Update (1Jan2015): Personal Support Workers (Domestic Employees and/or Independent Contractors providing services defined as Personal Support Work) should refer to the updated TNT PSW Billing Calendar for 2015. Due dates and times may have changed since this news item was originally posted, due to requirements imposed by TNT and/or DHS.
As many of you are well aware, there are considerable changes being made to the DD system (at the State, CDDP & Brokerage levels), at present.
One such change includes where & how Plan of Care is being tracked and when & how Service Providers are being paid.
The State has hoped to get all Plan of Care information into their eXPRS data system by July 1, 2014. That implementation date was tabled, due to the fact of what can best be described as ‘growing pains’ (certain Provider information was not yet in the system, the system itself was not yet ‘production-ready,’ etc.).
The State has instead decided to ‘phase in’ the new eXPRS data system in stages. This means that certain providers will be billing directly in eXPRS, while others will still be submitting invoices and timesheets in a manner similar to how they always have, for the time being.
What does this mean for you, or your organization, in terms of how, when and where you will bill for services? That depends on the type of provider you or your organization are qualified / classified as and possibly also the type of services you are providing.
Below, we will try to explain who bills what, when, where and why. Please bear with us, and our apologies for a lot of information all in one place…
Provider Organizations (AKA, Agencies & General Businesses)
Days Support Activities (DSA) & Supported Employment (SE) Services:
Day Support Activities & Supported Employment services will be billed directly into the eXPRS computer system for services rendered 1Sep2014 and after (to be entered and paid 1Oct2014 and after).
The provider organization will enter their services directly into eXPRS and will also submit a physical invoice to SDRI for verification of hours and days of service prior to disbursement. On verification / approval of the days, hours & services rendered, brokerage staff will authorize the release of funds in eXPRS and then State will issue payment.
SDRI does not yet know what the State’s finalized eXPRS submission deadline(s) and/or payment schedule(s) will be, but will try to keep providers apprised as information becomes available.
Any Services other than DSA & SE:
For the time being, these invoices will continue to be sent directly to SDRI according to the existing 2014 Agency & Contractor Billing Calendar. Typically invoices are due by the 15th of the month, or the next business day if the 15th is on a weekend or holiday. Invoices should be submitted for one full closed calendar month inclusive (first – last day). E.g., August 1st-31st, submitted on or before September 15th. Invoices presented complete & timely should be paid (checks mailed) no more than 4 business days after the due date.
Independent Contractors
“Personal Support Work” Services:
According to HB3618, certain direct support services are defined as “Personal Support Work” (typically, these are personal care [ADL / IADL, in the home or community], Respite or Relief Care [Hourly or Daily], and ‘Ongoing’ Job Coaching) and, according to Oregon DHS interpretation of HB3618, those Independent Contractors providing these specifically-defined services are also considered to be ‘Personal Support Workers’ (AKA, PSWs or IC-PSWs) while providing them.
In lieu of paying for these services out of eXPRS (which is not yet ready to handle Plan of Care [POC] and associated payments for Independent Contractors), IC-PSW hours and mileage will be paid through TNT (a fiscal intermediary service). Invoices for PSW services will still be submitted to SDRI. However, the changes to PSW payments include a move to twice-monthly billing. This means there will now be two billing cycles per month. TNT will be paying in half-monthly increments, going forward.
SDRI asks that Independent Contractors break down their billing into half-monthly increments as well (1st-15th and 16th-End of Month ONLY).
Due to the format that TNT requires payment data to be submitted in, SDRI needs Independent Contractors to change the method of prorating ‘group’ ADL / IADL / Attendant Care / CIS / Respite activities.
Previously, the standard was to divide the ‘rate’ by the group size (e.g. serving 2 clients transformed a 1:1 rate of $20/hr into a [1:2 staff:client ratio] rate of $10/hr). The new standard for prorated group services is to instead list only your 1:1 rate (e.g. $20/hr) and instead prorate the number of units (e.g., when supporting 2 clients at $20/hr for 4 hours, you would list the ‘rate’ as $20/hr, the ‘actual hours’ as 4 and the ‘prorated hours’ as 2, then tally the total of all prorated hours).
For example:
| Date | Group Size | 1:1 Rate | Actual Units | Prorated Units |
| 9/1/14 | 1 | $20/hr | 5 | 5 |
| 9/5/14 | 2 | $20/hr | 8 | 4 |
| 9/11/14 | 3 | $20/hr | 6 | 2 |
| Total Prorated Hrs: | 11 | |||
| Total Wages Due: | $220 | |||
| 9/1/14 | 1 | $0.485/mi | 35 | 35 |
| 9/5/14 | 2 | $0.485/mi | 40 | 20 |
| 9/11/14 | 3 | $0.485/mi | 90 | 30 |
| Total Prorated Miles: | 85 | |||
| Total Mileage Due: | $41.23 | |||
| Invoice Total: | $261.23 |
Also, due to the extreme workload these changes have put office staff under, SDRI requests that invoices be submitted no later than 3 PM on the Billing Day for a given pay cycle, in order to give Admin staff enough time to receive, process and route invoices to Personal Agents for authorization. While SDRI will try to accommodate invoices submitted ‘a few minutes late’ (due to heavy incoming fax volumes), SDRI reserves the right to hold until the next processing cycle any invoices presented after the deadline. It is suggested that Independent Contractors submit invoices as soon as hours have been worked, invoices and progress notes drawn up and customer signatures obtained.
