Questions Submitted to the Internal Review Committee (IRC)
Anniversary Date
When can an anniversary date be changed? (11/7/2012)
The only time an anniversary date can be changed is if a Participant leaves and re-enters the system or if a Participant becomes a fiscal intermediary (FI).
Where can the anniversary date be found? (10/3/2011)
The anniversary date is included in the Agency Authorization Summary Spreadsheet that has been emailed to each Agency's Executive Director.
Billing
We understand in times of illness and/ or weather emergencies the residential provider must provide the day program service, and that the residential provider must bill the day program provider directly. Please explain the process we are to follow in doing so. (12/20/2012)
That is an agreement that the two agencies involved must consent to. The Department requests that each agency keep a complete record of the transaction so, when an audit is done the paper trail can be easily followed.
My agency is receiving a smaller amount of case management (support coordination) for certain clients. Why is this happening? (5/2/2012)
Any client with both FI & Non-FI agencies, the Non-FI agency will receive a smaller Support Coordination fee.
Client's family is unable to afford the medical visits co-pay. May the Agency use community based supports by professional staff to reimbursement family? (4/26/2012)
Agency may not bill for services not provided. Co-payment should be billed to Medicaid for reimbursement.
Client passed away in the beginning of the month. How should the agency billed for case management. (4/26/2012)
The agency is to use a pro-rated formula. Use a monthly case management rate (for that particular quarter) divide by the number of days in the month of death multiply by the number of days before death. Case management is not to be authorized more than 12 units in a fiscal year.
Some of our clients attend a workshop during the day but would rather utilize some of their day activities funding for supervised events. Is there any restrictions? (2/10/2012)
Day Program authorizations are flexible in nature to allow clients to vary activities to meet their needs.
What is the cost of care limit? (1/12/2012)
Contact DHS for general information, if your agency has a specific client in mind their cost of care letter should have a contact person.
One of our consumers went to the ER accompanied by staff at 11PM, was admitted to the hospital at 4AM. Can the Agency bill for the night? (12/16/2011)
The Agency can bill for services provided for a participant even if they did not sleep in the GH when the participant was in the emergency room with an Agency staff person waiting for admission to the hospital. If and when a patient is admitted to a hospital the Agency can no longer bill for residential or community based services. The Department expects Agency staff to accompany participants to the emergency room to assist in the evaluation, treatment and admission process. This continuity of care pre-admission to a hospital will be funded up until admission. Similarly, the Department expects Agencies to assist in the discharge planning and transportation back to the residential setting.
What does the modifier 2 represent? Do we need to use it for billing? (12/16/2011)
Agencies need to use all modifiers indicated on the allocation sheets in the correct order. Please see pages 14 and 15 of the June 17, 2011 training session packet for a detail listing of modifier combinations.
Should Agencies expect paper authorizations to be mailed for all clients? (12/16/2011)
At this time the Department is sending out paper authorizations for any change made to the system. For each quarter the Department will send an Excel spreadsheet listing all your clients.
How are the service allocation being authorized? (12/16/2011)
The service allocations are being authorized on a quarterly basis.
Are Agencies responsible to bill for phone conversations? (12/16/2011)
Billing should be for face to face interaction.
Can a nurse checking medication be billed as community based supports by professional staff? (12/16/2011)
No separate rate code is available for these services. Please see the rate methodology posted on our website. The rates are based on assumptions that part of the employees' time is performing non face to face duties. For example coordination with doctors, travel, training, support coordination plan, etc.
May a client use family support funding for home care services? (12/16/2011)
A client can use family support funding for home care services. If the client wants home care services than the Agency should send a request to have units transferred from family supports.
When billing, claims are being suspended with code 245 "claims exceed authorization balance"? Please explain. (12/2/2011)
Agency may not bill for more than 1 quarter period at a time. For example, billing will not be accepted if date range is from 7/1/11 to 12/31/11. Claims must be for time period 7/1/11 to 9/30/11 and 10/1/11 to 12/31/11.
If there is units available, would it matter if billing at higher rate? (11/29/2011)
Only bill for authorized units. Agency must deliver services as described on the IISP. If billing at higher rate, dollars will be used quicker.
