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New Rates Effective July 1, 2015 (Providers)

5/21/2015

 
For the original publication, please click here. The following is a text version of the original publication. 
--
To: Bureau of Developmental Disabilities Services Providers 
From: Cathy Robinson, Director, Bureau of Developmental Disabilities Services 
RE: New Rates Effective July 1, 2015 
Date: May 21, 2015 

On July 1, 2015 new rates will be in effect for Community Habilitation – Individual (CHIO), Facility Habilitation Individual (FHIO) and Respite for both the Family Support and Community Integration and Habilitation Waivers. Residential Habilitation Services (RH10 and RH20) will have new rates under the Community Integration and Habilitation Waiver. The new rates are in the table below and a new rate chart will be posted on the Division of Disability and Rehabilitative Services’Announcements webpage. 

While these rates are being implemented across both waivers, the Bureau of Developmental Disabilities Services (BDDS) anticipate only a relatively small number of individuals will be immediately impacted by the new, increased rates. This group of individuals will see a change in their Cost Comparison Budgets (CCBs) that will result in a need for team discussion to determine if the service package continues to be appropriate for them. 

Although the new rates do not go into effect until July 1, 2015, BDDS will be converting to the new rates prior to that in order to give case managers and providers an opportunity to review the changes prior to the July 1 conversion. Below is the timeline for the conversion and the actions case managers will need to take after the conversion is complete.


  • May 23 and 24, 2015 conversion of rates will take place in the INSite system. The conversion process will update rates and create new a CCB and Notice of Action (NOA).
  • For the Family Supports Waiver:
    • The hours of CHIO, FHIO and Respite will be adjusted so that individuals CCB’s will remain at the $16,545 cap for this waiver.
    • When more than one of these services is being provided each service will be reduced proportionately.
  • For the Community Integration and Habilitation Waiver:
    • The hours of CHIO, FHIO and Respite will be adjusted so that individuals DAYS Reserve will remain at the allocation for the individual ($5,500; $10,500; $18,000)
    • When more than one of these services is being provided each service will be reduced proportionately.
    • Once the conversion takes place, case managers should review CCB’s with the team to determine if there is any need to update the CCB based on the rate changes.
    • For individuals who have a DAYS reserve above the normal allocations listed above the hours of CHIO, FHIO and Respite will be adjusted to bring the DAYS reserve to the level it was prior to the rate increase.
    • For RHS 10 and RHS 20 the Objective Based Allocation (OBA) and the RHS allocation will be increased to reflect the number of hours the individual is currently receiving. RHS hours will continue to be provided at the levels required in 460 I.A.C.
  • Updated NOA’s will begin going out to NOA email address on May 26, 2015 and will continue to be sent out through May 29, 2015. On each of these four days 25 percent of the NOA’s will be sent out. This so that the email systems for both the State and providers will not be adversely affected by the volume of emails being sent.
  • If providers have not received their NOA’s by close of business on June 1, 2015 they should submit a ticket to the INSite help desk with a list of individuals who they did not receive an NOA on but they believe they should have.
  • NOA’s will only be issued to providers when the provider is rendering one of the services which have had a rate increase. NOA’s will not be issued to providers of services that did not have a rate increase.
If you have questions or issues regarding this conversion please send an email to BQIS.Help@fssa.IN.gov.

2015 Rate Conversion Timeline
  • 5/24-5/25/15: Conversion of rates will take place in the INSite system 
  • 5/26-5/29/15: Updated NOA’s will begin going out to NOA email address (25 percent each day) 
  • 6/1/15: Providers should confirm receipt of NOA by close of business this day (NOTE: NOA’s will only be issued to providers when the provider is rendering one of the services which have had a rate increase. NOA’s will not be issued to providers of services that did not have a rate increase). 
  • 5/27-6/30/15: Case managers should review CCB’s with the team to determine if there is any need to update the CCB based on the rate changes 

Medicaid Waiver Services, Codes, and Rates, Effective July 1, 2015
For Family Supports (FSW) Waiver and Community Integration and Habilitation (CIH) Waiver And Money Follows the Person – Community Integration and Habilitation (MFP-CIH) Grant
 

