IMPORTANT NOTICE TO OREGON PROVIDER ORGANIZATIONS
RE: APD-PT-19-003* Policy Transmittal: Agency Billing Activities Effective 2/1/2019
As of Friday, 2/1/19, most eXPRS submissions by provider organizations will automatically be paid by ODDS without case management review. (Service codes OR539, OR570, and OR310 are excluded from this change.) The Oregon Office of Developmental Disabilities Services (ODDS) will conduct post-payment reviews of provider organization documentation. This change may expedite payment to some provider organizations, but it does not change documentation requirements.
Oregon Administrative Rule 411-415-0090 requires Case Management Entities (both CDDPs/counties and Brokerages) to conduct extensive and specific monitoring of services including but not limited to:
- Ensuring all services provided align with those authorized in the ISP
- Confirming support and progress toward goals
- Confirming individual choice is being honored
The review of provider organization progress notes is an invaluable tool in meeting these monitoring mandates. For this reason, the six Portland metro-area brokerages will continue to expect to receive progress notes for all services delivered. Per the state’s transmittal, these notes must include:
- Customer name
- Provider of service
- Dates of service (the date range is sufficient)
- Units of service provided (total number of units for the period is sufficient)
- A progress note summarizing the service provided and progress toward goals (weekly or monthly summaries are perfectly acceptable)
As guidance, please review the following from the Indirect Case Management Monitoring Worker’s Guide:
Adequate provider agency progress notes focus on describing the supports a person received to achieve the desired outcome. These include the ADL, IADL, medical and behavioral supports identified on the ISP as being needed. The notes should focus on the specific activities (i.e. “visited a museum”) only insofar as they are important to achieving the desired outcomes as described in the ISP. Simply stating the name of the service associated with the procedure code is not sufficient (i.e. “Provided Day Support Activities” is not an adequate progress note to support a claim by the agency or for the purposes of indirect monitoring.) An adequate note will allow a SC/PA to determine if the services are consistent with those authorized in the ISP. Provider agency progress notes are also a place for the provider to convey observations about possible changes in support needs, challenging behaviors and a wide variety of topics. These reported observations should be reviewed by the SC/PA for their potential impact on risk identification, new person-centered information, and service planning. The SC/PA’s supporting progress note should reflect their assessment of the observations and the actions they will take in response, if any.
This excerpt demonstrates that progress notes are an important tool in monitoring supports and communicating changes in an individual’s needs and choices. As such, we request that providers submit progress notes for all supports no later than one month after the provision of services. For example, notes for services provided in February will be due by the end of March.
In compliance with the transmittal, we will be notifying ODDS when we do not receive progress notes within the 30-day window.
We anticipate that issues with overlapping billings will likely continue. As CDDPs/counties Brokerages are no longer part of the invoicing and payment processes, providers will need to seek resolution of these issues from ODDS.
Finally, we trust that our provider organization partners share our values with regard to continuing to offer customers the authority to review and authorize their services via signature. We will have one-on-one conversations with each of our customers regarding their options, and plan to solicit broad customer and family input on how to ensure choice continues to be offered and honored.
Thank you for your continued partnership and your service to our shared customer base as we work together through this next transition.
*Source: http://www.dhs.state.or.us/policy/spd/transmit/pt/2019/pt19003.pdf
