Waiver Clarification: Double Billing

Below, you will find the email conversation regarding double billing concerns that have been brought up by Waiver Providers and case managers. 

 

From: “Myszak, Tracy J” <Tracy.Myszak@fssa.in.gov>

Subject: FW: Music Therapy Clarification

Date: November 2, 2012 11:43:47 AM EDT

To: “Lindsey Wright” <aimtpres@gmail.com>

Lindsey,

In the examples cited, it is fine for both providers to bill. The Case Manager is incorrect in their interpretation.  DDRS is addressing this concern with the Case Management Companies.  Let me know if you continue to have questions –

Tracy Myszak

Deputy Director

Division of Disability and Rehabilitative Services

402 W. Washington St., W451

Indianapolis, IN  46204

(317) 232-1147

 

From: Lindsey Wright [mailto:aimtpres@gmail.com]

Sent: Wednesday, October 31, 2012 4:16 PM

To: Myszak, Tracy J

Subject: Re: Music Therapy Clarification

Tracy,

I apologize for the time it has taken me to respond to this email. I wanted to give our task force time to identify the most recent examples of this misinterpretation of our service.  I have listed a few examples:

REDACTED, Case Manager in Terre Haute/ Vincennes and REDACTED, Case Manager in Muncie have stated:

1. Respite staff or residential staff cannot take a client to therapy because both services would be billing at the same time.

2. When music therapists visit client’s homes the residential company needs to stop billing while we are there.

REDACTED, Case Manager in Indianapolis cited the specific passage from the waiver manual regarding personal assistance.  She stated that the residential company transporting clients to the music therapy clinic would need to leave while these clients were receiving services.  This would usually be normal practice but these two clients have many behavioral and personal needs that need to be attended to throughout the session.

REDACTED, Case Manager in Lafayette had stated that she had recently been informed that RHS and music therapy could not bill at once.  Therefore RHS staff would no longer be able to take the client to therapy.

The Association for Music Therapy (AIMT) agrees that there are rare instances where these services need to be billing simultaneously.  This would include consultation with RHS staff before, during, or after sessions to ensure a transition of learned skills to the work/home/community setting and extreme behavioral needs. We are also concerned when there is not staff available if a toileting need may arise. Finally, we are concerned that many of our clients need to have staff for transportation due to their health or behavioral needs.

AIMT would be happy to meet to discuss this issue further or answer additional questions.  We are committed to furthering the understanding of music therapy and increasing access to the service in the state of Indiana.  Thank you for your clarification on this issue.

Lindsey Wright, MT-BC

President

Association for Indiana Music Therapy

317.374.9366

 

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On Sep 26, 2012, at 2:14 PM, Myszak, Tracy J wrote:

Lindsey,

The State agrees that there may be rare instances when two services must be delivered and billed during the same time period.  The cited reference from the Version 3.5 HCBS Waiver Application, page 127 uses personal assistance (such as your example of toileting) only as an example illustrating that two services with similar lists of allowable (reimbursable) activities or components should not both be allowed to bill for conducting an same activity that occurred while both were being delivered, as that would be duplication of services.  Only one provider could bill for the toileting activity even if both were “allowed” to render it.

There was no intention by the State to infer that Music Therapy is a form of personal assistance.  It would be helpful if you would provide specific instances of the mis-interpretation from case managers so that we can address it.

Thank you and let me know if you have additional questions –

Tracy Myszak

Deputy Director

Division of Disability and Rehabilitative Services

402 W. Washington St., W451

Indianapolis, IN  46204

(317) 232-1147