Rate Reform: Rate Model Implementation Frequently Asked Questions

This page contains answers to the most frequently asked questions regarding the Rate Model implementation process.

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1. What is a Rate Model?

AA Rate Model is a standardized rate setting methodology that will be used throughout the regional center system. Rate Models for most service codes were developed as part of the Rate Study conducted in 2019 to improve transparency into service utilization and promote a stable and high-quality supply of providers. The rate models with the updated cost components as of February 2022 will be used to calculate the rate adjustment effective April 1, 2022.

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2. Where can I learn more about the Rate Study?

AInformation on the Rate Study submitted to the legislature in March 2019 can be found here.

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3. Where can I submit questions, comments and concerns regarding rate reform?

APlease send your e-mail to: ratesquestions@dds.ca.gov.

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4. Where can I find the Rate Model rates?

AThe rate models with the updated cost compoents as of February 2022 are located here.

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5. How will I know the updated rate for my program?

AThe rate models with the updated cost components as of February 2022 will be used to calculate the rate adjustment effective April 1, 2022.

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6. Since the Rate Study was completed in 2019, when will the rate models be updated?

AThe current rate models as of February 2022 are published on the DDS website, by regional center.

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7. How will the regional centers gather information on staff qualifications to properly adjust the rates?

ARegional Centers will reach out to providers as needed to gather the required information. Instructions on how to complete the data collection forms can be found here.

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8. Will there be a review period prior to, or after, implementation for providers to address questions/concerns?

AProviders who believe there is an error in the rate calculation may submit the rate review form to their Regional Center no later than 60 days after receiving their rates.

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9. Where can I learn more about the rate changes effective April 1, 2022?

ARecording of the November 2021 meetings about these changes are located here.

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10. If a provider started services for example after April 2020, will they receive a rate increase?

AYes. If you are providing services under an applicable service code, your rate will be adjusted. 

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11. Will the rates vary across all regional centers?

AYes, rates will vary across regional centers because the Rate Models include differences in regional cost assumptions such as wages, travel, and others.

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12. If two vendors work in the same area, will they be paid the same standard rate, or will there be differences from vendor to vendor performing the same service?

AThe Rate Models were constructed in consideration of costs providers faced in delivering a particular service consistent with the state’s requirements. This allows providers to receive the same rate for the same service in the same area consistently across the Regional Centers.

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13. How will rates be determined for providers serving consumers from multiple regional centers?

AProviders may have multiple rates for the same service when services are provided in multiple regional center catchment areas. More information can be found here.

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14. Are rates going to increase 25% each year until rates reach the targeted rate?

ANo. The April 1, 2022 rate adjustment will be 25% of the difference between the provider’s current rate and applicable target Rate Model.  Please refer to Welfare and Institutions Code Section 4519.10 for details on subsequent rate changes.

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15. Which rate will be used to compare to the Rate Model for the changes that will occur in April 2022?

AThe rate adjustment will be calculated on the provider’s current rate which will include rate increase adjustments effective prior to March 31, 2022.

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16. We received a rate increase in 2020 that was meant to sunset in December 2021. How does this factor into the Rate Model increases?

APlease refer to the Department’s October 19, 2021, letter which states that those rate increases will remain in effect. The rate adjustment in April 1, 2022 will be based on the providers current rate and will include any increase adjustment effective prior to March 31, 2022.

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17. When will service providers receive rate increases?

ARate Model calculations are completed.  For those below the Rate Model, incremental rate adjustments will occur in April 2022, January 2023, and July 2024.

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18. Were rates for the Tailored Day Service included in the Rate Study?

ANo. The rate study did not establish a rate model for this service.

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19. Will there be an ongoing annual Cost of Living Adjustment (COLA) wage adjustment, or changes to the IRS mileage rates after 2025?

AUpdates to the rate models after 2025 would be subject to the state budgeting process.

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20. Will the rate model implementation effect Alternative Services?

ANo. The Alterative Services monthly rates are not applicable for the April 1, 2022, rate increases.

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21. Many behavior programs do not currently have Registered Behavior Therapists on staff. What will the expectation be regarding the implementation of this aspect of the rate study?

