Notice to providers with prior authorization to bill exceptional rates

The Centers for Medicare and Medicaid approved a 2% rate increase as of December 11, 2014 for eight services available in the NOW and COMP Waiver Programs. The Departments of Behavioral Health and Developmental Disabilities and Community Health worked collaboratively to assure that the rate adjustments were made available to providers as quickly as possible. This required the adjustment of over 11,000 prior authorizations to support the adjusted rates. Ninety-six percent (96%) of those prior authorizations could be adjusted within the Waiver Information System in order to facilitate provider reimbursement as quickly as possible. The remaining 4% require manual recalculation of the exceptional rate in the cases where a base rate was used for calculation of additional or specialized staffing patterns.  

Recalculation of exceptional rates has already begun and you may have noticed that in all renewed exceptional rate requests since late January. You will have seen those recalculations in the form of one exceptional rate approval for continuation and a separate approval letter for that period from December 11, 2014 to the date of renewal. DBHDD staff is working to recalculate exceptional rates with base rate increases for all of those individuals whose renewal date occurs later this year. The Division expects to complete those recalculations by April 6 at the latest.

Rate tables listing new rates as of 12/11/14 are available on the DCH Medicaid Management Information System as banner messages dated 1/29/15 at this hyperlink: NOW/COMP Rate Tables. The banner messages in PDF format are also attached for your convenience.

Please contact Catherine Ivy at [email protected] with any questions or concerns.