Medicaid Service Update

To:  All ADvantage Case Management Providers

Subject: Update to CDPASS Service Plan Line Data Entry

Date: October 25, 2022

Effective 10-25-2022 there is a change in how the Case Manager (CM) will enter the Budget information to the S5125 and S5125-TF Service Plan lines. The T2025 (OPX) process is not changing.

The budget worksheet allows for the calculation of a “Gross Desired Hourly Wage” for PSA (S5125) and APSA (S5125TF) services. This number was traditionally broken out into an individual “Unit Rate” to be entered into Harmony on the service line in the “Rate per Unit” field.

Going forward, the Rate per Unit line will be left at the Harmony default rate for the service.  This allows the full cost of the service to be captured instead of the wage rate of the Member’s employee.

In addition, a new field has been added to the S5125/S5125-TF service lines to capture the Gross Desired Hourly Wage, which will no longer need to be broken out into unit rates.  The Case Manager will enter this information directly from the Budget Worksheet.

There is an image on page 2 of this bulletin illustrating how these lines will appear in Harmony.

NOTE:

• CMs should not change/edit the default unit rate in the ‘Rate per Unit’ field – the new default rate represents the full cost of the CDPASS service option to the Member's plan.
• CMs must add the Gross Desired Hourly Wage as determined on the budget worksheet in the new field added for this purpose.

The FMS provider will be using the Budget Worksheet and Pay Rate forms to ensure that employees are being paid the appropriate wage rates for PSA/APSA services. Please ensure that these documents are being submitted correctly and attached to the following Plan Notes, as appropriate:

Budget Worksheet                                                    Pay Rate forms
Note Type = CD-PASS                                                  Note Type = CD-PASS
Note Subtype = CD-PASS Budget Worksheet          Note Subtype = Pay Rate form

If you have any questions regarding the information provided above, please feel free to contact us via Harmony Provider Question.    

COMMUNITY LIVING, AGING AND PROTECTIVE SERVICES (CAP)
MEDICAID SERVICES UNIT (MSU)
ADvantage Administration | State Plan Care Unit | Medical Eligibility Services
Office: 918-933-4900 | CareLine: 800-435-4711