Non-“Personal Support Work” Services:
Any services not defined as ‘Personal Support Work’ (typically, but not limited to: services to Waivered DD clients in categories such as behavioral supports & nursing delegation, time-limited job coaching / job development, and any services to Private Pay, Scholarship or Mental Health clients) will be paid through SDRI alongside and following the same timeline as Agency & General Business invoices for services that are not Day Support Activities or Supported Employment services. Again, those invoices are typically due by the end of business on the 15th of the month (or the next business day, if the 15th is on a weekend or holiday) for services rendered from the first day through the last day of the prior calendar month. If they are submitted timely and complete, they should be paid (checks mailed) 4 business days after the due date.
Domestic Employees
“Personal Support Work” Services:
In lieu of paying for these services out of eXPRS (which is not yet ready to handle Plan of Care [POC] and associated payments for Domestic Employees), all hours and miles for Domestic Employees providing “Personal Support Work” services Waivered DD clients will be paid through TNT (a fiscal intermediary service).
Part of the changes to PSW payments include a move to twice-monthly billing. This means there will now be two billing cycles per month. TNT will be paying in half-monthly increments, going forward. SDRI asks that Domestic Employees break down their timesheets into half-monthly increments (1st-15th and 16th-End of Month ONLY). That is, please DO NOT include days / hours past the 15th of the month (e.g. hours from the 16th, 17th, 18th) on timesheets that should ONLY be for the 1st half of the month. Put those hours on the subsequent timesheet (for the last half of the calendar month). Any hours beyond the 15th written into a timesheet for the first half of the month WILL NOT be paid until those hours are re-reported correctly on the subsequent timesheet (including dates from the 16th to the end of the month).
Also, due to the extreme workload these changes have put office staff under, SDRI requests that timesheets be submitted no later than 3 PM on the Billing Day for a given pay cycle, in order to give Admin staff enough time to receive, process and route timesheets to Personal Agents for authorization. While SDRI will try to accommodate timesheets submitted ‘a few minutes late’ (due to heavy incoming fax volumes), SDRI reserves the right to hold until the next processing cycle any timesheets presented significantly after the deadline. It is suggested that Domestic Employers of Record submit timesheets as soon as hours have been worked, once the timesheet(s) have been signed (by the Employer of Record).
Non-“Personal Support Work Services”:
Hours:
Hourly services provided by Domestic Employees, to customers who are not on a DD Waiver (customers privately paying for services, ‘scholarship’ customers and ‘mental health’ customers), will be paid through TNT according to the same twice-monthly schedule as Domestic Employees providing ‘Personal Support Work’ services.
Mileage:
Mileage paid to Domestic Employees for services provided to customers who are not on a DD Waiver (customers privately paying for services, ‘scholarship’ customers and ‘mental health’ customers) will be paid through SDRI (TNT is either unable or unwilling to process these mileage payments) according to the payment schedule for Agency / General Business services that are not Day Support Activities or Supported Employment. While mileage for these services will be paid at the end of the month along with Agency / General Business checks, they can and should be submitted alongside the timesheets with hours for the same dates. That is, submit mileage for the last half of Aug 14 & the first half of Sep14 along with the hours for the last half of Aug14 & the first half of Sep14. The mileage for non-PSW services will simply be paid approximately 4 business days after the Agency / General Business billing due date of the 15th (or the next business day after a weekend and/or holiday), e.g. on the 19th of Sep14.
TNT Information Updates
If any updates need to be made prior to Domestic Employee or Independent Contractor payments via TNT, SDRI’s provider coordinator needs to submit those changes to TNT no later than 3 business days prior to the PSW Billing Days. Realistically, this means that providers need to get any changes to our Provider Coordinator at least 4 business days to a week prior to the PSW Billing Days each month, in order to allow enough to to correct any errors or inconsistencies, process the changes in SDRI’s data system, and forward the changes on to TNT in time for TNT to successfully change their own records prior to payment.
Such updates include (but are not limited to): Direct Deposit enrollments, Direct Deposit deletion / new account forms, Declaration of Relationship forms, W-4s, W-9s, Employer Packets, Change of Address forms, etc.
Please Note: the above is according to the best information SDRI has available to us at the moment of this writing, but may be subject to change, depending on future guidance from TNT, SEIU or Oregon DHS. SDRI will do its best to keep provider abreast of any additional changes. SDRI appreciates your patience and understanding…