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Tags Posts tagged with "Waivers"

Waivers

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PA Family Network has announced important workshops and Good Life Groups for April 2024. You can register for upcoming events at PA Family Network’s website. View the full listing below.

Support Groups

LifeCourse Workshops

Waiver Workshops

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The purpose of this bulletin is to provide guidance on documentation needed to substantiate a claim as well as provide guidance on the service documentation processes. This information is applicable to providers and Supports Coordination Organizations (SCO) that render services through the Consolidated, Community Living, P/FDS, and Adult Autism Waivers as well as Targeted Support Management (TSM) and base-funded services.

Documentation to provide a record of services delivered to an individual must be prepared and kept by the provider, SCO, or common-law employer for the purposes of substantiating a claim and documenting service delivery. The Office of Developmental Programs (ODP) has developed Technical Guidance for Claim and Service Documentation for providers of services in the Adult Autism Waiver and providers of services for all other waivers and base-funded services, which provide specific information for providers and SCOs on the documentation that must be kept for each service in order to support a claim and to document service delivery. These apply to services rendered by providers and SCOs that have enrolled directly with ODP, organized health care delivery systems, and services delivered through both self-directed services models, Agency with Choice, and Vendor Fiscal/Employer Agent.

Providers are encouraged to review and consider using the Medical Assistance Provider Self Review Protocol to proactively identify and address any claim documentation-related problems. The protocol can be found here.

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ODP Announcement 22-007: UPDATE provides information to providers in order to prepare for upcoming rate increases that are scheduled to be published in the Pennsylvania Bulletin on February 26, 2022.

Per the final public notice for Fee Schedule Rates, Department-established fees, and the AWC FMS Department-established fees rendered through the Consolidated, Community Living (CLW), and Person/Family Directed Support (P/FDS) waivers:

  • The anticipated effective date for the increased Fee Schedule Rates is January 1, 2022; however, the effective date in the Home and Community Services Information System (HCSIS) will be March 1, 2022.
  • The anticipated effective date for the Department-established fees for residential ineligible services is July 1, 2022, and HCSIS will reflect the same effective date.
  • Both the Fee Schedule Rates and Department-established fees for residential ineligible services will be visible in HCSIS on February 28, 2022. Compensation will be for the period January 1, 2022–February 28, 2022. The updated fee schedule rates will not be loaded in ISPs for the period January 1, 2022–February 28, 2022. Instead, the current rate will remain for that period, and ODP will be compensating providers, via gross adjustments, for the difference between the rate billed and the updated fee schedule rate for dates of service rendered during the period January 1, 2022–February 28, 2022. This is intended to eliminate the provider’s effort of voiding and rebilling claims.

ODP anticipates processing gross adjustments during the April to May 2022 timeframe to ensure all billing for dates of service January 1, 2022–February 28, 2022 has been completed. Providers are strongly encouraged to bill in a timely manner to minimize the need for corrections.

Since the new rates will have a begin date of March 1, 2022, two service/rate segments in authorized status will be present on ISPs, assuming no errors set. One service/rate segment will reflect the period July 1, 2021, to February 28, 2022, or the begin date of the service when it was initially authorized on the plan during Fiscal Year (FY) 2021–2022. The second service/rate segment will reflect the period March 1, 2022, to June 30, 2022.

Authorized units on the first service/rate segment, July 1, 2021–February 28, 2022, will reflect 67% of total authorized units for the FY 2021–2022. The second service/rate segment will reflect 33% of total authorized units for the remainder of FY 2021–2022. If an individual requires more than 33% of the total annual authorized units for the remainder of FY 2021–2022, a revision to the plan will be necessary to move units from the first service segment to the second service segment on the ISP. For the period July 1, 2021, to February 28, 2022, providers should bill normally for any services rendered.

See the ODP Announcement for the full instructions.

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Image by Werner Moser from Pixabay

ODP Announcement 21-095 discusses the availability of a 30-day public comment period for the proposed fee schedule rates for services funded through the Consolidated, Community Living, Person/Family Directed Support (P/FDS), and Adult Autism Waivers as well as Base-funded programs. Please review the announcement for further details on both the rates and the public comment period.

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The new rates for the Office of Developmental Programs’ (ODP) services have been released:

As everyone knows, this rate refresh is a critical development and long awaited. We also know that we will need a thorough analysis of the adequacy of these rates. For that reason, RCPA has partnered with PAR, MAX, and the Alliance of Community Providers to hold a webinar on Tuesday, January 4, 2022, at 10:00 am. More information on this webinar will be coming later today.

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