Managing the Impact of Temporary Enhanced Rates

Managing the Impact of Temporary Enhanced Rates for Community Participation Support and Transportation Trip on Individual Support Plans (ISP) and Annual Fiscal Limits

The Home and Community Services Information System (HCSIS) was automatically updated to include the temporary increases to the CPS and Transportation Trip fee schedule rates. Critical revision will not be necessary for most ISPs to implement the change to the fee schedule rates. However, ODP recognizes that the temporary rate increases may result in an individual’s ISP exceeding the CL or P/FDS waiver caps. As a result, ODP Announcement 21-021 provides guidance to ISP teams to do the following:

1. When adjusting the ISP, Supports Coordination Organizations should select a manual review. Even if the manual review is selected and there is no service change to the ISP, an auto authorization will occur, and Administrative Entities should conduct a quality assurance review.
2. If the implementation of the temporary enhanced rates puts an ISP budget total over the respective cap established for the P/FDS waiver or the CL waiver, ISP teams should review current utilization of the services and adjust services accordingly in an attempt to bring the ISP budget within the cap. ISP Teams should follow the guidelines in the ISP Manual when looking at service utilization on an ISP, as follows:
   1. Determine if the designated service has the desired effect to address the specified need, which promotes the achievement of an Outcome Statement.
   2. Determine if there is an established limit associated with the service.
   3. Determine if the units in the ISP are necessary based on the individual’s current needs and are not above the established limit.
   4. Review the previous year’s utilization to inform discussions for future decisions.
   5. Determine continued need and skill attainment.
3. When it is determined that, due to underutilization, service units can be reduced after completing a service utilization review; an ISP Team Meeting should occur to ensure individuals, families, and providers are aware and agree with any changes to the ISP. If an individual or family does not agree, the SC should request a cap exception by submitting the request to the Administrative Entity, using the existing process. ISP Teams will have an opportunity to revise ISPs for Fiscal Year 21-22 in accordance with forthcoming guidance, including taking the individual’s needs into account for Fiscal Year 21-22 which could include restoring units that were reduced this year.
4. If the waiver cap for the P/FDS or CL waiver will be exceeded after utilization is reviewed and adjusted accordingly, the ISP team should request a cap exception by submitting the request to the Administrative Entity, using the existing process. Please refer to ODP Announcement 20-069 for the process and cap exception form.