How Providers are Paid

SCHSP Conference

March 14, 2017

John D. Rockefeller, an Ohio native, started Standard Oil. Rockefeller was at one point the world’s richest man and

first ever American billionaire. Considering he was a

billionaire in the early 1900’s he is still considered as the richest person in

modern history. When a reporter asked him, “How much money is enough?” He

responded, “Just a little bit more.”

How DDSN pays Providers for services • Band System (Capitated Contracts)• Daily rates to non-Board QPLs• One of 3 Fixed Price Bid Contracts

(QPL, HM, TFH)• Non-Capitated Grants• Special One-time Grants

The Funding Band System for paying the DSN Boards was initiated in

1998 as a means of uniform payments for services to DSN

Boards. Prior to the funding bands, individual rates were negotiated

with each DSN Board.

The Funding Band System adds flexibility to the Boards to provide

funding across all capitated services.

By their very nature, the Band system is an average for each type of

capitated service.

The funding bands are designed to pay DSN Boards prospectively up

front to ensure that cash is available to meet the documented service

needs of consumers.

Bands eff. 7/1/16

Band A State funded Community Supports 14,222

Band B At Home - IDRD Waiver 12,990

Band C Supported Residential - SLP II 31,666

Band D Supported Residential - SLP I 19,568

Band E Supported Residential - CTH I 24,297

Band F Supported Residential - Enhanced CTH I 38,104

Band G Residential Low Needs 61,563

Band H Residential High Needs 82,398

Band I At Home - Community Supports Waiver 13,612

Band R Residential Placement from Regional Centers 90,529

Residential Band H - Individuals whose costs exceed $104,632

may be considered for outlier status,

At Home Band B - Individuals whose costs exceed $34,358

may be considered for outlier status.

Residential Band R does not qualify for outlier status.

The Qualified Providers are paid retrospectively through one of the

three Fixed Price Bids. The rates are simply the bands converted to a

daily rate.

7/1/2016

Revised

QPL Rate

Rate Increase Unit

Residential High Needs - CRCF/CTH II 225.75 36.83 Daily

Residential Low Needs - CRCF/CTH II 168.67 37.28 Daily

Residential - HASCI CTH II 228.33 7.51 Daily

Supported Residential - SLP II 80.83 2.39 Daily

Supported Residential - SLP I 1,453.73 31.29 Monthly

Supported Residential - CTH I Monthly

Supported Residential - Enhanced CTH I 2,451.12 50.89 Monthly

Day Supports 22.92 0.43 Half Day

Supported Employment - Individual 70.10 1.33 Hour

Case Management 136.94 3.55 Monthly

Early Intervention - Family Training 23.07 0.60 15 minutes

Respite 11.30 - Hour

Personal Care 1 3.23 15 Minutes

Adult Companion 9.50 Hour

Residential R Band 248.02 6.44 Daily

DSN Boards then report the various services provided to DDSN, which in

turn bills Medicaid to receive reimbursement for Medicaid eligible

consumers. DDSN receives reimbursement from Medicaid

approximately 2 months after the prospective payment is made to the

DSN Board.

Individual Service Reports (ISR’s)

• Respite, Companion/Caregiver, SLP I

• Logs mailed to Case Managers the last week of the month prior to the month of service

• Logs due back to DDSN/SURB by the end of the month subsequent to the month of service

• If the consumer does not receive any services, write “NO SERVICES RECEIVED” and return the log to DDSN/SURB

RESLOG & DSAL

• Submit & Approve logs timely

• Service Error Correction Forms (SECF)

• Adding new consumer to the log – reporting

• Day Service authorization – Funding – Consumer Budget & STS

• Who do I invoice for Day Services?

• CTH II & at home – Financial Manager

• SLP & CTH I - DDSN

• HASCI - DDSN

• Approve attendance logs

• Case Manager monitoring – unauthorized services

• 3 month lag (February WCR will be reflected in May 1st & 16th

payments)

• Run the report from R2D2 excluding PCA for under 21 & All Nursing Services

• Reimbursements must be received within 6 months of the date the payment was recouped on your payment schedule.

The amounts put into the funding bands in 1998 and again in 2006 when DDSN rebased the funding bands were based on the audited

Financial Statements and Medicaid Cost Reports of the DSN Boards.

The funding bands have been adjusted over the years for pay

increases, health insurance increases, retirement contribution

increases when appropriated by the General Assembly.

What is in the Funding Bands?

Residential cost – the average cost of residential supports for each residential setting

DDSN did not put a specific dollar amount in the bands for any particular cost category whether that is personnel, transportation, etc. DDSN took the ‘total’ cost from DSN Boards audited Financial Statements/Medicaid cost reports and put the ‘total’ cost into the funding band. So whatever costs were on the providers books, those costs are in the funding band.

What is in the Funding Bands?

Day Supports – the average cost of day supports for the number of consumers in each funding band who receive day supports

For example: if 90% of the consumers in a particular residential funding band received day supports, only funding for those consumers was put into the funding band. The theory is that if consumers stay in the residence during the day, the staff costs associated with them staying in the residence are picked up in the residential component.

What is in the Funding Bands?

Day Supports – the average cost of day supports for the number of consumers in each funding band who receive day supportsAgain, DDSN did not put a specific dollar amount

in the bands for any particular cost category whether that is personnel, transportation, etc. DDSN took the ‘total’ cost from DSN Boards audited Financial Statements/Medicaid cost reports and put the ‘total’ cost into the funding band.

What is in the Funding Bands?

Other Waiver Supports:

The amount of waivers services (such as respite, PCA, prescription drugs, etc.) actually received by consumers based on Medicaid paid claims.

Additional Information

Two DDSN Directives have additional information:

• 250-10-DD - Funding for Services.

• 250-11-DD - Outlier Funding Request System –Capitated Funding System.