Authorizations do not reflect if an Agency is opened on a holiday. How can we bill actual units vs authorized units? (11/29/2011)
Only bill for authorized units.
There are 250 day program days per year but there's 6120 units which came to 255 days. Which is correct? (11/29/2011)
For a Day Program the Department expects services to be available to participants for a minimum of 6 hours daily for 250 days per year.
Does the ORS funds need to be used first? (11/29/2011)
Yes, the ORS funds need to be used first. This process has not changed.
What billing mechanism and code may be used when a client does not attend their day program, and the Agency sends staff to the client's home? (11/9/2011)
Regardless of the location of the Day Program the IISP should be developed in accordance with the quarterly resource allocation or authorization.
If someone other than a DSP provides services to an individual, can we bill for that time? (10/11/2011)
Yes, for example if a program coordinator is performing DSP functions, then bill Community Based Support base rates.
What is the billing code for a service where the participant can not attend Day Program but has staff going to their home? (10/11/2011)
Please use code T2020. If the home based Day Program per diem rate is being used, then agency may not bill/use transportation code since the participant does not have community integrated activities.
What is the rate code for nursing staff that spend time doing phone calls, care plan, etc? (10/11/2011)
No separate rate code is available for these services. Please see rate methodology posted in our website. The rates are based on assumptions that part of the employees' time is performing non face to face duties. For example coordination with doctors, travel, training, support coordination plan, etc.
DD Regulations
How to access CPI training? (5/4/2012)
Please contact the Crisis Prevention Institute and schedule a training.
What is the Department's credentialing criteria for job development and assessment? (2/10/2012)
The Department is in the process of developing a new training contract for the certified job coaches. In the interim, the Department will accept the Sherlock Center's Supporting Meaningful Employment ACRE Certificate in Employment Supports to satisfy the credential criteria which can be found in the regulations under section 45 Job Development and Assessment.
May the Agency e-file client information including but not limited to; reports, emergency fact sheets, individual service plans, surveys, etc.? (2/1/2012)
The Department will accept e-file records, be sure to follow disaster recovery guidelines, HIPAA, State and Federal regulations.
We would like to send plans/ PO prior the 45 days requirement. Will the plans/PO be accepted by the Department?
(12/16/2011)
The Department will not accept plans and PO prior to the 45 day requirement. For further details please see section 36.1.6 "Supports Intensity Scale" of the DD Regulations.
We have clients who require nursing but whose funding does not fall under extraordinary level. How can we capture this cost? (11/29/2011)
Our rates assume some medical support as described in section 44.2.9 of the DD Regulations.
Please clarify section 49.45, there are no subcategories listed? (11/29/2011)
49.46 through 49.54 are subsections to 49.45. These subsections require annual training and competency evaluations for support staff.
Where does BHDDH stand with new people being referred? (11/29/2011)
The referral process has not changed.
Regarding section 17.2 of the regulation, can the agency use the last four digits of a client's social security number? (11/9/2011)
Yes, please include the client's name and the last four digits of a client's social security number.
Section 37.1 does not refer to staffing patterns or schedules, why does the plan need to include these items? (11/9/2011)
When drafting the intended plan specific to an individual, the staff and ratios should be included in the plan because it is unique to that particular participant.
Is there a model that Agencies can follow for guidance in establishing Code of Ethics? (10/25/2011)
Please see DD Regulations section 7.0 "Organization Ethics" for guidelines.
Is BHDDH bound by a Code of Ethics? (10/25/2011)
Yes, BHDDH is bound by the RI Code of Ethics.
Is certification required for CPR? (10/18/2011)
Yes, CPR needs two year certification AND a yearly documented training. The annual training can be in whatever form the Agency chooses (i.e.-a review from the nurse). Please ensure that the annual training is documented and the documentation is maintained (Section 49.50). This requirement is the same as in the previous regulations.
Does First Aid have to be a certified training? (10/18/2011)
No, the regulations do not require a specific First Aid training. Please review section 49.0, subsections 49.44 through 49.54 "Support Staff Training" for more information. These requirements were contained in the 2008 Regulations.
