Upcoming Service Changes for Providers
Several upcoming service changes are in development for 10/1/15 and 4/1/16 that affect the provision of Residential Habilitation services and Article 16 Clinic Offsite services.
The following link is a PowerPoint focusing on the General Overview of all 10/1/15 and 4/1/16 changes:
10/1/15 Changes: Supportive IRAs, CRs, Family Care Homes
- After October 1, 2015, reimbursement for certain services will change for people who live in supportive Individual Residential Alternatives (IRAs), Supportive Community Residences (CRs) and Family Care Homes. For individuals who reside in these settings, residential habilitation providers must pay for all aide services in the residence including personal care services, home health aide services, homemaker services, and consumer directed personal assistance programs. The residential provider is also responsible for these services that are delivered on weekends and weekday evenings in the residence and in community locations. Separate Medicaid billing for these services is not allowed.
- Residents can continue to attend Supplemental Group Day Habilitation services provided on weekday evenings or on weekends, but the service must be reimbursed by the residential provider.
- Residents can continue to receive Community Habilitation services on weekends and weekday evenings, but the service must be reimbursed by the residential provider.
- There is an exception for Community Habilitation and personal care services that support the person at an integrated job site where he/she is competitively employed. When these services support the individual to maintain competitive employment, the service may be delivered on weekends and weekday evenings and be separately billed to Medicaid.
10/1/15 Changes: Supervised IRAs and CRs
- After October 1, 2015, Supervised IRA and CR providers are responsible for paying for or providing nutrition services that are related to the person’s residential Habilitation services as well as certain psychological services (behavioral intervention and support services) that are related to the person’s residential Habilitation services. These behavioral intervention and support services are delivered by licensed psychologists, licensed clinical social workers, or behavior intervention specialists.
Additional information on the 10/1/15 changes are available at the following links:
10/1/15 Changes: Individual Day Habilitation (IDH) Termination
- Individual Day Habilitation (IDH) is being terminated due to duplicative services in the Home and Community Based Services (HCBS) Waiver Agreement.
- The termination of IDH is necessary due to the October 1, 2014 expansion of Community Habilitation (CH) services that results in no significant difference between the scope of services and activities included in IDH and the scope of services and activities that can be funded through either Community habilitation and/or Group Day Habilitation.
- An individual can choose to receive Community Habilitation, Group Day Habilitation, or a combination of both services in order to meet his/her service needs.
Additional information on the 10/1/15 IDH changes are available at the following links:
4/1/16 Changes: Article 16 Clinics Offsite Services Changes
- Delivery of Article 16 Clinic Offsite Services may continue after 4/1/16, but New York State cannot continue to bill these services as “clinic” services.
- Any therapy services (Physical Therapy, Occupational Therapy, Speech Language Pathology, and Psychotherapy) must be provided at a certified on-site clinic, either a satellite clinic or a main clinic.
- Or the therapy services may be provided via the Independent Practitioner Services for Individuals With Developmental Disabilities (IPSIDD) state plan option, previously known as Preventive Services option (see below).
4/1/16 Changes: Independent Practitioner Services for Individuals With Developmental Disabilities (IPSIDD) Option
- The IPSIDD State Plan option, previously known as Preventive Services, is a pending State Plan Amendment which provides for the delivery of clinic therapies such as physical, occupational, and speech therapy; social work; and psychology services that may be provided in certain locations, including OPWDD certified residential and day programs.
- IPSDD Therapists will enroll as Medicaid providers; services will be claimed as independent practitioner claims, or as a “group practice” claim.
Additional information on the 4/1/16 changes are available at the following link:
Provider Enrollment Memo and Attachments -- Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD): IPSIDD Provider Enrollment Memo and Attachments
IPSIDD Clinician Application for OPWDD Approval: IPSIDD Clinician Application for OPWDD Approval Form
IPSIDD Clinician Contacts: IPSIDD Clinician Contacts
IPSIDD Overview: WebEx 1/5/16 IPSIDD Overview 1-5-16 PPT
IPSIDD Q & A: WebEx 1/5/2016 Q & A