The Medicaid Services System (MSS), including the Cost Projection Tool (CPT)

The Medicaid Services System (MSS) is a comprehensive system that integrates cost projection, prior authorization, daily rate calculation and payment authorization of Individual Options (IO) and Level One (L1) waiver services. MSS was developed to be a user-friendly system, achieve efficiencies, and ensure compliance in the waiver cost projection and authorization process. MSS houses the following DODD applications related to cost projection and authorization of IO and L1 waiver services:

Service Rates and Codes (SRC)

SRC is an application internal to DODD that contains the rates and services codes for every IO and L1 waiver service. The Cost Projection Tool (CPT) interfaces with SRC to obtain rates and service codes for the purpose of cost calculations. 

Cost Projection Tool (CPT) 

The CPT is a single, common application for cost projection to be used by all County Boards of Developmental Disabilities (County Boards) and providers. It provides a core DODD system to integrate other Department applications. CPT improves data flow, integrity, and streamlines the payment authorization process. County Boards are required to use CPT to project costs for individuals with an IO or L1 waiver at initial enrollment, and redetermination. Paragraph I of OAC 5123:2-9-06 describes CPT implementation.

Prior Authorization (PA)

The Prior Authorization application was developed to interface with CPT, and creates an electronic request and budget using the costs generated in CPT. The request is transmitted to DODD through the PA application. Users can view the status of prior authorization requests that they have submitted. 

Daily Rate Application (DRA)

DRA is an application that apportions Homemaker/Personal Care (HPC) service costs of IO waiver enrollees living in shared settings, to calculate the appropriate level of reimbursement associated with HPC Daily Billing Units (DBUs). The DRA obtains site costs directly from an interface with CPT.

Who to Contact for More Information:
Email System Innovation and Technical Assistance at Dailyrate-Support@list.dodd.ohio.gov for program related questions
Email Information Technology at DRA-Support@list.dodd.ohio.gov for technical questions

Services Payment Authorization (SPA)

SPA is the area within MSS that replaces the former Payment Authorization for Waiver Services (PAWS) application. SPA directly interfaces with CPT and is the location where Counties recommend authorization for the costs of services projected in CPT. Projected costs must be authorized in SPA before they flow to the DRA.

The Medicaid Services System Flow Chart

Graphically displays the Medicaid Services System and all of its interfaces: MSS Flow Chart

Other MSS Resources

MSS Support Center 1-800-617-6733, select option #2

Additional Information regarding Medicaid Services

General Information about Ohio's Medicaid Services

Information about Money Follows the Person, also known as Helping Ohioans Move, or HOME Choice): 

Information for Medicaid Managed Care:

Medicaid Managed Care Weekly

Consumer's Guide to Choosing a Medicaid Managed Care Plan (MCP) 

Managed Care Regional Map 

Services Available Under CORE and CORE Plus

 

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