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Modified Enhanced Reimbursement for Center-Based Services

Since July of this year, county boards of developmental disabilities have funded the state match needed to support the Acuity C rate for all center-based Adult Day Support (ADS) and Vocational Habilitation (VH) services.  This reimbursement level will remain in place for services delivered through December 31, 2020.

Services delivered on or after January 1, 2021, will be reimbursed at the Acuity B rate for all center-based ADS/VH services for people whose acuity group assignment is A, A-1, or B.  Reimbursement for people whose acuity group assignment is C will be at Acuity C rates.  Providers are asked to continue to utilize the Restart billing codes for people whose Acuity group assignment is A-1, A, or B.  Traditional ADS/VH billing codes are to be utilized for people whose Acuity group assignment is C.

In this critical time, everyone will be required to work collaboratively, operate differently, and be proactive to limit the spread of COVID-19.

It is important for people to engage in the activities they choose, with the services they need in the safest way possible. Given the higher rate of COVID-19 transmission and the likelihood of complications for people with developmental disabilities, DODD is asking teams to work closely with people with developmental disabilities and their families to determine the safest way to deliver adult day or employment services.

Through the person-centered team process, the team should consider, at any time in the process, alternative ADS, VH, or ICF Day Program options, including virtual or in-home services, as facility-based services may not be the wish of every person or the desire of every team.

Current flexibilities that exist for providers:

  • ADS/VH can be provided in a person’s home, virtually, or on behalf of when determined appropriate through the person-centered planning process.
  • Personnel flexibility
    • ADS/VH providers may provide Homemaker/Personal Care (HPC) and Residential Respite.
      • Subcontracting with residential providers; or
      • Expediting adding these services to their provider certification
    • Onboarding DSPs
    • Sharing of direct support professionals (DSP) across agencies
    • Subcontracting with DSPs certified as independent providers of HPC
  • Reimbursement:
    • STEP billing code
    • Restart billing code

Information, examples, and details of the above flexibilities can be found on the DODD COVID-19 Adult Day Guidance page or contact the DODD Statewide Support Team for any needed technical assistance.