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Guidance: DODD Billing Concessions

In an effort to ensure service authorization and billing requirements are not undue barriers to service delivery and provider reimbursement throughout the coronavirus (COVID-19) state of emergency, the Ohio Department of Developmental Disabilities (DODD) is making the following changes to its processes for services delivered on or after March 12, 2020: 

  • Services authorized through electronic means (by telephone, email, etc.) will be reimbursed without being reflected in DODD’s Payment Authorization for Waiver Services (PAWS) system. County board of developmental disabilities should document the authorization locally through TCM case notes when possible, or by any other means available.  

  • An approved prior authorization (PA) will not be required for services that exceed the Ohio Developmental Disabilities Profile (ODDP) funding range for people enrolled in the Individual Options (IO) Waiver.

  • DODD’s Medicaid Services System (MSS) will not prevent the submission of claims that exceed the three percent (3%) limitation within the Monthly Rate Calculator (MRC).

  • Homemaker/Personal Care (HPC) services will be permitted to be delivered and reimbursed on the same day as Ohio Shared Living, if needed and authorized by the person’s individual service plan (ISP) team. 

  • Services for Level One Waiver enrollees will be reimbursed up to the total available funding within the waiver, which includes the current amount available for non-adult day array services ($6,750), plus the amounts currently available for adult day array services and Non-Medical Transportation.  

  • The $8,520 Emergency Services Benefit for the Level One Waiver will continue to be available, in addition to the funding reference in the previous bullet. 

  • The individual cost caps for the Self-Empowered Life Funding (SELF) Waiver are not being changed, but if enrollees have a need for services that exceed the established cost caps for children or for adults, county boards are being asked to identify ways to meet the specific needs. 

  • Independent providers are permitted to exceed the 60-hour ceiling per week for providing services, if necessary, to maintain the health and safety of the people receiving supports, if needed and authorized by the person's ISP team. 

Please direct any questions regarding reimbursement for services to the DODD Support Hotline at 1-800-617-6733, option 2. 

It is likely that the expanded need for services in smaller groups and in residential settings will increase the cost of waiver services during the state of emergency. DODD acknowledges that the financial commitment to support the required state matching funds obligation for waiver services is shared between the department and county boards. As such, expenditures during this period will be closely monitored, and DODD will fully honor its financial partnership with county boards. As more information becomes available regarding the specific details of the various emergency funds that might be utilized to support services, DODD will collaborate with county boards about how to best access and allocate any available funding.