Joined: 03 Nov 2006
|Posted: Sat Nov 04, 2006 12:06 am Post subject: the new annual plan
|I do not think families have been notified of these pending changes(surprise). I think it is critical that we all meet with providers and CM's of our loved ones and have an understanding of what this will mean to the services they receive.
TO: Medicaid Providers for the DD, Autism and Support Services Waivers
FROM: Peter Bisbecos, Director DDRS
RE: Annual Plan Modifications
DATE: November 1, 2006
On November 1, 2005 Indiana implemented the Annual Plan, a streamlined billing process for
Residential Habilitation and Support Services (RHSA) and Day Services (DSRV). As a result,
for the first time in several years, 650 individuals have been notified that they are now able to
receive services. Already 568 have responded positively and have begun the process to get a
waiver. This increase to those in services and future planned increases would not have been
possible without the active cooperation and support of the individuals we serve, their families,
providers and case managers. Thank you all for working with us as we continue to move
forward with our important mission and vision.
In addition to the move to the Annual Plan, DDRS has implemented a number of significant
changes over the past year. These changes have focused on using State resources in a more
efficient and effective manner. Moving individuals, when appropriate, from fully State funded
services to federally matched programs, identifying individuals served in State funded programs,
and initiation of the OASIS project have increased the ability of the DDRS to serve individuals
with disabilities across the lifespan.
As you are aware, Annual Plan rates for RHSA and DSRV are based on an annual budget for
each individual divided by 365 to arrive at a standard daily rate. The service flexibility and
billing simplification of the Annual Plan has encouraged many Individual Support Teams to try
new and innovative service approaches that would not have been allowed under the old model.
This approach required approval by the Centers for Medicare and Medicaid Services (CMS).
DDRS and OMPP have had an open and on-going dialog with CMS during the planning and
implementation phases. We have made significant progress in these discussions with CMS. For
example, we have successfully demonstrated that the new service groupings provide important
flexibility and reflect typical service provision. After considerable discussion, we have received
specific direction from CMS on changes that must be made to the Annual Plan.
The first change to the Annual Plan will be the move from billing on enrolled days to billing only
on days served. This change will be made by taking an individualís current daily rate,
annualizing it and dividing that rate by the actual number of days served between November 1,
2005 and October, 31, 2006. By using the full year of attendance, we expect to arrive at a daily
rate that takes into account typical attendance patterns. The new daily rate will be billed by
providers only on days the individual receives service, but should result in an annualized budget
reflective of what is currently committed.
The State expects to incorporate an absentee flexibility factor of 25% for Day Services and 15%
for Residential Habilitation and Support Services into each daily rate. In addition, the State is
committed to implementing a monthly cap that allows unused units in one month to be rolled
into future months. The absentee factor will provide cushion if an individualís estimated
attendance differs modestly from the last year and the rolling monthly cap will ensure the
annualized budget is not exhausted before the end of the individualís plan of care year. It is
important to note that the Stateís financial commitment to the Medicaid waiver programs
remains the same.
The shift to billing on days served will take a significant amount of work and cooperation from
all. Specific forms and instructions on submitting attendance days for the past year will be
distributed by November 3, 2006, sent to your companyís contact for Notices of Action (NOA).
Our goal is to move to billing on days served for services rendered beginning January 1, 2007.
We encourage providers to begin gathering attendance data from the monthly attendance logs for
the individuals they serve.
After that change is in place, we have committed to CMS that we will submit additional
amendments on each waiver by July 1, 2007. These amendments will reflect a uniform rate
model for Residential Habilitation and Support Services and Day Services. We are actively
working to identify models that both maintain the daily rate and meet federal requirements. As
with the move to billing on days served, INArf and Arc of Indiana are participating in these
discussions. Additional information on this process will be shared as it becomes available.
The commitment of the Annual Plan was to provide payment for services as described in the
Individual Support Plan to assist the individual in achieving personal outcomes. We will create
an outlier processes to review and address rate issues for those individualís whose attendance
histories result in unusually high daily rates. Please expect further information on this process in
This transition will require everyoneís best effort and continued commitment to the individuals
we serve. During this time of transition, I will ask you to keep in mind the significant
improvements we have made to the service delivery system and the individuals that have been
added to services www.IN.gov / fssa
Equal Opportunity / Affirmative Action Employer
Mitchell E. Daniels, Jr., Governor
State of Indiana
DIVISION OF DISABILITY AND REHABILITATIVE SERVICES
402 W. Washington Street, P.O. Box 7083
Indianapolis, IN 46207-7083
as a direct result of our partnership.