2 staff serving 4 individuals is $10.80/unit. The provider bills AQW at $11.19/unit and the agency enters "1" in the staff size field to indicate that 1 staff is qualified for the competency add on.

(Previous guidance memo regarding add-on available here.)

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