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IDD Update
June 16, 2011

Office of Developmental Programs (ODP) Informational Memo #074-11: Fiscal Year 2011-12 Updates to Consolidated and Person Family/Directed Support Waiver and Base Services is available.  These 2011/12 proposed rates and fees in HCSIS should be used to process claims submitted to PROMISe for services provided beginning July 1 until a notice announcing final rates is published.

 Changes to Medical Assistane (MA) Fee Schedule effective July 1:

  • Supports Coordination Organizations (SCOs) moved to state-set rates,
  • Non-residential Services and Respite Services moved to the MA fee schedule,
  • Respite camp remains a vendor service, and
  • New to the MA fee schedule are Home and Community Habilitation Unlicensed, Licensed Day Habilitation (Adult Training), Prevocational Services, Supported Employment, Transitional Work, and Respite Services.

All services placed on MA fee schedule in 2010/11 remain.

Cost-based services to continue include:

  • Transportation per diem and trip,
  • Residential eligible services, and
  • Residential eligible outlier review process.

Residential vacancy policy of therapeutic leave and medical will continue. ODP will not incorporate an occupancy factor in residential rates effective July 1.

The Department of Public Welfare will request hat the Centers for Medicare and Medicaid Services approve Revenue Reconciliation for residential eligible services through June 30, 2012.

Prudent pay is effective July 1. Previously, ODP has an exemption from prudent pay to allow providers to be paid sooner. ODP has just released Informational Packet #075-11: Prudent Payment of Claims Policy Enforced Effective July 1, 2011. All ODP waiver services will be subject to Prudent Payment Claims detailed on Medical Assistance Bulletin #99-06-04. Detail is provided regarding the Prudent Payment system and timelines before provider payment is issued. The payment cycle is approximately 25-31 calendar days from the provider’s claim submission date. Questions may be directed to the ODP Claims Resolution Section at ra-odpclaimsres@state.pa.us or 866-386-8880.

Please send issues/concerns regarding these changes to Linda Drummond (linda@paproviders.org).

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