Exceptional Rate Process – Modification

February 22, 2015

Modifications have been made in the Exceptional Rate (ER) process to facilitate approval of ER ISARs in a timely way. Please review the modifications highlighted below.  Please contact Joan Bender or your Regional Supports Specialist with questions about the process.
  • Provider applies for approval as an ER provider. DDS approves or denies the application.
  • Provider completes the Individual Exceptional Supports Request Check Sheet as required. The form is located at the DBHDS website under the Individuals and Families tab.
If the SIS is completed within required timeframe
  • The ISAR is pended by Service Authorization staff while the Regional Support Specialist (RSS) verifies the SIS information included on the Check Sheet. (It is not necessary to attach the SIS to the application.)
  • If the SIS information verifies that the individual is eligible for ESR, the RSS completes an Individual ES Request Checksheet Addendum and sends it via encrypted email to the Support Coordinator who will upload the document to the pended ISAR. Note that in this situation the SC, rather the provider, will directly upload the Individual ES Request Checksheet Addendum to the ISAR; SC forwards the ISAR to Service Authorization staff for approval and Service Authorization staff will approve or deny the ER request based on their review.
 In the event the SIS has not been completed within required timeframes
  • Service Authorization staff will pend the ISAR. They will coordinate with the RSS to ensure an Initial/ Reassessment Request has been submitted to Ascend.
  • When the SIS has been completed, the SC will notify the RSS and the RSS will complete the Individual ES Request Checksheet Addendum as outlined above.
 In the event the SIS has been completed within required timeframes and the SC does not feel it adequately describes the individual’s current level of support needs
  • The SC will submit an Initial/Reassessment Request to the RSS.
  • The RSS will review the Request for justification of the need for reassessment and coordinate with the SC if additional information is needed.
  • If the Reassessment Request demonstrates the need for reassessment the Request will be forwarded to Ascend for completion. Decisions about Reassessment Requests in these situations will be made on a case by case basis.