Social Services Block Grant

1. Social Services Block Grant/General Revenue (SSBG/GR) A funding source for In-Home Services

2. What is Social Services Block Grant/General Revenue (SSBG/GR)? SSBG is a funding source combining: Federal funds allocated to states through Title XX of the Social Security Act State funds appropriated by the Missouri Legislature called General Revenue (GR) The amount of funds available has grown increasingly smaller through the years.

3. Authorization The provider will receive a telephone call from the Division of Senior and Disability Services asking them if they can provide services to the client. The provider will also receive a Long Term Alternative Care System (LTACS) printout that has client information, level of care, services authorized, etc.

4. This is an example of an LTAC aka LCDE Print. Section A is the Client Information. Client name, client address and telephone number. �CO� is the county code the client resides in. �LA� is the Living Arrangements and the marital status of the client. �CRANE� indicates whether or not the client is active in the Central Registry of Abuse, Neglect and Exploitation. The next ten fields reflects the client's level of care score. These fields will have either a 0, 3, 6 or a 9 with 0 being the lowest and 9 being the highest: �MON� is for Monitoring. �MED� is for Medication. �TRT� is for Treatment. �RES� is for Restorative Services. �REH� is for Rehabilitation. �PC� is for Personal Care. �DIET� is for their dietary needs. �MOB� for Mobility. �BEH� is for behavior or Mental Conditions. LOC is the total level of care score. Clients must have a total of 21 points to be authorized for services. �PRTY/RISK� field is the Priority Risk Indicator. This indicator is to assist the provider in determining scheduling priorities during staffing shortages or in the event of a weather emergency. 1 is a high priority. 2 is a medium priority. 3 is considered a low priority. �DISASTER: FROM AND THRU� field tracks any future disasters that will have an impact on the client.This is an example of an LTAC aka LCDE Print. Section A is the Client Information. Client name, client address and telephone number. �CO� is the county code the client resides in. �LA� is the Living Arrangements and the marital status of the client. �CRANE� indicates whether or not the client is active in the Central Registry of Abuse, Neglect and Exploitation. The next ten fields reflects the client's level of care score. These fields will have either a 0, 3, 6 or a 9 with 0 being the lowest and 9 being the highest: �MON� is for Monitoring. �MED� is for Medication. �TRT� is for Treatment. �RES� is for Restorative Services. �REH� is for Rehabilitation. �PC� is for Personal Care. �DIET� is for their dietary needs. �MOB� for Mobility. �BEH� is for behavior or Mental Conditions. LOC is the total level of care score. Clients must have a total of 21 points to be authorized for services. �PRTY/RISK� field is the Priority Risk Indicator. This indicator is to assist the provider in determining scheduling priorities during staffing shortages or in the event of a weather emergency. 1 is a high priority. 2 is a medium priority. 3 is considered a low priority. �DISASTER: FROM AND THRU� field tracks any future disasters that will have an impact on the client.

