Announcements for Traumatic Brain Injury Service Providers
The Department of Health (DOH) issued two notices to Traumatic Brain Injury (TBI) waiver service providers this month. Earlier in the month, DOH outlined the process for implementing the 10 day notice to terminate waiver services to ensure consistency amongst waiver service providers. DOH refers providers to two parts of the Provider Agreement whereas participant's health and welfare are not jeopardized and participant's must be informed of the provider's intent to terminate waiver services. DOH provides clarity on terminating waiver services separate from terminating service coordination. DOH attached a Notice of Intent to Discontinue Providing Waiver Services and a separate notice to discontinue Service Coordination.
The second DOH notice was sent out on Tues., Dec. 16, in which DOH announced to TBI providers that DOH is seeking to increase TBI providers’ rates for select services, effective Nov. 1, 2014 if approved by CMS and the Division of Budget (DOB). In addition, there are potential increases effective April 1, 2015 if approved in the final State budget, and subsequently approved by DOB and CMS.
DOH proposes the following fee increases to DOB, effective Nov. 1, 2014, as they can be accommodated within the 2014-15 Global Medicaid Cap. Please review for the distinction between the new rates for upstate and downstate providers.
|
Program/Service |
New Fee Upstate |
New Fee Downstate |
|
Home & Community Support Services |
$21.36 |
$20.84 (per hour) |
|
Positive Behavior Intervention Support |
$53.24 |
$69.21 (per hour) |
|
Structured Day Program |
$17.31 |
$22.50 (per hour) |
|
Independent Living Skills |
$35.49 |
$46.14 (per hour) |
|
Community Integration Counseling |
$70.98 |
$92.27 (per hour) |
|
Service Coordination Monthly |
$388.19 |
$504.65 (per month) |
|
Service Coordination Initial |
$530.15 |
$689.21 (one time) |
As per the notice, these increases represent one-half of the DOH proposed increase per unit of service that will be recommended for Legislative and DOB approval for the 2015-16 and 2016-17 fiscal years.
Effective April 1, 2015, DOH recommends the following fees which increase reimbursement by approximately $22,000,000 annually:
|
Program/Service |
New Fee Upstate |
New Fee Downstate |
|
Home & Community Support Services |
$23.42 |
$22.34 (per hour) |
|
Positive Behavior Intervention Support |
$54.02 |
$70.24 (per hour) |
|
Structured Day Program |
$17.56 |
$22.84 (per hour) |
|
Independent Living Skills |
$36.02 |
$46.82 (per hour) |
|
Community Integration Counseling |
$72.03 |
$93.64 (per hour) |
|
Service Coordination Monthly |
$393.92 |
$512.11 (per month) |
|
Service Coordination Initial |
$537.99 |
$699.39 (one time) |
LeadingAge NY has been actively advocating for an increase in waiver service rates. We anticipate that a similar rate increase should be forthcoming for the Nursing Home Transition and Diversion waiver, as well.
For further information on the proposed TBI rate increase, please contact Thomas Sheedy of the Bureau of Mental Hygiene Services Rate Setting at 518-486-7164.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871