Sept 2014 Changes to Provider Organization Day Support Activities (DSA) and Employment Services

Effective 09.01.2014, the State of Oregon Office of Developmental Disabilities has made significant changes to day program, sheltered workshop, and supported employment services offered by provider organizations. Please see below for some Frequently Asked Questions related to the September 2014 transition and translation of Day Support Activities and Employment Activities.

What is DSA? DSA stands for Day Support Activities. This is a new title (with new rates) for a subset of services offered exclusively by provider organizations.  DSA includes both attendant services and skills training and may be provided in either a facility or the community.

Why is this change being made? The State is aligning rates and service descriptions across both brokerage and 24/7 comprehensive services. Unfortunately, brokerages and brokerage-specific providers weren’t included in the planning for this change, which has resulted in a rocky implementation process.

What’s changing? Effective September 1st, 2014, many traditional services (like Community Inclusion and Skills Training,)  when provided by provider organizations, will be collapsed into the new DSA heading. There are rate changes associated with this change. Further, these services must now be billed through Oregon’s online payment system, eXPRS.

What’s happening with Employment Services? Employment services and rates have been adjusted and amended as well. As with DSA services, billing will now go through eXPRS for services provided September 1st, 2014 forward.

Where did the new rates come from? The rates were determined by the State of Oregon Office on Developmental Disabilitiesas part of its ReBAR efforts.

Are these rates and definitions permanent? We don’t know. The state has pulled together a workgroup, set to begin meeting in late September and through October 2014. The workgroup has provider organization, county, brokerage, customer, and family representation. The group will give recommendations for everything from rates to service definitions. The first meeting is on September 29th, 2014.

Do provider agencies charge the same rate for every customer? No. Each customer has an individual rate based on his/her assigned Tier. The Tier is determined by the Adult Needs Assessment his/her Personal Agent conducts prior to ISP planning.

Can Personal Support Workers or Independent Contractors provide DSA? No. DSA is a provider organization-specific service. Similar services are provided by other provider types, but they are labeled differently and have a different set of rates.

What if my agency isn’t in eXPRS? You should contact Julie Harrison or Acacia McGuire Anderson directly. You need to ensure you have a properly set up provider number.

What’s a Medicaid provider number? A Medicaid provider number is assigned to you by the State. You must have a Medicaid provider number in order to bill in eXPRS and be paid for certain services provided September 1st, 2014 forward. If you provide DSA or Employment services to brokerage customers, you need a provider number ASAP. Brokerages can no longer pay you directly for these services. Nate Deeks and Acacia McGuire Anderson are responsible for assisting provider organizations having trouble with this particular issue.

What services to brokerage customers will be billed through eXPRS? For services PROVIDED September 1st, 2014 forward, all DSA, employment and employment path related services will be billed and paid through eXPRS. This includes: Day Support Activities, Individual Supported Employment, Small Group Supported Employment, Discovery/Career Exploration, and Employment Path Services.

What are the steps a provider agency needs to take to get paid for DSA and/or employment services?
The provider agency must log into eXPRS, find the specific customer for whom services was provided, locate their active Plan of Care, then bill against that Plan of Care. At the same time, the provider organization must send a copy of their customer-approved invoice and progress notes to the Personal Agent (as you always have.) From there, brokerage staff will review your invoice, go into eXPRS and give the state the thumbs up to release payment.

How do I know if my agency and customers are affected? We have been in direct contact with many provider organizations over the past month. Additionally, INW sent out mailers in the last week of September, notifying provider organizations directly of what we believe the translation will look like. However, if you have questions or believe we should make adjustments to the changes, Larry Deal (503.546.2950 x10) or Ron Spence (503.546.2950 x12.)

Will provider organizations receive new service agreements from INW? INW will not be sending new service agreements, but will send you a translation document which amends the current agreement. If you require additional documentation, please call us directly.

Do I have to submit an invoice to the brokerage anymore? Yes. You should submit your customer-approved invoices and progress notes to your Personal Agent as you always have. Nothing has changed there. Brokerages are not a pay and chaseenvironment.