5. Section B lists the provider�s name and the NPI number of the authorized provider for the client. Section C is the Authorized Services Section. �FD� reflects the funding source of the authorized service. Funding source will be either: An MD which means the client is funded through the MO HealthNet Division for Medicaid services. A BG which means the client is funded through Social Services Block Grant/General Revenue (SSBG/GR) Or DU, which means the client is dual authorized and is funded by both MO HealthNet and Block Grant. �SV� is the service field. This will inform you of the service that is being authorized and to be provided to the client. PC: Personal Care (billed in 15 min increments. 1 unit = 15min) AC: Advanced Personal Care (billed in 15 min increments. 1 unit = 15 min) RN: Authorized Nurse Visit (1 unit = A visit. No matter how long you are in the home, or how many times you go home during the same day.) HC: Homemaker (billed in 15 min increments. 1 unit = 15min) DC: Day Care (full day) (billed in 15 min increments. 1 unit = 15min) D2: Day Care (half day) (billed in 15 min increments. 1 unit = 15min) R2: Basic Respite (billed in 15 min increments. 1 unit = 15min) R3: Advanced Respite (billed in 15 min increments. 1 unit = 15min) R4: Advanced Block Respite (6 � 8 hours) (1unit = 6-8hours) R5: Advanced Daily Respite (17 � 24 hours) (1unit = 17-24hours) R6: Nurse Respite (4 hour block) (1unit = 4 hours) RS: Basic Block Respite (9 � 12 hours) (1unit = 9-12hours) DM: Home delivered Meals �RCF� is the field that indicates whether or not the authorization is an RCF service. A Y indicates the client resides in a residential care facility and an N indicates the client resides in his or her home. �UNIT� filed indicates the maximum number of units that will be reimbursed to the provider in a 31-day calendar month. �OPEN� is the date of when the services can begin. �CLOSE� is the last allowable date that service can be delivered. �VEN� indicates which Vendor from Section B is being authorized to provide the services to the client. �CO-PAY� indicates the amount of copy to be paid by a BG funded client for each unit of service. �DA=13 DATE� is the date the information had been entered.Section B lists the provider�s name and the NPI number of the authorized provider for the client. Section C is the Authorized Services Section. �FD� reflects the funding source of the authorized service. Funding source will be either: An MD which means the client is funded through the MO HealthNet Division for Medicaid services. A BG which means the client is funded through Social Services Block Grant/General Revenue (SSBG/GR) Or DU, which means the client is dual authorized and is funded by both MO HealthNet and Block Grant. �SV� is the service field. This will inform you of the service that is being authorized and to be provided to the client. PC: Personal Care (billed in 15 min increments. 1 unit = 15min) AC: Advanced Personal Care (billed in 15 min increments. 1 unit = 15 min) RN: Authorized Nurse Visit (1 unit = A visit. No matter how long you are in the home, or how many times you go home during the same day.) HC: Homemaker (billed in 15 min increments. 1 unit = 15min) DC: Day Care (full day) (billed in 15 min increments. 1 unit = 15min) D2: Day Care (half day) (billed in 15 min increments. 1 unit = 15min) R2: Basic Respite (billed in 15 min increments. 1 unit = 15min) R3: Advanced Respite (billed in 15 min increments. 1 unit = 15min) R4: Advanced Block Respite (6 � 8 hours) (1unit = 6-8hours) R5: Advanced Daily Respite (17 � 24 hours) (1unit = 17-24hours) R6: Nurse Respite (4 hour block) (1unit = 4 hours) RS: Basic Block Respite (9 � 12 hours) (1unit = 9-12hours) DM: Home delivered Meals �RCF� is the field that indicates whether or not the authorization is an RCF service. A Y indicates the client resides in a residential care facility and an N indicates the client resides in his or her home. �UNIT� filed indicates the maximum number of units that will be reimbursed to the provider in a 31-day calendar month. �OPEN� is the date of when the services can begin. �CLOSE� is the last allowable date that service can be delivered. �VEN� indicates which Vendor from Section B is being authorized to provide the services to the client. �CO-PAY� indicates the amount of copy to be paid by a BG funded client for each unit of service. �DA=13 DATE� is the date the information had been entered.

6. SSBG/GR Co-Pay Services subject to co-pay: Personal Care Advanced Personal Care Homemaker Services Chore Services Basic Respite Care Advanced Respite Co-pay is applicable for all authorized units of service. The co-pay amount will be noted in Section D of the LTACS All SSBG/GR funded services are subject to a co-pay. These services include personal care, advanced personal care, homemaker services, chore services, basic respite care and advanced respite care. Division of Senior and Disability Services staff calculate the amount of co-pay, if any. The co-pay amount will be noted in Section D of the LTACS printout.All SSBG/GR funded services are subject to a co-pay. These services include personal care, advanced personal care, homemaker services, chore services, basic respite care and advanced respite care. Division of Senior and Disability Services staff calculate the amount of co-pay, if any. The co-pay amount will be noted in Section D of the LTACS printout.

