Q1. What is vendorization and what is its purpose?
AVendorization is the process for identification, selection, and utilization of service providers based on the qualifications and other requirements necessary in order to provide services to consumers. The vendorization process allows regional centers to verify, prior to the provision of services to consumers, that an applicant meets all of the requirements and standards specified in regulations. Applicants who meet the specified requirements and standards are assigned a unique vendor identification number and service code.
Q2. Are service providers vendored by DDS or regional centers?
ADDS does not vendor service providers. Service providers are vendored by the regional center in whose catchment area the service is located, known as the vendoring regional center. Although vendors are prohibited from being vendored by more than one regional center, a vendored service provider may be utilized by non-vendoring regional centers, known as “user” or “utilizing” regional centers, as well as the vendoring regional center. The vendor identification number assigned by the vendoring regional center must be used by all regional centers purchasing the vendored service (Title 17, Sections
54326(a)(14) and
54340(a)).
Q3. What are the different roles of the Department and regional centers in vendoring service providers?
AThe vendoring regional center is responsible for ensuring that the applicant meets licensing and Title 17 requirements for vendorization, determining the appropriate vendor category for the service to be provided, and approving or disapproving vendorization based upon their review of the documentation submitted by the applicant. Although not involved in the vendorization process, the Department does establish rates for community-based day programs and respite agencies after completion of vendorization.
Q4. What documentation do I need to submit to the regional center when requesting vendorization?
AIn addition to a Vendor Application (Form
DS 1890), and the Applicant/Vendor Disclosure Statement (Form
DS 1891), applicants must submit the documentation specified in Title 17, Section
54310. Contact your local
regional center for a vendorization package.
Q5. If I meet all of the requirements, must a regional center vendor me?
AA regional center must vendor an applicant who meets all the requirements for the service to be provided if the service is to be provided in that regional center’s catchment area. While a program cannot be denied vendorization due to a perceived lack of need for the service by the vendoring regional center, vendorization in no way obligates that regional center to purchase service from that vendor. (Title 17, Section
54320)
Q6. How long might the vendorization process take?
AOnce a potential service provider has obtained all necessary licenses, submitted a complete application and all necessary documentation to the vendoring regional center, the regional center has 45 days to approve or disapprove vendorization. (Title 17, Sections
54320,
54322,
54380)
Q7. Do I have to be vendored by each regional center that uses my service?
ANo. You must be vendored by the regional center in whose catchment area you are located only. Once vendored, any regional center may refer consumers to that program.
Q8. How can I determine in which regional center’s catchment area my program/service is located?
ALocation for site-based programs is determined based upon the address of the program site. For programs which are conducted solely in the community, location is determined based upon the vendor’s business address. (Title 17, Section
54340)
Q9. Does my program have to be licensed?
AMost site-based programs have to be licensed by the Departments of Social Services or Health Services (Title 17, Sections
54342,
56740,
56760(a)(1)).
Q10. Where do I find Day Care & Residential Facility licensing requirements?
Q11. What are community-based day programs?
ACommunity-based day programs are programs which provide services to individuals on less than a 24-hour basis in the community. Per regulations, only activity centers, adult development centers, behavior management programs, independent living programs, infant development programs, and social recreation programs are community-based day programs. Requirements for community-based day programs are discussed in Title 17, Sections
56710 through 56774.
Q12. What are miscellaneous services?
AMiscellaneous services are goods or services which are not similar to any of the descriptions of goods or services specified in regulations. A new miscellaneous service code must be requested by the regional center and approved by the Department prior to vendorization of that service. Once a miscellaneous service code has been established for a specific good or service, that service code may be utilized by any regional center if required to meet consumer(s) needs. (Title 17, Section
54356)
Q13. What is the importance of a vendor number or a service code?
AThe vendor number provides an identification number unique to each vendor. The service code identifies the type(s) of service provided by that vendor. The vendor number and service code are assigned for the purpose of identifying providers of a specific type(s) of service and allowing tracking of expenditures by vendor and/or service type.
