Ohio Home and Community-Based Service Waivers

1. Ohio Home and Community-Based Service Waivers All Services Plan (ASP) Provider Education and Technical Assistance

2. What is an All Services Plan? An All Services Plan is the service coordination and payment authorization document that identifies specific goals, objectives and measurable outcomes for an individual’s health and functioning expected as a result of services provided by both formal and informal caregivers, and that addresses the physical and medical conditions of the individual. At a minimum, the All Services Plan shall include: • Essential information needed to provide care to the individual that assures their health and welfare; • Billing authorization; and • Signatures indicating the individual’s acceptance or rejection of the all services plan. Ohio Administrative Code: 5160-45-01 (formerly 5101:3-45-01)

3. What specifics are in an ASP? The All Services Plan contains the individuals: • Goals/Objectives • Method used to meet the goals/objectives • Service(s) to be delivered • Units (Bases and Subs) • Billing Codes • Service delivery Start and End Date(s) • Contact Information for All Team Members • Payment Source and Authorized Service Amounts • Patient Liability Information • Authorizing Signatures

4. All Services Plan Authorization The All Services Plan (ASP) authorization identifies: • Each service provider • Details the number of hours/units authorized • Outlines the service delivery schedule • Specifies what services/tasks are to be performed • A new ASP is generated no less than annually • Amendments/Updates are made as needed throughout the year, based on the individual’s needs

5. Before You Bill • You, and the services you provide, must be listed on the ASP BEFORE billing for services. You are responsible for assuring you have WRITTEN authorization for the services you deliver. • You must have documentation of the services you provided. • Your timesheet must be signed exactly as identified in the ASP, (Individual’s or authorized representative signature shall be documented on ASP. If this cannot be completed, case manager must document alternative, 5160:46-04 (B)(8)(g)). • You cannot bill more than the total number of hours/units or dollar amount authorized on the ASP, or for more services than you provided. • You must have authorization from the case manager, not the individual, guardian and/or authorized representative.

6. Provider’s Responsibility As a provider, you are responsible for knowing and understanding ALL applicable Ohio Administrative Code rules and all applicable laws. You can find these regulations at http://codes.ohio.gov/oac or http://emanuals.odjfs.state.oh.us/emanuals • You must have written approvalon the Individual’s All Services Plan (ASP) before you provide any service or submit any billing for the delivered service. • You are responsible for assuring your billing is accurate. You must follow the ASP and assure that your billing accurately reflects the actual face-to-face services you have delivered and documented to the Individual.

7. All Providers Must: • Obtain a copy of the ASP prior to delivering services • Deliver services as written/authorized in the ASP • Keep a copy of the ASP for your records, and keep a copy of the ASP in the individual’s home • Obtain an updated written copy of the ASP whenever changes are approved verbally by the case manager • Obtain an updated copy of the ASP whenever there is a change in services, or a change in the Individual’s schedule • Submit a written request to the case management agency when an ASP update is needed, or overdue

8. Providers Shall Not: • Provide more services than authorized on the ASP. • Perform services not identified on the ASP. • Deviate from the schedule identified on the ASP. • Bill a service code you are not authorized to bill. • Fail to collect Patient Liability from the Individual. Note: Requested changes to the All Services Plan by the individual must be communicated to the case manager and the change should not be implemented until written approval has been received from the case manager.

9. Billing Accuracy/ Remittance Advice Prior to billing for services, providers must: • Have all required documentation including the authorization on the All Services Plan. • Check all claims to ensure the claim has the correct code, date of service, and served individual. • Ensure that the clinical documentation matches the appropriate individual, length of visit, date billed, and PAID amount. • Once you are paid, review the remittance advices by comparing the payment to clinical documentation to assure you have support for the amount billed. If you do not, you should make adjustments to your claims immediately. If an overpayment is found or a claim was billed incorrectly, provider has 60 days to resubmit a correction to the claim.

10. When you don’t comply… • If you bill for more hours/dollars than you are authorized to provide on the All Services Plan, you will have to pay the money back to the State of Ohio. If it appears you made these errors intentionally, you may be charged with a criminal offense. • Providers who are found to have a pattern of over-billing or are found to intentionally over bill, may be in jeopardy of having their provider agreement (provider number) inactivated through temporary suspension or permanent termination. • Without an active provider agreement, providers are not permitted to render services, or to bill for services provided.

11. Example of Goal/Objective/Method Providers must deliver the services identified, as described, per the schedule noted in the ASP.

12. Units Page The Units page lists the goals, service/billing code, bases and subsequent units, authorization dates, the provider and contact information, payment source, and dollar amount authorized.

13. What are Base and Sub Units? Services are authorized in Base and Subsequent Units (referred to as bases and subs): • The first hour of service is called a Base Unit, and is reimbursed at a higher rate. • After the first hour of service, services are authorized in 15 minute increments. These increments are called Subs or Subsequent Units (meaning they are subsequent to, or follow, the Base Unit.) 1 hour of delivered service is billed as 4 Subs For example: a 4 hour visit (shift) is authorized as: 1 Base Unit (first hour) + 12 Subsequent Units The ASP Units Page will tell you how many Bases and Subs you are authorized to provide throughout the month.

14. For more information on Bases and Subs: See Ohio Administrative Code Rules: • 5160-46-06 (formerly 5101:3-46-06); • 5160-50-06 (formerly 5101:3-50-06)

15. Example of Nursing Provider /Payment Source The below example notes the following: • Billing code T1000 for Private Duty Nursing(PDN) • Base of 5(first hour of service); subsequent units of 0 • Service start date of 12/25/2008 • Provider—Sally Sue LPN with location • Provider phone number and email (if applicable) • Medicaid as Payer 7) Maximum reimbursement amount of $283.25 per month for 5 base and 0 subsequent units

16. Example of Personal Care Aide /Payment Source The below example notes the following: • Billing code T1019 for Personal Care Aide(PCA) • Base of 5(first hour of service); subsequent units of 60 • Service start date of 1/9/2009 • Provider—Jim Jones CSTO with location • Provider phone number and email (if applicable) • Medicaid as Payer • Maximum reimbursement amount of $309.00 per month for 5 base and 60 subsequent units

17. All Services Plan Team Signature Page The Signature Page identifies who participated in the meeting to develop the ASP, and lists how they participated (In person, by phone, email, etc.)

18. For additional information… • Ohio Medicaid: http://www.medicaid.ohio.gov/ • Lawriter (Ohio Administrative Codes listed by number): http://codes.ohio.gov/orc/ • Department of Jobs and Family Services E-manuals: http://emanuals.odjfs.state.oh.us/emanuals • PCG: http://ohiohcbs.pcgus.com/

19. QUESTIONS Please email questions regarding this training to: ohiowaivers@pcgus.com

20. Public Consulting Group, Inc. P.O. Box 151510 Columbus, Ohio 43215 (877) 908-1746, www.ohiohcbs@pcgus.com