tdd budget submission and review processes

1

TDD Budget Submission and Review Processes

2

Timeframes

•  Annual budget proposals –  To be submitted by county boards 30 days in advance of

start of new span

•  Budget adjustments –  May be emergency or change in circumstance –  Emergencies - CB verbally authorizes increased units for

provider –  Proposed budget adjustment submitted to DODD only if

increase in waiver authorization, not state plan, is needed –  Budget worksheet updated by CB for state plan

increases

3

How to submit •  Submit the following documents to

TDDbudget.doc@dodd.ohio.gov for all budget proposals: –  Waiver budget summary –  State plan budget summary

•  Emergency requests must specify “emergency” in the subject line, as well as in the name of the attachment.

•  A single e-mail may be sent which includes budget proposals for multiple people ONLY if all the documents for a single person are included in one attachment.

•  DO NOT –  Include any additional text in the body of the e-mail –  Include any special characters in the subject line of the e-mail

�

4

Documentation

•  Budget adjustments –  For people who have not had an annual plan by CB:

•  Include total authorized waiver dollars from start of span to start of current month in the “reason” box

– Obtained by looking in the MITS breakdown under the units tab of the ASP.

•  Use the cost calculator to project costs from the start of the

current month through the remainder of the span –  The first span entered into the cost calculator may still reflect

the previous service pattern/authorization if the proposed budget adjustment begins mid-month.

–  For people who have annual plans developed after 2/16/13, county boards will update the previous cost calculator.

5

What to submit

•  For budgets exceeding previous year’s authorized costs due to home modifications also include –  Therapy reports –  Itemized estimate

•  For all other budgets exceeding previous year’s authorized costs by more than 2%, DODD may request supporting documentation which may include, but not be limited to: –  Assessments used to develop the service plan –  Service plan –  Care plan (physician’s orders, ODH 485)

�

6

Home modifications

•  Work flow: –  CB obtains therapy evaluation –  CB requests at least 3 bids –  CB approves lowest bid, unless contraindicated –  CB updates ISP and submits budget proposal to DODD for review/

approval –  Vendor completes work –  SSA verifies using form available on DODD website –  Vendor may bill for services upon receipt of verification

�

Home modifications

7

Adaptive equipment

•  Work flow: –  Verify medical necessity for device/equipment –  Explore alternative funding sources (Medicaid card) –  CB updates ISP and submits budget proposal to DODD for review/

approval –  CB will inform provider when authorization has been received from

DODD –  Provider may then bill for the equipment/device

�

Adaptive equipment

8

Notifications

•  Authorized amount to be entered by DODD in WMS

•  E-mail will be sent to CB contact person identified on budget submission

•  If amount authorized is less than the amount proposed by CB, a new monthly breakdown will need to be submitted

�

9

Due Process

•  CB will issue appeal rights and take the lead in all hearings when: –  The CB denies the request for a state plan service or an increase in

state plan services –  The CB denies the request for a waiver service or an increase in

waiver service –  DODD agrees with a reduction in waiver authorization proposed by

the CB

•  DODD will issue appeal rights and take the lead in all hearings when: –  DODD approves less that the amount proposed by the CB –  DODD denies a budget adjustment submitted by the CB

�

10

County transfers For individuals with budget authorizations in WMS: •  Proposed budget and authorized budget fields revert to zero

upon transfer to a new county •  DODD will re-enter the baseline, proposed and authorized

amounts listed for the previous county •  DODD will send an e-mail to the contact person provided for

the receiving county which includes the monthly breakdown for the remaining months of the span.

For individuals transferring to other counties prior to having budget authorizations in WMS, the receiving county would refer to the ASP and units authorized in Enterprise.

�

11

Sharing services

•  Individuals enrolled in TDD cannot be added to CPT sites

•  Plans will need to reflect the typical times during which an individual enrolled in TDD shares services with others.

•  TDD providers will use the “HQ” modifier to bill for these times and will be paid at 75%.

•  A TDD provider may deliver services at a ratio of no more than 1:3.

�

12

Ongoing tech support

•  Cost calculator will be posted on the TDD section of DODD’s website

•  ONLY trained staff should use the tool – CB staff who have attended this session may provide

training to other CB personnel �•  MDA personnel will provide ongoing technical

assistance regarding use of the tool and budget submission (Lori, Rik, Donna, Jeanne, and Matt). Questions may continue to be submitted through TDDinbox@dodd.ohio.gov.

Ongoing tech support