AThe first step of the rate model implementation is to only change rates effective on April 1, 2022.

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22. Based on the rate study, the mileage is included in the new rate per billable hour. For providers who have billed for mileage and the base rate separately, what does this mean for the changes in April 2022?

AYes, they can continue to bill separately in April of 2022.

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23. For service providers with rates above the Rate Model, when will rates be decreased?

AService providers with rates above the Rate Model be held harmless (no change to rate) until June 30, 2026, after which time the provider’s rates will be adjusted to the Rate Model.

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24. The rate study shows that there will be changes and requirements for some services, do those take effect April 2022?

ANo, recommended changes in the rate study will not be required April 2022.

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25. Where can we find the definition of Early Interventionist Specialist (EIS) and Early Interventionist Assistant (EIA)? Do they include staff without credentials?

AFor definitions, please see this document.

The rate study makes recommendations on credentialing, but these are not requirements to receive the rate adjustment effective April 1, 2022.

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26. Will the purchase of service specify who is going to provide services to the child for Early Start, such as Early Intervention Specialist or Therapist for the April 1, 2022, rate adjustment?

AThere will be no changes to authorization. The same standard will be required effective April 1, 2022.

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27. Effective July 1, 2025, service code 805 (Infant Development) will have different rates by staff level. Will the service coordinator have to write multiple authorizations for each service?

AThe details on fully implementing the recommendations outlined in the rate study are forthcoming. Please note, there are no required billing changes for the April 1, 2022 adjustment.

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28. Will DDS be considering licensed mental health professionals as “Therapists,” especially given that DDS is focusing on social-emotional development as the primary objective for Early Start?

ACurrently the rate models include some therapist classifications such as marriage & family therapist.

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29. Will any of the rates require a credential for the April 2022 adjustments?

AThere are no changes to provider qualifications requirements tied to the rate adjustment effective April 1, 2022.

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30. How do the rate models account for the wear and tear of vehicle’s that providers purchase?

ARate models account for the cost of vehicles by using the Internal Revenue Service’s standard rate. The IRS standard mileage rate incorporates all vehicle-related expenses, including acquisition and depreciation, registration, maintenance and repairs, gasoline, and insurance. In 2022, the IRS’s mileage rate includes 26 cents per mile for depreciation.

Recognizing that transportation companies often use larger vehicles, the rate models for this service include a higher amount for acquisition and depreciation. The rate models for non-ambulatory services provided under the transportation-additional component rates similarly include a higher depreciation cost.

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31. How will trip mileage be calculated?

AThe rate models for transportation services are based on per-trip rates that do not vary based on the length of the trip.

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32. For providers who provide door-to-door service for multiple participants, will the average miles per trip be the average total miles for all participants on a specific route or average miles round trip for each individual rider?

AThe rate models for transportation services include assumptions related to the number of miles traveled per trip and the number of individuals transported. The rate models for transportation companies also include an assumption regarding time and mileage traveled by the vehicle without passengers to account for driving the vehicle to and from its assigned location.

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33. Will there be separate rates for providers who use company vehicles and those who reimburse staff for use of private vehicles?

AThe rate models do not distinguish between services provided using company vehicles and those provided using staff’s private vehicles.

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34. The rate study shows a difference between ambulatory and non-ambulatory trips. Current rates are on a trip basis (ONE RATE), but our regional center asked for the percent of trips for each category. Should providers expect a transition to the two rate types at some point?

ADDS does not expect Regional Centers to make changes to current billing agreements at this time so, if a vendor currently has a single rate for both ambulatory and non-ambulatory services, they will continue to have a single rate after April 1, 2022. The calculated April 1 rate adjustments will take into account the mix of ambulatory and non-ambulatory services currently being delivered.

The rate study does assume that vendors will ultimately be transitioned to separate rates for ambulatory and non-ambulatory services. DDS will work with Regional Centers and vendors on the timing of this transition to ensure sufficient time to make the necessary changes.

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35. How do you differentiate the miles needed for a client transportation versus distance traveled to reach the client?

AThe rate models for transportation services include assumptions related to the number of miles traveled per trip. The rate models for transportation companies also include an assumption regarding the time and mileage traveled by the vehicle without passengers to account for driving the vehicle to and from its assigned location. The detailed assumptions for each service can be found here.

