#dayservices

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Strawberries 🍓 🍓 🍓 😋 #lotsofthemtoo #jammaking and #strawberrytarts here @all_ab0ut_y0u #ldservices #dayservices #learningdisabilityservices #sheffield #southsheffield #woodthorpe #yoursupport #yourway #contactus#today #wepromotesheffield #sheffieldissuper #sheffieldbiz #notforprofitorganisation #charity #caringforourcommunity (at All About You)

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Just some of the stunning artworks @harley_gallery #welbeck #daysout with @all_ab0ut_y0u #ldservices #dayservices #southsheffield #meaningful#activities #onetoone #support #personcentredcare #tailoredsupport #yoursupport #yourway #abilitynotdisability #thisability #contactus #today (at Welbeck)

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ODEP Webinar: Building Meaningful Lives in a Modern World

Did you miss the ODEP webinar on February 8th about meaningful integrated day activities?  Click this link to access a recording of the webinar.  Guest speakers included:

o   Sara Murphy, EFSLMP National Subject Matter Expert and Director, TransCen's WorkLink 

o   Gail Fanjoy, EFSLMP National Subject Matter Expert and CEO, Katahdin Friends, Inc.

Objectives for the webinar included:

o   Define "meaningful integrated day activities"- what they are and what they are not

o   Distinguish between inclusion, exclusion, segregation, and integration that can direct staff planning and supports

o   Understand what a fully-inclusive weekly schedule consisting of meaningful integrated day activities and wrap around supports looks like for an individual with a disability 

o   Hear stories and learn strategies to understand what a meaningful day looks like in practice using big city and small town examples.

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Flexible Day Services

In March, Central Office staff conducted presentations regarding some of the changes to the HCBS waivers.  Effective October 1, 2015 Day Services will no longer be restricted to Monday through Friday from 7:30 a.m. to 6:00 p.m.  Providers are advised to begin planning for flexible day services immediately. While we acknowledge that flexible day services might not be a priority for some of the persons you support, it is imperative to identify the persons that it is important to.  Please note that no changes should be made in the delivery of services as outlined in the person’s ISP without the individuals input as part of the planning process.  It is also important to note that the maximum number of units for Day Services has not changed.  Please review the .pdf at this link for further guidance on flexible day service hours.  For questions, please contact [email protected] or [email protected].  

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Ounce of Prevention

This week we focus on billing requirements for Day Services.  Per the waiver definition, Day Services are limited to 5 claims per calendar week and 243 claims per calendar year.  Please note that effective April 1, 2015, edits will be implemented within PCP to enforce these limits.  This is being done to promote accuracy in billing, reduce opportunities for fraud, waste, and abuse, and strengthen our compliance with CMS and TennCare requirements. These edits will also provide timely feedback to the provider when Day Service limits are exceeded to allow for follow up review and evaluation.

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Day Services Reminder

We have been made aware that providers continue to have questions about the requirements for providing, documenting, and billing for day services. Below is an excerpt from the Waiver definition of day services regarding what must be done to receive reimbursement for that service. Providers must document the amount of time spent receiving a day service to equal at least 6 hours per day (with the exception of “c” below).  If you still have questions or particular scenarios for which you would like to have clarification please contact [email protected], [email protected], or [email protected]. 

The provider may receive the per diem reimbursement for Day Services if:

a.         The person receives 6 hours of direct services comprised of any combination of Community-based, Facility-based, and or Supported Employment Day Services.

b.         The person receives 6 hours of In-home Day Services. The reimbursement shall be the per diem rate for In-home Day Services.  (If In-Home day services are provided for any portion of the day In-Home services is the only day service that can be billed for that day.)

c.         The person receives at least 2 hours of Day Services and there is documentation that the person was unable to complete the full 6 hours of Day Services for reasons beyond the provider’s control (e.g., sickness of the person).

Reimbursement for a combination of different Day Services (e.g., community-based, facility-based, and or supported employment) provided on the same day shall be made in accordance with the following:

a.         If the person receives up to or in excess of 6 hours of a combination of Community-based and Facility-based Day Services, the reimbursement shall be the per diem reimbursement rate for the type of service provided for the greatest amount of time that day.

b.         If the person receives up to or in excess of 6 hours of a combination of Day services that includes Supported Employment, the reimbursement shall be the per diem reimbursement rate for Supported Employment Day Services.

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Day Services Inclement Weather Billing

While we can certainly appreciate the impact that inclement weather has on our provider community, we must also consider our obligation to ensure that services are paid in accordance with our approved federal waivers.  Unfortunately, even in observance of the most recent severe weather emergency, a service (in this case, Community-Based Day Services) cannot be billed unless it is actually provided.  Further, provision of In-Home Day Services due to inclement weather is clearly beyond the scope of the currently approved waiver service definition.  We could not subject either the department or providers to potential violations of the False Claims Act.

Additionally, as you know, the rate for both services is inclusive of 20 days per year of leave time built into the methodology that was specifically included to cover just such events.  All this said, we also understand the realities for providers who feel they are left in a situation where they are required, by their respective provider agreement, to maintain adequate staffing that meets the unanticipated needs of persons receiving supports.  Data reviewed recently indicates that many of the persons receiving day services bill the maximum number of days allowed each year.  So, even if we could allow these services to be paid, the net impact would not result in any additional payments to providers in light of the 243 day per year limit.

While we could go through a process of removing those 20 days from the methodology and allowing for those 20 days to be separately billed, payment for the 20 additional days would then clearly depend on actual delivery of services, but it could include cases of inclement weather (which we would need to define in the waiver).  The net result, however, would not yield any higher total payments to providers and in fact, might yield less.  If we contemplate potential changes to the In-Home Day benefit, we would further want to ensure above all else that protections are in place that would help ensure services are always provided in an integrated community setting whenever possible. Thankfully, events such as these are rare, even if challenging.