DODD Frequently Asked Questions
Medicaid Frequently Asked Questions
The information below contains Frequently-Asked Questions on the subject of the current "pause" in Waiver Reimbursement Transition activities. These will be refreshed often, as needed.
Why has a “pause” been recommended by the Department?
Over the past 20 months, Ohio’s DODD system has been working to design and implement a transition to a new waiver reimbursement system. This change is necessary because the federal government requires a statewide approach to Medicaid reimbursement and did not support Ohio’s previous system of individually negotiated rates. Ohio negotiated a twenty-four month transition period, from July 2005 to June 2007, to transition all DODD waiver consumers to this new statewide reimbursement system. This implementation period was phased in, in order to work out all of the complex details and provide training to individuals and their families, County Boards of DODD and providers.
Unfortunately, a number of complex details remain unresolved, and these are hindering progress on some of the later transition phases. The Department, under new leadership of Director Martin, recognizes the importance of creating a reimbursement system that works. At the same time, any changes to the new reimbursement system must be approved by the federal government. The Department has made the suggestion to the field to “pause” the transition so that Ohio can develop and propose some changes to the federal government, with the goal of improving our new reimbursement system.
How will the “pause” affect individuals who have already transitioned to the statewide system?
The federal government continues to require Ohio to transition payment for all waiver services to a statewide reimbursement system. Over the course of the past twenty months, many individuals have transitioned to the new system. This “pause” will not affect transitions that have already occurred, and the existing service levels that have already been established for many individuals. In other words, during this “pause” period, no one who has been transitioned to the new system should be returning to the former system of negotiated rates.
Will there be any formal guidance about how long the "pause" will be?
Working with staff from the Ohio Department of Job & Family Services, the Department plans to offer a detailed proposal to the federal government by the end of March. This will include a new timeline proposal. Any and all changes to the existing system – including the timeline - must be approved by the federal government. Until feedback from the federal government is received, the Department cannot offer a viable estimate regarding the length of the “pause.” However, given the Department initiated the “pause,” we will not hold county boards accountable to previously stated deadlines in light of this.
Does this “pause” apply to all transitions?
The Department is recommending a “pause” for all transitions with the following guidance for exceptions:
- If the county board of DODD has made a financial commitment related to an individual’s transition service plan (example: negotiated a new lease for an apartment for a person who is scheduled to move in the short term);
- If a county board of DODD is enrolling a new individual on the waiver;
- If a prior authorization request is pending, please see question #6; or
- Other extenuating circumstances as identified by the County Board of DODD.
Does this "pause" include Adult Day Services?
The Department will be examining opportunities to improve Ohio’s approach for reimbursement of Adult Day Services; thus, the “pause” is recommended to apply to Adult Day Services, as well.
What happens if the county board of DODD has already submitted a prior authorization request for an individual whose transition is scheduled to occur within the next few weeks?
No later than March 2, 2007, the Department will provide each County Board of DODD with a list of all prior authorization requests currently pending for that county. If a county board wishes to move forward with any of the pending prior authorization requests, the board must contact Dan Gazdik, a Waiver Unit Manager (dan.gazdik@dmr.state.oh.us) with that direction. Otherwise, the requests will be held pending feedback from the federal government on any potential system improvements. Further direction regarding the “paused” prior authorization requests will be issued at that time.
How will this “pause” affect any state hearings that are pending?
All administrative state hearings related to transitions that have already occurred will continue to be processed without interruption.
How is this fair to those who have already transitioned and had to get a new roommate or lose some staffing time?
The federal government is requiring Ohio to implement a statewide reimbursement system for DODD waiver services. That requirement has not changed. Ohio’s current request to CMS to “pause” implementation in order to make some improvements will not “stop” or “reverse” progress made to date.
Over the past twenty months, various individuals and their families, providers, and county board staff have expressed concerns about different components of the new reimbursement system. This “pause” is an attempt to address some of these concerns in a manner that builds upon much of the foundation that has already been established. In order to negotiate any changes with CMS, it will be imperative to focus on only a few areas and then show discernable results. That said, it is virtually guaranteed that some concerns that have been voiced to the Department will remain unaddressed. We apologize for that, but at the same time, we must acknowledge our inability to construct a system that meets the ideal of every stakeholder in light of limited financial resources.
Where should I direct any additional questions regarding this “pause?”
The Department encourages all stakeholders to send questions to the following email address: waiver.support@odmrdd.state.oh.us. Department staff will review questions sent to this email box at least twice per weekday throughout the duration of the “pause” and will manage responses in one of two ways:
- For questions asked by more than one person, both the question and a response will be posted on the Department’s web page. A link will be available on Monday February 27, 2007, via http://mrdd.ohio.gov
- For questions that are specific to an individual situation, Department staff will follow up directly with the person who poses the question. For this reason, it may help to include your name and a telephone number where you can be reached.
The Department will make an attempt to respond to questions within three working days.
Download Waiver Transition FAQs (PDF)
return to Waiver Transition Updates
A free Adobe Acrobat Reader is required to view and print the .PDF forms on this page. 