Effective April 16, 2020 OPWDD has implemented a new retainer program for providers of Day Habilitation, Prevocational Services, and Community Habilitation.
This new program replaces the retainer payments available through April 15, 2020 for Day Habilitation and Prevocational Services. The new program will also be available retroactively to March 18, 2020 for Community Habilitation.
In order to participate in the program providers must complete an attestation acknowledging and agreeing to the following terms effective April 16, 2020:
- The Agency’s day service utilization since the date of facility closure is below 80% of the monthly average for July through December 2019.
- The Agency has retained staff in the 100, 200, and 300 CFR categories at the same levels as March 7, 2020 and the Agency will not layoff or furlough any employees in these categories. If an agency has already laid-off staff the Agency should make its best effort to return the staff to their positions. If laid-off employees are not willing to return, the attempt to re-employ them should be adequately documented.
- Agencies must remain productive by providing essential services to individuals currently served and providing assistance to support OPWDD residential facility providers or emergency “step down” intensive respite facilities operated by the provider or another provider.
- Agencies are subject to normal OPWDD and Medicaid billing laws, regulations, and policies.
- Agencies will cooperate with OPWDD and other agencies to address staffing shortages and enter into a signed cooperative staffing agreement with at least one other agency. Such agreement should be submitted to OPWDD by June 15, 2020. In certain situations where a shared staffing agreement is not practical, such as residential facilities where it would be unsafe to share staff, and exception may be made.
Claims may be submitted to eMedNY beginning on May 1, 2020 and are to be billed semi-monthly. Claims billed on the first of the month will be for the period through the 14th. Claims billed on the 15th of the month will be for the for the period from the 15th through the end of the month. The first payment received for the May 1, 2020 bill date for Day Habilitation and Prevocational Services will be prorated to include the period April 16, 2020 through April 30, 2020. Retainer payments for Community Habilitation for the period March 18, 2020 through April 15, 2020 will be paid at a later date not yet determined.
The payment amount received by Agencies will be calculated using the 80% of the average monthly paid claims for the period July 2019 through December 2019. New York State will calculate the amount of the retainer payment and notify agencies how many units they are authorized to bill for.
While agencies are receiving 80% of their revenue as retainer payments they are not limited to providing and billing for services, however some limitations do apply. There can be no duplication of billing for services provided in residential settings as Supervised IRA’s are already receiving an increased rate to accommodate the extra level of services that will need to be provided. The agency is limited to 100% of their average monthly billing for July 2019 through December 2019. For example, if billed services exceed 20% of the monthly billing amount the retainer payments will be reduced to limit total payments to 100%.
OPWDD is allowing flexibility in the delivery of service through various means.
- Day Habilitation, Prevocational Services, and Community Habilitation may be temporarily provided remotely via telehealth without prior approval. Telehealth includes the following:
- Delivering services via live two-way audio and communication, such as FaceTime, Zoom, or Skype
- Telephonic communications using only the telephone
- Agencies may temporarily provide and bill Medicaid for services that support the person and his/her family while maintaining social distancing. For example, Day Habilitation Prevocational Services, and Community Habilitation staff may deliver groceries. For these types of services, the time that staff spend traveling to the person’s home, running the errand, and returning to the worker’s home may be billed as service time.
- During mandatory school closures Community Habilitation services for school aged children and young adults may be provided during what would regularly be considered part of the school day.
- Life Plans and Staff Action Plans do not need to be formally updated at this time if the same services are being billed, but Agencies should be sure that staff are aware of the best way to safely deliver services.
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.