H04-091 – Policy/Procedure
November 22, 2004
TO: / Area Agency on Aging DirectorsHome and Community Services Regional Administrators
Division of Developmental Disabilities Regional Administrators
FROM: / Penny Black, Director, Home and Community Services Division
Linda Rolfe, Director, Division of Developmental Disabilities
SUBJECT: /
Changes in Home Care Agency Billing Procedures – Effective January 2005
Purpose: / To inform staff and providers of changes that will happen in January 2005 related to how contracted home care agencies bill for Chore, MPC, COPES, and MNIW services.Background: / Area Agencies on Aging (AAA) currently act as payees for MPC and Chore as well as most COPES billings related to contracted home care agency services for Home and Community Services (HCS) clients. A few AAAs also act as payees for MPC billings authorized to contracted home care agencies for Division of Developmental Disabilities (DDD) clients. The current MPC and Chore contracted agency SSPS codes for Home and Community Services (HCS) clients require a payee. The COPES and MNIW SSPS codes were not set-up to require a payee, although in most cases the AAA has been established as the payee when authorizations are opened.
Aging and Disability Services Administration (ADSA) made a decision that home care agencies will bill SSPS directly for services rendered from January 2005 forward. This change is intended to:
· Streamline billing processes;
· Reduce time spent by AAAs on billing reconciliation; and
· Redirect limited state resources to case management activities rather than administrative functions.
To implement the direct billing process, it is necessary to modify contracted home care agency SSPS codes for MPC and Chore so that a payee will no longer be required.
What’s new, changed, or
Clarified / Effective January 1, 2005, contracted home care agencies will bill SSPS directly for all Chore, MPC, COPES, and MNIW services.
A transaction generator will be done through SSPS in early January 2005 that will result in the following:
· Authorizations that have the AAAs as payees with end dates beyond December 31, 2004 will be terminated by SSPS.
· New authorizations will be created that will remove AAAs as payees for Chore, MPC, COPES, and MNIW authorizations open under SSPS codes 4221, 4521, 4583, 5257, 5283, and 5583.
· SSPS codes 4221, 4521, and 4583 will be modified so that a payee is no longer required.
· New authorizations will be created that will remove AAAs as payees from DDDs MPC and Waiver personal care authorizations open under SSPS codes 7110, 7111, 7172, 7249, 7374, 7377, 8110, 8172, 8210, 8272, 8310, and 8372.
ACTION REQUIRED BY STAFF:
Any open authorization where services have expired will need to be changed manually by the AAA.
Home care agencies will direct questions related to client authorizations directly to the authorizing entity (AAA, HCS, or DDD). Prior to January 2005, each AAA will determine the contact procedures for authorization questions. This information will be shared with home care agencies at SSPS training sessions to be held in December.
General information regarding SSPS, payment dates, invoice express, direct deposit and answers to commonly asked questions can be found at the SSPS website, http://www1.dshs.wa.gov/msa/ssps/. Additional SSPS contact information will be given at the training sessions in December.
Information related to payment adjustments will be provided during the training sessions.
ACTION: / 1. Beginning with services provided January 2005, contracted home care agencies will be invoicing SSPS directly for services provided under Chore, MPC, COPES, and MNIW. This change does not impact billings for other services such as Respite, SCSA, caregiver training or health insurance reimbursement.
2. AAAs are to notify their contacted home care agencies and encourage them to attend one of the training sessions related to direct SSPS billing procedures. AAA contract monitors and other interested AAA staff are also encouraged to attend. To register, contact Sandra Colegrove at (360) 725-2552 or . Training dates are scheduled at the following locations:
ADSA Headquarters Office (Conf. Room 1-7)
640 Woodland Square Loop Lacey, WA
· 9:00-12:00 December 7, 2004
· 1:00-4:00 December 7, 2004
Seattle Municipal Tower Building (40th Floor, Conf. Room 4060)
700 Fifth Avenue Seattle, WA
· 9:00-12:00 December 13, 2004
Aging & Long Term Care of Eastern WA (Conf. Rooms B&C)
1222 N. Post Spokane, WA
· 9:00-12:00 December 15, 2004
· 1:00-4:00 December 15, 2004
3. AAAs are to inform ADSA of how they want contracted agencies to interface with their case management program regarding authorization questions and concerns. AAAs are to notify Aaron Van Valkenburg no later than December 3, 2004 of the local contact procedures. Possible contacts include an individual within the agency who will field all calls, or having the authorizing case manager contacted directly.
Related
REFERENCES: / Service Authorization, Billing and Payment Procedures (page 3)
ATTACHMENT(S):
CONTACT(S): / Aaron Van Valkenburg, Program Manager
Telephone: (360) 725-2554
Service Authorization, Billing and Payment Procedures
Authorization of Services, Billing and Payment Procedures
Authorization of Services
Once you have been chosen by a Department of Social and Health Services (DSHS) client to provide services, you will receive in the mail:
1. A letter from the Social Service Payment System (SSPS). This letter tells you:
§ the name of the client to whom you are authorized to provide service;
§ the type and maximum number of service units you are authorized to provide;
§ The rate and the unit (hour, day, miles, etc.);
§ The time period you are authorized to provide service.
§ Other pertinent information on invoicing and taxes.
These forms are documentation that you have been authorized to provide services to a particular client and should be kept in your files. If any information is incorrect, contact the Case Manager or Social Worker identified on the letter.
2. A description of the work to be provided to the client will be sent separate from the SSPS letter. You’ll receive what’s called the Service Summary, or the Assessment Detail, or both, depending on the service you are providing.
SSPS Billing and Payment Procedures
Payment for your services will be made through the State of Washington Social Services Payment System (SSPS).
1. SSPS mails an invoice to you on the 22nd of each month or the following business day for authorizations completed prior to that date.
2. Follow the directions on the Invoice to indicate the amount of service you provided. You can submit the invoice by using the Telephone Invoice Express system, or by mailing it. Using the Telephone Invoice Express is recommended.
3. After SSPS receives and processes the invoice, a check for services is mailed to you or deposited directly into your account if you apply for Direct Deposit (instructions on the invoice).
Checks are not processed or sent out for services in the month services are performed. Invoices processed before 4:30PM on the last business day of the month will be processed for payment the first business day of the next month. Invoices processed before 4:30PM each business day after the first business day of the next month after services were performed, will be processed and typically mailed the next business day.
The SSPS website, www1.dshs.wa.gov/msa/ssps/index.htm has a lot of helpful information on SSPS in general and Invoice Express, Direct Deposit, payment dates, tax information, and answers to commonly asked questions.
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