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Riverside Developmental Disabilities Miami County Ohio

Provider Rules

Timeline for HCBS Adult Day Waiver Redesign

Funding redesign stakeholders agree to final adult day service rates

Rules will take effect April 1 if approved during final public hearings

Published Thursday, July 14, 2016
by Scott Marks 
On Friday, July 8, DODD convened a meeting of funding redesign stakeholders to discuss and negotiate final details regarding proposed Adult Day Array service rates.  Represented at the meeting were OACB, the Ohio Provider Resource Association, Ohio Health Care Association, The ARC of Ohio, Ohio Self-Determination Association, Ohio Association of Adult Services, and the Privatization Support Group.
The purpose of the 90-minute meeting was to reconcile the various public comments made through the rule clearance process and establish consensus measures that the stakeholders and DODD could implement in the draft rules. The primary topics included the proposed elimination of the day rate and combo code for providers of HCBS services and the proposed budget limitation increase for individuals enrolled on waivers. This negotiation process yielded the following results:
A Daily Rate can continue to be billed for services performed for 5-7 hours using the same daily rate as per current model, so long as only one billing code/service is provided throughout the day. 
Example: A person receiving Vocational Habilitation services for 5 hours a day can still be billed at the daily rate, however, someone utilizing any or all of the 3 the add-ons (Community, Behavior, and/or Medical) will have to be billed on a 15-minute unit basis.  This means anyone receiving an add-on will not be able to be billed at a daily rate.  
For those authorized for the community add-on, the daily rate will only be able to be billed on days that the community add-on is not provided.
Additionally, if an individual served is moving between vocational habilitation and adult day supports, they would also have to be billed on a 15-minute unit basis as of April 1, 2017. 
As a result, the Combo code will be eliminated for those utilizing both/multiple services in a day. For county boards SSAs, services can still be authorized with a combination code. However, providers will not be able to bill combo code as of October 1, 2016.
Concerning the budget limitation increase, DODD and stakeholders agreed to a budget increase to allow for a 260-day service calendar year. Considering utilization rates, this increase could also allow for increased community employment services and/or utilization of the service add-ons.  
This represents a much more modest budget increase as compared to the original budget increase as proposed in the draft rules released on June 3.   For example, someone with Acuity A in CODB area 5 would have a budget limitation increase from $9,840 to $10,660 as opposed to an increase to $12,840 as originally proposed.
OACB and county board representatives who have participated in the Funding System Redesign Workgroup are optimistic that the final day service rates proposed will meet the case management objectives of county boards while providing flexibility to providers to begin supporting adult day services in the community.  The rules are headed to a final public hearing at DODD before being submitted to JCARR for approval.
OACB would like to thank Superintendents Laura Zureich (Champaign/Shelby), John Pekar (Fairfield/Vinton), Dan Ottke (Clermont), and Jason Umstot (Licking) as well as Business Managers Eric Hammer (Lake) and Gary Smith (Licking) and Employment Services Coordinator Vic Gable (Wood) for their continuing support throughout the two-year funding redesign process.
For more information about the proposed rule change, please contact Scott Marks (smarks@oacbdd.org) at 614-431-0616.  Electronic copies of each final draft rule are available by clicking the links below.
Proposed Rules on Adult Day Services
New ADS Rules 4.1.17 Definitions - Download
Adult Day Support (5123:2-9-17) - Download
Adult Day Support Rule Overview - Download
Career Planning  - Download
Career Planning Overview - Download
Funding Info - Download
General Requirements (5123:2-9-19) - Download
Group Employment Support (5123:2-9-16) - Download
Group Employment Support Overview - Download
Individual Employment Support overview - Download
Money Management Rule Overview - Download
Non-Medical Transportation (5123:2-9-18) - Download
VocHab Overview - Download
260 Day Add Ons - Download