How have the new DD regulations changed from the prior edition? (10/11/2011)
The section of the Regulation that provides for Health and Wellness Standards has not changed since the 2008 DD Regulations. Please ensure that in referencing the Regulations that you are utilizing the final Regulations as promulgated with an effective date of 8/3/11. The 8/3/11 Regulations can be found by going to the Secretary of State's website Final Rules and Regulation Database Search
Will the RICLAS Specialty Clinics by eliminated? (10/11/2011)
Over the past 2 years the Department has begun to limit the scope of the RICLAS Specialty clinics. Participants have a broader access to all healthcare facilities, reducing the need for specialty clinics not integrated into community healthcare system. All adult DD individuals should have access to medical providers of their choice.
I'm looking for some clarification regarding 45.13 in the June 2011 Proposed Regulations regarding transporting clients from his/her "residence" to and from the participants employment/day activities. This regulation only refers to participants living in residential homes that the agency operates not for participants who live at home with their families- is that correct? If you could clarify this for me I would greatly appreciate it. (9/20/2011)
Section 45.13 of the regulations: Transportation is a program that provides transportation of a Participant from his/her residence, or the immediate vicinity thereof, to and from the Participant's program for the purpose of participating in employment/day activities approved by the Department. In providing these services, the DDO shall utilize the most clinically appropriate, least restrictive method of transporting the Participant. This regulation does not exclude clients who live at home with their family. The transportation units are allocated to the agency with the residential or family support funding. You may have the funding allocated to a different agency by completing a form requesting a change. (The form is located on the website: BHDDH Agency Billing Training Session #2 handout).
Funding Level
How is the funding level established for each client? (11/9/2011)
The resource allocation is based on a SIS. If SIS has not been performed and client is receiving services then, the resource allocation is based on previously approved level of service cross walked to the new levels effective 7/1/11.
May individuals choose how they spend their resource allocation? (11/9/2011)
Yes, clients may choose how they will spend their resource allocation.
It seems that individuals cannot switch agencies until prior approval from BHDDH? (11/9/2011)
Correct, before the actual move the Department must receive paperwork (ISP request a transfer of existing funds and a PO); this policy as not changed. Please give the Department 30 days to process request. New Agency may choose, the individual's start date anytime after the 30 days, unless the request is an emergency.
Were the new rates based on individual assessments? (10/25/2011)
There were no individual assessments. A cross over between new and old levels translated into updated rates.
How will the quarterly allocation be communicated to the families? (10/25/2011)
Authorizations are mailed to the client and/or family member.
Is the funding level assigned under Case Management the same funding level assigned under Independent Living? (10/11/2011)
Yes, the funding levels for Case Management and Independent Living are the same.
Purchase Order(PO)/ Individualized Service Plan(ISP)/ Interim Individualized Service Plan(IISP)
Must the agency answer all questions listed on the IISP? (4/25/2012)
Yes, agencies should be answering these questions to be best of their knowledge. Also, all signatures must be present in order for the Department to accept the IISP as complete. If the questions are not complete or if signatures are missing the IISP along with PO will be sent back for completion which could potentially have an affect on approval.
Please clarify the ISP process. I know some agencies have filled out IISP's and are using these for the entire year until a client's "regular" ISP is scheduled. Is this fine or do we have to complete a formal ISP within 60 days of a client being placed? The regs sound like a formal ISP is due within 60 days but most agencies are using the IISP for the first year. (3/29/2012)
An IISP can be used while the ISP is developed. The system expectation is that a fully comprehensive ISP will be developed and completed in accordance with the process and in compliance with the requirements described in "Section 37.0 Development of an Individualized Service Plan" within ninety (90) days of a Participant's entry into services with a DDO. The Department will be amending the regulations, DD Regulation 37.3, to increase the time from sixty (60) to ninety (90) days for the development of an ISP.
