RCPA - Rehabilitation and Community Providers Association


IDD Updates
May 2, 2012

Remember to mark your calendars now for PCPA’s Capitol Day on June 5. The Legislative Press Conference and Rally will begin promptly at 12:00 p.m. More details are available on the web site.

For Supports Coordination Organizations (SCOs): PCPA business member Allen Warshaw, Rhoads & Sinon, has engaged Herbein + Company, Inc. to assist in analyzing the SCO Modeled Rates. Each SCO will receive a request and survey from this firm asking for assistance. They are requesting a seven-day turnaround.  Mr. Warshaw has been working with several SCOs that have filed formal rate appeals with the Bureau of Hearings and Appeals. This survey will assist in determining if the Office of Developmental Programs (ODP) state set fee schedule rates were developed using relevant working parameters and conditions.

For ICF/ID Providers: On April 26 ODP’s Kathy Deans held a conference call to discuss the billing changes to Schedule 12 and 12A for Day Programs. An overview is attached. Members who need a copy of Schedule 12 should contact Linda Drummond.

The Southeast Region ODP held a Risk Management Forum addressing “Practical Approaches for Risk Management When Incident Reports Involve Challenging Behaviors.” Initial notification to Incident reports to HCSIS must be done within 24 hours of the incident. Effective July 1, ODP will reinforce this 24-hour timeline to comply with new provisions in the Centers for Medicare and Medicaid Services waivers that include this as a measurable performance outcome. ODP has also developed “Criteria for Incident Closure,” which is an ODP internal document that will be used to ensure protocols and procedures are followed.

The Department of Public Welfare’s Medicaid Infrastructure Grant (MIG), Works for Me Program, promotes employment for persons with disabilities. Mini grants are available for up to $5,000 for the period July 1 – October 31. Proposals will be accepted until June 15. The grants are open to community agencies, and organizations that serve people with disabilities.

ODP has just released Informational Memo #034-12: Billing Changes Fiscal Year 2012-13. This does not include the new fee-schedule rates but it does provide an overview of changes on billing rules effective July 1, 2012. These include:

  • Vacancy Factor will eliminate billing for medical and therapeutic leave;
  • Vacancy Factor will eliminate permanent vacancy as a discrete billable service;
  • ODP-established fee for Residential Habilitation Ineligible will eliminate requirement to bill room and board charges;
  • Vacancy Factor will change the Licensed Out of Home Respite Services eligible for reimbursement;
  • Procedure code descriptions for Transportation Trip and a new billing rule for Transportation Aide;
  • Procedure code reimbursements for Assistive Technology will have a lifetime limit ($10,000);
  • A list of consolidated waiver procedure codes that will not be eligible for reimbursement after July 1; and
  • A list of P/FDS waiver procedure codes for services that will no longer be included in this waiver.

Implementation of these changes are contingent on CMS’ approval of both waivers and the final 2012/13 budget approved by the General Assembly.
Questions may be directed to ra-odpclaimsres@state.pa.us


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