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Respite Fee Changes

OPWDD has released amended respite fees and regulations that will be effective 7/1/17, although they remain subject to CMS approval. The school age and recreation are being combined into a single category, and being assigned the higher rate associated with recreation. Intensive rates will see a sizable increase as well. Below are some of the other major points of emphasis:

* Providers must use the new fee schedule beginning on 7/1/17. No previous guidance should be followed.

* DDROs will continue to authorize respite units and service hours.

* Intensive Respite Requirements: the individual must be precluded from all other respite categories and have high behavioral or high medical needs and which will be determined by the DDRO.

o Medical: and RN or LPN must oversee the service (although the clinician does not have to deliver the service directly), and the individual must have a PONS.

o Behavioral: LMSW or BIS must oversee the service (although does not have to deliver the service directly), and must have a behavioral plan written by a licensed LMSW/BIS.

* Transportation: If the agency provides transportation to or from the respite service, then billing can be applied from the moment transportation begins, however it is not supplemental funding (add on). Additional units should be requested from the DDRO if necessary.

* Multiple Services are billable for same person on the same day, but no overlap of time.

* Days Limit: The new rules for Site Based Overnight Respite will allow for 30 consecutive days within a 90- day time period. A commissioner approved extension can be authorized in an emergency. The belief is this will be more flexible than the previous 42 day rule over 12 months.

* If an agency thinks the changes are going to adversely impact their current program, they should contact the local DDRO who will work with them towards possible solutions.

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