Waiver Type INsite Code Service Description Natl. Code Modifiers Rate Unit/ Size Unit/$ Limit
FSW CIH MFP
-CIH
1 2 3 4
X X X ADS1 Adult Day Services, Level 1 S51 01 U 7 U 5 U 1   $21.95 .50/Day 2 Units/ Day
X X X ADS2 Adult Day Services, Level 2 S51 01 U 7 U 5 U 2   $28.80 .50/Day 2 Units/ Day
X X X ADS3 Adult Day Services, Level 3 S51 01 U 7 U 5 U 3   $34.29 .50/Day 2 Units/ Day
X X X AS14 Adult Day Services, ¼ Hour, Level 1 S51 00 U 7 U 5 U 1   $1.38 .25/Hou r 12 Units/Day
X X X AS24 Adult Day Services, ¼ Hour, Level 2 S51 00 U 7 U 5 U 2   $1.80 .25/Hou r 12 Units/Day
X X X AS34 Adult Day Services, ¼ Hour, Level 3 S51 00 U 7 U 5 U 3   $2.14 .25/Hou r 12 Units/Day
X X X BMG O Behavior Management, Basic H00 04 U 7 U 5 U 2   $18.20 .25/Hou r  
X X X BG1 O Behavior Management, Level 1 H00 04 U 7 U 5 U 1   $18.20 .25/Hou r  
X X X CMG T Case Management T20 22 U 7 U 5     $125.0 0 1.00/Mn
th
1 Unit/Month
X X X CHG 2 Community Habilitation, Group (2:1) T20 20 U 7 U 5 U 2   $8.48 1.00/Ho
ur
 
X X X CHG 3 Community Habilitation, Group (3:1) T20 20 U 7 U 5 U 3   $8.48 1.00/Ho
ur
 
X X X CHG 4 Community Habilitation, Group ( 4:1) T20 20 U 7 U 5 U 4   $8.48 1.00/Ho
ur
 
X X X CHG 6 Community Habilitation, Group (6:1) T20 20 U 7 U 5 U 6   $4.72 1.00/Ho
ur
 
X X X CHG 8 Community Habilitation, Group (8:1) T20 20 U 7 U 5 U 8   $4.72 1.00/Ho
ur
 
X X X CHG B Community Habilitation, Group (10:1) T20 20 U 7 U 5 U B   $4.72 1.00/Ho
ur
 
X X X CHIO Community Habilitation, Individual T20 20 U 7 U 5     $23.09 1.00/Ho
ur
 
  X X CT Community Transition T20 38 U 7 U 5     Individ ual 1.00/Uni t $1,000 Lifetime
  X X EM1 Electronic Monitoring, 1 Participant A92 79 U 7 U 5 U A   $13.62 1.00/Ho
ur
 
  X X EM2 Electronic Monitoring, 2 Participants A92 79 U 7 U 5 U 2   $6.81 1.00/Ho
ur
 
  X X EM3 Electronic Monitoring, 3 Participants A92 79 U 7 U 5 U 3   $4.54 1.00/Ho
ur
 
  X X EM4 Electronic Monitoring, 4 Participants A92 79 U 7 U 5 U 4   $3.41 1.00/Ho
ur
 
  X X EMOI Environmental Modification (Install) S51 65 U 7 U 5 N U   Individ ual 1.00/Uni t $15,000 Lifetime
  X X EMO M Environmental Modification (Maintain) S51 65 U 7 U 5 U 8   Individ ual 1.00/Uni t $500/Year
X X X INSP Equipment – Assess/Inspect/Train T10 28 U 7 U 5     $17.99 .25/Hou r  
X X X FBS Facility Based Support T10 20 U 7 U 5 U A   $1.85 1.00/Ho
ur
 
X X X FHG2 Facility Habilitation, Group (2:1) T20 20 U 7 U 5 U A U 2 $8.48 1.00/Ho
ur
 
X X X FHG4 Facility Habilitation, Group (4:1) T20 20 U 7 U 5 U A U 4 $8.48 1.00/Ho
ur
 
