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Provider Update: August 25, 2015

Rate Conversion Notification

Rate reductions for the ADvantage and State Plan Personal Care programs have been approved at all levels required and will go into effect on September 1, 2015. All systems should reflect the decrease in rates on that date. Rate decreases for the following services are listed.

Case Management

Service

Code

Current Rate

New Rate

Decrease

Case Management Standard

T1016

$14.25

$13.75

$0.50

Case Management Very Rural

T1016 TN

$20.40

$19.69

$0.71

Transitional Case Management Standard

T1016 U3

$14.25

$13.75

$0.50

Transitional Case Management Very Rural

T1016 TN U3

$20.40

$19.69

$0.71

Personal Care

Service

Code

Current Rate

New Rate

Decrease

ADvantage Personal Care

T1019

$3.92

$3.78

$0.14

Advance Supportive/ Restorative

T1019 TF

$4.22

$4.07

$0.15

CD-Pass

Service Code Current Rate New Rate Decrease
Personal Service Assistant S5125 $3.32 $3.20 $0.12
Advanced Personal Service Assistant S5125 TF $3.98 $3.84 $0.14
Optional Expense T2025 $1.00 $0.97 $0.03

In-Home Respite

Service

Code

Current Rate

New Rate

Decrease

2-7 hours

T1005

$3.92

$3.78

$0.14

Extended Respite (1/Day)

S9125

$165.88

$160.07

$5.81

Assisted Living

Service

Code

Current Rate

New Rate

Decrease

Standard Care Level

T2031

$45.61

$44.01

$1.60

Intermediate Care Level

T2031 TF

$61.55

$59.40

$2.15

High Care Level

T2031 TG

$86.10

$83.09

$3.01

The following rates are affected for State Plan Personal Care

Service

Code

Current Rate

New Rate

Decrease

Personal Care

T1019

$3.92

$3.78

$0.14

  • 6Gs: Due to the magnitude of this conversion, Member specific ADV6g printouts will not be distributed. Each agency will receive a comprehensive report, detailing all service lines affected for each Member served.

  • T1016 Case Management: Regarding the Case Management service line (T1016): The service plan, before the conversion, will end a service line and begin a new service line. A maximum of 25 units of T1016 will remain on the ending service line with a date ending 8/31/2015. The remaining T1016 units will be transferred to the service line beginning 09/01/2015 at the decreased rate.

  • October 31, 2015 submission: Providers are advised to submit addendums requesting amendment to the Service Plan no later than October 31, 2015.

The MSU has taken great care in making the rate conversion as seamless as possible, but any change, especially one this substantial, may result in some anomalies.

Please be aware that any issues we find may not be uncommon and we will transmit any necessary mass email updates immediately upon discovery.

Thank you in advance for your support as we implement this change.

If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at: aauproviderquestion@aau.okdhs.org

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