Provider Association

October 19, 2015

Commissioner Remarks:

Listening Tour: issues that need to be addressed in the short term:

  • Respite- availability of this critical service , must increase opportunities
  • Managed Care- going back to work with actuaries to look at different models to ensure we have one that is efficient, has low administrative fees, and strong care coordination
  • Minutes from Transformation Panel- must be more timely

Listening Tour for Integrated employment is starting

Concern with clinical services being taken out of Day Hab- possibility of interruption of services must be avoided. Have to stick with 1/1/16 implementation.

Room and Board supplements- 66% budget neutrality as of 7/1/14, went to 90% as of end of this year. 2016-2017 OTDA coming up with alternative approach to give 100%. This seems to be an issue mostly with downstate providers.

SEMP- Providers need to be aware of all ways to bill for services. OPWDD goal is to help providers bill. There is more money available than under previous rates. By next month there will be a new ADM. There will be a separate ADM for self-directed SEMP. We must re-structure our business. There is an ability to do more. Lengthy discussion that most providers are billing at about 60% of previous billings. Request made to help keep providers whole during this transition. Commissioner Delaney said they are looking at mechanism to do this. There will be no reimbursement for training.

Work Centers: Forums being held. New guidance expected in November.

Kate Marley & Jill Pettinger:

Satellite Clinics- April 2016 they will amend authorization levels. July 1, 2016- cost verifications of Day Hab PPA’s for clinic space. Local government units will be notified of CON’s sent. DQI staff ready to go to satellite sites and will discuss any issues noted at time of audit. Will issue a single approval.

Preventative Services- must establish group practice to provide these services, unless you are an independent practitioner able to bill Medicaid.

Roger Bearden & Mary Ellen Moeser:

HCBS Heightened Scrutiny- looking to providers to self-assess. Will provide agencies with aggregated data, but will be able to get report by OC #. Non-residential settings guidelines to be sent out soon. Need clarification on Day Hab sites.

Donna Cater (DOH) & Laura Rosenthal:

Getting closer on People First Community Services Fund. Having issues with special populations. Still have draft rate runs for ICF and IRA. Template funding loaded for Day Hab on 9/11/15. Family Care rates are increasing as of 10/1/15.

AbibaKindo:

Reports on respite and site based day hab are due from Regional Offices to Commissioner by 1/1/16.