Current through Register Vol. 50, No. 9, September 20, 2024
A. The
reimbursement for all services will be paid on a per claim basis. The
reimbursement rate covers both service provision and administration. Services
which utilize a prospective flat rate of one-quarter hour (15 minutes) will not
be paid for the provision of less than one-quarter hour of service.
B. Supported Employment Services.
Reimbursement shall be a prospective flat rate for each approved unit of
service provided to the beneficiary. A standard unit of service in both
individual and group supported employment services is one-quarter hour (15
minutes). A standard unit for individual ongoing follow along and job
assessment is a fee for service rate.
C. Day Habilitation. Reimbursement shall be a
prospective flat rate for each approved unit of service provided to the
beneficiary. A standard unit of service is one-quarter hour (15
minutes).
D. Prevocational
Services. Reimbursement shall be a prospective flat rate for each approved unit
of service provided to the beneficiary. A standard unit of service is
one-quarter hour (15 minutes).
E.
Respite, housing stabilization transition services and housing stabilization
services shall be reimbursed at a prospective flat rate for each approved unit
of service provided to the beneficiary. One-quarter hour (15 minutes) is the
standard unit of service.
F.
Habilitation. Reimbursement shall be a prospective flat rate for each approved
unit of service provided to the beneficiary. One-quarter hour (15 minutes) is
the standard unit of service.
G.
Personal Emergency Response System (PERS). Reimbursement for the maintenance of
the PERS is paid through a monthly rate. Installation of the device is paid
through a one-time fixed cost.
H.
Direct Service Worker Wages and Bonus Payments
1.
Establishment of Direct Service Worker Wage Floor for Medicaid
Home and Community-Based Services for Intellectual and Developmental
Disabilities
a. Effective October 1, 2021,
providers of Medicaid home and community-based waiver services operated through
the Office for Citizens with Developmental Disabilities employing direct
service workers will receive the equivalent of a $2.50 per hour rate
increase.
b. Effective October 1,
2021, this increase or its equivalent will be applied to all service units
provided by direct service workers with an effective date of service for the
identified home and community-based waiver services provided beginning October
1, 2021.
c. The minimum hourly wage
floor paid to direct service workers shall be $9 per hour.
d. All providers of services affected by this
rate increase shall be subject to a direct service worker wage floor of $9 per
hour. This wage floor is effective for all affected direct service workers of
any work status whether full-time or part-time.
e. The Department of Health (LDH) reserves
the right to adjust the direct service worker wage floor as needed through
appropriate rulemaking promulgation consistent with the Administrative
Procedure Act.
2.
Establishment of Direct Service Worker Workforce Bonus Payments
a. Providers who provided services from April
1, 2021 to October 31, 2022 shall receive bonus payments of $300 per month for
each direct service worker that worked with participants for those
months.
b. The direct service
worker who provided services to participants from April 1, 2021 to October 31,
2022 must receive at least $250 of this $300 bonus payment paid to the
provider. This bonus payment is effective for all eligible direct service
workers of any working status, whether fulltime or part-time.
c. Bonus payments will end October 31,
2022.
d. LDH reserves the right to
adjust the amount of the bonus payments paid to the direct service worker as
needed through appropriate rulemaking promulgation consistent with the
Administrative Procedure Act.
e. -
e.ii. Repealed.
3. Audit
Procedures for Direct Service Worker Wage Floor and Workforce Bonus Payments
a. The wage enhancement and bonus payments
reimbursed to providers shall be subject to audit by LDH.
i. - iv. Repealed.
b. Providers shall provide to LDH or its
representative all requested documentation to verify that they are in
compliance with the direct service worker wage floor and bonus
payments.
c. This documentation may
include, but is not limited to, payroll records, wage and salary sheets, check
stubs, etc.
d. Providers shall
produce the requested documentation upon request and within the timeframe
provided by LDH.
e. Non-compliance
or failure to demonstrate that the wage enhancement and/or bonus payment were
paid directly to direct service workers may result in the following:
i. sanctions; or
ii. disenrollment from the Medicaid
program.
4.
Sanctions for Direct Service Worker Wage Floor and Workforce Bonus Payments
a. The provider will be subject to sanctions
or penalties for failure to comply with this Rule or with requests issued by
LDH pursuant to this Rule. The severity of such an action will depend upon the
following factors:
i. Direct Service Worker
Wage Floor
(a). failure to pay I/DD HCBS
direct service workers the wage floor minimum of $9 per hour;
(b). the number of I/DD HCBS direct service
workers identified as having been paid less than the wage floor minimum of $9
per hour; or
(c). the persistent
failure to pay I/DD HCBS direct service workers the wage floor minimum of $9
per hour;
ii. Direct
Service Worker Workforce Bonus Payments
(a).
failure to pay eligible I/DD HCBS direct service workers the $250 monthly
workforce bonus payments;
(b). the
number of eligible I/DD HCBS direct service workers identified as having not
been paid the $250 monthly workforce bonus payments; or
(c). the persistent failure to pay eligible
I/DD HCBS direct service workers the $250 monthly workforce bonus payments;
or
iii. failure to
provide LDH with any requested documentation or information related to or for
the purpose of verifying compliance with this Rule.
I. ...
1. Establishment of Support Coordination
Workforce Bonus Payments
a. Support
coordination providers who provided services from April 1, 2021 to October 31,
2022 shall receive bonus payments of $300 per month for each support
coordination worker that worked with participants for those months.
b. The support coordination worker who
provided services to participants from April 1, 2021 to October 31, 2022 must
receive at least $250 of this $300 bonus payment paid to the provider. This
bonus payment is effective for all eligible support coordination workers of any
working status, whether full-time or part-time.
2. Audit Procedures for Support Coordination
Workforce Bonus Payments
a. The bonus payments
reimbursed to support coordination providers shall be subject to audit by
LDH.
b. Support coordination
providers shall provide to LDH or its representative all requested
documentation to verify that they are in compliance with the support
coordination bonus payments.
c.
This documentation may include, but is not limited to, payroll records, wage
and salary sheets, check stubs, etc.
d. Support coordination providers shall
produce the requested documentation upon request and within the timeframe
provided by LDH.
e. Noncompliance
or failure to demonstrate that the bonus payments were paid directly to support
coordination workers may result in the following:
i. sanctions; or
ii. disenrollment from the Medicaid
Program.
3.
Sanctions for Support Coordination Workforce Bonus Payments
a. The support coordination provider will be
subject to sanctions or penalties for failure to comply with this Rule or with
requests issued by LDH pursuant to this Rule. The severity of such action will
depend upon the following factors:
i. failure
to pay support coordination workers the $250 monthly workforce bonus
payments;
ii. the number of
employees identified as having been paid less than the $250 monthly workforce
bonus payments;
iii. the persistent
failure to pay the $250 monthly workforce bonus payments; or
iv. failure to provide LDH with any requested
documentation or information related to or for the purpose of verifying
compliance with this Rule.
J. Dental Services. Dental services are
reimbursed according to the LA Dental Benefit Program.
K. Community Life Engagement Development.
Reimbursement shall be a prospective flat rate for each approved unit of
service provided to the beneficiary. One-quarter hour (15 minutes) is the
standard unit of service.
L.
Transportation. Reimbursement shall be a prospective flat rate for each
approved unit of service provided to the beneficiary. A standard unit is a
daily rate.
M. Specialized Medical
Equipment and Supplies. Reimbursement shall be a prospective flat rate for each
approved unit of service provided to the beneficiary.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
