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Questions Submitted to the Internal Review Committee (IRC)

Anniversary Date


When can an anniversary date be changed? (11/7/2012)

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Where can the anniversary date be found? (10/3/2011)

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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)

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My agency is receiving a smaller amount of case management (support coordination) for certain clients. Why is this happening? (5/2/2012)

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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)

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Client passed away in the beginning of the month. How should the agency billed for case management. (4/26/2012)

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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)

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What is the cost of care limit? (1/12/2012)

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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)

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What does the modifier 2 represent? Do we need to use it for billing? (12/16/2011)

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Should Agencies expect paper authorizations to be mailed for all clients? (12/16/2011)

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How are the service allocation being authorized? (12/16/2011)

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Are Agencies responsible to bill for phone conversations? (12/16/2011)

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Can a nurse checking medication be billed as community based supports by professional staff? (12/16/2011)

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May a client use family support funding for home care services? (12/16/2011)

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When billing, claims are being suspended with code 245 "claims exceed authorization balance"? Please explain. (12/2/2011)

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If there is units available, would it matter if billing at higher rate? (11/29/2011)

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Authorizations do not reflect if an Agency is opened on a holiday. How can we bill actual units vs authorized units? (11/29/2011)

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There are 250 day program days per year but there's 6120 units which came to 255 days. Which is correct? (11/29/2011)

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Does the ORS funds need to be used first? (11/29/2011)

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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)

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If someone other than a DSP provides services to an individual, can we bill for that time? (10/11/2011)

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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)

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What is the rate code for nursing staff that spend time doing phone calls, care plan, etc? (10/11/2011)

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DD Regulations


How to access CPI training? (5/4/2012)

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What is the Department's credentialing criteria for job development and assessment? (2/10/2012)

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May the Agency e-file client information including but not limited to; reports, emergency fact sheets, individual service plans, surveys, etc.? (2/1/2012)

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We would like to send plans/ PO prior the 45 days requirement. Will the plans/PO be accepted by the Department? (12/16/2011)

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We have clients who require nursing but whose funding does not fall under extraordinary level. How can we capture this cost? (11/29/2011)

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Please clarify section 49.45, there are no subcategories listed? (11/29/2011)

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Where does BHDDH stand with new people being referred? (11/29/2011)

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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)

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Section 37.1 does not refer to staffing patterns or schedules, why does the plan need to include these items? (11/9/2011)

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Is there a model that Agencies can follow for guidance in establishing Code of Ethics? (10/25/2011)

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Is BHDDH bound by a Code of Ethics? (10/25/2011)

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Is certification required for CPR? (10/18/2011)

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Does First Aid have to be a certified training? (10/18/2011)

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How have the new DD regulations changed from the prior edition? (10/11/2011)

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Will the RICLAS Specialty Clinics by eliminated? (10/11/2011)

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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)

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Funding Level


How is the funding level established for each client? (11/9/2011)

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May individuals choose how they spend their resource allocation? (11/9/2011)

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It seems that individuals cannot switch agencies until prior approval from BHDDH? (11/9/2011)

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Were the new rates based on individual assessments? (10/25/2011)

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How will the quarterly allocation be communicated to the families? (10/25/2011)

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Is the funding level assigned under Case Management the same funding level assigned under Independent Living? (10/11/2011)

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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)

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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)

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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)

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Which Agency must complete and sign an IISP if the client receives services from a home care agency? (2/9/2012)

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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)

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Where should the completed PO/IISP/ISP be mailed to? (12/16/2011)

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Does the Agency need to provide the social worker with completed PO/IISP/ISP? (12/16/2011)

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My Agency name is not listed on the PO drop down menu. Who can I contact to correct this matter? (12/16/2011)

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When a participant splits their time receiving services between two Agencies, are BOTH Agencies required to submit the paperwork to BHDDH? (12/16/2011)

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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)

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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)

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Does the plan have to be submitted quarterly? (12/16/2011)

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How can an Agency change Day Program funding from one Provider to another? (12/16/2011)

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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)

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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)

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What anniversary date to use on the PO when it's a new client? (12/9/2011)

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May the Budget worksheets be sent "unprotected"? (11/29/2011)

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What is the staff to consumer ratio that should be used in the PO? (10/31/2011)

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Do you accept faxed signatures? (10/31/2011)

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What is the procedure to handle changes in Day program? (10/11/2011)

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Are staffing patterns and/or scheduling required in the IISP? (10/11/2011)

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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)

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Respite


The residential PO does not have a line for respite. (4/23/2012)

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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)

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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)

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May a SLA provider transfer respite allocation to an Respite provider? (2/13/2012)

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For 3rd quarter FY12, we do not see the authorization for Respite or the billing codes for any of our clients? (12/23/2011)

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Does the Department allow respite units to be moved from one quarter to another? (12/16/2011)

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Will the Respite Providers be able to move money from Respite budget into Stipend budget? (11/9/2011)

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What is the Agency liability in regards to Respite? (10/29/2011)

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Will the Department customize respite and stipend assessment to be based on the individual's needs? (10/29/2011)

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Does the Department plan on simplifying the process for Emergency Placement? (10/29/2011)

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Does the Provider have to keep track of respite hours provided? (10/25/2011)

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If we need a signature for respite, do we get it from the provider agency or billing agency? (10/11/2011)

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Are the respite dollars included in the Community Based resource? (10/11/2011)

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How do I handle authorized Emergency Respites? (10/11/2011)

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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)

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Can an Agency be the fiscal intermediary for respite? (12/16/2011)

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What happens if an SLA does not have a High School Diploma? (10/29/2011)

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How were the SLA rates affected? (10/25/2011)

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If a client becomes SLA, what paperwork is needed? (10/11/2011)

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What is the new SLA payment to be paid to host family? (10/11/2011)

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Staffing Ratios


How to calculate staff ratio requirements for Community Resident & Day Program under the new regs? (9/20/2011)

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Termination of Services


Who at the Department should be contacted regarding notices for termination of services? (4/5/2012)

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What is the procedure to terminate services? (10/3/2011)

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Transportation


We the agency would like to reimbursement family members for transportation. Is that allowable? (4/5/2012)

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May the agency add transportation reimbursement to a client's paycheck since the client is paying for transportation out of pocket? (4/5/2012)

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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)

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My agency would like for the transportation units to be allocated to us. What is the procedure? (3/19/2012)

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When using the form to transfer transportation allocations, should it be done on a quarterly basis or annual? (12/16/2011)

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May the Agency use Community Based Supports hours to offset Transportation? (12/16/2011)

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What does the Transportation rate fund? (10/3/2011)

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