The Centers for Medicare and Medicaid Services (CMS) has approved renewal of the New Options (NOW) Waiver through September 30, 2022. The renewal reflects collaborative work by the Georgia Departments of Behavioral Health and Developmental Disabilities (DBHDD) and Community Health (DCH) to align service rates with the Comprehensive Supports (COMP) Waiver Program and enhance supports to families and individuals through changes to respite services, community living support, therapy services and expand options to encourage the use of supported employment. The frequently asked questions and answers below are designed to assist providers and family members, in understanding specific elements of the NOW Waiver renewal and invite them to participate in implementation plan meetings. Provider/family forums will be scheduled to begin in January 2018 to answer questions and provide additional information about the implementation schedule.
General Information about the NOW Waiver Program Renewal
What are the primary changes approved by CMS with the NOW Waiver renewal?
Aligns community living support rates and expands the service to allow differential rates for shared CLS services, in which two to three waiver participants share support staff in an independent living setting. The shared CLS model was developed for adults with intellectual and developmental disabilities who wish to live independently as housemates but require supervision and assistance.
Adopts reimbursement rates that reflect provider costs for both overnight and shorter-visit respite services by increasing the rate for overnight, or “full-day,” respite service and providing a 15-minute unit that accommodates one-to-three people.
Increases the maximum cost cap for physical, occupational, and speech therapies.
Adds nutrition services to the list of professional services available for authorization through the waiver.
Provides greater flexibility and assistance to individuals who wish to pursue supported employment in community settings.
Service Enhancements for Families
Reimbursement rates for respite services are increasing. Both the 15-minute rate and the daily, or “overnight,” rate will remain. Similar to residential rates, overnight respite will accommodate individuals with a higher level of need by adding a new rate category.
The 15-minute respite rates are designed to accommodate one waiver participant, or two-to-three waiver participants served concurrently; each individual or shared staffing model has an associated procedure code and rate.
The annual respite limits are being increased from the current cap of $3,744 to $4,608 minimum (or slightly more if the individual’s support needs are great). The new limits are based on 30 days of the daily respite rate.
Service Enhancements for individuals and Families
Community Living Support Services:
CLS will be reimbursed under six rate categories: basic; extended; two-person basic and extended; three-person basic and extended.
Participant-directed CLS currently awarded at the maximum allowable cap will be recalculated at the new maximum cap with each waiver participant’s next plan year.
Shared two- and three-person CLS will be recalculated at the new rates beginning with the waiver participant’s next plan year in order to allow development of shared ISP supports.
Therapy and Nutrition Services:
Increases the maximum allowable cap for combined or single adult therapy services: physical therapy, occupational therapy and/or speech therapies.
Add nutrition services to the NOW Waiver program to provide professional services for individuals with complex nutritional needs.
Where can I find the new procedure codes and rates?
DCH’s Georgia Medicaid Management Information System will post the procedure codes and rates under Part III Policies and Procedures for New Options Waiver Program (NOW) beginning January 1, 2018. The information can be accessed at: http://www.mmis.georgia.gov/portal/PubAccess.Provider%20Information/Provider%20Manuals/tabId/54/Default.aspx
Providers, families and individuals will be invited to join the Division of Developmental Disabilities in discussion of the NOW Waiver Renewal changes, implementation plans in January and February 2018.