Information for Families on Changes to Provider Reimbursement for Employment Supports and Day Services Providers

The challenging economic environment that started last year and continues today has significantly reduced state revenues. This has led to a series of reductions in the Department of Developmental Services’ (DDS) budget. While the DDS public operations have received most of the reductions, the funds used to pay private providers have also been affected. Given the reductions this year and the reductions already in the 2011 budget, action is required to adjust the funding for Day Service providers.
The department is making an important change to the payment process for providers of day service programs for its consumers.  DDS is implementing a system of paying providers only for the services utilized by their participants beginning 2/1/10. This means they will be reimbursed for their costs only on the days a consumer attends the program. Up until now, providers were paid for day service programs on an annual basis without regard to how often participants attended the program. Targeted reductions based on utilization ensure the best value for the taxpayer’s dollar while providing the most service possible for individuals who are supported by the Department. This is the department’s priority during these lean times.
Agencies will receive a reimbursement rate for each individual participant based on the amount currently in their contract for that person. Group day services will be reimbursed on a per diem or daily basis. The per diem rate will be inflated to allow individual participants to be absent from the  program for 35 days a year for vacation, sick and holiday time without reducing the present reimbursement of the provider. Each day an individual participant is absent after the 35 days will reduce the provider accordingly. The provider will be fully paid for a day of service in a group day program as long as the participant attended at least 2 hours and 45 minutes. This recognizes that some individuals will sometimes attend partial days because of appointments or other commitments. Individual participants who attend on a part time basis in accordance with their individual plan will have a prorated daily rate based on the number of days they are scheduled to attend on a weekly basis.
If the consumer participates in either Individual Supported Employment or Individualized Day programs, the provider will be reimbursed on a per hour basis for every hour of support they provide to the person.
The department encourages all individuals to attend their day program on a regular basis. Since the program has been developed to meet the individual needs of the participant, it is in the best interest of the individual to maximize attendance in order to receive supports necessary to achieve the specific goals and objectives developed for them.
We appreciate that this is a significant change for the providers of day services and are working with any of those for whom this poses an extreme hardship because of the needs of the people they serve. The department has chosen this approach to reduce its costs to absorb the reductions made to the day service account without reducing services to consumers and their families.
If you have any questions about this change, please call your case manager.