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IDD Updates - Week of December 19, 2011
December 19, 2011

December 23
The Office of Developmental Programs (ODP) has just released to the Stakeholder's Planning Workgroup four documents related to the Consolidated and Person/Family Directed Support (P/FDS) Waiver Renewals. George Kimes is a member of this work group. These documents reflect proposed changes to the Consolidated and Person/Family Directed Support Waivers. Prior to ODP finalizing the renewal applications and submission to the Centers for Medicare and Medicaid Services, ODP and PCPA are requesting member review and comments.

The documents are:

  • Waivers Comparison Side by Side:  Proposed changes to the Consolidated and P/FDS waivers. (General explanation of the issues, proposed changes, and current and proposed language.)
  • Waivers Attachment A: Consolidated Summary of the Final QIS
  • Waivers Attachment B: Appendix G current language
  • Waivers Attachment C: Appendix G proposed language

(Appendix G was difficult to include in side by side document due to the number of content and reorganization changes being proposed to that appendix, therefore that appendix is included in the separate documents: B=(current language for G) and C= (proposed revisions for G).

To help ODP manage incoming comments, please use the attachment called “Side-by-Side of Proposed Consolidated and P-FDS Changes” to record comments in the comment column. Please submit your comments to RA-ODPComment@pa.gov by January 1, 2012. Please also share a copy of your comments with Linda Drummond at PCPA (linda@paproviders.org).

ODP has released the following information, available at www.odpconsulting.net:

  • Informational Packet #176-11: Peer Review Process and Training. The Certified Investigator Program contractor, Columbus Organization, will provide Peer Review Process training. The schedule will be released in the near future. Provider staff trained in the Labor Relations Alternatives Peer Review Process are responsible for conducting peer reviews and clarification of this process is included in the packet.
  • Informational Memo #177-11: Billing Adjustments, Voids, and Resubmissions Effective January 1, 2012 and Forward to Support the v5010 Federal Initiative. Any questions should be submitted to the ODP Claims Resolution Section (ra-odpclaimsres@pa.gov).

December 22
On December 20 state Budget Secretary Charles Zogby presented a 2011/12 budget briefing to legislative leaders.

A December 21 Harrisburg Patriot News article provides some interesting comments from the Democrats reaction to the briefing and the state’s projected revenues.

A copy of the December 20 Capitolwire report on the budget briefing is also available.

December 20
PCPA member Terry McNelis, vice president ID services, NHS Human Services, was recently interviewed on the NBC Channel 10 Philadelphia news regarding funding cuts for persons with intellectual disability. The newscast is accessible from the link.

The MH/MR Administrators Association announces that effective January 3, 2012 it will change its name to “Pennsylvania Association of County Administrators of Mental Health and Developmental Services.” The new web address will be www.mhdspa.org.

The Office of Developmental Programs (ODP) has released the following information, available at www.odpconsulting.net:

  • Announcement #172-11: Provider Enrollment Hyperlink Updated on DPW Website. Any provider who intends to offer waiver or base services through ODP must enroll in PROMISe in order to submit claims and receive payment for services rendered.
  • Announcement #173-11: Provider On-Site Audit Webcast and Registration for Follow-up Conference Call Available. ODP has scheduled four follow-up conference calls for AEs and providers to allow participants to interact with ODP staff regarding additional clarifications related to the implementation of the on-site audit process. A webcast is available.
  • Announcement #174-11: ODP Supports and Services Directory (SSD) Reminder. All providers of services to individuals enrolled in the Consolidated or Person/Family Directed Support waivers must sign up for services in the SSD that they anticipate delivering in 2012/13 by January 13, 2012, and must remove services and service locations that are unused by the same date.
  • Announcement #175-11: PROMISe Cutover Dates and Downtime Schedule for the v5010 Go Live. The listed downtime dates and times are those that will prevent providers from submitting claims to PROMISe and cause intermittent issues with some screens and processes in HCSIS.

December 19
It had been PCPA’s understanding that the Office of Developmental Programs (ODP) intended to share a side-by-side comparison of the current waiver to its waiver renewal applications. This has not been received. The two waivers renewal applications should be sent to the Centers for Medicare and Medicaid Services (CMS) by the end of December or beginning of January as the current waivers expire June 30, 2012. The only document released by ODP with information regarding the waiver renewals is “Consolidated and P/FDS Waiver Renewal Process and Proposed Revisions”. This PowerPoint indicates comments should be sent to ODP (ra-ODPcomment@pa.gov) by December 22. If members comment, please forward a copy to Linda Drummond.

Highlights of proposed changes:

  • Moving all services except residential eligible and transportation trip to the fee schedule effective July 1, 2012.
  • Service definition change on transportation from per diem to per trip, with clarification on definition of “trip.”
  • Removing language in the definition of prevocational services on where the service can be provided;  will focus on the intent/purpose of the service.
  • Development of a statewide Vacancy Factor which will be added to provider rates rather than using therapeutic leave days.
  • Deleting the “home finding” option, which has not been used.
  • Reinforcing the need for the SIS in developing individual service plans.
  • Appendix B: Reserving a waiver spot for individuals in medical/rehabilitation care beyond 30 days to prevent discharge from the waiver then having to reapply.
  • Appendix C: Looking at level of acuity rather than size of home; intent to tie the SIS to program needs and design.

When ODP notified providers in June that they were moving all services except residential to a fee-schedule effective two weeks after the notification, PCPA data collected from numerous members indicated cuts in rates of 30 – 68 percent. At that time we did share with ODP the impact of these changes to a fee-schedule and requested a review of the financial data used to determine these fees. This may be an important item for provider comment.
ODP has met with the Human Services Research Institute (HRSI) regarding methods to determine “resource allocations.”  HSRI will present information via webinar at the January 17, 2012 IDD Committee meeting.

From Idaho: “Federal Judge: Idaho must raise Medicaid rates for some services for developmentally disabled.” A lawsuit by five businesses providing services including residential habilitation to over 6,200 individuals was filed because the state’s Department of Health and Welfare kept provider rates at a 2006 level. The US District Judge said the law is clear on Medicaid rates; they must incorporate the actual cost of providing a service.

ODP Informational Memo #171-11: Claims Processing Issue Identified for SC Waiver Claims. Provides details on the reprocessing of November -denied Supports Coordination waiver claims which are expected to be included in the January 4 waiver claim submission file. A copy of the memo is available at www.odpconsulting.net.

 The original link sent for the December 13 House Human Services Committee hearing on the ODP system was not working The new link is http://media2.pahousegop.com/Generator.asp?videoname=114430716.wmv.

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