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 Disabilities as 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’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 chase environment.
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.