Can I bill for two different services on the same invoice? Yes, you can, but you’ll need to itemize and clearly spell out the differences in services.

Are there changes to what provider organizations can/cannot bill for?
One large change is that provider organizations cannot bill for miles driven while concurrently providing Day Support Activities.

Are DSA services pro-rated? No. DSA services are never pro-rated, regardless of the number of people served at one time.

Why are services in eXPRS limited to a monthly allotment when brokerage plans are written at an annual allotment? We hope this will be corrected in eXPRS very soon as it is already causing issues for providers and customers. We have a commitment from the new DD Director that annual authorizations are allowable in the system. In the meantime, the monthly limit in eXPRS creates a false restriction of services (counter to how plans were written.) If you see that the monthly restriction is too tight for a customer’s actual utilization (but keeps within the customer’s annual contracted agreement with you) give us a call and we will work towards correction in eXPRS. Thanks for your patience while this gets sorted out.

What happens if I submit “old” invoices for services provided before September 1st, 2014? Those services will not be billed through eXPRS. So, you can skip going into eXPRS and just send the bill directly to your PA. Payment will come via direct deposit or paper check from Independence Northwest.

What if I run into issues with billing? Please call Larry Deal (503.546.2950 x10) or Ron Spence (503.546.2950 x12.) We will respond to provider organization issues within 1 working day. Our aim is to work with providers to clear up issues as soon as possible.

 

Source Documents:

Oregon Ranks 26th in UCP’s Annual Case for Inclusion Report

Vermont offers the best Medicaid services for individuals with intellectual and developmental disabilities while Mississippi provides the worst, according to United Cerebral Palsy’s 2011 report “The Case for Inclusion.” Oregon comes in at 26.

1. Vermont
2. Arizona
3. Michigan
4. New Hampshire
5. California
6. Washington
7. Delaware
8. Nevada
9. Massachusetts
10. Connecticut
11. New Mexico
12. Colorado
13. Hawaii
14. Minnesota
15. Pennsylvania
16. South Carolina
17. New York
18. Idaho
19. West Virginia
20. Wisconsin
21. Wyoming
22. Georgia
23. South Dakota
24. Montana
25. Kansas
26. Oregon
27. Florida
28. Missouri
29. Maine
30. Alaska
31. Maryland
32. Alabama
33. Kentucky
34. Rhode Island
35. Iowa
36. North Dakota
37. Louisiana
38. Virginia
39. Ohio
40. New Jersey
41. Tennessee
42. Indiana
43. North Carolina
44. Utah
45. Oklahoma
46. Nebraska
47. District of Columbia
48. Illinois
49. Texas
50. Arkansas
51. Mississippi

Metro Area Brokerages to Add Capacity through Summer

There are currently five support services brokerages supporting individuals with developmental disabilities in the Portland metro area. In the last year, capacity in brokerages has become an issue as we all reached our contracted limits with the Department of Human Services.

After discussions with stakeholders, the Department of Human Services has announced initial expansion plans to create capacity for those who have been waiting. During the months of August and September, four of the five metro brokerages will add staff to allow for an additional 90 individuals to begin receiving services. The expansion of services was announced prior to the recent across-the-board budgetary cuts. Due to the current climate, plans beyond October are not yet clear.

This expansion is a statewide effort and capacity is being added to counties and brokerages statewide.

Independence Northwest grew by leaps and bounds in its first two years (opening 450 customers in a record 18 months) and for this and other reasons, we have chosen not to increase our contracted capacity at this time. We applaud the efforts of the Department of Human Services and our fellow brokerages statewide.

DD Coalition: Developmental Disabilities Services Funding At Risk As Oregon Faces Significant Budget Deficit

Important Announcement from the DD Coalition:

Developmental Disabilities Services funding is at risk as Oregon faces a significant budget deficit. Oregon’s Department of Human Services (DHS) and the newly-created Oregon Health Authority (OHA) are now formulating budget priorities for the current and upcoming two year fiscal cycle. If DD services are important to your family, friends, business and/or community, EMAIL DHS TODAY at dhs.oha@dhs.state.or.us.

