Aging and Disability Services Council Sharon Swift Butterworth ...

nursing, physical therapy, occupational therapy, or speech [begin addition], hearing, and
language therapy [end addition] [begin deletion] pathology [end deletion] services, but a valid
physician's order is missing. [begin addition] DADS [end addition] [begin deletion] DHS [end
deletion] applies the error to the total number of units claimed and not covered by a valid [begin
addition] physician's [end addition] order.
(7) [begin addition] DADS [end addition] [begin deletion] DHS [end deletion] reimburses
the [begin addition] HCSSA [end addition] [begin deletion] provider agency [end deletion] for a
claim for service, other than a pre-enrollment home health assessment, delivered prior to the
eligibility effective date on the notification of Community Based Alternatives services form.
[begin addition] DADS [end addition] [begin deletion] DHS [end deletion] applies the error to
the entire amount reimbursed for such services that were delivered before the effective date on
the form.
(8) [begin addition] DADS [end addition] [begin addition] DHS [end deletion] reimburses
the [begin addition] HCSSA [end addition] [begin deletion] provider agency [end deletion] for
any hours or items that consisted of non-billable time and activities as identified in [begin
deletion] the rule [end deletion] §48.6080 of this [begin addition] subchapter [end addition]
[begin deletion] title [end deletion] (relating to Non-Billable Time and Activities). [begin
addition] DADS [end addition] [begin deletion] DHS [end deletion] applies the error to the entire
amount reimbursed for such services.
(9) [begin addition] DADS [end addition] [begin deletion] DHS [end deletion] reimburses
the [begin addition] HCSSA [end addition] [begin deletion] provider agency [end deletion] for
more than four hours of nursing used to decide whether to delegate to an [begin addition] adult
foster care [end addition] [begin deletion] Adult Foster Care [end deletion] provider. [begin
addition] DADS [end addition] [begin deletion] DHS [end deletion] applies the error to the total
number of units reimbursed for such services.
(10) [begin addition] DADS [end addition] [begin deletion] DHS [end deletion] reimburses
the [begin addition] HCSSA [end addition] [begin deletion] provider agency [end deletion] for
more than 10 hours during the [begin addition] ISP [end addition] [begin deletion] participant's
individual service plan [end deletion] year for nursing services being performed by [begin
addition] an LVN or RN [end addition] [begin deletion] a nurse [end deletion] to prevent service
breaks caused by the attendant not being available to provide delegated nursing tasks. [begin
addition] DADS [end addition] [begin deletion] DHS [end deletion] applies the error to the total
number of units reimbursed in excess of the 10 hour maximum for such services.
(11) [begin addition] DADS [end addition] [begin deletion] DHS [end deletion] reimburses
the [begin addition] CBA [end addition] provider [begin deletion] agency [end deletion] for an
amount in excess of the amount documented on the [begin addition] invoice or receipt [end
addition] [begin deletion] invoice/receipt [end deletion] for [begin addition] an adaptive aid,
dental services, medical supply [end addition] [begin deletion] adaptive aids, medical supplies
[end deletion], or minor home [begin addition] modification [end addition] [begin deletion]
modifications [end deletion]. [begin addition] [begin addition] DADS [end addition] [begin
deletion] DHS [end deletion] applies the error to the total number of dollars reimbursed in excess
- 26 -