Consumer Directed Services

Posted 30 Noviembre 2011 by admin & filed under Provider News.

Superior HealthPlan is providing additional clarification for Consumer Directed services payment rates for determining the budget and billed by Consumer Directed Service Agencies and the and financial management service fee.

Effective 8/1/2011, HHSC provided specific procedure codes and modifiers to represent the financial management service fee that is retained by the Consumer Directed Service Agency for the management of the consumer directed services for members. The code and modifiers are:

T2040 mod U3 – Agency fee for STAR+PLUS Waiver (SPW) members = $202.00 per month

T2040 mod U7 – Agency fee for non STAR+PLUS Waiver (SPW) members = $110.00 per month

Effective 9/1/2011, the monthly fee was reduced for STAR+PLUS Waiver members ONLY:
T2040 mod U3 – Agency fee for STAR+PLUS Waiver (SPW) members = $194.02 per month

Due to the creation of the monthly service fee being billed and paid separately from the PAS services, the payment rates for determining the budget and billed by Consumer Directed Service Agencies changed as a result. The change was effective 8/1/2011 to coincide with the effective date of the monthly financial management service fee. The rates are as follows:

Code	Modifier	Description	Rate  w/Enhanced	Rate/Non Rate Enhanced
S5125	U3, 99, 99, UC	PAS – SPW	$11.86	$10.86
S5125	99, 99, 99, UC	PAS – NON SPW	$10.94	$9.94

 

The members budget should to be calculated using the payment rate times the number of units authorized during the budget and service plan period, based upon the number of units authorized by the Superior Service Coordinator for PAS.

 

Thank you for all the Superior work you do!