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Tags Posts tagged with "NG5"

NG5

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The Office of Developmental Programs (ODP) has announced a delay in the implementation of the Performance-Based Contracting (PBC) measure RD.01.1, which restricts residential placement options for individuals with higher needs. As originally written, RD.01.1 stated that beginning January 1, 2026, primary tier providers would not be permitted to accept new referrals for individuals assessed at Needs Group 5 (NG5) or higher. This requirement has now been delayed by two years.

  • Effective January 1, 2028, primary tier providers may not accept new referrals for individuals in NG5 or higher.
  • This restriction does not apply to:
    • Individuals already receiving residential services prior to January 1, 2028; or
    • Individuals whose needs assessment results in an increase to NG5 or greater after services have begun.

Until December 31, 2027, it remains permissible for Administrative Entities (AE) and Supports Coordination Organizations (SCO) to refer individuals in NG5 to a primary provider. However, AEs and SCOs may choose to limit these referrals to Select and Clinically Enhanced providers.

Contact:

Questions regarding this announcement should be directed to ODP electronically.

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As of December 2, 2023, Residential Habilitation procedure codes that reflect Needs Group 5 (NG5) have been loaded into the Home and Community Services Information System (HCSIS). These procedure codes have not been automatically added to provider service offerings. Providers will need to add the appropriate NG5 procedure codes via the service management screens in HCSIS. The instructions for adding a service can be found on the HCSIS Provider Updates Tip Sheet.

For any future NEA NG5 requests, please contact the rate setting mailbox for guidance. Previous communication regarding NG5 can be found here.

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