#dayservices

Did you miss the ODEP webinar on February 8th about meaningful integrated day activities?  Click this link to access a recording of the webinar.  Guest speakers included:

o   Sara Murphy, EFSLMP National Subject Matter Expert and Director, TransCen's WorkLink 

o   Gail Fanjoy, EFSLMP National Subject Matter Expert and CEO, Katahdin Friends, Inc.

Objectives for the webinar included:

o   Define "meaningful integrated day activities"- what they are and what they are not

o   Distinguish between inclusion, exclusion, segregation, and integration that can direct staff planning and supports

o   Understand what a fully-inclusive weekly schedule consisting of meaningful integrated day activities and wrap around supports looks like for an individual with a disability 

We have been made aware that providers continue to have questions about the requirements for providing, documenting, and billing for day services. Below is an excerpt from the Waiver definition of day services regarding what must be done to receive reimbursement for that service. Providers must document the amount of time spent receiving a day service to equal at least 6 hours per day (with the exception of “c” below).  If you still have questions or particular scenarios for which you would like to have clarification please contact [email protected], [email protected], or [email protected]. 

The provider may receive the per diem reimbursement for Day Services if:

a.         The person receives 6 hours of direct services comprised of any combination of Community-based, Facility-based, and or Supported Employment Day Services.

b.         The person receives 6 hours of In-home Day Services. The reimbursement shall be the per diem rate for In-home Day Services.  (If In-Home day services are provided for any portion of the day In-Home services is the only day service that can be billed for that day.)

c.         The person receives at least 2 hours of Day Services and there is documentation that the person was unable to complete the full 6 hours of Day Services for reasons beyond the provider’s control (e.g., sickness of the person).

Reimbursement for a combination of different Day Services (e.g., community-based, facility-based, and or supported employment) provided on the same day shall be made in accordance with the following:

a.         If the person receives up to or in excess of 6 hours of a combination of Community-based and Facility-based Day Services, the reimbursement shall be the per diem reimbursement rate for the type of service provided for the greatest amount of time that day.

While we can certainly appreciate the impact that inclement weather has on our provider community, we must also consider our obligation to ensure that services are paid in accordance with our approved federal waivers.  Unfortunately, even in observance of the most recent severe weather emergency, a service (in this case, Community-Based Day Services) cannot be billed unless it is actually provided.  Further, provision of In-Home Day Services due to inclement weather is clearly beyond the scope of the currently approved waiver service definition.  We could not subject either the department or providers to potential violations of the False Claims Act.

Additionally, as you know, the rate for both services is inclusive of 20 days per year of leave time built into the methodology that was specifically included to cover just such events.  All this said, we also understand the realities for providers who feel they are left in a situation where they are required, by their respective provider agreement, to maintain adequate staffing that meets the unanticipated needs of persons receiving supports.  Data reviewed recently indicates that many of the persons receiving day services bill the maximum number of days allowed each year.  So, even if we could allow these services to be paid, the net impact would not result in any additional payments to providers in light of the 243 day per year limit.