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MR Update #06-07: Provider Qualifications, OMR Rate Setting and Agreements, Medicaid Changes, Employment Bulletin and IM4Q
April 18, 2006

Provider Qualifications
The Office of Mental Retardation (OMR) has released information regarding rate setting changes and provider qualifications:

  • Mental Retardation Bulletin for Provider Qualification Pilot Program,
  • Provider Qualification Pilot Program Application,
  • Provider Qualification Pilot Program Supporting Documents Required, and
  • Latest Rate Setting Frequently Asked Questions (FAQ).

Agencies interested in participating in the Provider Qualifications Pilot are asked to complete and submit the application form by May 15 to OMR. Any questions regarding the provider qualifications criteria may be addressed to Beth Hovenstine at ra-omrproviderqualif@state.pa.us or by calling the OMR customer service number at 888-565-9435.

Rate Setting Implementation
OMR is implementing a rate setting methodology statewide to come into compliance with statutory and regulatory requirements for federal waiver administration. The requirements are applicable to all counties, administrative entities, and providers responsible for implementing waiver and base services on behalf of OMR.

The Centers for Medicare and Medicaid Services have agreed to provide the state with a two-year rate implementation period due to the sweeping changes that are required of the system. All providers must be registered in HCSIS with their sites and service offerings for each site accurately recorded. All counties will need to enter rates for each provider, site, and service. Direct questions to the Regional OMR office.

OMR Agreements
The Centers for Medicare and Medicaid Services (CMS) has approved the standard operating agreement to be used between the Office of Mental Retardation (OMR) and counties/administrative entities. The new agreement is intended to standardize policies governing local management of waiver services. The agreement requires the county or administrative entity to manage waiver services in accordance with a uniform set of policies and practices. OMR is preparing to submit to CMS approval agreements between OMR and providers and agreements between providers and counties/administrative entities. Electronic copies of the contracts are available from Linda Drummond at PCPA.

CMS Medications Return
CMS has instructed State Medicaid Directors to order Medicaid programs to require nursing homes and Intermediate Care Facilities for the Mentally Retarded (ICFs/MR) to return unused medications to pharmacies. Nursing homes are specified in the letter. However an article in the National Association of State Directors of Developmental Disabilities Services newsletter, Perspectives, indicated that a CMS official said this also applies to ICFs/MR. This requires Medicaid to be repaid for unused treatments when patients die, are discharged, or have their prescriptions changed. This policy became effective April 1, but will not affect dual eligible beneficiaries who receive their prescription drugs through Medicare Part D. For a copy of the letter access www.cms.hhs.gov and search under State Medicaid Director Letters 3/22/06.

IM4Q
The Individual County FY 2004-05 MH/MR Independent Monitoring for Quality (IM4Q) Summary Reports have been sent to the Institute on Disabilities for development into an annual overview. The FY 2004-05 National Core Indicators final report is available electronically from Linda Drummond at PCPA.

IM4Q issues recently addressed by the steering committee include:

  • IM4Q programs may distribute generic information to individuals, families, and staff such as voter registration information and community events. However it is not appropriate to disseminate agency specific information.
  • Beginning in FY 2006/07, OMR will discontinue approving requests to substitute persons from the Independent Monitoring sample for those in the Person Family Driven Supports sample who have refused to be interviewed. Local IM4Q programs should not expect to receive payment for surveys they were not able to complete.

Employment Bulletin
Mental Retardation Bulletin #00-06-08: Employment for Individuals in ICFs/MR clarifies how individuals living in Intermediate Care Facilities for Persons with Mental Retardation can be employed and receive habilitation services to promote employment outcomes. Habilitation services to achieve an employment outcome must be coordinated with the district Office of Vocational Rehabilitation (OVR). When OVR funding is available for an individual’s supported employment, ICF/MR funding may only be used for habilitation services which are not funded by OVR. For a copy of the bulletin contact Linda Drummond at PCPA.

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