What should we do when a client has met their IISP or ISP goals? I assume we should write new goals for them but does this mean a new written IISP or ISP that has to be submitted? Should we just keep progress notes saying that the goals have been met and what the new goals are? (3/29/2012)
When developing the ISP, goals need to be developed in a clinically appropriate manner, including objectives that are measurable and indicate the desired level of performance or behavior that the Participant is trying to achieve. There shall be ongoing monitoring of the ISP and related documentation. See DD Regulations 37.19, 37.20, and 37.21. It is expected that when a goal has been "achieved" that the appropriate supports will continue to be provided to the Participant to ensure that the achievement is sustained. New goals should be documented by the support coordinator and discussed at the next annual ISP meeting.
Which Agency must complete and sign an IISP if the client receives services from a home care agency? (2/9/2012)
The Department will accept one plan per person. The IISP and P/O should be signed by all service providers (regardless of service type) who will provide services/support to the individual. If services are to be provided by a Home Care Agency these services should be included in the IISO and P/O. The Home Care Agency does have to sign the IISP and P/O. If the Home Care Agency can not provide services, then the Home Care Agency should contact the support coordinator.
I have a person we support who is currently receiving day supports from another agency. They would like to drop the other agency and receive community based day supports from us. I will put this in the new IISP, ISP and the purchase orders. My question is, how do I do the timing? (12/27/2011)
If it's a straight transfer (not an increase in funding), the start date is when the person starts with the new agency.
Where should the completed PO/IISP/ISP be mailed to? (12/16/2011)
Completed PO/IISP and ISP should be mailed to the Division of Developmental Disabilities, 6 Harrington Road Cranston, RI 02920, attention Leslie Ramos.
Does the Agency need to provide the social worker with completed PO/IISP/ISP? (12/16/2011)
The Department will provide the social worker with copies of the PO/IISP and ISP.
My Agency name is not listed on the PO drop down menu. Who can I contact to correct this matter? (12/16/2011)
When a participant splits their time receiving services between two Agencies, are BOTH Agencies required to submit the paperwork to BHDDH? (12/16/2011)
The Department will accept one plan per client. The IISP and PO should be signed by all service providers who will provide services/support to the individual.
Agencies were told that PO must be in by October 1, 2011 should we use the new allocation or the old allocation/ Does the PO have to be in by October 1st? (12/16/2011)
Agencies should use the new allocation. Since this process is new to all of us, the Department is being flexible with dates. PO should be send to the Department as soon as it's convenient.
I was looking for clarification on Part C section of the PO's. The instructions state "Enter all units you wish to purchase in per hour increments". I'm hearing conflicting information that we are required to use 15 minute increments. Could you please provide clarification? (12/16/2011)
The language on Part C of the PO has been corrected. Please use the unit increment description to bill accordingly.
Does the plan have to be submitted quarterly? (12/16/2011)
No the plan is done on a yearly basis. The PO is filled out and submitted with the plan. Agencies may either allocate services equally or fill out a PO for each quarter with the allocation. All PO's must be submitted with the plan.
How can an Agency change Day Program funding from one Provider to another? (12/16/2011)
A plan needs to be submitted with a PO to change the Day Program from one Agency to another.
On trying to finalize the IISP, the primary Provider is telling me that I'm required to answer all of the questions on the IISP regardless of the fact that I'm the secondary Provider. Please clarify? (12/16/2011)
On the IISP any questions that are not Agency specific should be answered by the Agency with the support coordination.
We are under the assumption that the Department is looking for IISP's and PO's for any plans that were done between January 2011 and July 2011. Please clarify? (12/16/2011)
The IISP and PO were due for any client who's anniversary date was after July 1, 2011. The IISP and PO are due 45 days prior to anniversary dates. If your Agency is behind in submitted IISP and PO, please do so as soon as possible.
What anniversary date to use on the PO when it's a new client? (12/9/2011)
Do not indicate an anniversary date on the PO, the Dept will assign a date. Once approved you will receive an authorization from the Dept and also the social worker will call to inform that services should start.
May the Budget worksheets be sent "unprotected"? (11/29/2011)
The Department is not able to send the Budget worksheets as "unprotected" spreadsheet.
What is the staff to consumer ratio that should be used in the PO? (10/31/2011)
The IISP and PO should equal the resource allocation per the SIS level.
