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Fee-for-Service is Coming!

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john-zahorsky
John Zahorsky
Eden’s Director of IT and Privacy Officer
March’s guest author gives us an update on Fee-for-Service.
The biggest piece of FFS for Eden is the Community Care Waiver (CCW) which will transition all of our residential participants from the DDD contract to direct Medicaid billing.

Fee-for-Service is coming! Fee-for-Service is coming! With this cry, sounding like a peculiar version of Paul Revere’s, Eden responded to the Division of Developmental Disabilities (DDD) call when first announced more than four (4) years ago.  During the intervening years, Eden has been developing and executing plans, making preparations from the mundane to the magnificent, and establishing itself in the eye of DDD as a leader in the sector’s transition to Fee-for-Service (FFS) funding. Just over a year ago, DDD chose Eden to run a FFS pilot that included 12 adult participants who are in the supports program. According to DDD, the rest of Eden’s adult participants will begin transitioning to FFS within the next few months. The following is a brief outline of what Eden has accomplished so far regarding this enormous undertaking and how we plan to proceed, enabling a smooth and beneficial transition from a contract model to a FFS model.

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Eden embraced the concept of FFS early on and has been recognized by DDD from the outset as a key agency in the transition process. We were identified as one of the provider agencies to work with and provide service details to the rate setter, enabling rates to be set at a level that allows funding for appropriate care. Our readiness allowed us to be in the second group of agencies that went live with FFS; as such, we have over a year of experience with billing NJ Medicaid for services. This experience combined with our general preparedness allowed Eden to be identified as one of three agencies that will be part of the first cohort to roll out residential (CCW) FFS.

The biggest piece of FFS for Eden is the Community Care Waiver (CCW) which will transition all of our residential participants from the DDD contract to direct Medicaid billing. Due to comments made by DDD, Center for Medicare/Medicaid Services (CMS), and NJACP for the first time in over three (3) years we have a high degree of confidence that the CCW was approved on March 31 2017 and the transition to FFS will begin in the next several months. This will be a significant step for Eden as it will address funding issues that stem from contract rates that were set 20 to 30 years ago and will allow for direct billing for Behavioral Assessment and Monitoring as we fade out mechanical restraints.

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Eden’s next steps regarding FFS will be based on the approval of the CCW. If the waiver is approved as anticipated Eden will be scheduling a town hall style meeting for later this spring to discuss the implications for all families. While this meeting will be designed to address the transition in general and for a larger group, we also prepare for individual meetings where we can discuss specifics for our participants in a more private setting.

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