Last month, the Department of Health Services (DHS) announced the implementation of the HCBS Minimum Fee Schedule which will use $258 million of American Rescue Plan Act (ARPA) funding.

This new fee schedule will go into effect on October 1, 2024. The minimum fee schedule will establish minimum amounts managed care organizations (MCOs) must pay providers for certain adult long-term care services. Medicaid programs included are Family Care, Family Care Partnership, and Program of All-Inclusive Care for the Elderly (PACE).

MCOs must follow the minimum fee schedule beginning October 1, 2024. MCOs will continue to be contractually required to negotiate rates and pay above the minimum when needed to get members the care they need. DHS will monitor MCOs to ensure they are paying providers at or above the minimums. MCOs will take on contractual penalties if they fail to pay the minimums.

Importantly, DHS recently held a webinar sharing information about the fee schedule and answering provider questions. The webinar and accompanying slideshow will be very helpful for providers to familiarize themselves with the new process. There is a new page dedicated to this on the ForwardHealth website with lots of important information. Please take some time to familiarize yourself with the information included.

The new webpage includes the tier structure and amounts of the fee schedule for various settings; there are also FAQs and a link to the recorded webinar and slides.

Please keep in mind that even though the fee schedule goes into effect on October 1, MCOs are working on a short timeline and will not be ready by that date. MCOs are working on getting internal updates complete and will be getting provider contracts underway soon. DHS has instructed MCOs to have contracts complete by December 31^st and then payments will be retroactive to October 1^st.

Lastly, this is a MINIMUM fee schedule – if your current rates fall below the rates listed in the linked table, they will increase to meet the new minimums. If your rates are already above these rates, you should not see a decrease in your rates. If that happens, or you see other abnormalities in rates or what you are expecting once this is in effect, please reach out to WHCA/WiCAL who will also share with DHS. The slides linked on the ForwardHealth webpage also include specific contacts for each MCO specifically for the fee schedule.