1. 1/31/2019
Template Update
July 17, 2017

2. Template Topics Template Funding- Billing Review
1/31/2019
Template Topics
Template Funding- Billing Review
Template Funding- Individuals’ Cost in 7/1/17 Rate
Template Value – Individuals’ Costs not Fully Included in 7/1/17 Rebase or Authorized but not yet Receiving Services as of 7/1/17

3. Template- Billing Review
1/31/2019
Template- Billing Review
OPWDD undertook a desk review to ensure that providers were only billing for authorized individuals.
OPWDD pulled payment data from eMedNY and compared it to those flagged in TABS as being eligible for Template Funding.
Regional offices reviewed initial list and provided feedback. After DDROs’ review, letters were sent to providers identifying unflagged individuals requiring further follow- up (mailed 6/9/2017).

4. Template Funding- Billing Review
1/31/2019
Template Funding- Billing Review
Responses Received
Total Providers
Total Number of Individuals
Individuals that agencies confirmed are not template eligible 31
523
Individuals that OPWDD needs to review further based on agency’s response 32
225
Agencies that have yet to respond 14 94
Agencies that are no longer in operation 2
127
Unique Totals
681
9592
1Some agencies identified individuals in both categories.
2Some individuals were billed for services by more than one agency.
*as of 7/13/2017

5. Template Funding- Billing Review
1/31/2019
Template Funding- Billing Review
Next Steps
For those agencies that agreed that individuals were not eligible, OPWDD will work with them to adjust Medicaid claims.
Follow up with agencies who have not responded
OPWDD will continue to work with providers to resolve eligibility issues

6. Template Funding- Individuals’ Cost in 7/1/17 Rate
1/31/2019
Template Funding- Individuals’ Cost in 7/1/17 Rate
As of 7/1/17, agencies should no longer bill the separate Specialized Funding rates for individuals who were authorized for Template Funding prior to 6/30/2014 for Downstate and 12/31/2014 for Upstate. (letter mailed 6/14/17)
Costs for these individuals have been captured in the agency’s most recent CFR and will be recognized in the agency’s rebased rates for 7/1/17.
137 agencies
794 distinct individuals

7. 1/31/2019
Template Value – Individuals’ Costs not Fully included in 7/1/17 Rebase or Authorized but not yet Receiving Services as of 7/1/17
Effective 7/1/17 - OPWDD can no longer accept new applications for Template Funding. Template Funding will be replaced by High Needs Funding Methodology.
Services for approx. 900 individuals are currently being billed and will remain eligible for enhanced funding.
Approx. 500 individuals who have been authorized for Template Funding prior to 7/1/17 but are not yet receiving services.

8. 1/31/2019
Template Value – Individuals’ Costs not Fully Included in 7/1/17 Rebase
For these individuals, Residential Habilitation billing will transition to the High Needs rate code that will be at the current template funding levels.
Day Habilitation billing will remain using existing rate code/locator code combinations for template funding.

9. Template Value –Authorized but not yet Receiving Services as of 7/1/17
1/31/2019
Template Value –Authorized but not yet Receiving Services as of 7/1/17
Correspondence was sent to providers identifying Template authorized individuals who will start services after 7/1/17 (approx. 400 individuals).
OPWDD has documented approx. 100 individuals who are template authorized but providers have yet to be identified. Template funding will be available once an individual chooses a provider.
Billing of Residential Habilitation and Day Habilitation will be the same as described for the individuals whose costs are not fully included in the rebase.
Template Funding for these individuals will be available until July 1, 2019 when the CAS is expected to be implemented.