Tri-Counties Regional Center (TCRC) is submitting an AB637/1543/1106 Waiver Proposal to the Department of Developmental Services (DDS) in accordance with statutory requirements. Specifically, TCRC is seeking approval for two proposals: 1) an allowance to utilize a Usual and Customary (U&C) rate for PCA, RN, and LVN services through Nursecore of Santa Barbara, a Home Health Agency and 2) to use Financial Management Services (FMS) agencies for payment of social recreational services.
Both proposals offer an innovative means to provide needed services and were developed though consultation and collaboration with our stakeholder community.
Both proposals will increase the quality and quantity of direct services to individuals and will respond to the expressed need for timely access to service providers.
Both proposals are cost effective, as costs will not exceed the current projected costs of funding comparable services through existing vendored service providers.
The proposals will be implemented within our existing budget.
Improved Rates for a Home Health Agency Provider-Service Contacts with Providers
TCRC is seeking an allowance to utilize U&C rates for the Home Health Agency, Nursecore of Santa Barbara, to provide PCA, LVN, and RN services. TCRC is seeking approval under the area of “Service Contracts with Providers”. As DDS is aware, the Covid-19 pandemic created a huge strain on our healthcare system. Today, healthcare agencies are struggling with nursing shortages throughout the country. This shortage is particularly taxing our service providers, as SMA rates are lower than what nursing staff can expect to be paid in the community. TCRC is seeking to request a waiver of the California Code of Regulations, Title 17, Section 57336, so that TCRC can utilize a Usual and Customary rate with an existing service provider that is higher that the established SMA rate.
The increased rates in this proposal would ensure that Nursecore has the ability to recruit and maintain qualified staff, allowing TCRC to increase its capacity to serve individuals currently requiring health-care support in their own homes.
Use of FMS Agencies for Social Recreation Services-Support to Self-Advocates and Families to Secure Their Own Services
TCRC’s proposal will increase access to newly restored social recreation services consistent with Welfare and Institution Code (WIC) section 4648.5, under the category of “supports to consumers/families to secure their own services”. There are a variety of generic, community based, non-vendored social recreation providers who are not interested in becoming vendored. Additionally, the community practice of many available non-vendored social recreations services is to require up-front payments for their services, which many of the TCRC families are not in the position to do. As such, our underserved families are not able to secure social recreations options of their choosing.
As a remedy, we propose adding social recreation services as a Participant-Directed Service. We are requesting a waiver of the California Code of Regulations, Title 17, Section 58886 to include these restored services. Adding social recreation services as a Participant-Directed Service will allow more access and flexibility in the delivery of said services and ensure Medicaid reimbursement of said services. Individuals and families will be able to procure community-based services (such as parks and recreation services, YMCA, music and art, etc.) through the use of an FMS Co-Employer or FMS Fiscal/Employer Agent agency as per California Code of Regulations, Title 17, Section 58886.
Additionally, we are requesting the ability for up-front payments to social recreation service providers via FMS agencies because many non-vendored social recreation service providers require up-front payment for their services. As such, we are requesting that Welfare and Institution Code (WIC) 4648 (a)(3) and California Code of Regulations (CCR), Title 17 section 5432(a)(10) be waived. The WIC code section requires regional center to reimburse service providers for vendored or contracted services. The CCR section states that all vendor shall “Bill only for services which are actually provided to consumers and which have been authorized by the referring regional center”.
Similarly, we ask that the following sections of the Welfare and Institutions Code e waived: WIC code 56029(s), 50608(d), 50612 (a)(b)(1)(A)-(C). All of these sections imply that regional centers are to reimburse for services by describing the need to first authorize services which are then provided and billed for by the provider.
Public Hearing Schedule for January 4, 2023
Input, comments, and suggestions are being solicited from the community at large. Please submit written public comments via email to ResDev@tri-counties.org by January 6, 2023.