June 2010 Commonwealth of Pennsylvania Office of Developmental Programs (ODP) Revenue Reconciliation for Waiver Direct Service Providers FY 2009/2010 Q4 Adjustment Form Training Agenda Overview of the Q4 Provider Adjustments Form Situations Requiring Completion of the Q4 Provider Adjustments Form Q4 Provider Adjustments Form: Worksheets Q4 Provider Adjustments Form: Examples Submitting the Completed Q4 Provider Adjustments Form Questions 1 1
Overview of the Q4 Provider Adjustments Form The purpose of the form is to adjust the starting revenue target for changes in the volume of services provided in FY 09/10. Information submitted in the form will be used to establish the quarterly adjustments to the starting revenue target. Providers should carefully read the "Overview and Definitions" Tab and the "Instructions" Tab before completing and submitting their form. Adjustments reflected in the form should be for Waiver Cost Report services only (refer to the RR Services Tab in the form). Providers will be expected to establish and maintain documentation supporting the adjustment entries submitted in the form. The data in the form will be validated against independent data sources and other information available to ODP. 2 Overview of the Q4 Provider Adjustments Form (continued) Providers should complete only one form per MPI number. Providers with multiple MPI numbers must submit multiple forms. To protect health information that is subject to privacy laws, do not reference Waiver participants by name or provide any personal health or identification information. Supports Coordination Organization s do not need to submit the Q4 Provider Adjustments Form being discussed today as there will continue to be separate adjustment forms and process for Supports Coordination Organizations. Providers that do not submit a completed Q4 Provider Adjustments Form will not have adjustments reflected in their identified revenue reconciliation targets. 3 2
Situations Requiring Completion of Q4 Provider Adjustments Form New individuals that represent a change in service authorizations for the provider organization Existing individuals with a change (increase or decrease) in service authorizations and/or units of service provided Terminated service authorizations (individual no longer utilizes the service) Closed a service location Opened a service location Change in services provided (e.g., changing from a 2-individual home to a 3-individual home) Individual converted from Base funding to P/FDS or Consolidated Waiver funding or from P/FDS or Consolidated Waiver funding to Base funding Emergency closure (including closing the service location for weather) 4 Q4 Provider Adjustments Form: Worksheets Overview and Definitions provides an overview of the revenue reconciliation process Non RR-Services provides a list of FY 09/10 services that are not included in revenue reconciliation by type of service (Base, Fee Schedule, PDS and Outcome-Based) RR Services provides a list of FY 09/10 Waiver Cost Report services included in revenue reconciliation, the corresponding FY 08/09 procedure code and a general service description Instructions provides instructions for both the Provider Information Tab and the FY 0910 Tab Provider Information allows for entry of provider identification and contact information FY 0910 allows for entry of adjustments to Waiver Cost Report services due to changes in the volume of services provided in FY 09/10 5 3
Q4 Provider Adjustments Form Example 1: Service location 0001 changed to service location 0002 Slides 6 through 11 will be used in conjunction with the Q4 Provider Adjustments Form_TRAINING.xls file Example 1: Service location 0001 changed to service location 0002 mid-way through FY 09/10 on December 31, 2009, with no change in the procedure code Separate entries should be made on the FY 0910 Tab for service location 0001 and 0002 Service Location Code (SLC) 0001 Populate the FY 08/09 information (Columns G through K) for SLC 0001 Enter description of adjustment in the Comments Column (F) Reflect the total units authorized and provided from July to December 2009 and 0 units authorized and provided from January to June 2010 Service Location Code 0002 Enter N/A for the FY 08/09 information (Columns G through K) since this service location was not open during FY 08/09 Enter description of adjustment in the Comments Column (F) Reflect 0 units authorized and provided for July through December 2009 and total units authorized and provided for January through June 2010 6 Q4 Provider Adjustments Form Example 2: Service location 0003 is new and opened on July 1, 2009 Example 2: Service location 0003 is new and opened on July 1, 2009 One entry should be made for each service that is delivered at service location 0003 (W6092 and W6093 in the example) Enter N/A for the FY 08/09 information (Columns G through K) since this service location was not open during FY 08/09 Enter the total units authorized and provided for each month in FY 09/10 7 4
