TDD Frequently Asked Questions. 2. Who is responsible for getting/maintaining/monitoring the plan of care?

Transcription

1 TDD Frequently Asked Questions Service Planning 1. Is a plan of care the same as the service plan/isp? No, the plan of care is the physician s authorization for services. It may be documented on the JFS 485 form or an alternate form. Plans of care are required for waiver nursing and personal care aide provided by a Medicare Certified home health agency and for waiver nursing provided by an independent provider. 2. Who is responsible for getting/maintaining/monitoring the plan of care? An agency provider of waiver nursing or personal care aide and an independent provider of waiver nursing are responsible for obtaining an initial plan of care from the individual s physician and updates to the plan of are at least once every 60 days. Support Administrators need to be aware of the contents of the plan of care and need to reference the plan of care in the service plan. 3. Are county boards going to use the assessments developed by DODD for self-administration of medication, tube feedings, and insulin? Yes, county board personnel will be required to use the tools developed by DODD when the need for an assessment is identified. However, unlicensed personnel are not permitted to administer medications or perform health-related tasks under the TDD waiver. A person who is unable to self-administer medications or perform health-related tasks either with or without assistance must have those tasks performed by an unpaid support or a nurse. Service Verification 1. Who can sign a timesheet for an individual who is unable to sign? An individual s chosen representative may sign on the individuals behalf. The method by which services are going to be verified should be specified in the individual s service plan. 1

2 2. Is a family member who is also a provider able to sing the timesheet? No, someone other than the provider of services is required to verify service provision. The method by which services are going to be verified should be specified in the individual s service plan. Provider Qualifications 1. Can a family member be a provider? Legally responsible family members include parents of minor children and spouses. Legally responsible family members may only provide waiver nursing and only as an employee of an agency. Non-legally responsible family members may be providers of TDD services either as independent providers or as employees of agencies. 2. Can a guardian be a provider? Only a related guardian may be a provider. Unrelated guardians may not provide services under the waiver. 3. Is agency staff required to have annual background checks? No, the requirement for annual background checks applies to only non-agency or independent providers only. Provider Training 1. What are the two training sessions required for providers servicing people enrolled in TDD? All providers are now required to have training in the rights of individuals with developmental disabilities as established in Ohio Revised Code and Major Unusual Incidents (MUI) definitions and reporting processes. Current providers must have training prior to 1/31/13. All new providers must have training prior to serving individuals enrolled in this waiver. Training is required each calendar year, thereafter. 2. Where is the training being offered? Providers should contact their local county board of developmental disabilities to see if training is being offered. The courses are also available online through vendors such as the Ohio Association of County Boards ( 2

3 3. Can agency providers develop training for their employees? Yes, agencies may develop training for their employees on the topics of Rights and MUI. Training regarding MUI must conform with training requirements outlined in Ohio Administrative Code 5123: Provider Authorization and Billing 1. If providers no longer submit calendars to county boards each month, how will billing match the plan? The All Service Plan and service authorization currently in place for individuals enrolled in the TDD Waiver will remain in effect after 1/1/13. The county board will develop an individualized service plan (ISP) at the time of the individual s annual review. While the All Service Plan remains in effect, providers must adhere to the authorizations listed in the methodology section on the goals page of the All Service Plan for the service being provided. After the county board develops an individualized service plan (ISP), providers will provide and bill for services in accordance with the service authorizations included with the new plan. 2. Are providers able to change shifts? Yes, when individual is served by multiple providers of the same service, the days/hours worked by each provider can vary. However, changes must be made with the approval of the individual served and must remain within the service authorization specified in the All Service Plan or ISP. 3. Can the county board change the service authorization that is in place on 1/1/13? All service authorizations for individuals enrolled in the TDD waiver are reviewed and approved by the Ohio Department of Developmental Disabilities (DODD). A county board may propose changes to the service authorization when the individual experiences a change in status that cannot be addressed through other resources, including unpaid supports, local-funded services, private insurance, and/or Medicaid state plan services. 4. Who do I contact with questions about the number of units I am authorized to provide? Providers should contact the Support Administrator (case manager) assigned to the individual served with all questions regarding service plan and service authorizations. 5. Is anything changing about how providers bill for services? No, billing for TDD providers will continue to be submitted directly through MITS. Nothing will change with the process, rates, or codes used for billing TDD services. Providers who use a billing agent may continue to use the same billing agency after January 1,

4 6. Who do I contact with questions related to my billing or issues with my payment? If a claim is denied as a result of exceeding the cost cap for waiver services, make sure that was billed is consistent with the number of units and dollars for each service authorized in the individual s service plan. If the claims are consistent with the service plan, the provider may contact for assistance. Request for assistance should only be submitted to TDDinbox after ensuring billing is consistent with the plan and ONLY for claims denied as a result of exceeding the cost cap. All other claims issues related to the TDD waiver and/or state plan home health or private duty nursing services must initially be directed to the Ohio Department to Medicaid. The ODM contact number for assistance is Billing inquiries should no longer be directed to CareStar. The Ohio Department of Medicaid will continue to process all claims for providers of TDD services. Provider resources are located at the following link: 7. Is it true that a prior authorization number is no longer required when billing for home modifications or adaptive equipment? Yes, effective January 1, 2013, a prior authorization number is no longer required when billing for home modifications or adaptive equipment. After DODD reviews/approves the proposed budget submitted by the county board, the county board will inform the provider that work may begin or the equipment may be ordered. For home modifications, the county board will verify completion of work and give the provider a copy of the verification form. Upon receipt of the verification form, the provider may bill for services without entering a prior authorization number. The county board will also confirm receipt of the appropriate equipment and notify the provider when they may proceed with billing. Service-specific Questions: 1. Can an individual be charged for meals that are provided at an Adult Day Health Center? No, payment to the Adult Day Health Center provider incudes the cost of at least one meal daily that meets individuals dietary requirements. 2. If the Adult Day Health Center provider does not transport individuals to/from the site, what other services can be used for transportation? Individuals may use Supplemental Transportation or Personal Care Aide for transportation to an Adult Day Health Center site. 4

5 3. If an Adult Day Health Center provider transports individuals, does the service start/stop as soon as individuals enter/leave the vehicle or when they enter/leave the center s site? The Adult Day Health Center service begins when the person arrives at the service site and ends when the person leaves the Adult Day Health Center location. 4. Are TDD home modification providers able to sub-contract services? Yes, home modifications may sub-contract services. However, the provider billing for the service is ultimately responsible to ensure the modification was completed in accordance with the specifications. 5. How often does a vehicle used for Supplemental Transportation need to be inspected by Ohio Highway Patrol? The vehicle must be inspected prior to use for Supplemental Transportation. 6. Are there a maximum number of days each year that out-of-home respite may be provided? No, there is no maximum number of days an individual is able to receive out-of-home respite each year. However, when individuals are receiving the majority of services in an institutional setting through the out-of-home respite service, the Support Administrator may need to assess ether or not the individual should maintain enrollment in a home and community based services waiver. Compiled from DODD s memo to Service Providers dated 1/30/13 and DODD s Transitions- Developmental Disabilities Waiver Frequently Asked Questions 5