Q14. Are regional centers restricted to purchasing services from vendored service providers only? Are there exceptions?
AYes. Regional centers are prohibited from referring any consumer to an applicant until the vendor application is approved and cannot reimburse a vendor for services provided before vendorization. However, if the regional center determines that the health or safety of a consumer is in jeopardy, and no current vendor is available to provide the needed service, the regional center may approve emergency vendorization. (Title 17, Sections
50612,
54324,
54326(c)(4))
Q15. What is emergency vendorization?
AEmergency vendorization allows a regional center to approve vendorization of an applicant prior to completion of the vendorization process if the regional center determines that the health or safety of a consumer is in jeopardy and no current vendor is available to provide the needed service. If emergency vendorization is approved, the applicant may provide services for no more than 45 days, after which the emergency vendorization will lapse if the regional center does not approve vendorization within 45 days of the initial authorization. If a lapse of emergency vendorization occurs, the vendor will not be allowed to reapply for emergency vendorization. (Title 17, Section
54324)
Q16. If I move my program within the same regional center catchment area, what must I do?
AYou must notify the vendoring regional center, in writing, at least 30 days prior to the change in location. Keep in mind that the new location must be licensed before being used, so this must be figured into your timeframes. (Title 17, Section
54330)
Q17. If I move my program into a new regional center catchment area, what must I do?
AYou must notify the current vendoring regional center, in writing, at least 30 days prior to the change in location. Keep in mind that the new location must be licensed before being used, so this must be figured into your timeframes. You must contact the new regional center in whose catchment area you will be moving to begin the vendorization process for a new vendor. (Title 17, Sections
54310,
54330)
Q18. Can State employees or regional center employees be vendored to provide services to regional center consumers?
AOfficers or employees of the State of California and regional center employees generally may not be vendored to provide services to consumers. Some exceptions may apply. Please contact DDS directly at 916-654-1954 for additional information. (Title 17, Sections
54314,
54500,
54505,
54510,
54511,
54512,
54520,
54521,
54522,
54523,
54524,
54525)
Q19. If I open a new/additional location(s), do I have to submit a new vendor application and request a new rate for the new program(s)?
AYes. Each location must be separately licensed and vendored and a new rate must be established for the new/additional location(s). (Title 17, Sections
54340 (a)(1)(A),
54302,
54306,
54308,
54310,
54312,
54314,
54316,
54318,
54319,
54320,
54322,
54324,
54326,
54327,
54327.1,
54327.2,
54330,
54332)
Q20. Can I contract out for some of my direct care services?
AYes, you may under certain circumstances. Any consultants, subcontractors or community resources must be identified on the vendor application submitted to the vendoring regional center. Subcontracting is allowed where the unique needs of a consumer can only be met by a licensed professional not available on program staff, and must be approved by the regional center. (Title 17, Sections
54310,
56710,
56756,
56772,
58524)
Q21. What appeal rights do I have?
AA service provider may appeal the denial of vendorization by a regional center, and perceived non-compliance with the vendorization regulations by regional centers, or the setting of a rate by the Department. There are also appeal provisions for audits. It is probably best to refer to regulations for the specifics of each type of appeal. (Title 17, Sections: Vendorization appeals,
54380,
54382,
54384,
54386,
54388,
54390; Rate appeals,
57940,
57941,
57942,
57944,
57946,
57948; Audit appeals,
50730,
50731,
50732,
50750 50751,
50752,
50753,
50754,
50755)
Q1. How long must I retain cost and billing documentation and records?
ARecords which can be used to verify the billings for services provided to regional center consumers must be maintained for five years after the final payment has been received for any given fiscal year, or until all audit exceptions have been resolved. Consumer records, payroll records, time sheets and any records used to complete a cost statement must be retained for at least five years, or until all audit exceptions have been resolved. (Title 17, Sections
50605,
54326,
56728)
Q2. What happens when a supported-living consumer’s needs become significantly greater than was the case when the supported living arrangement began?
