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ISP

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ODP Announcement 22-007: UPDATE provides information to providers in order to prepare for upcoming rate increases that are scheduled to be published in the Pennsylvania Bulletin on February 26, 2022.

Per the final public notice for Fee Schedule Rates, Department-established fees, and the AWC FMS Department-established fees rendered through the Consolidated, Community Living (CLW), and Person/Family Directed Support (P/FDS) waivers:

  • The anticipated effective date for the increased Fee Schedule Rates is January 1, 2022; however, the effective date in the Home and Community Services Information System (HCSIS) will be March 1, 2022.
  • The anticipated effective date for the Department-established fees for residential ineligible services is July 1, 2022, and HCSIS will reflect the same effective date.
  • Both the Fee Schedule Rates and Department-established fees for residential ineligible services will be visible in HCSIS on February 28, 2022. Compensation will be for the period January 1, 2022–February 28, 2022. The updated fee schedule rates will not be loaded in ISPs for the period January 1, 2022–February 28, 2022. Instead, the current rate will remain for that period, and ODP will be compensating providers, via gross adjustments, for the difference between the rate billed and the updated fee schedule rate for dates of service rendered during the period January 1, 2022–February 28, 2022. This is intended to eliminate the provider’s effort of voiding and rebilling claims.

ODP anticipates processing gross adjustments during the April to May 2022 timeframe to ensure all billing for dates of service January 1, 2022–February 28, 2022 has been completed. Providers are strongly encouraged to bill in a timely manner to minimize the need for corrections.

Since the new rates will have a begin date of March 1, 2022, two service/rate segments in authorized status will be present on ISPs, assuming no errors set. One service/rate segment will reflect the period July 1, 2021, to February 28, 2022, or the begin date of the service when it was initially authorized on the plan during Fiscal Year (FY) 2021–2022. The second service/rate segment will reflect the period March 1, 2022, to June 30, 2022.

Authorized units on the first service/rate segment, July 1, 2021–February 28, 2022, will reflect 67% of total authorized units for the FY 2021–2022. The second service/rate segment will reflect 33% of total authorized units for the remainder of FY 2021–2022. If an individual requires more than 33% of the total annual authorized units for the remainder of FY 2021–2022, a revision to the plan will be necessary to move units from the first service segment to the second service segment on the ISP. For the period July 1, 2021, to February 28, 2022, providers should bill normally for any services rendered.

See the ODP Announcement for the full instructions.

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ODP Announcement 22-007 informs providers that the new Fee Schedule Rates and Department-established fees are anticipated to be visible on Individual Support Plans (ISPs) in HCSIS on February 14, 2022.

The anticipated effective date for the increased Fee Schedule Rates is January 1, 2022; however, the effective date in the Home and Community Services Information System (HCSIS) will be February 15, 2022. The anticipated effective date for the Department-established fees for residential ineligible services is July 1, 2022, and HCSIS will reflect the same effective date. Both the Fee Schedule Rates and Department-established fees for residential ineligible services will be visible in HCSIS on February 14, 2022.

Of note, on January 6, 2022, the P/FDS cap was increased to $41,000, and the Community Living Waiver cap was increased to $85,000.

This communication provides guidance and addresses Individual Support Plan (ISP) related impacts.

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ODP Announcement 21-061 announces a full-day virtual training session available for registration in August, September, and October 2021 on Residential ISP Staffing, as described in ODP Announcement 21-057.

The 20 full-day virtual training sessions are geared toward key residential provider and SCO staff who regularly attend team meetings, supervise staff who attend team meetings, or train staff that attend team meetings, and AE staff who review and approve plans. It is expected to be conducted in “mixed” audience groups (Provider, SCO, AE reps and Office of Developmental Programs’ staff) to better assure exposure to a variety of perspectives and roles.

One person per entity is invited to attend to provide a maximum of 30–35 people per session. Participants and their agencies will need to commit to the understanding that, upon completion, they will be a resource at their home agency. The training will be interactive. All training participants must complete the prerequisites located on MyODP on the course registration page.

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