how providers are paid - south carolina hsp... · one point the world’s richest man and first...
TRANSCRIPT
John D. Rockefeller, an Ohio native, started Standard Oil. Rockefeller was at one point the world’s richest man and
first ever American billionaire. Considering he was a
billionaire in the early 1900’s he is still considered as the richest person in
modern history. When a reporter asked him, “How much money is enough?” He
responded, “Just a little bit more.”
How DDSN pays Providers for services • Band System (Capitated Contracts)• Daily rates to non-Board QPLs• One of 3 Fixed Price Bid Contracts
(QPL, HM, TFH)• Non-Capitated Grants• Special One-time Grants
The Funding Band System for paying the DSN Boards was initiated in
1998 as a means of uniform payments for services to DSN
Boards. Prior to the funding bands, individual rates were negotiated
with each DSN Board.
The Funding Band System adds flexibility to the Boards to provide
funding across all capitated services.
By their very nature, the Band system is an average for each type of
capitated service.
The funding bands are designed to pay DSN Boards prospectively up
front to ensure that cash is available to meet the documented service
needs of consumers.
Bands eff. 7/1/16
Band A State funded Community Supports 14,222
Band B At Home - IDRD Waiver 12,990
Band C Supported Residential - SLP II 31,666
Band D Supported Residential - SLP I 19,568
Band E Supported Residential - CTH I 24,297
Band F Supported Residential - Enhanced CTH I 38,104
Band G Residential Low Needs 61,563
Band H Residential High Needs 82,398
Band I At Home - Community Supports Waiver 13,612
Band R Residential Placement from Regional Centers 90,529
Residential Band H - Individuals whose costs exceed $104,632
may be considered for outlier status,
At Home Band B - Individuals whose costs exceed $34,358
may be considered for outlier status.
Residential Band R does not qualify for outlier status.
The Qualified Providers are paid retrospectively through one of the
three Fixed Price Bids. The rates are simply the bands converted to a
daily rate.
7/1/2016
Revised
QPL Rate
Rate Increase Unit
Residential High Needs - CRCF/CTH II 225.75 36.83 Daily
Residential Low Needs - CRCF/CTH II 168.67 37.28 Daily
Residential - HASCI CTH II 228.33 7.51 Daily
Supported Residential - SLP II 80.83 2.39 Daily
Supported Residential - SLP I 1,453.73 31.29 Monthly
Supported Residential - CTH I Monthly
Supported Residential - Enhanced CTH I 2,451.12 50.89 Monthly
Day Supports 22.92 0.43 Half Day
Supported Employment - Individual 70.10 1.33 Hour
Case Management 136.94 3.55 Monthly
Early Intervention - Family Training 23.07 0.60 15 minutes
Respite 11.30 - Hour
Personal Care 1 3.23 15 Minutes
Adult Companion 9.50 Hour
Residential R Band 248.02 6.44 Daily
DSN Boards then report the various services provided to DDSN, which in
turn bills Medicaid to receive reimbursement for Medicaid eligible
consumers. DDSN receives reimbursement from Medicaid
approximately 2 months after the prospective payment is made to the
DSN Board.
Individual Service Reports (ISR’s)
• Respite, Companion/Caregiver, SLP I
• Logs mailed to Case Managers the last week of the month prior to the month of service
• Logs due back to DDSN/SURB by the end of the month subsequent to the month of service
• If the consumer does not receive any services, write “NO SERVICES RECEIVED” and return the log to DDSN/SURB
RESLOG & DSAL
• Submit & Approve logs timely
• Service Error Correction Forms (SECF)
• Adding new consumer to the log – reporting
• Day Service authorization – Funding – Consumer Budget & STS
• Who do I invoice for Day Services?
• CTH II & at home – Financial Manager
• SLP & CTH I - DDSN
• HASCI - DDSN
• Approve attendance logs
• Case Manager monitoring – unauthorized services
• 3 month lag (February WCR will be reflected in May 1st & 16th
payments)
• Run the report from R2D2 excluding PCA for under 21 & All Nursing Services
• Reimbursements must be received within 6 months of the date the payment was recouped on your payment schedule.
The amounts put into the funding bands in 1998 and again in 2006 when DDSN rebased the funding bands were based on the audited
Financial Statements and Medicaid Cost Reports of the DSN Boards.
The funding bands have been adjusted over the years for pay
increases, health insurance increases, retirement contribution
increases when appropriated by the General Assembly.
What is in the Funding Bands?
Residential cost – the average cost of residential supports for each residential setting
DDSN did not put a specific dollar amount in the bands for any particular cost category whether that is personnel, transportation, etc. DDSN took the ‘total’ cost from DSN Boards audited Financial Statements/Medicaid cost reports and put the ‘total’ cost into the funding band. So whatever costs were on the providers books, those costs are in the funding band.
What is in the Funding Bands?
Day Supports – the average cost of day supports for the number of consumers in each funding band who receive day supports
For example: if 90% of the consumers in a particular residential funding band received day supports, only funding for those consumers was put into the funding band. The theory is that if consumers stay in the residence during the day, the staff costs associated with them staying in the residence are picked up in the residential component.
What is in the Funding Bands?
Day Supports – the average cost of day supports for the number of consumers in each funding band who receive day supportsAgain, DDSN did not put a specific dollar amount
in the bands for any particular cost category whether that is personnel, transportation, etc. DDSN took the ‘total’ cost from DSN Boards audited Financial Statements/Medicaid cost reports and put the ‘total’ cost into the funding band.
What is in the Funding Bands?
Other Waiver Supports:
The amount of waivers services (such as respite, PCA, prescription drugs, etc.) actually received by consumers based on Medicaid paid claims.