Indiana DCS Publishes Residential Provider Manual

Recently, the Indiana Department of Child Services ("DCS") published its Residential Treatment Service Provider Manual (the "Manual") which sets forth guidance on the new DCS rate-setting rules which apply to residential providers, and may significantly impact Indiana Medicaid providers. In particular, the Manual provides guidance on how residential providers must go about requesting a review of their new DCS residential rates. Letters recently went out to providers indicating what their future DCS rates will be, and if a provider disagrees with the rate, the provider has only thirty (30) days from the date of the letter to request a rate review. Importantly, the Manual sets out the following points:

The request for review is applicable when the provider believes that:

Errors have been made in the cost report submitted to the department, calculation of the rate, or the determination by the department of the reasonableness of any cost; or,
The determination of the rate by the department has an adverse impact on child welfare in Indiana and no other residential provider in the State of Indiana, or other licensed provider, can adequately address the adverse impact to child welfare in the State of Indiana.

The administrative review request must be submitted on the DCS form, Residential Treatment Services Provider and Child Placing Agency Rates Administrative Review Request (available here). The request must contain the following:

Identification of the current rate and approved new rate, as applicable to a specific program or service offered by the residential provider;
An updated or revised cost report for the applicable program or service, including an itemized statement of administrative and indirect costs that the residential provider considers allowable under the provisions of this rule;
A clear, concise statement of the reasons for the requested change; and
A detailed statement of related information in support of the change.

The DCS review of the rate will include at least three (3) representatives from DCS, with at least one (1) representative each being from Fiscal, Programs and Services, and Legal/Licensing. DCS will notify the provider of its decision on the administrative review within thirty (30) days of DCS’ receipt of the request for review. If DCS issues a decision approving the base rate, the provider may request an administrative appeal within fifteen (15) days of receipt of DCS’ notice of the administrative review decision.

The administrative appeal request must be submitted on the DCS form, Residential Treatment Services Provider and Child Placing Agency Rates Administrative Appeal Request (available here). An administrative appeal against DCS will be conducted under applicable provisions of the Administrative Orders and Procedures Act. The residential provider will have the burden of proving that, by a preponderance of the evidence, DCS’ decision following the administrative review was erroneous. Two (2) or more separate appeals with the same or substantially the same facts may be consolidated by the administrative law judge into one appeal. During the period of a review or an appeal, DCS will pay the rate stated in the most recent letter mailed to the provider. If a new rate is established during the review or appeal, the new rate will be applied retroactively to the effective date stated in the original rate notification letter. Any rates already paid will be adjusted up or down.

If you have questions regarding the Manual, or would like assistance with requesting a review of your DCS residential rate, please contact Leigh Ann Lauth O'Neill at 317-238-6346.