The following comments are specific to day services.

DAY SUPPORT services have been redefined and the PREVIOUS (and now repealed) definition stated:

A.     Service description. Day support services shall include a variety of training, assistance, support, and specialized supervision for the acquisition, retention, or improvement of self-help, socialization, and adaptive skills. These services are typically offered in a nonresidential setting that allows peer interactions and community and social integration.

The proposed NEW regulations eliminates the words training and assistance---and substitutes “skill building, supports and safety supports”.  This seems acceptable as long as the level of assistance typically provided to recipient can now be defined as supports and safety supports.

Also, community integration is now REMOVED from the definition—does this present problems for providers and recipients who benefit from community integration activities or can these be “rebranded” in service plans as skill building?

A unit block has replaced the unit.  Providers have continuously requested a definition of “rounding” when increments of time are provided.  The new regulations seem to be logical and easy to implement in that a unit block is ANY time from one hour through 3 hours and 59 minutes.  So if a recipient receives 65 minutes of service each day for five days, the provider can bill for 5 unit blocks. 

 “Service providers shall be reimbursed only for the amount and level of day support services included in the individual’s approved Plan for Supports based on the setting, intensity and duration of the service to be delivered.”

This would suggest that any PREPARATION such as administering and analyzing the SIS would NOT be reimbursable BUT there we contend that there could be some room for interpretation if the Plan for Supports (which is submitted to DBHDS and approved by them) references the SIS development as a key component of the service plan.

For a number of day services (including day support, pre-vocational and supported employment, there is new language which states essentially that  DMAS will over these services (in other words purchase) ONLY after determining that this service is not available from DRS for this Waiver individual.  This sounds logical and in fact the current practice has been embedded in the actual Waiver application wherein DRS makes a statement then that as a co requisite to Waiver enrollment, DRS is affirming that this person would not be served by DRS because of the severity of their need and therefore are “cleared” for Waiver enrollment.  The question is: will this practice continue wherein that DRS “disclaimer” is solicited at the initiation of the Waiver by the Support Coordinator OR is there now a new requirement for EACH time that a day service is being requested?

The regulations are silent on the fact that for individual supported employment, the DRS rates are accepted and are specific to each provider.  On the rate schedule that DMAS publishes, this statement is made.  Could this statement be in the regulations so that it is clear that for Individual SE, the Waiver reimbursement rate is specific to each provider as approved by DRS?

We contend that the Therapeutic Consultation service language revision needs to be expanded.  It is still limited to just the consultation and DOES NOT include the actual therapeutic intervention recommended by the consultation.  This severely impacts the services providers who implement costly behavioral or other therapeutic intervention programs without additional compensation.