STATE OF WASHINGTON



354330023114000STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services Division1625600238760HCS MANAGEMENT BULLETIN00HCS MANAGEMENT BULLETINPO Box 45600, Olympia, WA 98504-5600H20-008 – InformationFebruary 4, 2020 TO:Home and Community Services (HCS) Division Regional AdministratorsDevelopmental Disabilities Administration (DDA) Regional Administrators Area Agency on Aging (AAA) DirectorsFROM:Bea Rector, Director, Home and Community Services DivisionDebbie Roberts, Deputy Assistant Secretary, Developmental Disabilities AdministrationSUBJECT:Negative Adjustment Functionality in the Individual ProviderOne (IPOne) Payment SystemPURPOSE:To provide information to field staff regarding negative adjustment functionality in IPOne, and related Administrative Hearings BACKGROUND:The ability for Individual Providers (IPs) to negatively adjust timesheets was turned off in July 2016 to allow for implementation of overtime. An adjustment is a change to a previously paid timesheet. A negative adjustment is a change to a previously paid timesheet that reduces the units/hours/mileage previously paid and creates an overpayment owed by the IP to DSHS. A positive adjustment is a change to a past paid timesheet that adds to units/hours/mileage previously claimed and will generate an additional payment to the IP in the next regular payroll. An overpayment related to negative adjustments is a debt to the Department owed by a provider for any payment or benefit to a recipient or to a vendor in excess of that to which is entitled by law, rule, or contract, including amounts in dispute.The ability to adjust a paid timesheet to add hours, units or mileage to that timesheet continues to be available to IPs. Providers will also continue to have the ability to make a change to a timesheet that results in no payment, a “net zero” adjustment (i.e. moving the same number of units from one date to another date).WHAT’S NEW, CHANGED, OR CLARIFIED:System improvements and development in IPOne for the implementation of negative adjustment functionality have been completed. Individual Providers will be able to submit a negative adjustment to a previously paid timesheet effective January 29, 2020. Call PPL Call Center for HelpWhen this functionality is available in IPOne, providers are strongly encouraged to call the PPL IPOne Call Center for assistance. PPL call center agents and Program Support Specialists are trained to assist IPs with successfully completing negative adjustments. Field staff are asked to reinforce this direction by encouraging providers to contact the call center for assistance with completing a timesheet adjustment.IPs who wish to adjust a paper timesheet submitted via fax or mail (whether the adjustment is to add or remove any paid hours/units/mileage) must contact the IPOne call center to complete this action.The IPOne call center has agents that can support providers in thirteen languages. See the link below for the multilingual telephone list. Providers with a language other than the thirteen supported languages will receive translation services as needed.What Providers Will See in IPOneWhen providers initiate a negative adjustment to a previously paid timesheet, they will be given two options for repayment of the debt created. These options appear in a dialog box in IPOne, which appears on screen after the timesheet changes are made. This box requires the IP make a selection before finalizing the adjustment submission. By selecting their answer, IPs will be able to request either an “offset” or “non-offset” repayment method, see example below. When an IP selects an “offset” repayment, the amount of the debt will be deducted from the IP’s next paycheck, up to 100% of the check amount. When an IP selects “non-offset” repayment, the amount of the debt is forwarded to the Office of Financial Recovery (OFR) for collection, and the IP will receive a Notice of Debt, information about Administrative Hearing Rights, and a monthly invoice thereafter until the debt is repaid in full.ACTION:AuthorizationCase managers must authorize services timely and accurately to ensure timely and accurate payment for providers. Timely authorization of services means that the service is authorized before it is provided to the client. Accurate authorization means the number of units, the start and end dates, the service code and RAC are correct for the period of time authorized. Authorizations must not exceed what the client is eligible to receive. Authorizations must not exceed what the provider is eligible to provide per their workweek limit. AdjustmentWhen