7. Provider Number is the seven (7)-digit number shown on the first page of your Participation Agreement for Home and Community Based Services, also referred to as a contract. The Provider Name and Provider Address noted on the invoice MUST agree with your Provider name and Provider address on file with the Division of Senior and Disability Services AND with the Office of Administration�s vendor file. Any address change must be submitted to the MMAC Provider Contracts via a Change Request form at least five days prior to the change taking place. County Code and Name: You can use the county code as shown on the LTACS printout; and you can use the code sheet for the county name. A county code sheet is included in this session�s handouts. Every county in which services are provided shall be submitted on separate invoices. The county code/name must be a county in which you are authorized to provide services in, as stated in your SSBG/GR contract. Invoice Date: This is the day the invoice was completed by your billing staff. Delivery month and year: Is where you enter the month and the year in which services were delivered. Each month in which services are provided shall be submitted separately. Multiple months shall not be sumitted on the same invoice. Regular or Supplemental Type Invoice: Each invoice must be identified as either a Regular of a Supplemental Invoice. Your first billing for the client in a month is a Regular invoice. If you are adding or taking away units for a month that has already been paid, this would be a Supplemental Invoice. DCN (Departmental Client Number): the client�s DCN can be found on the LTAC and must be noted on the invoice to be processed correctly and promptly. Client Name: Last name first. First name last. The client�s name must be billed as shown on the LTAC. Delivered Units: The delivered units are the number of units delivered for that month for each service type. You bill in whole units. Signature/Date: Each invoice must be signed and dated by a designated provider representative. Failure to do so will result in the invoice being mailed back to the provider, and delay payment to the provider. Once completed, you can either mail the invoice to the address on the invoice or you can fax it the attention of Sarah Pape at 573-526-5047. In the event of an overpayment to a provider, the provider should submit a SSBG/GR In Home Service Invoice with all the necessary information, and where you would put a unit amount for a service, you would put a negative amount. For example, you notice you were overpaid for Joe Smith by 5 units for PC services. You would fill out the invoice as usual, but in the PC field you would enter a -5. You DO NOT send a check to the Division. The amount overpaid will be withheld from the next reimbursement due to the Provider. Provider Number is the seven (7)-digit number shown on the first page of your Participation Agreement for Home and Community Based Services, also referred to as a contract. The Provider Name and Provider Address noted on the invoice MUST agree with your Provider name and Provider address on file with the Division of Senior and Disability Services AND with the Office of Administration�s vendor file. Any address change must be submitted to the MMAC Provider Contracts via a Change Request form at least five days prior to the change taking place. County Code and Name: You can use the county code as shown on the LTACS printout; and you can use the code sheet for the county name. A county code sheet is included in this session�s handouts. Every county in which services are provided shall be submitted on separate invoices. The county code/name must be a county in which you are authorized to provide services in, as stated in your SSBG/GR contract. Invoice Date: This is the day the invoice was completed by your billing staff. Delivery month and year: Is where you enter the month and the year in which services were delivered. Each month in which services are provided shall be submitted separately. Multiple months shall not be sumitted on the same invoice. Regular or Supplemental Type Invoice: Each invoice must be identified as either a Regular of a Supplemental Invoice. Your first billing for the client in a month is a Regular invoice. If you are adding or taking away units for a month that has already been paid, this would be a Supplemental Invoice. DCN (Departmental Client Number): the client�s DCN can be found on the LTAC and must be noted on the invoice to be processed correctly and promptly. Client Name: Last name first. First name last. The client�s name must be billed as shown on the LTAC. Delivered Units: The delivered units are the number of units delivered for that month for each service type. You bill in whole units. Signature/Date: Each invoice must be signed and dated by a designated provider representative. Failure to do so will result in the invoice being mailed back to the provider, and delay payment to the provider. Once completed, you can either mail the invoice to the address on the invoice or you can fax it the attention of Sarah Pape at 573-526-5047. In the event of an overpayment to a provider, the provider should submit a SSBG/GR In Home Service Invoice with all the necessary information, and where you would put a unit amount for a service, you would put a negative amount. For example, you notice you were overpaid for Joe Smith by 5 units for PC services. You would fill out the invoice as usual, but in the PC field you would enter a -5. You DO NOT send a check to the Division. The amount overpaid will be withheld from the next reimbursement due to the Provider.

