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Rate Reform, QIP, and Provider Directory Updates
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Thank you for reading these latest updates and progress on developments for rate reform, the Quality Incentive Program (QIP), and the Provider Directory. We appreciate the ongoing partnership and patience of all regional centers and service providers in advancing these efforts. This work is a major investment in the infrastructure and future of California’s developmental disabilities services system. | |
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Rate Reform Update:
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Current rate models and rates for 2025 with updated minimum wage and IRS mileage have been posted on the DDS Rate Models and Rates webpage.
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FMS rates for Participant-Directed Services under Service Code 490 and Service Code 491 have been updated. Fiscal Employer Agent (FEA), Service Code 490, previously had separate per-individual monthly rates based on the number of Participant-Directed Services received. Effective January 1, 2025, there no longer are separate rates based on the number of Participant-Directed Services received per individual. For FMS, Sole/Co-Employer, Service Code 491, there are no changes other than the rate increase. Updated rates were posted on Friday February 14, 2025, on the reimbursement rates webpage.
- Supported Employment-Group under Service Code 950 will continue with its current billing method based on Job Coach hours using the same rate as Supported Employment-Individual. This is a change from the previous recommendation of billing based on number of individuals per group. This billing method will continue until further notice and at least through December 31, 2025. The Department will be updating posted rates for Service Code 950 on the rate reform webpage. A revised directive is forthcoming.
Quality Incentive Program (QIP) Update:
- With each release, the Department will include instructions to regional centers to make the following one-time QIP incentive payments. Regional centers will have 90 days to issue these payments:
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Provider Directory enrollment: One-time incentives for eligible providers as outlined in the QIP provider directory directive will be sent to regional centers.
- Employment Capacity: Third quarter of Fiscal Year (FY) 2024/2025
- DSP Workforce Survey: Participation in the survey conducted in early 2024 for Calendar Year (CY) 2023
- Early Intervention: Incentive payments earned during the second quarter of CY 2024
- Employment Access: Incentive payments earned during the third quarter of FY 2023/2024
- The following table outlines all QIP payments to-date, as well as the upcoming release of QIP payments.
Summary Of QIP Payments
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*Payment approvals will start and be updated as service providers validate data.
- Focus group meetings are gathering feedback and input from the community. These focus groups discuss potential quality measures and opportunities for providers to earn their quality incentive rate component in employment, workforce, prevention and wellness, and Provider Directory enhancement. Future focus groups are being planned to discuss possible quality measures in the areas of timeliness and early intervention services. Focus group feedback and input will be summarized and shared with the full QIP workgroup at its meeting on March 17, 2025.
Provider Directory Update:
The Department wants to acknowledge all the support the Provider Directory has received from the service provider community and regional centers. We appreciate everyone’s patience and collaboration with corrections and updates. Substantial progress has been made. Several thousand updated vendor numbers were loaded this month, creating the opportunity for service providers to login and update their information in the system and earn the incentives:
- More than 1,900 records were added to the Provider Directory in January and an additional 2,160 in early February.
- Service Providers who received an email notification of a new record or invitation to register are encouraged to log in, make sure they are registered, and verify and submit their records to keep the QIP portion of the rate.
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Some vendors inactive for up to four years have resumed billing for services. These vendorizations are active in the SANDIS/UFS system but were not previously loaded into the Provider Directory due to the lack of billing activity. A list of these vendors has been posted on the Department's website.
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The Senate Bill 138 Initiatives summary timeline and document describes the law’s requirements and provides an update on the work being done to meet them, including the standardization of vendorization procedures.
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Next Steps (Key take aways, action items, or important dates): | |
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Rate Reform:
- Work continues with provider groups in areas such as Transportation, Early Start and Specialized Therapeutic Services to address rate reform issues.
- Regional centers and service providers have through March 31, 2025, to finalize the correct service code alignments, the rate, and completion of the Service Acknowledgement Form, which must specify the rate. Once the Service Acknowledgement Form is completed, regional centers will update authorizations, as needed, from the transitional rate to the updated aligned service code(s), subcode(s) and rate model rate.
- The Service Acknowledgement Form is mandatory for all service providers using service codes within rate reform. This agreement informs the provider and regional center of any changes to service codes, subcodes and rate changes.
- These forms should not contain blanks for this information when signed, since the form is a formal agreement.
- Completed forms are required to finalize the transition to the new service codes, subcodes and rates.
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Service providers that do not sign this form will be considered noncompliant and subject to potential termination under California Code of Regulations Title 17 section 54370 (c). Given this, regional centers are strongly encouraged to work with providers and the Department to make sure the forms are accurate and available timely for consideration and review before the March 31, 2025 deadline.
- Providers are encouraged to communicate concerns with rate calculations to the regional center, as review of rates will be ongoing.
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Providers also may submit a rate review form if they believe there is an error in rate calculation. Please note that if provider eligibility for the quality incentive rate component (ten percent) is pending due to completion and validation of information in the Provider Directory, the Service Acknowledgement Form may need to be updated again in the future when eligibility for the quality incentive rate component is finalized.
- Through December 31, 2025, service providers will continue to use the transitional rate for each individual currently receiving services until their individual authorization, based upon their Individual Program Plan or Individual and Family Service Plan, begins utilizing the new rate model service code(s), subcode(s) and rates.
Quality Incentive Program (QIP):
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The Employment Access and Employment Capacity incentive measures continue through June 30, 2025. Providers are encouraged to take advantage of these opportunities to earn quality incentives in addition to the rate models.
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Keep an eye on the Department’s Events webpage for upcoming QIP Workgroup meetings. Workgroup meetings are open to the public and held from 2pm – 4pm PT on these dates:
- March 17, 2025
- June 16, 2025
- September 15, 2025
- December 15, 2025
Provider Directory:
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The Department has consolidated six provider group lists into three to simplify QIP eligibility verification. Service providers can locate their vendor name and number on these lists on the Provider Directory website to affirm they will receive the full benchmark rate (100 percent) effective January 1, 2025, even if retroactive payments are necessary. If not on the "QIP Eligible" list, service providers can then review the "Need Survey" or "New Providers" lists to identify next steps needed to qualify. The lists are explained on the website, are updated weekly, and are the basis for calculating QIP payments.
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