IPs want to make an adjustment to a previously paid timesheet, field staff should advise the IP to call the IPOne call center for assistance in completing the adjustment activity. An agent will assist the provider to make the needed change to the previously paid timesheet (either positive or negative adjustment).If an IP has unintentionally created a negative adjustment, they should contact the IPOne call center to correctly adjust their timesheet, in order to ensure the IP’s timesheet accurately reflects hours worked and correct units/mileage claimed for payment. Timesheet Adjustments and OvertimeAn adjustment to a past paid timesheet to remove overtime incurred and paid will not remove any contract action that was assessed to the IP for that month of service. IPs should not be encouraged to adjust past paid timesheets solely for the purpose of removing a contract action, for two primary reasons:If the provider actually worked those hours, they will be paid for that time worked even if that means incurring an unauthorized payment of overtime rates; andContract actions expire after 1 year, per Chapter 3 of the LTC Manual.Overpayments and Administrative Hearings related to Negative AdjustmentsWhen an overpayment is created, the debt is forwarded to the Office of Financial Recovery (OFR), and OFR sends a Notice of Debt to the IP.The Notice of Debt to the IP includes information about how to request an administrative hearing. IPs have a right to request an administrative hearing when they receive notice of an overpayment from the department. This request must be made within twenty-eight (28) days of the IP's receipt of notice of the overpayment. To request an administrative hearing, an IP must send a timely written request to OFR that:(i) States the basis for contesting the overpayment notice;(ii) Includes a copy of the department's notice with the request; and(iii) Is sent by certified mail return receipt requested (CMRRR) or another trackable delivery rmation and tools will be provided to department staff for overpayment administrative hearings related to negative adjustments. Two training sessions, IPOne Portal Navigation (Session 1) and Overpayment Research (Session 2), are being delivered to Administrative Hearing Coordinators (AHC) in January 2020. These trainings will provide information to AHCs intended to help them prepare for Individual Provider overpayment hearings related to negative adjustments. Six in-person/webinar plus two webinar-only training sessions have been organized to accommodate the schedules of the Administrative Hearing Coordinators. A separate training for Case Managers and other non-Admin Hearing Coordinator staff regarding negative adjustments will also be made available in early 2020.Future ActionThe Authorization Adjustment section in IPOne holds potential provider overpayments requiring review prior to being sent to OFR for recoupment. Items in this section are often the result of authorization changes made by field staff, and will require review and validation before being forwarded for recoupment activity. Staffing plans are currently being developed for HQ staff to complete this review and validation. More information will be announced to field staff when these plans are finalized.At this time, no action in the IPOne Authorization Adjustment section will be needed from field staff. Some field staff may have access to this page depending on each user’s IPOne permissions and access levels, but field staff should not go into this page or work any items in the queue.RELATED REFERENCES:RCW 43.20B.010RCW 43.20B.675388-71-0548 WAC42 CFR 433 Subpart FIPOne Call Center Multilingual Telephone List ?- click “Contact Us” tabPPL IPOne Call Center 844-240-1526ATTACHMENT(S):PPL IPOne Provider Negative Adjustment section of the IPOne IP Training Manual (new section added to the manual, as well as being separately posted on the PPL website linked here, at the “Training” tab)CONTACT(S):Dustin Quinn Campbell, Payment Systems Unit Manager, ALTSA360.725.2535Dustin.Quinncampbell@dshs. Lonnie Keesee, Acting Eligibility and Payment Systems Unit Manager, DDA360.407.1547Lonnie.Keesee@dshs.Jodi Lamoreaux, Payments Program Manager, ALTSA360.789.4830Jodi.Lamoreaux@dshs. Jennifer Smith, Individual ProviderOne Program Manager, ALTSA360.725.2551Jennifer.Smith4@dshs. Lori Shepherd, Individual ProviderOne Payment Specialist, DDA360.407.1509Lori.Shepherd@dshs.Stacy Graff, Individual Provider and Administrative Hearing Program Manager360.725.2533Stacy.Graff@dshs. ................
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