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Waiver Reimbursement System Modernization – Bidders Library

Information on this page has been organized to provide additional information that may be useful in relation to the Ohio Department of Developmental Disabilities’ Request for Proposals (RFP) related to the modernization of its waiver reimbursement system.  There are links to information related to current assessments, cost projection and service authorization tools, rate models, and other topics referenced in the RFP.

Assessments:

Acuity Assessment Instrument (AAI) is used to determine staff needed to support a person participating in Adult Day Supports, Vocational Habilitation, Group Employment Support, Individual Employment Supports, and Career Planning services.  The Ohio Developmental Disabilities Profile (ODDP) is used to determine the funding range available to support a person not only in their home but to access his/her community.

MSS/MRC:

The Medicaid Services System (MSS) is the application used by the local county boards of developmental disabilities to enter a person’s waiver services being authorized during the course of that waiver year.  MSS calculated the total costs of all waiver services entered based on the current rate of reimbursement for each waiver service.  The final step in the MSS application is the enrollment of the Payment Authorization of Waiver services (PAWS) which allows claims to be paid for providers when they submit their claims through the department’s online billing application (e.g., eMBS).  The Monthly Rate Calculator (MRC) generates a Daily Billing Unit (DBU) reimbursement for those persons living in congregate sites sharing staff. 

Rate Structure:

Each waiver service has specific factors that are used to determine the rate of reimbursement (e.g., rate structure) for that service. 

County Board Match:

The department reimburses claims submitted by authorized providers at 100% of the original claim.  The department then bills each county board of developmental disabilities quarterly for their apportionment of the total reimbursement payments (e.g., Match).

Rules:

Each waiver service’s scope, provider qualifications, requirements for service delivery, documentation of services, payment standards, and rates are capture in that service’s rule.

Appendix  - Billing unit, service codes, and payment rates for remote support

Blueprint Group ADWS:  

The Blueprint Group for Adult Day Waiver Services (ADWS) generated a report with recommendations on December 31, 2020, that advised the Ohio Department of Developmental Disabilities on implementation strategies to improve adult day support services and competitive, integrated employment outcomes.