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SCO

ODP Announcement 22-085 announces clarification for Supports Coordination Organizations (SCO) on resuming Waiver and Targeted Support Management (TSM) Supports Coordination (SC) in-person monitoring. Many adjustments have been made to the Office of Developmental Programs (ODP) policy and operations during the COVID-19 pandemic. Appendix K allowed for SC services to be provided remotely during the pandemic. ODP planned to replace the Appendix K guidance with new requirements detailed in the Intellectual Disability and Autism (ID/A) Waiver renewals and the Adult Autism Waiver (AAW) amendment effective July 1, 2022, to allow for some SC individual monitoring to continue to be completed remotely.

Both the ID/A Waiver renewals and the AAW amendment are pending approval with the Centers for Medicare and Medicaid (CMS). Therefore, ODP is issuing guidance to clarify the expected requirements of individual monitorings performed by SCs. This announcement outlines the updated requirements for SC in-person and remote monitoring and obsoletes that section of Appendix K.

ODP expects SCOs that were unable to meet the June 30 deadline for completing the in-person monitoring for at-risk individuals to continue to follow their plan and communicate with the ODP regional office to ensure that all the priority individuals are seen in-person.

This announcement outlines requirements for SCOs to implement no later than October 1. For additional questions, please contact your appropriate ODP regional office.

The purpose of this bulletin is to provide guidance on documentation needed to substantiate a claim as well as provide guidance on the service documentation processes. This information is applicable to providers and Supports Coordination Organizations (SCO) that render services through the Consolidated, Community Living, P/FDS, and Adult Autism Waivers as well as Targeted Support Management (TSM) and base-funded services.

Documentation to provide a record of services delivered to an individual must be prepared and kept by the provider, SCO, or common-law employer for the purposes of substantiating a claim and documenting service delivery. The Office of Developmental Programs (ODP) has developed Technical Guidance for Claim and Service Documentation for providers of services in the Adult Autism Waiver and providers of services for all other waivers and base-funded services, which provide specific information for providers and SCOs on the documentation that must be kept for each service in order to support a claim and to document service delivery. These apply to services rendered by providers and SCOs that have enrolled directly with ODP, organized health care delivery systems, and services delivered through both self-directed services models, Agency with Choice, and Vendor Fiscal/Employer Agent.

Providers are encouraged to review and consider using the Medical Assistance Provider Self Review Protocol to proactively identify and address any claim documentation-related problems. The protocol can be found here.

This communication is intended to provide guidance to all stakeholders who participate in the process of transitioning an individual from Residential Habilitation Service to Supported Living or Lifesharing. Updated information includes instructions for adding procedure codes for transition payments and directions to AEs. The new language is below:

Once a request is approved, ODP will issue communication directly to the Provider, AE, and SC with instructions for adding the transition payments to the individual’s ISP. The communication will contain procedure codes, steps for adding the service to the ISP, and additional instructions for submitting claims.

By signing the transition request form, the AE is indicating they agree that the provider has presented a plan that ensures the individual’s health and safety needs will be meet in the proposed Lifesharing or Supported Living program. A move date does not need to be determined for a signature to be applied, but the AE may use discretion to request more detailed transition information from the provider to assure a reasonable and safe transition plan is in place.

The Office of Developmental Programs (ODP) held a webinar for residential and day service providers, families, and Supports Coordination Organizations (SCO) to cover best practices for reopening day service provider facilities on June 6, 2022. The handout from the webinar is available for reference. Please see below:

ODP Announcement 22-039 describes actions the Administrative Entities (AE) and Supports Coordination Organizations (SCO) must take when an Office of Developmental Programs’ (ODP) waiver or base participant is admitted to a nursing facility in order to ensure a coordinated transition to Long-Term Care (LTC) services and prevent service interruptions. Read the full announcement for details.

ODP Announcement 22-049 provides guidance to Supports Coordination Organizations (SCOs) for a return to in-person individual monitoring as well as Questions and Answers from the webinar held on April 5, 2022.

Please review “ODP Announcement 22-035: Update on ODP’s Expectation for Resuming In-Person Individual Monitoring Conducted by Supports Coordinators” for further information regarding in-person individual monitoring.

The Office of Developmental Programs (ODP) has announced the Children with Medical Complexities Training Series – Part 1: Expanding Supports for Children with Medical Complexities webinar series for ID/A Supports Coordination Organizations and Administrative Entities. This webinar will be held Thursday, April 21, 2022, from 2:00 pm–3:30 pm.

In this introductory session to providing supports to children with medical complexities, ODP Medical Director Gregory Cherpes, MD, and Chief Nursing Officer Rhonda Gengler, RN, will provide an overview of the training series’ topics that will be covered in greater detail in subsequent sessions. Particular focus will be given to a companion document that will serve to augment the Supports Coordinator (SC) monitoring tool and assist the supports coordinator during monitoring visits.

A virtual office hour session will be held on April 26 from 2:00 pm–3:00 pm to address further questions with ODP staff. Registration information will be provided at a later date.

ODP Announcement 22-014 informs providers that the United States General Services Administration announced a change for the rate of Transportation Mile reimbursement rate, procedure code W7271, beginning January 1, 2022. The new rate is $0.585 per mile.

This communication provides notice of the rate change as well as provides instruction for Supports Coordination Organizations (SCOs) on how to add transportation mileage to the vendor screen. It also instructs direct service providers on how to submit claim adjustments, if applicable.