OASIS suspension update
For a printable/PDF copy of this update, please visit our web site at www.arcind.org and click on "OASIS," or click on the this direct link to the pdf:
FSSA Continues OASIS Review
April 23, 2009
FSSA Continues OASIS Review
The rollout of OASIS remains suspended while FSSA continues to closely review Medicaid waiver budget allocations of people who submitted an OASIS Review Request. These reviews are assisting FSSA in identifying problems with the assessment tool and the financial modeling used to determine the allocation under OASIS.
The following information applies to recipients of the Developmental Disabilities and Autism Medicaid waivers whose budgets were scheduled for renewal in April, May and June of this year.
What Does “Suspension of the OASIS Rollout” Really Mean?
- What has been suspended is the further rollout of allocations for Medicaid waiver budgets under the new OASIS system.
- There are approximately 1,200 people who have received allocations under OASIS. These are people who have annual Medicaid waiver budget renewal dates
in April, May and June of 2009. - People who received new allocations under OASIS were told that their new budget allocation will take effect within a certain time frame.
Until that time they will continue to receive their current budget amount. The transition time is based on how much the new allocation increases or decreases.
The greater the change the longer the transition time. - It is very important to talk to your IPMG case manager to clarify when your new budget allocation under OASIS is scheduled to take effect, and to discuss whether or not the new budget will meet the needs of your loved one.
It is not too late to submit an OASIS Review Request. Following are the steps to take if there is a concern about an OASIS allocation.
- If your allocation is significantly over or under what is needed to keep your loved one healthy and safe, or you feel that the assessment does not accurately reflect your loved one, you should ask your IPMG case manager for anOASIS REVIEW. This can only be initiated by the IPMG Case Manager.
- Just asking your case manager to review the budget is not the same as officially requesting an OASIS Review. Every Review is tracked on line to allow FSSA to know exactly where it is in the process.
- In many cases the first step in the OASIS Review is a request to the case manager to provide additional information. If your case manager requests information from you, it is important to respond quickly so the case manager can get the information to FSSA as soon as possible and keep the Review process moving.
- The Review process may lead to a new ICAP Assessment, with addendum questions, to determine
if there is new information that was not previously submitted, or information that was not submitted correctly.
- The OASIS REVIEW COMMITTEE will then look at each case and determine if the individual’s assessment needs to be redone.
What Action Can You Take If Your Current Budget Will Not Provide the Services You Need?
- Many people received notice that their OASIS allocation will result in an increased budget.
However, some people face several months before they transition onto their new budget under
OASIS. Thus, existing budgets remain in effect.
- It will be difficult for some people to continue to purchase the same amount of services with their existing budget due to the fact that rates for some services have been increased – meaning the same amount of funding must be used to purchase what is now a higher cost service. This could result in a reduction of services that can be purchased.
- If an existing budget results in loss of services you should immediately request that your IPMG case manager submit a BUDGET MODIFICATION REQUEST (BMR). Only an IPMG case manager can submit a Budget Modification Request.
- It is critical to address this so your loved receives the services he or she needs during the transition to OASIS. One parent shared with us that they are losing about an hour of support a week, but they are ok with that. Another parent is very angry that they will be losing two hours of support services, five days a week. In this case the loss of support services is unacceptable and a BMR will be submitted.
- To be considered, the BMR must demonstrate that the change is needed to keep the person healthy, safe and progressing in their goals, and that it is only needed due to the change in rates.
- It is important for the team to complete and submit the initial budget as soon as possible, get approval of that budget, and then submit a BMR. A BMR cannot be submitted until there is an approved Budget.
Should people who are very concerned about their allocation also file a formal appeal?
- While an appeal is not a required part of the process, anyone who is concerned about their allocation should know that they have a legal right to file an appeal within 30 days of an action being taken.
- An appeal is a formal legal process that results in the appointment of an administrative law judge to conduct a hearing about the action that is being appealed.
It may take 30-90 days for a hearing to be scheduled and another 30 days for a ruling to be issued. - The Arc recommends that families first ask their case manager to submit an OASIS REVIEW REQUEST. An appeal, if desired, can be filed within 30 days of the original notice of the OASIS allocation. If the Review is successful an appeal can always be withdrawn at a later date.
If you have any questions, please call, write or e-mail The Arc of Indiana. We’re here to help.
The Arc of Indiana
107 N. Pennsylvania Street, Suite 800
Indianapolis, IN 46204
317-977-2375 800-382-9100
www.arcind.org thearc@arcind.org
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