Q4 Provider Adjustments Form Example 3: Service location 0004 is new and opened on November 15, 2009 Example 3: Service location 0004 is new and opened on November 15, 2009 One entry should be made for each service that is delivered at service location 0004 (W7090 in the example) Enter N/A for the FY 08/09 information (Columns G through K) since this service location was not open during FY 08/09 Enter 0 units authorized and provided for July through October 2009 Enter the total units authorized and provided for November 2009 through June 2010 8 Q4 Provider Adjustments Form Example 4: Individual changed from base-funded to Waiver-funded Example 4: Individual A changed from Base-funded to Waiver-funded on February 1, 2010. Individual B was Waiver-funded for all FY 08/09 and FY 09/10 One entry should be made for each Waiver-funded service that was delivered to Individual A (W7012 / W7013 in this example) during FY 09/10 on or after February 1, 2010 Enter the corresponding FY 08/09 information. In this example, although the facility is a 2-individual home and both individuals lived in the home during FY 08/09, only the 365 days authorized and provided to Individual B is reported July 2009 through January 2010: Enter the units authorized and provided for Individual B only February 2010 through June 2010: Enter the units authorized and provided for both Individual A and Individual B 9 5
Q4 Provider Adjustments Form Example 5: Individual had an increase or decrease in service authorizations on March 10, 2010 Example 5: Both Individuals C and D were receiving Supported Employment services at service location 0006. Individual C had an increase in service authorizations due to a change in need on March 10, 2010. Individual D left the provider on September 1, 2009 and was no longer receiving services after this date. One entry can be made that combines the impact of the change in service authorizations for both Individual C and Individual D Enter the FY 08/09 information based on authorized and provided services for both individuals (example assumes only Individuals C and D received services and no changes in services authorized occurred in FY 08/09) Note: If additional individuals were served at this service location in FY 08/09 & FY 09/10, their total authorized and provided units should be included. Enter the services authorized and provided for each month, reflecting the changes in services authorized and provided for both individuals 10 Q4 Provider Adjustments Form Example 6: Change in service from a 2-individual to a 3-individual facility at the same service location Example 6: Service location 0007 changed from a 2-individual Community Home (W6092 / W6093) to a 3-individual Community Home (W6094 / W6095) on December 16, 2009. This service location was a 2-individual Community Home for all of FY 08/09. An entry should be made for W6092, W6093, W6094 and W6095 W6092 / W6093 Enter the corresponding FY 08/09 information in Columns G through K since it was a 2-individual Community Home in FY 08/09 Enter the total units authorized and provided for July through December 2009, making an adjustment in December to account for service location 0007 licensed as a 2-individual Community Home for 15 of the 31 days Enter 0 units authorized and provided for January through June 2010 W6094 / W6095 Enter N/A in Columns I through K as this service and service location combination did not exist in FY 08/09 Enter 0 units authorized and provided for July through November 2009 Enter the total units authorized and provided for December 2009 through June 2010, making an adjustment in December to account for service location 0007 licensed as a 3-individual Community Home for 16 of the 31 days 11 6
Submitting the Completed Q4 Provider Adjustments Form Providers should refer to the "Overview and Definitions" Tab and the "Instructions" Tab before completing and submitting their form The following file naming convention, as outlined on the Instructions Tab, should be used: The Q4 Provider Adjustments form should be named XXXXXXXXX_Provider_Adjustments_Q4.xls, where XXXXXXXXX is the provider s 9-digit MPI number Note: Providers should complete only one form per MPI number. Providers with multiple MPI numbers must submit multiple forms. Providers should submit forms to ra-odprevenuerpt@state.pa.us by Wednesday, July 14, 2010. Please ensure that the email address is typed correctly, as ODP did not receive many forms in Q3 due to typos in the email address. All questions related to the form should be submitted to ra-ratesetting@state.pa.us. Note this is a different email address than used to submit the forms. 12 Questions? 7