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Authors Posts by Carol Ferenz

Carol Ferenz

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Hole torn in a dollar bill with medicaid text

Deputy Secretary Ahrens has shared information regarding avoidable Medicaid non-renewals for individuals. If an individual is receiving waiver services and loses their MA, this has the unfortunate outcome of the individual being dis-enrolled in the waiver. In turn, services rendered during a time when the individual is ineligible will not be paid through waiver funds.

If your agency serves as a representative payee or provides waiver services, especially residential services, this can have a serious impact on both your agency and the individual receiving services. Of note:

  • As of 10/17/2023, the Office of Developmental Programs (ODP) has a record of 444 enrolled individuals (223 of whom are waiver participants) whose MA was not renewed procedurally. These participants’ renewal dates span April through September 2023.
  • 176 individuals (45 of whom are waiver participants) were registered and had their MA closed due to ineligibility.

The primary reasons appear to be that asset limits were exceeded and determination paperwork had not been returned (procedural closure). There are individuals who receive residential services in these groups. Please note that sometimes paperwork may go to a guardian or representative payee. In those situations, it’s important that there is communication between the provider and the responsible person. In particular, providers should be aware of the following:

  • Individuals receive MA renewal paperwork in the mail at their home address. Providers/SCOs should ensure that the CAO always has up-to-date contact information for individuals receiving MA.
  • Renewal dates differ. Individuals should receive renewal info about 90 days prior to the due date.
  • If a provider has questions about renewal dates for individuals, AEs and SCOs are provided data on all individual MA renewal dates.

Please ensure that your agency is aware of the renewal dates and is prepared to respond quickly and/or assist the guardian or family member who may be receiving the paperwork. Additionally, please be cognizant of the asset limits and consider opening an ABLE account if all the individual’s needs are met.

For any questions, contact Carol Ferenz.

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The Office of Developmental Program (ODP) has shared Final Fee Schedule Rates for Select Services Funded Through ODP’s Waivers and Guidance About Community Participation Support Impacted By the End of Appendix K. The purpose of this communication is to announce that the following Fee Schedule Rates have been published as final in the Pennsylvania Bulletin:

  • Residential Habilitation Needs Group 5 services funded through the Consolidated Waiver;
  • Group Music Therapy, Art Therapy, and Equine Assisted Therapy funded through the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers; and
  • Adoption of the enhanced rates as the fee schedule rates for Community Participation Support (CPS) funded through the Consolidated, Community Living, and P/FDS waivers and Transportation Trip funded through the Consolidated, Community Living, P/FDS and Adult Autism waivers.

This communication also provides guidance about implementing Fee Schedule Rates and procedure codes for Community Participation Support/Day Habilitation teleservices in the Consolidated, Community Living, P/FDS and Adult Autism waivers that become effective November 11, 2023, when Appendix K flexibilities end.

Please review the announcement for additional information and detail.

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Photo by Markus Winkler from Pexels

The Office of Developmental Programs (ODP) has informed RCPA that the final rates for services that will be impacted by the ending of Appendix K, which includes CPS, transportation, and Residential Needs Group 5, will be published in the PA Bulletin this weekend. The rates were first published as proposed rates in the Pennsylvania Bulletin, Volume 53, Number 21, on Saturday, May 27, 2023.

In some cases, these rate changes will require a critical revision to Individual Support Plans (ISP). Information regarding implementing Needs Group 5 for individuals served in residential habilitation with exceptional needs is outlined in ODP Announcement 23- 083.

Please watch for an announcement from ODP with additional information this weekend.

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The Office of Developmental Programs (ODP) has shared ODPANN 23-089, which informs stakeholders of ODP’s participation in the 2023 National Core Indicators (NCI) State of the Workforce (SoTW) survey. It also requests confirmation of current contact information from eligible providers. Please review the communication and the copy of providers list for additional information.

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This is a final reminder that the Office of Developmental Programs (ODP) shared ODPANN 23-080: Office of Developmental Programs (ODP) Residential Provider Survey for Selective Contracting. The purpose of this announcement was to notify ODP providers rendering residential services (including residential habilitation, LifeSharing, and/or supported living) that they are required to complete a survey. The survey must be completed no later than today, November 9, 2023.

Please review the announcement and survey for additional information and details. Contact ODP directly with any questions.

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