AThe cost comparison specified in Title 17, Section
58617 applies only at the time a consumer’s supported living arrangement begins. Once the arrangement is established and ongoing, cost limitations on supported living services are subject to the general cost containment provisions of the Lanterman Act (such as maximum use of natural and generic supports, and a cost effectiveness test). For this reason, a consumer’s changing needs (increases or decreases) may be mirrored in a corresponding change in the cost of services required to satisfy those needs.
Q3. Are there any requirements for contracting with regional centers?
ARegulations contain certain requirements which must be included in all contracts between a regional center and a service provider. While these contracts can include other provisions, Title 17, Sections
50607 and
50608, contain the minimum provisions.
Q4. Where can I find the pertinent Wage Orders for my program?
AThe Division of Labor Standards Enforcement (DLSE), also under the Department of Industrial Relations, is responsible for interpreting and enforcing the IWC’s Wage Orders. They offer consultation by phone or e-mail, and are the proper source for information on working conditions, rules, and wages. They may be contacted by writing the Division of Labor Standards Enforcement at 455 Golden Gate Avenue, 9th Floor East, San Francisco, CA, 94102, Telephone 415-703-4810. Their web address, which includes locations of all District Offices, is
www.dir.ca.gov/dlse. Questions can be sent via e-mail to
dlse2@dir.ca.gov.
Q5. How are rates determined?
AThere are several different methods which are used to set reimbursement rates for services provided to regional center consumers, depending on the type of service. For example, services which are similar to services covered by MediCal are paid according to the rate schedule (Schedule of Maximum Allowances [SMA]) maintained by the California Department of Public Health. In-home respite service rates (procured through respite agencies) and community-based day program rates are set by the Rates & Fiscal Support Section. These rates are based on actual costs submitted on cost statements, within a range of lower and upper limits. New programs receive a temporary payment rate. Supported living rates are negotiated between vendors and regional centers, and transportation rates are based upon a standard rate schedule, state mileage rate, SMA, bids or negotiated contracts with regional centers. All other services are either negotiated contracts with regional centers or set at the vendor’s ‘usual and customary’ rate. (Title 17, Sections
57300,
58500,
58501,
58502,
58510,
58511,
58512,
58513,
58520,
58521,
58522,
58523,
58524,
58530,
58531,
58532,
58533,
58534,
58540,
58541,
58542,
58543,
58550,
58551,
58552,
58553,
58555,
58601,
58602)
Q6. What is a Temporary Payment Rate, and how is it determined?
AA Temporary Payment Rate (TPR) is the rate paid to a new community-based day or respite programs. This TPR is the mean rate for like programs receiving a permanent payment rate. Within 18 months of the start date of the program, the vendor must submit 12 consecutive months of actual allowable cost information to the Department for conversion to a permanent payment rate. Once the vendor has been notified of the rate established by the Department, the vendor and regional center may negotiate a lower level of payment or a service contract. (Title 17, Sections
57210(a)(17),
57520,
57522,
58000(a)(7),
58120,
58122)
Q7. What are “like programs”?
A“Like programs” are programs that provide similar services, are assigned the same service code, and provide the same staff-to-consumer ratio. (Title 17, Section
57210)
Q8. How are rate adjustments for community-based day programs, when recommended in preliminary audit reports, resolved?
ARate changes recommended in a preliminary audit report are sent by the regional centers to the Department of Developmental Services’ Rates & Fiscal Support Section. The Rates & Fiscal Support Section issues a new rate letter, reflecting the amount verified in the audit, with an effective date based upon the audited cost statement. (Title 17, Sections
50606,
57930)
Q9. What are my rights if I disagree with the audit?
