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OACPDS > Developmental Services > MaineCare > Support Waiver > Section 29 update

Developmental Services - Support Waiver

Section 29 Update - January 09, 2008

Some questions have recently been submitted on Section 29. This update will provide a status update:

Authorizations:

To date, 880 individuals have been approved, authorizations entered into the EIS and SAS forms sent to the Provider.

This has been a monumental volume of work for Ron Bridges and the staff working with him: Pat Winsor (part time), Linda Hill and other regional staff assigned as their schedules permit. We appreciate your patience. If you recall, the Support waiver was originally designed to provide a minimum package of services to about 300 individuals. It now will be the service package for 2,000 individuals.

The communication for this program has been from this small core of State staff to the Providers. There have been significant challenges in getting correct billing information to correspond to the Provider billing number. For many individuals who were receiving FSD, the numbers were assigned automatically, however, for those newly enrolled into community support or new to supported employment, obtaining the correct billing information has presented some communication challenges. So, in the spirit of improving the process, if you are called by a staff asking about a service you are authorized to provide to an individual approved for Section 29, please be prepared to give the exact address for the billing location for the specific service you are authorized to provide. I will ask staff to be more precise in their questions to you as well. The Provider number for the service MUST match the billing address or the billing will reject.

The priority group for Section 29 continues to be those individuals who were previously supported by the Social Services Block Grant funds. Ron Bridges and his staff continue to work with ISCs and Community Case managers to get these individuals into the program. If you have not received any information on an individual in this priority group, please e-mail Ron Bridges at Ron.Bridges@maine.gov and he will look into the individual case.

Many other individuals will be authorized into the program on a roll-out basis. If the individual you provide service to has not yet received their letter enrolling them into the program and you as the provider have not yet received the SAS, then you can continue to bill FSD until you are notified that they have been enrolled in the waiver. It is important to keep accurate record of when individuals move from FSD to the waiver, since all of those changes will need to be captured in contract amendments to close out the year.

Authorizations are based on what is recommended in the person centered plan. Authorizations must also be for approved services and in some instances, the description of the service in the plan does not qualify for the program. This has been found in several instances for individuals who are requesting authorization for supported employment and the work site described in the plan is sheltered employment. Some plans are requesting authorization for personal support. This is not a service offered in this waiver. Since the Department is under greater scrutiny to assure the service in the plan matched the service delivered, heightened review of the plan for initial authorizations is essential. It is important to “get it right” from the onset of this new waiver. So, again, if you are called by State staff to clarify the model of service, please be prepared to define the service and have corrections made in the person’s plan.

The Purchased Services Managers have been instructed to complete 6 month contacts to end this fiscal year for Section 24 services. We have had discussions with Herb Downs, Director of Audit about these contracts and we are also working with the Office of Maine Care Services to amend the Section 24 rules to a fee for service. There are a number of complex challenges that we are working through and the Department will continue to keep the 3x3 group involved in this issue. Rob Jones and I are in the process of sending out specific directions to the purchased services staff and they will be in touch with you soon to complete this work.

No progress has been made on adapting a MaineCare program to accommodate the FSD outreach programs to individuals in Nursing Homes. Providers should continue to bill section 24 (FSD) until that section is eliminated from the State plan at their current rates.

We continue to meet with respite providers who are assisting the Department is developing the respite service in Section 29. The Department will send an update on that in the next few weeks.

Again, thank you for your patience and cooperation as we ‘launch’ this new waiver. We do believe that we will be able to be more responsive after we get through the volume of the initial enrollments and authorizations. This will be a wonderful program for the individuals and families we support going forward.

Please continue to forward your questions to MACSP and will post responses on the web page.