OPWDD providers are considered essential and should continue providing services to the best of their ability while practicing alternative treatments and procedures to protect the health and safety of the individuals they support, their families, and their staff. In order to continue to serve the population, OPWDD has issued updated guidance on service provision and reimbursement.
Provider Flexibility and Telehealth
OPWDD is allowing flexibility in the methods used to provide services. No prior approval is necessary to begin providing services remotely for the following programs:
- Community Habilitation
- Day Habilitation
- Prevocational Services
- Supported Employment
- Pathway to Employment
- Intensive Behavior Service
- Support Brokerage
Providers should use clinical judgement in determining if telehealth is appropriate and if services can be effectively delivered through verbal prompting and cueing. Additional non-face-to-face services can be billed such as delivering groceries or running other errands to help support the individual and their family. OPWDD is also allowing the transportation time to be included in the time billed.
Staffing qualifications are also flexible at this time. Direct Service Providers (DSPs) may continue providing services without completion of all training required in 14 NYCRR Part 633.8. This allows newly hired DSPs, and those that have not yet completed their training, to provide direct services if essential staffing is not otherwise available. DSPs are also permitted to begin providing services while the criminal background check results are pending as long as the DSP receives direct supervision and is not included on the Medicaid Excluded Provider list.
Telehealth is permitted for use for all services listed above and Article-16 Clinic services.
Providers are permitted to use everyday technology such as Skype, FaceTime, and FaceBook messenger and other private communication methods during this time. Providers may be reimbursed for services delivered via telehealth using technology that is not HIPAA compliant as well as services delivered over the phone.
The following documentation should exist for services provided:
- Reason for encounter
- Name of provider and credential
- Location of provider and individual
- Date of visit, visit start and end time and duration
- Whether a staff person or a member of the individual’s circle of support attended the session and identify them by name and title
- Note the success of the session, any technological or equipment failures, and follow-up plans.
Billing for Telehealth Services
When billing for Article 16 Clinic services billed delivered using telehealth, a telehealth location code modifier should be used.
Life Plans & Staff Action Plans
Current life plans and staff action plans are to remain in place and be updated when normal services can be resumed. They need not be updated for the changes in services occurring during this time.
Intermediate Care Facilities
Continue to monitor all residents for symptoms of COVID-19. To the extent that they can be tolerated all residents should wear face masks, and they should remain in their rooms as much as possible. All visitation, unless medically necessary, is to be suspended.
Day Service Providers
Day Service Programs have been suspended since March 17, 2020. This suspension applies to the following programs:
- Day Habilitation (site-based and without walls)
- Day Treatment
- Prevocational Services
During this time providers are able to provide alternative programming for families that are negatively affected by the program suspensions. There is no need to obtain prior approval for the alternative programming, it should be implemented as soon as possible.
Emergency Response Plans
Day program providers should have received an e-mail with an excel template for an Emergency Response Plan. This plan must be completed and returned to OPWDD for approval by March 27, 2020. Even if a provider has already notified OPWDD of their closure, they are still required to complete and submit this plan. The spreadsheet requests an anticipated length of closure, which is unknown for many organizations since they are operating under OPWDD’s mandates, however, agencies should include how long they are able to sustain a closure without permanently closing operations.
The purpose of retainer day payments is to keep agencies afloat during this mandated closure.
Day service providers are permitted to bill Medicaid for retainer days for individuals who:
- Are authorized to receive day services from your agency; and
- Were actively receiving day services from your agency prior to the mandated suspension of services.
Retainer day payments may be billed to Medicaid in accordance with the individual’s pre-existing schedule for participation in your agencies day services.
Providers should use their judgement when determining which participants to bill for. For example, if there has been a large lapse of time since a participant’s last service was provided, the provider should not begin billing retainer days even if the participant is authorized to receive services through their program.
While OPWDD understands that the same level of services can not be provided during this time, there is an expectation that providers will continue to support individuals and their families as best as they can during this difficult time. The nature of services provided may change, such as services being provided in alternate locations or via non-face-to-face communication methods. Providers can also support individuals and their families through the delivery of groceries and supplies. These type of support services need not be delivered on each day that a retainer day is billed for, but some type of contact should be made on a weekly basis, or more frequently, if needed.
Providers that provide multiple services to an individual should only bill for a single service at a time. For example, if community habilitation services occur during the usual time that day services would be provided, the provider should only bill for one of these services.
Billing for Retainer Days
Billing should remain the same except for the revenue code. Revenue code “180-Leave of Absence” should be used, which will identify the claim as a retainer day. This will indicate to OPWDD that the documentation for this date of service may not be in line with typical requirements.
Mahnaz Cavalluzzi, CPA
Mahnaz has been a member of Cerini & Associates’ audit and consulting practice area for over 8 years where she focuses on serving nonprofit organizations, education, and healthcare clientele. Mahnaz has experience in financial statement audits, financial statement reviews, tax return preparation, cost report filing, and other consulting. Mahnaz brings her expertise, diversified background, and helpful approach to all of her engagements.