AVendors have multiple appeal rights under regulations. Again, these appeal rights are very specific, so it is best to consult regulations regarding audit appeals. Keep in mind that audit appeals must be submitted to the Department within 30 days of issuance of the final audit report. If an audit finding is overruled on appeal, the rate will be adjusted appropriately. (Title 17, Sections
50730,
50731,
50732,
50750,
50751,
50752,
50753,
50754,
50755)
Q10. I’m a respite service provider, providing service to more than one consumer, using the same respite worker in the same home. Is my rate the same as for one consumer?
AThe rate established for in-home respite service is a per-consumer per-hour rate. The vendor and regional center may negotiate a contract with a lower level of payment for any additional consumers when a single respite worker will be providing the service. If the vendor is unwilling to negotiate a lower rate for the additional consumer(s) being served by a respite worker, the vendor may be required to provide a respite worker for each consumer served. (Title 17, Section
58140)
Q11. What is a non-mobile supplemental rate?
AA non-mobile supplemental rate is a rate of payment for additional direct care staff required for programs serving non-mobile consumers. Activity centers, adult development centers, behavior management, independent living, and social recreation programs may supplement their direct care staff for non-mobile consumers. A supplemental rate may be obtained to provide such extra staff. The rate is based on the prevailing minimum wage, plus 20% for fringe benefits, divided by 10. This amount may be paid for each non-mobile consumer, based on a 1:10 staffing ratio. Requests for supplemental staff must be submitted in writing to the regional center. (Title 17, Sections
56756 and
57530)
Q12. What are the different roles of the Department and regional centers in setting community-based day program and respite agency rates?
AFor community-based day programs and respite agencies, the Department establishes the temporary payment rate and permanent payment rate based upon documentation submitted by the vendor. Prior to issuance of a temporary payment rate, the Department reviews the documentation submitted to ensure compliance with applicable laws and regulations and establishes the vendor’s rate based upon the vendor’s service category, staffing ratio, and the mean rate paid to existing vendors providing like services. Regional Centers are responsible for reviewing program cost and vendor income information submitted by vendors for establishment of a permanent payment rate. Regional centers ensure that the information submitted is complete and in compliance with applicable regulations, and that there are no known inconsistencies in the information reported by the vendor. The regional center must report the results of their review to the Department within 30 days from the date the Department notifies them of the review requirements. The Department establishes the permanent payment rate based upon the information submitted by the vendor.
Q13. What is my reimbursement rate if regulations state that I’m covered by a “Usual and Customary”(U& C) rate?
AA U& C rate is the rate of reimbursement for vendors who serve the general public and/or regional center consumers and for whom neither the Department nor the Department of Health Services have an established rate. A vendor’s U&C rate is the rate the vendor charges to members of the general public for comparable service if 70% or fewer of the individuals served are regional center consumers. If more than 70% of the individuals served are regional center consumers, the vendor and regional center must negotiate the rate of reimbursement. (Title 17, Section
57210(a)(19))
Q14. Do I have to accept a lower level of payment than the rate established by the Department?
ANo. While there are regulations covering the terms and conditions of negotiating and accepting a lower level of payment than the rate established by the Department, any lower level of payment must be agreed to by both parties. Generally, such agreements are mutually beneficial. For example, vendors sometimes accept a reduced rate for a period of time in cases where the regional center can guarantee a stable or increased number of consumer placements. The vendor can plan on a stable funding base, while the regional center can use scarce purchase of service dollars to provide services for more consumers. (Title 17, Sections
57300(d),
57439)
Q15. My rate is based on a cost statement that I submitted. Can I correct errors or omissions on this cost statement once my rate has been set?
AYes. You may appeal any errors made by you in the cost statement; errors made by the Department in calculating your rate, the effective date of the rate or the denial of requests for rate adjustments. Appeals must be filed within 12 months after the receipt of written notification from the Department of the vendor’s rate. Detailed instructions are in regulations. (Title 17, Sections
57940,
57941,
57942)
Q16. What is the Schedule of Maximum Allowances (SMA)?