Do you accept faxed signatures? (10/31/2011)
The Department will accept faxed signatures for emergency plans. Originals must be mailed to the Department within 14 days of fax date.
What is the procedure to handle changes in Day program? (10/11/2011)
The Department has had a long standing policy that if any changes are made to provider or service delivery location, then prior approval is needed from the Department. A new IISP and PO must be submitted. Please see DD regulations Section 37 "Development of an Individualized Service Plan".
Are staffing patterns and/or scheduling required in the IISP? (10/11/2011)
The IISP should include a program plan with a schedule of weekly services that the participant is entitled and eligible to attend. The plan reflects services that are being utilized by the client. The ISP requirements are listed in section 37 " Development of an Individualized Service Plan" of the DD Regulations.
If we are preparing the PO, do we include these respite dollars and units authorized to the respite provider on the PO? (10/11/2011)
The Department will accept one plan per person. The IISP and P/O should be signed by all service providers who will provide services/support to the individual. If services are to be provided by a Home Care Agency these services should be included in the IISP and P/O. The Home Care agency does not have to sign the IISP and P/O. If the Home Care agency can not provide services, then the Home Care agency should contact the support coordinator.
Respite
The residential PO does not have a line for respite. (4/23/2012)
Residential clients do not qualify for respite. SLA clients are given respite automatically therefore request is not needed.
Can I bill for a client receiving Respite with either the per diem or the 15 minute rate if the client is getting more than 9 hours of Respite in a day? Can I bill the SLA stipend with the respite per diem? (4/17/2012)
You may not bill the S9125 (Respite per diem) and the SLA stipend for the same day. You also may not bill more than 36 units of T1005 (Respite 15 minute) in a 24 hour period. If you have a client that is getting 9 or more hours of Respite in a given day you must bill 1 unit of S9125. You can not bill 96 units of T1005.
What is the Department's policy when a SLA host family member is unable to care for the SLA client due to illness? (2/17/2012)
If all of the quarterly respite allocation is expensed, with prior written Department authorization, the funds can be re-allocated from the stipend to pay the identified emergency respite provider.
May a SLA provider transfer respite allocation to an Respite provider? (2/13/2012)
Regarding SLA clients, respite is authorized and must be billed by the SLA agency. SLA provider is responsible to setup and coordinate respite since the agency is responsible for the client's care 24 hours a day. Therefore, in case of an emergency the family has a central agency that they can call.
For 3rd quarter FY12, we do not see the authorization for Respite or the billing codes for any of our clients? (12/23/2011)
Please see your spreadsheet. Column T is titled (Respite Amount), column U is titled (Respite Units). The Department did not provide billing codes because Agencies have the flexibility to use either per diem or regular respite rates.
Does the Department allow respite units to be moved from one quarter to another? (12/16/2011)
The Department will allow units to be moved from one quarter to another within the plan year. This request does not apply from year to year. Please submit "Request to Change Respite Allocation of Units" which can be found on our website under Billing/ IISP Trainings-BHDDH Purchase Order Training Session 10/24/11.
Will the Respite Providers be able to move money from Respite budget into Stipend budget? (11/9/2011)
The Department will not allow for money to be moved from respite to the stipend. The providers are allowed to use respite percentage in each quarter as needed.
What is the Agency liability in regards to Respite? (10/29/2011)
The Department recommends that the DDO Provider pay the Respite Provider. The use of Respite does not change liability.
Will the Department customize respite and stipend assessment to be based on the individual's needs? (10/29/2011)
The Department is examining the respite rate structure.
Does the Department plan on simplifying the process for Emergency Placement? (10/29/2011)
At this time the Department does not plan on changing the Emergency Placement process, it will remain at 30 days.
Does the Provider have to keep track of respite hours provided? (10/25/2011)
Yes, Provider should keep track of hours provided for record keeping purposes and accountability.
If we need a signature for respite, do we get it from the provider agency or billing agency? (10/11/2011)
The billing agency will need to sign.
Are the respite dollars included in the Community Based resource? (10/11/2011)
Individuals may choose to use respite services in their community service allocation. If individual chooses respite, the authorization is given to the designated respite provider.
