News & Information

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

ADS1

Adult Day Services, Level 1

S51 01

U 7

U 5

U 1

$21.95

.50/Day

2 Units/ Day

ADS2

Adult Day Services, Level 2

S51 01

U 7

U 5

U 2

$28.80

.50/Day

2 Units/ Day

ADS3

Adult Day Services, Level 3

S51 01

U 7

U 5

U 3

$34.29

.50/Day

2 Units/ Day

AS14

Adult Day Services, ¼ Hour, Level 1

S51 00

U 7

U 5

U 1

$1.38

.25/Hou r

12 Units/Day

AS24

Adult Day Services, ¼ Hour, Level 2

S51 00

U 7

U 5

U 2

$1.80

.25/Hou r

12 Units/Day

AS34

Adult Day Services, ¼ Hour, Level 3

S51 00

U 7

U 5

U 3

$2.14

.25/Hou r

12 Units/Day

BMG O

Behavior Management, Basic

H00 04

U 7

U 5

U 2

$18.20

.25/Hou r

BG1 O

Behavior Management, Level 1

H00 04

U 7

U 5

U 1

$18.20

.25/Hou r

CMG T

Case Management

T20 22

U 7

U 5

$125.0 0

1.00/Mn
th

1 Unit/Month

CHG 2

Community Habilitation, Group (2:1)

T20 20

U 7

U 5

U 2

$8.48

1.00/Ho
ur

CHG 3

Community Habilitation, Group (3:1)

T20 20

U 7

U 5

U 3

$8.48

1.00/Ho
ur

CHG 4

Community Habilitation, Group ( 4:1)

T20 20

U 7

U 5

U 4

$8.48

1.00/Ho
ur

CHG 6

Community Habilitation, Group (6:1)

T20 20

U 7

U 5

U 6

$4.72

1.00/Ho
ur

CHG 8

Community Habilitation, Group (8:1)

T20 20

U 7

U 5

U 8

$4.72

1.00/Ho
ur

CHG B

Community Habilitation, Group (10:1)

T20 20

U 7

U 5

U B

$4.72

1.00/Ho
ur

CHIO

Community Habilitation, Individual

T20 20

U 7

U 5

$23.09

1.00/Ho
ur

Community Transition

T20 38

U 7

U 5

Individ ual

1.00/Uni t

$1,000 Lifetime

EM1

Electronic Monitoring, 1 Participant

A92 79

U 7

U 5

U A

$13.62

1.00/Ho
ur

EM2

Electronic Monitoring, 2 Participants

A92 79

U 7

U 5

U 2

$6.81

1.00/Ho
ur

EM3

Electronic Monitoring, 3 Participants

A92 79

U 7

U 5

U 3

$4.54

1.00/Ho
ur

EM4

Electronic Monitoring, 4 Participants

A92 79

U 7

U 5

U 4

$3.41

1.00/Ho
ur

EMOI

Environmental Modification (Install)

S51 65

U 7

U 5

N U

Individ ual

1.00/Uni t

$15,000 Lifetime

EMO M

Environmental Modification (Maintain)

S51 65

U 7

U 5

U 8

Individ ual

1.00/Uni t

$500/Year

INSP

Equipment – Assess/Inspect/Train

T10 28

U 7

U 5

$17.99

.25/Hou r

FBS

Facility Based Support

T10 20

U 7

U 5

U A

$1.85

1.00/Ho
ur

FHG2

Facility Habilitation, Group (2:1)

T20 20

U 7

U 5

U A

U 2

$8.48

1.00/Ho
ur

FHG4

Facility Habilitation, Group (4:1)

T20 20

U 7

U 5

U A

U 4

$8.48

1.00/Ho
ur

FHG6

Facility Habilitation, Group (6:1)

T20 20

U 7

U 5

U A

U 6

$4.72

1.00/Ho
ur

FHG8

Facility Habilitation, Group (8:1)

T20 20

U 7

U 5

U A

U 8

$4.72

1.00/Ho
ur

FHGB

Facility Habilitation, Group (10:1)

T20 20

U 7

U 5

U A

U B

$4.72

1.00/Ho
ur

FHGC

Facility Habilitation, Group (12:1)

T20 20

U 7

U 5

U A

U C

$3.00

1.00/Ho
ur

FHG D

Facility Habilitation, Group (14:1)

T20 20

U 7

U 5

U A

U D

$3.00

1.00/Ho
ur

FHG9

Facility Habilitation, Group (16:1)

T20 20

U 7

U 5

U A

U 9

$3.00

1.00/Ho
ur

FHIO

Facility Habilitation, Individual

T20 20

U 7

U 5

U A

$23.09

1.00/Ho
ur

FCAR

Family & Caregiver Training, Family

S51 11

U 7

U 5

Individ ual

1.00/Uni t

$2,000/Year

FCNF

Family & Caregiver Training, Non-Family

S51 16

U 7

U 5

Individ ual

1.00/Uni t

$2,000/Year

IBI1

Intensive Behavioral Intervention, Lvl 1

H20 20

U 7

U 5

U 1

$104.6 0

1.00/Ho
ur

IBI2

Intensive Behavioral Intervention, Lvl 2

H20 20

U 7

U 5

U 2

$25.00

1.00/Ho
ur

MUT H

Music Therapy

H20 32

U 7

U 5

U 1

$10.78

.25/Hou r

OCT H

Occupational Therapy

G01 52

U 7

U 5

U A

$17.99

.25/Hou r

PAC

Participant Assistance and Care

T20 33

U 7

U 5

$23.24

1.00/Ho
ur

PRSI

Personal Response System, Install

S51 60

U 7

U 5

$52.07

1.00/Uni t

2 Units/CCB

PRS M

Personal Response System, Maintain

S51 61

U 7

U 5

$52.07

1.00/Uni t

1 Unit/Month

PHT H

Physical Therapy

G01 51

U 7

U 5

U A

$18.12

.25/Hou r

PV02

Pre-Vocational (2:1)