X X X FHG6 Facility Habilitation, Group (6:1) T20 20 U 7 U 5 U A U 6 $4.72 1.00/Ho
ur
 
X X X FHG8 Facility Habilitation, Group (8:1) T20 20 U 7 U 5 U A U 8 $4.72 1.00/Ho
ur
 
X X X FHGB Facility Habilitation, Group (10:1) T20 20 U 7 U 5 U A U B $4.72 1.00/Ho
ur
 
X X X FHGC Facility Habilitation, Group (12:1) T20 20 U 7 U 5 U A U C $3.00 1.00/Ho
ur
 
X X X FHG D Facility Habilitation, Group (14:1) T20 20 U 7 U 5 U A U D $3.00 1.00/Ho
ur
 
X X X FHG9 Facility Habilitation, Group (16:1) T20 20 U 7 U 5 U A U 9 $3.00 1.00/Ho
ur
 
X X X FHIO Facility Habilitation, Individual T20 20 U 7 U 5 U A   $23.09 1.00/Ho
ur
 
X X X FCAR Family & Caregiver Training, Family S51 11 U 7 U 5     Individ ual 1.00/Uni t $2,000/Year
X X X FCNF Family & Caregiver Training, Non-Family S51 16 U 7 U 5     Individ ual 1.00/Uni t $2,000/Year
X X X IBI1 Intensive Behavioral Intervention, Lvl 1 H20 20 U 7 U 5 U 1   $104.6 0 1.00/Ho
ur
 
X X X IBI2 Intensive Behavioral Intervention, Lvl 2 H20 20 U 7 U 5 U 2   $25.00 1.00/Ho
ur
 
X X X MUT H Music Therapy H20 32 U 7 U 5 U 1   $10.78 .25/Hou r  
X X X OCT H Occupational Therapy G01 52 U 7 U 5 U A   $17.99 .25/Hou r  
X     PAC Participant Assistance and Care T20 33 U 7 U 5     $23.24 1.00/Ho
ur
 
X X X PRSI Personal Response System, Install S51 60 U 7 U 5     $52.07 1.00/Uni t 2 Units/CCB
X X X PRS M Personal Response System, Maintain S51 61 U 7 U 5     $52.07 1.00/Uni t 1 Unit/Month
X X X PHT H Physical Therapy G01 51 U 7 U 5 U A   $18.12 .25/Hou r  
X X X PV02 Pre-Vocational (2:1) T20 15 U 7 U 5 U 2   $8.48 1.00/Ho
ur
 
X X X PV04 Pre-Vocational (4:1) T20 15 U 7 U 5 U 4   $8.48 1.00/Ho
ur
 
X X X PV06 Pre-Vocational(6:1) T20 15 U 7 U 5 U 6   $4.72 1.00/Ho
ur
 
X X X PVO 8 Pre-Vocational (8:1) T20 15 U 7 U 5 U A   $4.72 1.00/Ho
ur
 
X X X PV10 Pre-Vocational (10:1) T20 15 U 7 U 5 U B   $4.72 1.00/Ho
ur
 
X X X PV12 Pre-Vocational (12:1) T20 15 U 7 U 5 U C   $3.00 1.00/Ho
ur
 
X X X PV14 Pre-Vocational (14:1) T20 15 U 7 U 5 U D   $3.00 1.00/Ho
ur
 
X X X PV16 Pre-Vocational (16:1) T20 15 U 7 U 5 U 9   $3.00 1.00/Ho
ur
 
X X X PSTF Psychological Therapy, Family 908
46
U 7 U 5     $17.27 .25/Hou r  
X X X PSTG Psychological Therapy, Group 908
53
U 7 U 5     $4.81 .25/Hou r  
X X X PSTI Psychological Therapy, Individual H00 04 U 7 U 5 U 3   $15.45 .25/Hou r  
X X X RETH Recreational Therapy H20 32 U 7 U 5 U 2   $10.78 .25/Hou r  
  X X R&F Rent & Food for Unrelated Live-In Caregiver T20 25 U 7 U 5     $545.0 0 1.00/
Month
 
