Ohio DODD HPC Monthly Rate Calculator (MRC)

Ohio DODD HPC Monthly Rate Calculator (MRC)

Ohio DODD HPC Monthly Rate Calculator (MRC)

Administrators, Billing Teams

Home Personal Care (HPC) services in Ohio is a complex service that involves some added features to manage in SETWorks. There can be many different ratios of staff to consumers, and the different ratios are different levels of service that warrant different rates, for each consumer. 

DODD has simplified this process by creating a "Monthly Rate Calculator" (MRC), where the provider fills out a spreadsheet that has provided/billable hours for each site and consumer. The provider uploads it into DODD's site, and DODD generates a spreadsheet with calculated rates for each time period. This calculated rate spreadsheet is uploaded into SETWorks and creates service rates within SETWorks against each consumer-specific ratio-specific HPC service.

Completing the Monthly Rate Calculator (MRC) 

SETWorks helps provide data and reporting for completing the MRC.  These two reports have been constructed to assist with completing the MRC:

(SW) Ohio DODD HPC MRC Staffing Hours Report - By Department:  Sums up how many hours were provided per location of HPC services. 
(SW) Ohio DODD HPC MRC Staffing Hours Report (Detail):  Shows how much time was provided per activity record of HPC services, and breaks up the time and duration for each ratio change. E.g., One record many have gone from 1:1 and 1:2 throughout a day, and so that record will show 2 rows and how much time was spent 1:1 vs 1:2. 

Uploading the service rate file

With SETWorks you are able to import/upload the standard file that the DODD website outputs based on the uploaded Monthly Rate Calculator (MRC) file.  You are able to upload it as often as you would like, and have SETWorks automatically apply the rates to the appropriate services.  If authorizations do not already exist, they will have to be added manually.

The importer will create consumer/individual specific service line items within the Service/Phase Utility.  The MRC text file contains Medicaid IDs, not names, and so to map the Medicaid IDs to consumers, Entity Identifiers are used, which is the table at the bottom of the Service/Phase Utility that allows you to map values/IDs from one concept to another (in this case, mapping services to consumers).

Info
Note that the importer does not create authorizations. These will need to be created manually if they do not already exist.

HPC Setting Options

There are different features within SETWorks needed depending on what type of HPC service a provider offers:

Shared Living/Congregate Settings
- The caregiver lives in the residence where service is provided for up to four individuals.
- The MRC provides the applicate rate.

Non-Congregate Settings
- The caregiver visits the home to provide care to the consumer(s).
- Relies on the ratio-specific rates provided by the state.
- The reauthorization process is required to help manage the check in and out of staff and consumers and ensure the correct rates are applied.

Prior to importing the MRC text file, these steps will need to be done:

1. Create the consumer-specific services.  A service can be named something like "Waiver (OSOC) - Smith, John" for the On-Site On-Call service, with a corresponding "Waiver - Smith, John" for the standard one.
2. Create the Entity Identifier mappings.  See below for an example.  The "Entity" here is the service name that maps to the "Identifier Value", which is the Medicaid ID.


To view what rates have been applied, click the "rate change" link within the Service/Phase Utility for a given service.


Uploading the MRC Spreadsheet

Open provider files:


Select the Service Rate Upload (if you don't see this, contact your administrator or SETWorks support)


Reports

Service Rate History and Archive Report. As rates can change and be applied retroactively, a report has been created to view the entire history (including archive) of the service rate history and archive of all services.  This report is called Service Rate History and Archive Report.



(SW) Ohio DODD HPC MRC Staffing Hours Report - By Department:  Sums up how many hours were provided per location of HPC services. 
(SW) Ohio DODD HPC MRC Staffing Hours Report (Detail):  Shows how much time was provided per activity record of HPC services, and breaks up the time and duration for each ratio change. E.g., One record many have gone from 1:1 and 1:2 throughout a day, and so that record will show 2 rows and how much time was spent 1:1 vs 1:2.