Day Services Billing for New Waivers

August 26, 2016

Unlike services provided in Group Home settings, some of the Day Services are “new” services and must be added to the individual’s service plan in order to provided/billed.
  • The “conversion” to new billing codes will not happen automatically and if Day Support services are simply “converted” to the new options, all Day Support would become Group Day.
  • Because the unit of service changes from a “block” to an hour; we negotiated for permission for a provider to make that change for all individuals in their services simultaneously; the change will either occur at a date of the provider’s choosing or at the annual plan date for the individual – which ever is first.
  • The billing codes for Group Day, Community Engagement and Community Coaching are included in the Medicaid Memo attached here. Group Day and Community Engagement rates are based upon the SIS “tier” assigned.
  • Think of billing for a rate determined by the SIS Tier the same way you do for billing the Northern Virginia rate vs the Rest-of-State rate – there is no special code or modifier, you bill the rate applicable to the individual.
  • No specific changes have to be made on September 1st for most individuals.
  • Group Supported Employment providers should already know the process for informing Heather Norton of the group size (size when the group is full; vacancies do not change the specified size of the group); if you have questions contact her at 804-786-5850.
  • The current authorizations will end on 8/31/16 and new authorizations will be created with the code/modified H2024 U3 (more than 4 individuals per staff); this will enable providers to bill until such time as they correct the authorization to properly reflect the size of the group.