Reimbursement for Service Coordination

Service Coordination must be provided by a DOH approved provider and must be included in the SP to be reimbursed.

There are two (2) types of reimbursement for Service Coordination:

  1. Initial Service Coordination is reimbursed on a one-time only basis for each participant after the individual is an approved participant in the waiver. Reimbursement is for the work, time and travel expended in developing the Application Packet, including the Initial Service Plan.

    There are three (3) rates for Initial Service Coordination. These are based on whether the person is in the community and how long an individual has been in a nursing home. These are:

    • Diversion
    • Transition - six (6) months or less in a nursing home
    • Transition - greater than six (6) months in a nursing home

  2. Intensive Service Coordination is reimbursed in monthly units. As with all waiver services, Service Coordination must be included in the SP and can only be billed after the service is delivered. For reimbursement purposes, at a minimum, the SC must have at least one face-to-face meeting with the participant in the month for which bills are being submitted.