How do I handle authorized Emergency Respites? (10/11/2011)
Please submit a new Purchase Order for the duration of the Emergency Respite.
Shared Living Arrangement
How are the Shared Living host family stipend payments and Shared Living respite paid for? Can the Stipend and Respite be combined into one payment? (12/16/2011)
The host family stipend payment must be equal or greater than the Daily Reimbursement to host family as calculated in the Shared Living Arrangements rate model. It is the responsibility of the licensed DDO Provider to ensure that the respite providers have all of the required background checks and comply with the respite provider section of the regulations. From a policy position, the Department wants to ensure that SLA host families utilize respite dollars. From a quality, health and safety perspective the Department wishes to ensure that families and participants do have the ability to access respite hours. It is no longer an option for the host family to elect not to use the respite hours and apply the respite dollars to their stipend. The respite rates for SLA participants are higher than other respite providers because the Department recognizes that the unique nature of SLA may require the availability of specific respite providers for each participant to provide respite in the host family home.
Can an Agency be the fiscal intermediary for respite? (12/16/2011)
The Department needs to authorize respite directly to the SLA provider. SLA provider would then bill.
What happens if an SLA does not have a High School Diploma? (10/29/2011)
Going forward the Department will require SLA Providers to have proof of High School Diploma. The Department will review each variance request based on individual needs.
How were the SLA rates affected? (10/25/2011)
The SLA rates were not affected, a decrease was made to administrative fees.
If a client becomes SLA, what paperwork is needed? (10/11/2011)
Please follow the same process and paperwork as for new funding requests (IISP/ PO).
What is the new SLA payment to be paid to host family? (10/11/2011)
The new rates were posted in our website on 9/1/11 which includes SLA amount. Respite is to be paid by DD provider to Respite provider.
Staffing Ratios
How to calculate staff ratio requirements for Community Resident & Day Program under the new regs? (9/20/2011)
Termination of Services
Who at the Department should be contacted regarding notices for termination of services?
(4/5/2012)
A copy of the 30 day notice should be forwarded to Tom Martin and Jane Morgan.
What is the procedure to terminate services? (10/3/2011)
Please review section 27 "Termination of Services" and section 28 "Transitions" of the DD Regulations. As further explained in the DD Regulations, the participant has the right to appeal the provider's decision to terminate services.
Transportation
We the agency would like to reimbursement family members for transportation. Is that allowable? (4/5/2012)
The transportation fund can only be used for commercial transportation not private.
May the agency add transportation reimbursement to a client's paycheck since the client is paying for transportation out of pocket? (4/5/2012)
The Agency may only bill for services provided.
Public transportation is not acceptable because of safety concerns. Can the agency contract a taxi company and use the transportation funds for reimbursement? (4/5/2012)
The Agency may contract the taxi company and use the transportation rate for reimbursement. Any appropriate documentation should be maintained.
My agency would like for the transportation units to be allocated to us. What is the procedure? (3/19/2012)
The agency that currently holds the transportation allocation must fill out a "Request to change Transportation Allocation" that can be found under the Billing/IISP Training-BHDDH Purchase Order Training Session (10/24/11) and fax it to Deb Cunningham per instructions on the form.
When using the form to transfer transportation allocations, should it be done on a quarterly basis or annual? (12/16/2011)
Once the transportation is moved to the correct Agency, it will not need to be done again. When submitting the PO, please specify which Agency should have transportation.
May the Agency use Community Based Supports hours to offset Transportation? (12/16/2011)
The Provider cannot offset Transportation by using Community Based Support hours. However, in the Options Self-Directed Program, the family can elect not to receive specific transportation authorization. In which event, it's a self directed program and can cover the cost of program hours according to the ISP.
What does the Transportation rate fund? (10/3/2011)
The Transportation rate funds trips to and from Day Program activities, Residential Day activities, activities in the community, employment, etc. Transportation is also funded in the Residential Day program. The Residential Day rate is based on an average of 50 miles per week per client. The Day Program is based on an average of 5 miles per day per client. These rates were posted on our website on 9/1/11.
FAQs