8. The purpose of the Vendor Payment Summary is to inform the provider of the amount paid and any units that denied for each client billed on the invoice. All of the information contained on the Vendor Payment Summary form comes from the invoice, the authorization or the contract. The Provider Number in the top left hand corner is the Provider Number that was given on the invoice. The Provider Name and Address listed below the provider number is the name and address of the provider agency from the MMAC Provider Contracts Units� contract file�which is based on the provider number entered from the invoice. Underneath the address is the FIPS code and County name which is based on the county code entered from the invoice. In the center is the Invoice Date which is the date the provider noted on the invoice as the day the form had been completed. Below the Invoice date is the Service Delivery Month. This is indicating the submitted month and year of service delivered for these clients. Each month will have it�s own page. The ICN is a computer assigned control number. This number is assigned from the invoice. The RunDate is the date the invoice/claim was processed by the system. The Received Date is the date the invoices were received for processing. Contract Unit Costs is the rate that will be paid for a unit of the service indicated. Then we get to the client information. DCN and client�s name and it lists the services and units that were billed on the invoice. With BG clients, the summary will show you the client�s authorized units and their available units, shows the units that were billed and the units that were paid. If there were any units denied it will be noted under the denied units field with a denial code. All denial code reasons are noted on the last page of the summary. Total Amount Due is the number of units billed multiplied by the contract unit cost for that service. Client co-pay Due is the Amount the client is responsible for. State Amount Due is the Amount being paid from the state less the amount due from the client. The purpose of the Vendor Payment Summary is to inform the provider of the amount paid and any units that denied for each client billed on the invoice. All of the information contained on the Vendor Payment Summary form comes from the invoice, the authorization or the contract. The Provider Number in the top left hand corner is the Provider Number that was given on the invoice. The Provider Name and Address listed below the provider number is the name and address of the provider agency from the MMAC Provider Contracts Units� contract file�which is based on the provider number entered from the invoice. Underneath the address is the FIPS code and County name which is based on the county code entered from the invoice. In the center is the Invoice Date which is the date the provider noted on the invoice as the day the form had been completed. Below the Invoice date is the Service Delivery Month. This is indicating the submitted month and year of service delivered for these clients. Each month will have it�s own page. The ICN is a computer assigned control number. This number is assigned from the invoice. The RunDate is the date the invoice/claim was processed by the system. The Received Date is the date the invoices were received for processing. Contract Unit Costs is the rate that will be paid for a unit of the service indicated. Then we get to the client information. DCN and client�s name and it lists the services and units that were billed on the invoice. With BG clients, the summary will show you the client�s authorized units and their available units, shows the units that were billed and the units that were paid. If there were any units denied it will be noted under the denied units field with a denial code. All denial code reasons are noted on the last page of the summary. Total Amount Due is the number of units billed multiplied by the contract unit cost for that service. Client co-pay Due is the Amount the client is responsible for. State Amount Due is the Amount being paid from the state less the amount due from the client.

9. This is the Department of Health and Senior Services website. Click on the SENIOR & DISABLITY SERVICES tab. On the next page, choose Home/Community Based Services from the list on the right side of the page. And finally, on the next page, choose Provider Memos from the list on the left side of the page.This is the Department of Health and Senior Services website. Click on the SENIOR & DISABLITY SERVICES tab. On the next page, choose Home/Community Based Services from the list on the right side of the page. And finally, on the next page, choose Provider Memos from the list on the left side of the page.

10. The Provider Memo (PM), is a way the department communicates with the provider. Each memo will tell you about changes that may be occurring with services, rates or with the Department. The Provider Memo (PM), is a way the department communicates with the provider. Each memo will tell you about changes that may be occurring with services, rates or with the Department.