AThe Schedule of Maximum Allowances, also known as Medi-Cal rates, as developed by the Department of Health Care Services is established as the maximum rate of reimbursement for services reimbursed under the Medi-Cal program. By regulation, regional centers cannot pay more than the Medi-Cal rate (SMA) for the same service. (Title 17, Sections
57210(a)(14),
57332 (b))
Q17. How does a change in ownership of my community-based day program affect the program’s rate?
AThe rate will not change as long as the staffing ratio and program activities, as identified in the program design, remain unchanged. (Title 17, Section
57300(g))
Q18. Under what circumstances may I request a rate adjustment for my community-based day program?
AThere are several circumstances under which you can request a rate adjustment, including a modification in program design which results in a change in the approved existing staffing ratio or service code, relocation due to the loss of a tenancy agreement, or the loss or gain in vendor income which was used in calculating your rate. Requests of these types are considered requests for ‘anticipated’ changes. You may also request rate adjustments as a result of mandated service adjustments due to changes in existing statutes, laws, regulations or court decisions, or due to emergency relocations required to protect the health and safety of the consumers. Requests of this type are considered requests for ‘unanticipated’ rate adjustments. (Title 17, Sections
57920,
57922)
Q19. What’s the difference between ‘unanticipated’ and ‘anticipated’ rate adjustment requests?
ABesides the circumstances leading to the request, the major difference is that the regional center must fund ‘unanticipated’ requests effective the date of approval. Funding for ‘anticipated’ requests must be requested through the normal budget process and, if funding is made available in the Budget Act, becomes effective September 1 of the year following the date of the request or later, depending upon when the cost actually occurs. Requests for ‘anticipated’ rate adjustments must be made prior to December 1 of the year previous to the fiscal year in which the changes are expected to occur. ‘Unanticipated’ rate adjustments may be requested any time throughout the year. (Title 17, Sections
57920,
57922,
57924)
Q20. When my temporary payment rate (TPR) was converted to a permanent payment rate (PPR), the rate went down. How can this happen?
AThe TPR is calculated by taking the mean rate for all like programs receiving a permanent payment rate. The PPR is based on the actual costs of your program, up to the upper limit for your service code and staffing ratio. If the cost statement submitted to establish your permanent payment rate did not result in a rate equal to or greater than the rate you were receiving, your rate was reduced to the cost statement rate. (Title 17, Sections
57652,
58252)
Q21. Can vendors bill for absences?
ARegulations prohibit providers of non-residential services from billing for absences. However, for community-based day programs and in-home respite services agencies, absences are built into the rate. In setting the rate, the Department divides a program’s total costs by the actual units of service provided (hours or days, depending on the service code). We do not use the authorized number of days/hours that a consumer could have been in a program, but rather the actual days/hours of attendance. This way, each program’s actual pattern of absences and the costs incurred are already accounted for in their rate. Regional centers may pay residential facilities for temporary absences. (Title 17, Sections
54326(a)(10) and (11),
56917(h) and (h)(1))
Q22. What appeal rights do I have?
AA service provider may appeal the denial of vendorization by a regional center, and perceived non-compliance with the vendorization regulations by regional centers, or the setting of a rate by the Department. There are also appeal provisions for audits. It is probably best to refer to regulations for the specifics of each type of appeal. (Title 17, Sections: Vendorization appeals,
54380,
54382,
54384,
54386,
54388,
54390; Rate appeals,
57940,
57941,
57942,
57944,
57946,
57948; Audit appeals,
50730,
50731,
50732,
50750,
50751,
50752,
50753,
50754,
50755)
Q23. How are cost statement rates established?
