COVID-19 Emergency Preparedness and Response Appendix K – Effective 1/27/2020

COVID-19 Emergency Preparedness and Response Appendix K – Temporary Rate Increase

COVID-19 Emergency Preparedness and Response Appendix K – Performance Measure Update

As part of the Wyoming Department of Health, Division of Healthcare Financing’s (Division) effort to address continuing challenges associated with the COVID-19 public health emergency, the Division has identified the need to temporarily increase certain provider reimbursement rates for traditional Comprehensive and Supports Waiver services.  In order to maintain the direct support professional workforce and account for increased overtime pay, this temporary reimbursement rate increase will apply to the following services:

• Adult Day Services
• Child Habilitation Services
• Community Living Services
• Community Support Services
• Companion Services
• Crisis Intervention Support
• Homemaker Services
• Individual Habilitation Training
• Personal Care Services
• Respite
• Skilled Nursing Services
• Special Family Habilitation Home
• Supported Employment

This temporary rate increase will be effective as of March 13, 2020, and will expire on September 1, 2020.  Refer to the COVID-19 DD Waiver Temporary Fee Schedule for temporary rates.

This temporary rate increase will not be subtracted from participant individual budget amounts (IBAs), nor will it affect participant purchasing power.  Case managers will not be required to modify IPCs or calculate units that will be impacted by this increase.

The temporary increase will be implemented in two phases.  The first phase will address services billed from April 23, 2020 through August 31, 2020.  The second phase will address the retroactively applied increase for services between March 13, 2020 and April 23, 2020 that have already been billed.

Phase I – Beginning April 23, 2020, providers should use the rates posted on the Comprehensive and Supports Waivers Temporary Fee Schedule, which includes the temporary rates for the services listed above.  If providers have not yet billed for services delivered prior to April 23rd, they should use the rates listed on the Temporary Fee Schedule to do so.  Providers are expected to bill for the services they provide, in accordance with each participant’s individualized plan of care (IPC).   Billing for more service units than would typically be expected, in order to capitalize on the enhanced rate, is prohibited. The IPC must continue to account for services to cover the entire plan year. 

Phase II – The Division is working with Conduent to develop guidance on the steps that providers will need to take to bill for the difference between the typical rate and the temporary increased rate, for services that were provided and billed between March 13 and April 23, 2020.  This guidance will include step by step instructions for providers to follow.

As part of the Wyoming Department of Health’s effort to address continuing challenges associated with the COVID-19 public health emergency, the Division of Healthcare Financing, Developmental Disabilities Section (Division) will allow for a temporary 12.5% increase to a portion of participant self-directed budgets. This amount is consistent with the temporary reimbursement rate increase for traditional service providers, as communicated on April 23, 2020, and intended to ensure the continuity of the direct support professional workforce. This increase is earmarked for the purpose of increasing employee wages, and cannot be used to add additional services to the participant’s individualized plan of care (IPC). If the employer of record (EOR) chooses to increase employee wages for existing services, the increase may go into effect no earlier than the pay period beginning June 1, 2020. This temporary increase will expire on September 1, 2020.

In order to calculate and implement this increase, the following steps must be completed:

1. The case manager, in collaboration with the EOR must enter the participant’s full self-directed budget amount into the Annual self-direction budget box (yellow box) of the Self-Direction Temporary Rate Tool for COVID-19.
2. The EOR must use the Total temporary monthly self-direct budget amount (green box) to determine the temporary increased wages for self-directed employees. The EOR must stay within the temporary monthly budget when calculating wage increases. Failure to do so may result in a self-directed budget shortage for the plan year.
3. The case manager must upload the completed Self-Direction Temporary Rate Tool for COVID-19 into the Document Library in the Electronic Medicaid Waiver System (EMWS), and send an email to the area Participant Support Specialist (PSS) to let them know the Tool has been uploaded.
4. The EOR must submit a Pay Rate Revision Sheet to ACES$ for all self-directed employees who will be receiving a temporary wage increase.  Please note that the increase is due to COVID-19.
5. ACES$ will notify the Division when the Pay Rate Revision sheet has been received, and the PSS will respond to ACES$ with the updated self-directed budget to allow for the temporary rate increase.
6. Once the Pay Rate Revision Sheet has been processed and ACES$ has been provided with the modified budget, the wage may be paid to the employee. Please note that ACES$ Rate Revision policy will still apply.
   • Pay Rate Revisions must be received in office 5 business days prior to the start of a pay period to be effective for that pay period. Any revisions received later than 5 business days prior will not be effective until the following pay period.
7. When the funding for the temporary wage increases is no longer available, the EOR will be responsible for submitting new Pay Rate Revision Sheets to revert employee wages back to the prior wage. If the EOR fails to submit the new Pay Rate Revision Sheets and overspends the self-directed budget, they will be subject to termination of self-directed services, as outlined in Chapter 46, Section 12 of the Department of Health’s Medicaid Rules.

This temporary increase will not be evident in EMWS. However, the EOR will see an increase in the participant’s self-directed budget on the ACES$ portal equal to three months. Increases for three month increments will be added to the self-directed budget through August 31, 2020.

Although the additional funding for temporary wage increases will not be effective until June 1, 2020, case managers and EORs are encouraged to begin submitting necessary paperwork to the Division and ACES$ as soon as possible if the EOR wishes to increase a wage by the effective date. These increases are not retroactive. Employees cannot be paid the higher wage until all steps outlined above have been completed.

If you have any questions regarding this temporary increase, please contact your area Participant Support Specialist.