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36. When will rates need to be converted to trip rates?

ADDS does not expect Regional Centers to make changes to current billing practices at this time so April 1, 2022 rate adjustments are being calculated for existing billing units. A specific date has not been set for transitioning transportation services to trip rates, but DDS will work with Regional Centers and vendors on the timing of this transition to ensure sufficient time to make the necessary changes.

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37. What is the Quality Incentive Program?

AIn conjunction with rate reform, this will be a payment for providers meeting quality measures and/or benchmarks related to consumer outcomes, service provider performance, and the quality of services. The program is still in development and more information will be shared as it becomes available.

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38. How will quality payments be determined and what will they be based on?

AThe methodology for Quality Incentive payments has not yet been determined. A Quality Incentive Program stakeholder workgroup will be putting recommendations forward. A recording of the workgroup November 9, 2021, meeting is located here.

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39. Will Quality Incentive payments apply to those services that were not part of the Rate Study?

AServices included in the Quality Incentive payments have not yet been determined.

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40. What is the Direct Service Professional Training and Certification program?

ADDS is establishing a direct service professionals (DSPs) training and certification program to professionalize the workforce and enhance the services provided. The training and certification program will include higher wages for DSPs who complete the training and certification process. Any pay increases will be separate from the Rate Model rates.

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41. Will the Direct Service Professional Training and Certification pay increases be included in the Rate Model?

ANo. Any pay increases for this program will be separate from the Rate Model rates.

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42. How is the Direct Service Professional Training and Certification program different from the Direct Support Professional Training that DDS currently offers?

AThe Direct Service Professional Training and Certification will be a program that will include higher wages for DSPs who choose to complete the training and certification process.  The existing Direct Support Professional Training (DSPT) is a competency-based training program that is mandatory for DSPs working in licensed community care facilities vendored by regional centers. More information about the DSPT can be found here.

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43. Who will be eligible for the Direct Service Professional Training and Certification program?

AThe program is still in development and more information will be shared as it is available.

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44. What is the Direct Service Professional Bilingual Differential?

ADDS is establishing a pay differential for bilingual and multilingual direct service professionals to increase consumer access to staff who speak their preferred language.

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45. Will the Bilingual Differential be included in the Rate Model?

ANo.  Any pay differentials will be separate from the Rate Model rates.

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46. Who will be eligible for the Bilingual Differential?

AThe Bilingual Differential is intended for direct service professionals who communicate in a language or medium other than English, to increase consumer access to staff who speak their preferred language.  The program is still in development and more information will be shared as it is available.

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47. How will Bilingual Differentials be processed?

AThe program is still in development and more information will be shared as it is available.

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48. Who does this requirement apply to?

AProviders that received a rate increase as part of the implementation of the rate study effective January 1, 2023.

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49. What is the purpose of the direct care staff percentage?

ATo identify the amount of the rate increase that must be used to enhance the wages and benefits of staff who spend at least 75 percent of their time providing direct services to consumers.

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50. What is the effective date of this requirement?

AJanuary 1, 2023

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51. What percentage of the rate adjustment should be applied to the wages and benefits for direct care staff?

AThe percentage of direct care staff wages and benefits varies by rate model.

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52. Where can I find the direct care staff percentage for my service code?

AAn online look up tool showing the required percentage applicable to each service can be found here.

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53. How is the direct care staff percentage calculated using the rate models?

AThe direct care staff percentage is the “Staff Cost After Productivity Adj. per Billable Hour” divided by the “Rate per Billable Hour”. This information can be found in the complete rate models under the sections Productivity Adjustments and Administrative and Program Operations, respectively.

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54. How do I calculate the amount of my increase to apply to direct care staff wages and benefits?

APlease refer to the May 11, 2023 directive and enclosure found here.

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55. My rate adjustment is based off several service codes, what percentage should I use?

AIt is recommended that providers with multiple service codes, calculate each service code separately using the applicable direct care staff percentage. Providers can then use the weighted average of the service codes to determine the amount to be used toward their direct care staff spending.


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Last modified: May 15, 2023