Medicaid Waiver Post Payment Review - PSW Greater than 30
PERSONAL SUPPORT RATE REVIEW
(For Services Delivered in January 2016)
Review Date May 2016
Issue:
Personal Support became a Medicaid Home and Community-Based Services Waiver program effective July 1, 2002 as part of the consolidation of the former Home-Based Support Services program and the former Supported Living Services program. The rates for personal support are not set by the State. Rates are negotiated, within an overall monthly allotment, among the individual, family, provider, and service facilitator. A higher negotiated rate results in a fewer number of units of service. Personal Support providers may be either individual providers or agency staff.
Basis for Review:
As part of its ongoing efforts to ensure the financial integrity of the Waiver and to ensure that Personal Support is being used as intended and paid at a reasonable rate, the Medicaid Waiver staff conducted a review of bills of $30.00 or more submitted for January 2016 by the independent individual providers.
Method of Review:
The DHS Division of Developmental Disabilities requested a report from the Department's Management Information Services section of accepted Medicaid waiver claims for Personal Support by individual providers paid at a rate of $30 or higher. For the review, staff contacted the service facilitator and asked the following questions.
- Is the Personal Support Worker a relative?
- Does the Personal Support Worker reside with the person?
- Does the Personal Support Worker have special qualifications?
- Are there special circumstances justifying higher rate of pay?
The review revealed 30 paid bills with a rate of $30.00 or more.
PERSONAL SUPPORT RATE REVIEW
January 2016
| Number of bills |
Rate |
| 2 |
30.80 |
| 1 |
31.28 |
| 1 |
31.35 |
| 1 |
32.45 |
| 10 |
33.00 |
| 1 |
35.20 |
| 1 |
35.31 |
| 1 |
38.50 |
| 3 |
42.90 |
| 6 |
44.00 |
| 1 |
49.50 |
| 2 |
55.00 |
| 30 Total Bills |
|
Findings
- There were 30 individual providers paid at a rate of $30.00 or higher.
- Of the 30 individual providers, 16 were a relative that resided with the person receiving services.
- Of the 30 individual providers, 14 had special qualifications or were paid a higher rate due to special circumstances.
- Of the 14, 7 were teachers, 2 were Therapist, 3 were Behavior Therapist, 1 was a Personal Support Worker trainer at an agency and 1was paid at the higher rate due to longevity. The Service Facilitators' indicated the professionals were all working within the capacity of a Personal Support Worker for the person and not providing a professional service.
