This Informational Bulletin is to advise Waiver Service Providers, Independent Service Coordination (ISC) Agencies and other advocates that the Division of Developmental Disabilities (DDD) via an approved amendment to the Adult Waiver has increased the number of annual billable hours for Behavior Intervention and Treatment (56U) from 66 hours to 104 hours.
Prior to this approved amendment, individuals receiving services under the Adult Waiver were limited to 66 hours of behavior intervention/treatment per year for Medicaid Waiver reimbursement. As a result of stakeholder input during the course of transitions to community services regarding the adequacy of this maximum capacity, the Division took steps to amend the adult Waiver to allow a greater number of hours based on individuals' need for the service.
Process and Procedures
The Division is working with the Department's technology staff to modify the edits in the electronic billing and payment systems to allow for this increase in hours. MIS Staff are working as quickly as possible to have the programming completed before any providers exceed 66 hours later in the fiscal year. In the event a provider reaches that level before programming is completed, please resubmit the billings unit they are processed.
The increased maximum is effective July 1, 2016, for Fiscal Year 2017. Any billings for Fiscal Year 2016 submitted on or after July 1, 2016, are still subject to the 66 hour maximum capacity.