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Tags Posts tagged with "Fee-For-Service"

Fee-For-Service

The Office of Long-Term Living (OLTL) has announced new services that will be available as a result of the Community HealthChoices (CHC) Waiver renewal and OBRA Waiver renewal. Effective January 1, 2025, the following services will be available:

Chore Services – CHC Only

  • Provider Type: 59
  • Specialty Code: 431
  • Procedure Code: S5131

Teleservice Cognitive Rehabilitation Therapy – CHC and OBRA

  • Provider Type: 59
  • Specialty Code: 207
  • Procedure Code: W0176

Teleservice Counseling Services – CHC and OBRA

  • Provider Type: 59
  • Specialty Code: 231
  • Procedure Code: W0175

Teleservice Nutritional Consultation – CHC and OBRA

  • Provider Type: 59
  • Specialty Code: 230
  • Procedure Code: W0170

The rates for the OLTL Home and Community-Based Services (HCBS) rates, effective January 1, 2025, are available here.

Additional information on the licensure and certification requirements can be found in the Service Definitions under Appendix C of the waivers. Please note that these documents have not received final approval from the Centers for Medicare & Medicaid Services (CMS). Once approval is received, a ListServ message will be sent with links to the final approved waiver applications.

The Fee for Service rates for Teleservice Cognitive Rehabilitation Therapy, Teleservice Counseling Services, and Teleservice Nutritional Consultation have been added to the fee schedule attached to the ListServ.

For existing OLTL providers to enroll in the services listed above a request must be submitted to the enrollment and certification resource account. The required documentation should include an updated Provider Enrollment Information Form (PEIF), a copy of the required license or certification, and a copy of the job description for the service you are requesting to add to your provider profile. If you have any questions related to the new services you can reach out to the enrollment and certification unit at 1-800-932-0939, option 1, or via email.

CMS Webinar: June 14, 2023
1:30 pm – 3:00 pm ET
Register here

States can use outcome-based payment arrangements as an alternative or supplement to traditional fee-for-service (FFS) payments to incentivize 1915(c) waiver program providers with meeting targeted milestones or achievements. States offering outcome-based payment arrangements establish targeted outcomes that align with participant or program goals. This training will help states by:

  • Providing an overview of outcome-based payments in 1915(c) waiver programs;
  • Highlighting examples of outcome-based payments from 1915(c) waiver programs and outcome-based payments methodologies;
  • Discussing the impact of the COVID-19 Public Health Emergency and state responses using outcome-based payments; and
  • Discussing considerations for states implementing outcome-based payments in 1915(c) waiver programs.