AFor community-based day programs and in-home respite service agencies, each vendor’s rate is established utilizing actual allowable cost information and consumer attendance data submitted by the vendor. If the calculated rate is within the allowable range of rates for like programs, the vendor will receive the calculated rate. If, however, the vendor’s rate is below the lower limit or above the upper limit, the rate will be adjusted up to the lower limit or reduced to the upper limit, as appropriate. Once the vendor has been notified of the rate established by the Department, the vendor and regional center may negotiate a lower level of payment or a service contract. (Title 17, Sections
57300(d),
58140,
57540)
Q24. How does the Department set Supported Living Service (SLS) rates?
AThe Department does not set SLS rates, but, through its regulations, requires that SLS rates be arrived at through negotiations between the regional center and each SLS vendor. Once negotiated, the rate or rates are written into the vendor’s SLS contract. Title 17, Section
58661 allows great flexibility in negotiated rate types.
Q25. Is there a ceiling placed on SLS rates?
ANo direct ceiling for SLS rates exists; however, the regional center’s latitude in providing for the costs of any consumer’s supported living arrangement is governed by cost comparisons. Established limits on costs may indirectly affect SLS service rates. (Title 17, Section
58617)
Q26. Is there a separate SLS rate for a vendor’s administrative costs?
AYes. However, often the SLS rate for direct service includes an amount to cover administrative costs. In that event, no separate administrative rate is permitted. (Title 17, Sections
58660,
58662)
Q27. Does a consumer or family member have a say in the SLS rate the consumer’s SLS provider gets?
ANo. Only the regional center and the SLS vendor are parties to the negotiation of rates. However, the consumer and the family or consumer representative have a right to protest to the regional center when they believe necessary services are not being given to the consumer, for whatever cause.
Q28. Under the cost comparison requirements of Title 17, Section 58617(a), if alternative living arrangement costs were estimated at $50,000 annually, is the consumer entitled to have $50,000 spent on the Supported Living Arrangement?
AYes, but only when the full $50,000 is needed to provide a cost effective Supported Living Arrangement for the consumer. The regional center has a standing obligation to spend only that amount which is required to meet a consumer’s SLS needs, even if an alternative living arrangement, including a licensed residential facility placement, were to cost more.
Q29. Can a regional center pay for the rent and utilities of a SLS consumer’s apartment?
ANot ordinarily. The SLS concept holds that a consumer is responsible for the ordinary costs of living in the community (costs that people without disabilities have to pay) such as food, rent, and utilities. SLS is designed to supply the resources needed to overcome the barriers to living in one’s own home that result from the developmental disability (help with daily living activities, for example). But an exception exists, as specified in Title 17, Section
58611(b). Under special conditions specified in this regulation, a regional center director may determine it is appropriate to help pay rent and certain other ordinary living expenses for a SLS consumer.
Q30. How are rates for miscellaneous services established?
AThe maximum rate of reimbursement for miscellaneous services are established in accordance with the Schedule of Maximum Allowances (SMA) established by the Department of Health Care Services for services provided under the Medi-Cal program, the vendor’s usual and customary rate if the SMA does not apply to the services provided, or a negotiated rate if the vendor does not have an established usual and customary rate and the SMA does not apply. (Title 17, Section
57336)
Q1. What are the rate increase percentages and eligible service codes for the SB 81 rate increase and when will I know the new rates for my programs?
AThe percentage of rate increases and eligible service codes can be found
here. The rate increase will be applied to rates in effect on December 31, 2019, less the amount of any one-time increase, such as bridge funding (see response to #5 below). The Department or regional centers will contact vendors to inform them of their rate increase amount and new rate.
Q2. Do I need to keep track of how the rate increases are spent?
AThe statute that mandated the SB 81 rate increase does not require vendors to report on how the rate increase was used.
Q3. Will service providers receive a rate letter from the Department or the regional center?
AFor vendors, such as community-based day programs and respite agencies with Department-set rates, the Department will issue vendor-specific letters to inform them of their rate increase amount and new rate. For vendored services with negotiated rates, the regional center will contact the vendor with this information. Rates set by statute or regulation, will be updated and posted
here.