  X X RH1 O Residential Habilitation Services, Lvl 1
(Less than 35 hrs/week)
T20 16 U 7 U 5 U A   $24.29 1.00/Ho
ur
 
  X X RH2 O Residential Habilitation Services, Lvl 2
(Over 35 hrs/week)
T20 16 U 7 U 5     $20.41 1.00/Ho
ur
 
X X X RNU R Respite Nursing Care, RN T10 05 U 7 U 5 T D   $7.79 .25/Hou r  
X X X RNU R Respite Nursing Care, LPN T10 05 U 7 U 5 T E   $5.91 .25/Hou r  
X X X RSPO Respite Care Services S51 51 U 7 U 5     $24.29 1.00/Ho
ur
 
  X X ATCH Specialized Medical Equip/Supply, Install T20 29 U 7 U 5 N U   Individ ual 1.00/Uni t  
X     ATCH Specialized Medical Equip/Supply, Install T20 29 U 7 U 5 N U   Individ ual 1.00/Uni t $7,500 Lifetime
X X X ATC M Specialized Medical Equip/Supply, Maintain T20 29 U 7 U 5 U 8   Individ ual 1.00/Uni t $500/Year
X X X SPTH Speech Therapy 925
07
U 7 U 5 U A   $18.12 .25/Hou r  
  X X AF01 Structured Family Caregiving, Level 1 T20 33 U 7 U 5 U 1   $51.87 1.00/Da
y
1 Unit/Day
  X X AF02 Structured Family Caregiving, Level 2 T20 33 U 7 U 5 U 2   $75.67 1.00/Da
y
1 Unit/Day
  X X AF03 Structured Family Caregiving, Level 3 T20 33 U 7 U 5 U 3   $102.8 7 1.00/Da
y
1 Unit/Day
X X X SF1O Supported Employment Tier 1
(Monthly 1-5 hours)
T20 18 U 7 U 5 U 1   $175.9 5 1.00/
Month
 
X X X SF2O Supported Employment Tier 2
(Monthly 6-10 hours)
T20 18 U 7 U 5 U 2   $351.9 0 1.00/
Month
 
X X X SF3O Supported Employment Tier 3
(Monthly 11-15 hours)
T20 18 U 7 U 5 U 3   $527.8 5 1.00/
Month
 
X X X SF4O Supported Employment Tier 4 (Hourly) T20 18 U 7 U 5     $35.19 1.00/Ho
ur
 
X     TRN O Transportation T20 02 U 7 U 5     $5.00 1.00/Tri p 2 Trips/Day
  X X TRN O Transportation, Level 1 T20 02 U 7 U 5     $5.00 1.00/Tri p 2
Trips/Day,$2500/ Year
  X X TRN2 Transportation, Level 2 T20 02 U 7 U 5 U 2   $20.00 1.00/Tri p 2
Trips/Day,$5000/ Year
  X X TRN3 Transportation, Level 3 T20 02 U 7 U 5 U 3   $40.00 1.00/Tri p 2
Trips/Day,$7500/ Year
  X X VMO D Vehicle Modification, Install T20 39 U 7 U 5     Individ ual 1.00/Uni t $15,000 Lifetime
X     VMO D Vehicle Modification, Install T20 39 U 7 U 5     Individ ual 1.00/Uni t $7,500 Lifetime
X X X VMO M Vehicle Modification, Maintain T20 39 U 7 U 5 U 8   Individ ual 1.00/Uni t $500/Year
  X X WEL 1 Wellness Coordination Tier 1 T20 22 U 7 U 5 U 1   $52.77 1.00/Mn
th
1 Unit/Month
  X X WEL 2 Wellness Coordination Tier 2 T20 22 U 7 U 5 U 2   $111.9 6 1.00/Mn
th
1 Unit/Month
  X X WEL 3 Wellness Coordination Tier 3 T20 22 U 7 U 5 U 3   $223.9 2 1.00/Mn
th
1 Unit/Month
X X X WPA Workplace Assistance T10 20 U 7 U 5     $26.37 1.00/Ho
ur
 


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