• A time limited approval for “retainer day payments” (paying programs when services can’t be provided due to closure) will be effective for the period of March 18 through March 31. OPWDD will work with CMS to get an extension to the 14 days. This billing construct applies to Group Day Habilitation, Supplemental Group Day Habilitation, Site-Based Prevocational Services, Community Prevocational Services and Day Treatment. This does not apply to any other service. Providers with suspended day services will be eligible to submit claims to Medicaid with existing identifiers and be paid their service rate for those days that a person would typically receive the service (i.e., the provider can only bill for active, enrolled individuals based on the individual’s typical program schedule). As an example, if someone was attending the day program for 5 days per week, the provider would bill for 5 days. If someone was attending for 3 days, they would bill for 3 days. OPWDD advised that Day Habilitation providers with no residences should enter into arrangement with IRA programs for staff to work in an IRA unless day habilitation staff can be redeployed elsewhere. A new billing code is being established for these “retainer day payments.” 

• To address the individuals who reside in a provider’s Supervised Individualized Residential Alternative (IRA) and attend a day program operated by a different provider, OPWDD is working with the New York State Department of Health (DOH) on an enhanced Supervised IRA provider rate. (i.e., the enhanced rate will only be used for those IRA residents who were NOT receiving day habilitation services from their IRA provider). The construct of the rate increase is based on the time that the individual would spend away from the home at the external provider’s day programs closed effective March 18th. Provider associations are seeking clarity on the date on which this enhanced rate will be in effect, but we understand it will be in effective for the duration of the crisis. Individuals residing in the provider’s IRA and typically receiving day services from that same provider would be covered using the “retainer day” billing construct.  

• OPWDD is discussing approaches for the Supportive IRAs as these are not a 24/7 staffing model so the enhanced rate construct may not work. 

• OPWDD is currently developing similar guidance on billing for day services provided to individuals within Intermediate Care Facilities (ICFs).  

• OPWDD is also requesting CMS approval to adjust rates as necessary based upon utilization prior to the submission of cost reports (which may provide a vehicle to address the ongoing Day Habilitation billing issue if an extension in retainer days beyond the 14 is not approved). 

• OPWDD has requested that all recoupments be suspended, including the retroactive overpayments for the 7/1/19 rebased rates and we expect an update on this on Sunday’s 4:00 PM call.

• Providers of Self-Directed Community Habilitation for individuals under quarantine will also be able to bill for retainer days. OPWDD is still exploring an approach if the self-hired staff is under quarantine. 

• More flexible counting of non-face to face time such as travel start time, where a staff person leaves their home to go to the grocery store to purchase and drop off groceries to the family of an individual could count and providers could bill for the entire round trip. This applies to day services, community habilitation and respite. Expect that you should document what you do if delivering a service including start/stop time, and these activities may not necessarily appear in the person’s Staff Action Plan. 

• The Provider Associations also have submitted a proposal for far greater billing flexibility for Community Habilitation and Respite, which we will continue to push for approval. 

• Service location: Services will be able to be delivered at a variety of locations during the COVID-19 public health emergency (e.g., hotels, out-of-state).

• Face-to-face service requirements are being waived for Day Habilitation, Community Habilitation, Prevocational Services, Supported Employment, Pathway to Employment, Intensive Behavioral Services and Support Brokerage. This is to increase the use of telehealth modalities. No prior approval will be required, nor will changes in the Life Plan or Staff Action Plan be required at this time. Providers will be expected to use good clinical judgement in determining if the service can be best delivered remotely. This waiver does not include Respite services as the purpose of the service is relief for caregivers and remote service delivery is not authorized. 

• DSPs will be able to deliver HCBS even if not currently in their required trainings. This will also improve the provider’s ability to onboard new DSPs during the period of the Covid-19 public health crisis. 

• Limited exemptions from certain criminal background checks (CBCs) will be included. An example being that an employee may start working while their CBC is pending. Such provisional employees should not be left unsupervised during the period they are working with a pending CBC. 
• OPWDD is still working on addressing background checks for employees with a completed CBC that want to work at another provider agency. 
• OPWDD is also working on the reopening of companies that are conducting the CBCs. 

• Required staffing ratios may be modified.

• The current Life Plan and Staff Action Plan (SAP) of an individual will remain in effect through the duration of the COVID-19 public health emergency and there is no need for immediate changes. 
• Addendums can be completed after the public health emergency subsides.
• As new goals and supports are implemented in relation to addressing the COVID-19 situation, habilitation providers are not expected to update the current SAP.

• The Division of Quality Improvement’s Bureau of Program Certification (BPC) will not be conducting Site, Person-Centered or Agency Reviews at this time. 

• The deadline to submit the Consolidated Financial Report is extended.