T20 15

U 7

U 5

U 2

$8.48

1.00/Ho
ur

PV04

Pre-Vocational (4:1)

T20 15

U 7

U 5

U 4

$8.48

1.00/Ho
ur

PV06

Pre-Vocational(6:1)

T20 15

U 7

U 5

U 6

$4.72

1.00/Ho
ur

PVO 8

Pre-Vocational (8:1)

T20 15

U 7

U 5

U A

$4.72

1.00/Ho
ur

PV10

Pre-Vocational (10:1)

T20 15

U 7

U 5

U B

$4.72

1.00/Ho
ur

PV12

Pre-Vocational (12:1)

T20 15

U 7

U 5

U C

$3.00

1.00/Ho
ur

PV14

Pre-Vocational (14:1)

T20 15

U 7

U 5

U D

$3.00

1.00/Ho
ur

PV16

Pre-Vocational (16:1)

T20 15

U 7

U 5

U 9

$3.00

1.00/Ho
ur

PSTF

Psychological Therapy, Family

908
46

U 7

U 5

$17.27

.25/Hou r

PSTG

Psychological Therapy, Group

908
53

U 7

U 5

$4.81

.25/Hou r

PSTI

Psychological Therapy, Individual

H00 04

U 7

U 5

U 3

$15.45

.25/Hou r

RETH

Recreational Therapy

H20 32

U 7

U 5

U 2

$10.78

.25/Hou r

R&F

Rent & Food for Unrelated Live-In Caregiver

T20 25

U 7

U 5

$545.0 0

1.00/
Month

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

RH2 O

Residential Habilitation Services, Lvl 2
(Over 35 hrs/week)

T20 16

U 7

U 5

$20.41

1.00/Ho
ur

RNU R

Respite Nursing Care, RN

T10 05

U 7

U 5

T D

$7.79

.25/Hou r

RNU R

Respite Nursing Care, LPN

T10 05

U 7

U 5

T E

$5.91

.25/Hou r

RSPO

Respite Care Services

S51 51

U 7

U 5

$24.29

1.00/Ho
ur

ATCH

Specialized Medical Equip/Supply, Install

T20 29

U 7

U 5

N U

Individ ual

1.00/Uni t

ATCH

Specialized Medical Equip/Supply, Install

T20 29

U 7

U 5

N U

Individ ual

1.00/Uni t

$7,500 Lifetime

ATC M

Specialized Medical Equip/Supply, Maintain

T20 29

U 7

U 5

U 8

Individ ual

1.00/Uni t

$500/Year

SPTH

Speech Therapy

925
07

U 7

U 5

U A

$18.12

.25/Hou r

AF01

Structured Family Caregiving, Level 1

T20 33

U 7

U 5

U 1

$51.87

1.00/Da
y

1 Unit/Day

AF02

Structured Family Caregiving, Level 2

T20 33

U 7

U 5

U 2

$75.67

1.00/Da
y

1 Unit/Day

AF03

Structured Family Caregiving, Level 3

T20 33

U 7

U 5

U 3

$102.8 7

1.00/Da
y

1 Unit/Day

SF1O

Supported Employment Tier 1
(Monthly 1-5 hours)

T20 18

U 7

U 5

U 1

$175.9 5

1.00/
Month

SF2O

Supported Employment Tier 2
(Monthly 6-10 hours)

T20 18

U 7

U 5

U 2

$351.9 0

1.00/
Month

SF3O

Supported Employment Tier 3
(Monthly 11-15 hours)

T20 18

U 7

U 5

U 3

$527.8 5

1.00/
Month

SF4O

Supported Employment Tier 4 (Hourly)

T20 18

U 7

U 5

$35.19

1.00/Ho
ur

TRN O

Transportation

T20 02

U 7

U 5

$5.00

1.00/Tri p

2 Trips/Day

TRN O

Transportation, Level 1

T20 02

U 7

U 5

$5.00

1.00/Tri p

2
Trips/Day,$2500/ Year

TRN2

Transportation, Level 2

T20 02

U 7

U 5

U 2

$20.00

1.00/Tri p

2
Trips/Day,$5000/ Year

TRN3

Transportation, Level 3

T20 02

U 7

U 5

U 3

$40.00

1.00/Tri p

2
Trips/Day,$7500/ Year

VMO D

Vehicle Modification, Install

T20 39

U 7

U 5

Individ ual

1.00/Uni t

$15,000 Lifetime

VMO D

Vehicle Modification, Install

T20 39

U 7

U 5

Individ ual

1.00/Uni t

$7,500 Lifetime

VMO M

Vehicle Modification, Maintain

T20 39

U 7

U 5

U 8

Individ ual

1.00/Uni t

$500/Year

WEL 1

Wellness Coordination Tier 1

T20 22

U 7

U 5

U 1

$52.77

1.00/Mn
th

1 Unit/Month

WEL 2

Wellness Coordination Tier 2

T20 22

U 7

U 5

U 2

$111.9 6

1.00/Mn
th

1 Unit/Month

WEL 3

Wellness Coordination Tier 3

T20 22

U 7

U 5

U 3

$223.9 2

1.00/Mn
th

1 Unit/Month

WPA

Workplace Assistance

T10 20

U 7

U 5

$26.37

1.00/Ho
ur

New Rates Effective July 1, 2015 (Providers)

Archives