September 2, 2020
In addition to our Summary (directly below) please see the SDoH Notice at bottom of this message. Slides and an FAQ are available online.
Background: For NYS Council members that provide Community Habilitation and Day Habilitation services to children, Covid-19 Retainer Payments were established during the pandemic emergency to help maintain business operations when the services are unable to be provided and billed for under usual circumstances. For example, the Retainer Payment may be billed when the full utilization on thePOC (Plan of Care) cannot be billed for a participant (i.e., 30% hours are billed for telemedicine but 70% of hours cannot be provided and may be billed using the Retainer Payment). Information about Provider Attestation is on pages 21-22 of the Slides :
Provider Attestation (requirements):
- Retainer Payments will only be billed for those participants in which Community and/or Day Habilitation has been outlined as a service on the Health Home or C-YES Plan of Care and who were actively being served by the provider when COVID-19 quarantines occurred.
- Retainer Payments will only be billed for those participants unable to receive services due to complications experienced during the COVID-19 pandemic
- Retainer Payments will not be billed when the participant chooses to receive services through a different provider or dis-enroll from the service.
- Efforts have been made to deliver the service face-to-face or via telehealth; these efforts have been documented in the participant’s record along with the reason why the full service cannot be delivered to the participant via these modalities. 22 Provider Attestation
Provider Attestation (provider’s agreements):
- Provider agency acknowledges that all Retainer Payments will be subject to a final reconciliation and/or audit. If an agency fails to submit required and requested reporting, NYSDOH may take appropriate enforcement actions, including, but not limited to, immediate recoupment of any paid retainer funds.
- Retainer Payments will be subject to recoupment if inappropriate billing or duplicate payments for services occurred.
- Provider agency confirms it has not received funding from any other sources, including but not limited to unemployment benefits and Small Business Administration loans, that, in addition to the Retainer Payment, would exceed their revenue for the last full quarter prior to the COVID-19 state of emergency and that Retainer Payments at the level provided by NYSDOH would not result in revenues exceeding that of the quarter prior to the COVID-19 public health emergency.
- Any Retainer Payment amounts in addition to other public emergency funding sources in excess of pre-COVID-19 revenues will be recouped by NYSDOH.
———- Forwarded message ———
From: Schiller, Daniel W (HEALTH) <Daniel.Schiller@health.ny.gov>
Date: Wed, Sep 2, 2020, 9:33 AM
Subject: 1915(c) Children’s Waiver COVID-19 Appendix K – Retainer Payment Reminder
Day and Community Habilitation providers,
REMINDER: Attestations to be able to claim and receive Retainer Payments for Day and Community Habilitation services during the State of Emergency is due this Friday, September 4, 2020.
Please submit your attestations or any questions to BH.Transition@health.ny.gov