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Guidance: Reimbursement to Adult Day Support and Vocational Habilitation Providers

Thanks to the innovative thinking displayed by providers throughout the COVID-19 pandemic, there have been many ways people with developmental disabilities can access the services they need in Ohio. ADS and VH providers currently have three main options for the delivery and reimbursement of services;

  • non-facility-based ADS and VH services, which are being referred to as a Start Toward Emerging Possibilities, or STEP service delivery model,
  • facility-based ADS and VH services, and
  • Homemaker/Personal Care (HPC) services.

Providers cannot be reimbursed for STEP and facility-based ADS and VH services on the same day for the same person. However, providers may be reimbursed for HPC and STEP or facility-based ADS and VH on the same day for the same person.

STEP service delivery model

Through STEP which became available May 11, 2020, ADS and VH services can be reimbursed if delivered virtually or in the individual’s home, or a community setting (outside of a facility). ADS and VH services delivered in this manner are currently approved by the Centers for Medicare and Medicaid Services (CMS) through January 26, 2021. These ADS and VH services must have clearly defined outcomes for each person and be authorized through the person-centered team planning process.

STEP limits group size to four (4) or fewer people and does not permit services being delivered in a facility-based ADS or VH site for any part of the day. If STEP is utilized, the reimbursement rate is based on the service rates for Acuity Group C, and services are billed in 15-minute units.

Facility-based ADS and VH Services

ADS and VH services delivered in facility-based day programs are reimbursed through the existing ADS and VH rate structure, which utilizes the Acuity Group assignment for each person to determine the appropriate reimbursement rate. The duration of the service determines if the services are billed in fifteen-minute units or as a daily unit.

This approach includes any ADS and VH services that involve the person receiving services in an ADS or VH site as part of the service delivery day, even when the service delivery day includes various types of community activities.

Homemaker/Personal Care Services

If a person needs HPC services, they should choose from available, certified HPC providers. If no certified HPC providers are available to deliver the services due to the COVID-19 crisis, ADS and VH providers who are not certified to deliver HPC services may deliver and be reimbursed for services that would traditionally be categorized as HPC.

As these services are HPC, they cannot be reimbursed through the STEP model. These services are reimbursed through the existing ADS and VH rate structure, which utilizes the Acuity Group assignment for each person to determine the appropriate reimbursement rate. The duration of the service determines if the services are billed in fifteen-minute units or a daily rate. During the current state of emergency, this option may be utilized until the ADS and/or VH provider becomes certified to deliver HPC services or until a certified HPC provider can be obtained.

Providers currently certified in only ADS and/or VH are encouraged to apply to become certified to deliver HPC services to access the HPC rates for their delivery of HPC services.