Q4. Does the rate increase apply to tailored day services?
AIf vendored under one of the specified service codes receiving the SB 81 rate increase, tailored day service provider rates can be increased, consistent with the tailored day service rate setting as defined in Welfare and Institutions Code,
Section 4688.21.
Q5. How is the SB 81 rate increase going to be applied to those vendors who received the bridge funding rate increase?
AThe rate increases will be applied to rates in effect on December 31, 2019, less the amount of any one-time rate increases, such as bridge funding. Below is an example of how new rates, effective January 1, 2019, will be calculated. The example assumes an Adult Development Center service rate of $64.38 per day in effect on December 31, 2019, that includes $1.32 as a result of the 2.1 percent bridge funding rate increase and will be receiving an 8.2 percent SB81 rate increase.
- Remove the amount of bridge funding rate increase from the vendor’s rate in effect on December 31, 2019.
$64.38 (Current Rate) – $1.32 (Bridge Funding Rate Increase Amount) = $63.06
- Using the rate without bridge funding from Step 1, apply the percentage increase set forth in the SB 81 rate increase schedule posted on the Department’s website.
$63.06 (Calculated Rate from Step 1) x 1.082 (SB 81 Rate Increase %) = $68.23
- Add back the bridge funding amount to the new calculated rate in Step 2 that includes the SB 81 rate increase. Note that the bridge funding increase is only available until April 30, 2020, hence Step 3 no longer applies after this date.
$68.23 (Calculated Rate from Step 2) + $1.32 (Bridge Funding Increase) = $69.55 (New Rate)
Q6. Will providers receiving SB 81 rate increases also be eligible to request the 2020 State minimum wage rate adjustment?
AYes, if applicable, providers receiving the SB81 rate increase can also request a rate adjustment for the State minimum wage.
Q1. Can programs determine which services will be offered remotely?
AYes. Providers determine what services to offer. Individuals and families may work with planning teams to explore other options if they choose.
Q2. Is there any requirement for program design updates if a provider intends to remain largely remote moving forward?
ANo. Program designs do not need to be updated if the only differences are remote delivery and/or the schedule services are provided.
Q3. Can supplemental staffing be provided remotely?
APossibly, however the planning team must be clear about the function of this remote supplemental support.
Q4. Do staffing ratio requirements in remote services have to match those of the provider’s traditional day program?
AYes, staffing ratio requirements should align with the program design.
Q5. Given the elimination of the half-day billing rule, is there a minimum number of remote service hours needed to bill for a full day?
ANo. Billing rules are the same as in-person services.
Q6. The services listed as approved for remote delivery in the March 18, 2020 directive were defined according to service code. Is such a list available for remote services under the updated directive?
AThere is not a list of approved service codes. The directive applies to Day Programs, Independent Living Services, and Lookalike Day Programs.
Q7. In the rate study, there were certain service codes characterized as “look alike day programs.” Is there flexibility for regional centers to consider other programs serving a day program function as “look alikes” for the purpose of the recent directive on remote services?
A“Look alike” for this purpose is defined according to its function and is a service that serves a day program function but is not vendorized under a day program specific service code. There is no exhaustive service code list for “look alikes.”
Q8. Is the expectation that remote service delivery will address the goals identified in each individual’s IPP?
AYes, remote services should target goals in an individual’s IPP.
Q9. Does the unit of service for billing remain the same as for the traditional day program?
AUnits of service were not changed in the recent guidance on remote services.
Q10. In Alternative Services, delivering off materials or packets and other activities that are not part of the original Program Design were considered allowable billable services. Do these flexibilities continue under the recent remote services directive?
ANo. The only flexibility is the service location.
Q11. When considering additional supports needed to allow for remote participation in day programs, is it possible this may include supplemental residential support?
AYes, but this is tied to individual circumstances as determined by the planning team.
Q12. Will subcodes be required to identify remote services?
AThere is no separate subcode for remote services.