The budget projections are grim and there will be cuts! Community Forums have been held throughout Oregon over the past few weeks to discuss DHS/OHA budget and funding priorities. However, the number of people speaking on behalf of DD services were minimal. It is essential that DHS / OHA leadership hears about the importance of the services to individuals with developmental disabilities and their families.

DHS / OHA SPRING 2010 COMMUNITY FORUMS

1) Protect Funding for Services to People with Developmental Disabilities

DD services support one of Oregon’s most vulnerable populations across the lifespan through a diverse array of services. DD services are cost effective and efficient. Many of these services have already experienced reductions over the past several fiscal cycles including employment / day services and family support. There are no budget reductions that will not significantly impact the lives of vulnerable individuals with developmental disabilities and their families.

Background: The challenge facing Oregon is how to maintain funding even for existing services. The DD Coalition will join with other organizations to prioritize human services to vulnerable populations and to address the resource issues in the Oregon budget.

2) Protect Access to Adult Support Services

The Staley Settlement Agreement has resulted in cost effective and efficient delivery of services to adults with developmental disabilities entitled to Medicaid services. Access to Adult Support Services provided through the system of nonprofit brokerages must be preserved.

Background: The Staley Settlement Agreement ends in June of 2011. There are discussions occurring to extend the Agreement but it is not a given that will happen. It is important to maintain the current service structure, services, and access to supports.

3) Memorandum of Understanding Needed between DHS and OHA

Seniors and People with Disabilities, Developmental Disabilities Program must maintain the ability to operate services and implement quality assurance / quality improvement even if DHS no longer has the Medicaid Authority. There must be a detailed Memorandum of Understanding to protect the integrity of DD services.

Background: When DHS splits and OHA is created, the actual authority for Medicaid moves to OHA. A detailed agreement between the two agencies is needed to assure that the DD program can continue to implement and improve services.

4) Continue to Utilize the Fairview Community Housing Trust for its Intended Purposes

The Fairview Trust represents a promise made to Oregonians with developmental disabilties and families. By providing small amounts of funding for physical adaptations and accommodations, it fulfills a committment to community based living for hundreds of Oregonians with developmental disabilities each year.

Background: The Fairview Trust was established with the assets from the sale of the Fairview Training Center property. It is designed to serve generations of Oregonians with developmental disabilities.The funding is most often used for critical home modifications that address the health and safety issues. If the trust fund dollars are used by the state for other purposes, it is very unlikely that they would ever be replaced.

***Additional Public Participation Opportunity***

DHS and OHA have created new mission statements, and have created surveys that provide an additional opportunity for stakeholders to express their opinion regarding agency priorities. Please visit the DHS/OHA agency transition web site at www.oregon.gov/OHA/transition/vision.shtml to see the proposed mission statements and take the surveys.

NOTE: These surveys close on May 26! ACT NOW!

DHS external stakeholder survey

OHA external stakeholder survey

National Disability News Resource

Disability Scoop is the first and only nationally focused online news organization serving the developmental disability community including autism, cerebral palsy, Down syndrome, fragile X and intellectual disability, among others.

Five days each week Disability Scoop sifts through the clutter to provide a central, reliable source of news, information and resources. Plus, Disability Scoop is the only place to find original content and series like “Scoop Essentials” that take an in-depth look at what lies beyond the day’s headlines.

Oregon Developmental Disabilities Services by County

Ever wondered what services are available beyond your own county? Check out the DD Coalition’s fact sheets on county services for more information.

Baker County
Benton County
Clackamas County
Clatsop County
Columbia County
Coos County
Crook County
Curry County
Deschutes County
Douglas County
Grant County
Harney County
Jackson County
Jefferson County
Josephine County
Klamath County
Lake County
Lane County
Lincoln County
Linn County
Malheur County
Marion County
Mid-Columbia: Hood River, Wasco, Sherman Counties
Morrow, Wheeler, Gilliam Counties
Multnomah County
Polk County
Tillamook County
Umatilla County
Union County
Wallowa County
Washington County
Yamhill County

%d bloggers like this: