Medicaid Service Update
To: ADvantage and State Plan Personal Care Providers
Subject: 25% Provider Rate Increase
Date: September 16, 2022
The Medicaid Services Unit (MSU) is happy to announce the approval of the ADvantage Waiver Amendment by the Centers for Medicare and Medicaid Services (CMS) increasing provider rates by 25%. The complete list of services and rates can be found at the end of this bulletin. Rate increases are planned to take effect for dates of service beginning 10/01/2022.
Note: A separate bulletin will be sent addressing rates for the CDPASS service option.
Individual Member service authorizations will be converted automatically in Harmony to implement the new rates. MSU will end existing authorizations for 9/30/2022, and new authorization lines will be automatically added with a begin date of 10/01/2022 at the new rate. Members’ authorizations will receive new OHCA prior authorization (PA) numbers at that time.
To avoid billing issues after the conversion, providers must be as current as possible on their billing. The Units Paid report from the 9/21/2022 pay cycle will be used for conversion of authorization lines. Due to the high number of service authorizations that must be converted and transmitted to OHCA, the conversion process will take place over several days prior to 10/01/2022.
After the conversion, if a provider finds there were not enough units left on the authorization ending 9/30/2022, they may use the link on the next page to submit a request to add additional units. If additional units are needed on the line beginning 10/1/2022, those units should be requested through the regular service plan amendment process.
The link to the form to submit requests for additional units on ending lines will open to providers beginning at 7:00am on Monday, 10/03/2022 and close on 5:00pm, Friday, 12/02/2022. This will allow providers two (2) full months to evaluate available units and make any necessary adjustments.
Please use the link below to access the request form:
https://forms.office.com/g/0iyvMp5GkJ
| ADvantage Waiver Services | Code | Unit Type | Ending Rate | New Rate |
| Adult Day Health | S5100-U1 | 15-min | $2.08 | $2.60 |
| Adult Day Health - Therapy | S5105-TG | session | $11.70 | $14.63 |
| Adult Day Health - Personal Care | S5105 | session | $8.27 | $10.34 |
| Adult Day Health - Laundry | S5105_U1 | session | $7.80 | $9.75 |
| Case Management | T1016 | 15-min | $15.29 | $19.11 |
| Case Management - Very Rural | T1016-TN | 15-min | $21.89 | $27.36 |
| Transitional Case Management | T1016-U3 | 15-min | $15.29 | $19.11 |
| Transitional Case Management - Very Rural | T1016-TN-U3 | 15-min | $21.89 | $27.36 |
| Personal Care | T1019 | 15-min | $4.21 | $5.26 |
| Advanced Supportive/Restorative Assistance | T1019-TF | 15-min | $4.52 | $5.65 |
| In-Home Respite | T1005 | 15-min | $4.21 | $5.26 |
| Extended In-Home Respite | S9125 | per diem | $175.55 | $219.44 |
| Registered Nurse Skilled Nursing | G0299 | 15-min | $15.60 | $19.50 |
| Licensed Practical Nurse Skilled Nursing | G0300 | 15-min | $14.56 | $18.20 |
| Extended State Plan Registered Nurse Skilled Nursing | G0299-TF | 15-min | $15.60 | $19.50 |
| Extended State Plan Licensed Practical Nurse Skilled Nursing | G0300-TF | 15-min | $14.56 | $18.20 |
| Nursing Assessment/Evaluation | T1002 | 15-min | $15.60 | $19.50 |
| Assisted Living Tier 1 Services | T2031 | per diem | $48.99 | $61.24 |
| Assisted Living Tier 2 Services | T2031-TF | per diem | $66.11 | $82.64 |
| Assisted living Tier 3 Services | T2031-TG | per diem | $92.47 | $115.59 |
| Consumer-Directed Personal Assistance Services | S5125 | 15-min | $3.56 | $4.45 |
| Consumer-Directed Advanced Personal Services Assistance | S5125-TF | 15-min | $4.27 | $5.34 |
| Consumer-Directed Goods & Services | T2025 | 15-min | $1.04 | $1.30 |
| Home Delivered Meals | S5170 | per meal | $5.15 | $6.44 |
| Hospice Care | S9126 | per diem | $123.80 | $154.75 |
| Physical Therapy | G0151 | 15-min | $20.80 | $26.00 |
| Occupational Therapy | G0152 | 15-min | $20.80 | $26.00 |
| State Plan Services | Code | Unit Type | Current Rate | New Rate |
| State Plan Personal Care | T1019 | 15-min | $4.21 | $5.26 |
| State Plan Nursing Assessment/Evaluation | T1001 | per visit | $62.40 | $78.00 |
If you have any questions regarding the information provided, 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
