Transcript for:
Updates on Self-Directed Services Guidelines

Good morning everyone. Today is Friday, May 16, 2025. I'm Dr. Yumja Smalls, director of professional development with the DDA. We welcome you to today's Maryland Department of Health's Developmental Disabilities Administration's self-directed services information session, updates to reasonable and customary standards. If you would like to use close captioning so that you can read what is being said, click this button. Sometimes the transcription is not exact, but it's pretty close. All attendees are currently in listenonly mode and your mics and cameras are turned off. Today's presentation is available in the handout session section. Please click here to download the presentation. This meeting will be recorded and will be uploaded to the DDA's YouTube channel playlist and to the DDA website. If you have a question you would like us to read and answer your question, click here to add your question to our list. Before beginning our meeting, we also want to ensure civility for all of our meetings. This the free expression of diverse viewpoints is an essential value for our group. This freedom comes with the responsibility to engage respectfully which involves treating one another with dignity and respect in good faith. Univil behavior, disruptive conduct, abusive language threats or harassment will not be tolerated and may lead to being excused from the meeting. Thank you for helping. Thank you for helping to keep this productive and comfortable for everyone. And now I'd like to turn the mic over to Christy Colbert, DDA's statewide coordinator for self-directed services. Good morning, Christie. Good morning, Dr. Smalls. Thank you so much. Uh, and good morning, everyone. Uh, my name is Christy Colbreth, DDA statewide coordinator of self-directed services. It's great to see so many people on the call today as we share this important information. Our agenda today will be an overview of the employer and budget authorities and self-directed services. Next, we'll review the fisc year 2026 legislative budget bill requirements. We will review the updates to the reasonable and customary rate and wage charts. We'll review the changes being made to employee wages and vendor and provider rates. Then the financial management and counseling services providers will present on how to make these needed updates within their systems. Finally, we'll have some updates to the self-directed services manual and other resources that are available to you. Next slide. Participants have employer authority over some Medicaid waiver services. This means that the participant can be the employer of the person that is providing those services. As the employer, the participant chooses how much the employee is paid, what benefits they receive, and what their expectations are for the employee. The participant hires, terminates, and supervises under employer authority. Under employer authority, the participant is required to follow all employment laws and is also required to pay employees within the DDA's established reasonable and customary standards. Participants have budget authority over all Medicaid waiver services that can be self-directed. This means that the participant chooses how much to pay for the service within reasonable and customary standards. Budget and employer authority are explained more in a self-direct in the self-directed services training series module one which is titled self-directed services overview. Next slide. Provider and vendor rates and employee wages must be within the DDA's established reasonable and customary standards and person- centered plan budget allocation which is reflected on the self-directed services budget sheet. Participants with the support of their team may request an exception to the established reasonable and customary staff wage range up to no more than the established exception rate. Next slide. The Maryland General Assembly allocated funding for the purpose of allowing wage exceptions and geographical differential rates for self-directed services. These updated rate charts will be in effect beginning July 1st, 2025. Wage exception rates for employees cannot exceed 15% above the reasonable and customary wages for the employee standard maximum wage and geographical rates for vendors and providers cannot exceed 10% above the standard maximum rate. Please note there is not a geographical differential for reasonable and customary employee wages. We understand these changes will directly impact many participants. Participants may need to decrease rates for employees, DDA providers, and vendors. This task is important to both employer and budget authority. For the next slides, we will be sharing the action steps a participant must follow to make these changes. Next slide. It is important to know if your employees make at or below the standard wage or have an exception wage at or below the new exception wage maximum. No action will be needed. If your employees make above the standard wage, their rates may need to be decreased to be in compliance with the new wage exception rate. Next slide. Here is a listing of the standard maximum rate for each service for employees. These rates have not changed from the current rate tables. If your employees make at or below the standard wage, no action will need to be taken. Next slide. This chart and the chart on the following slide show the updated reasonable and customary rates and wages for employees that will be effective on July 1st, 2025. The reasonable and customary maximum is the current and unchanged maximum rate that can be paid for the service without a wage exception form. These were the rates that were shown on the previous slide. If employees are paid at or below the reasonable and customary wage maximum, which requires no wage exception, no action is needed from their employers. Action is also not needed by employers who currently pay employees at or below the new exception rate, which is the column on the far right. Employees making above this rate for the service listed will need to have their rates decreased to at or below this rate. This means that if your community development employees make more than $37.32, they their rate will need to be updated. If your employment services ongoing job supports employees make more than $37.32, their rate will need to be updated. If your nursing support services employees make more than $7464 per hour, their rate will need to be adjusted. And if your day-to-day administrative supports employees make more than $37.32 per hour, their rate will need to be adjusted. Next slide. Continuing to review the rate table for employees. Action is needed if your personal support employees are making more than $371 per hour. Action is needed if your personal support enhanced employees are making more than $4354 per hour. Action is needed if your respit care employees are making more than $2487 per hour. And action is needed if your support broker employees are making more than $37.32 per hour. Next slide. Let's review an example. This example shows a situation where no action will be required. Elliot Glenn lives in Baltimore City and has two employees. One employee works personal supports and makes $34 per hour. Another employee works community development services and makes $36 per hour. Reviewing the rate table, the employee working personal supports making $34 per hour is lower than the new exception rate of $371. The employee working community development services and making $36 per hour is lower than the new exception rate of $37.32. Because the employees current rates are lower than the new exception rate, no action is needed from Elliot. Next slide. Let's review another example. This example shows a situation where action is is needed. Casey Holden lives in McGomery County and employs three people. Two employees work personal supports and make $43.7 per hour. One employee works respit care services and makes $30 per hour. All of these rates are with a previously approved wage exception form. Reviewing the rate table, the employees working personal supports making $43.7 are higher than the new exception rate of $371. The employee working respit care services and making $30 is higher than the new exception rate of $2487. Because the employees all make more than the new exception rate, Casey must bring their rates down to those rates or lower. Personal support employees to $371 per hour and respit care employee to $24.87 per hour. Next slide. Participants should follow these steps to update rates for employees. First, they must send a letter to the employee notifying them of a rate change. The DDA has sample and template letters for participants to use with their support of their team. The letter must be sent out on or before June 8th, 2025. This is because Maryland law requires an employer to alert employees of wage decreases at least one pay period in advance. This labor law applies to the participant as the employer of record. Please note, participants who do not alert their employees of wage reductions will be in violation of this Maryland law. Please understand that the DDA and the financial management and counseling services providers are not the employers of record and are not subject to this labor law. Participants should also follow the participants financial management and counseling services provider process for changing wages for employees. Each financial management and counseling services provider is here today and will share details on their processes later in this presentation. Next slide. The DDA has sample letters and templates available to participants who will need to change the rate of employees to meet the updated reasonable and customary rate standards. Participants may create their own letters as well. The letter should include the following. The date the letter is sent on or before June 8th, 2025. The employees name. The employees address. The subject which we suggest to be update and hourly rate. The effective date. The date of change on or before July 1st, 2025. the waiver services that are affected, the new wages for those waiver services, and the participants name and their signature. Next slide. Next slide. Let's review a sample letter. This is a letter from Alex Smith to their personal supports and community development services employee Jordan Jones. Alex has sent this letter to Jordan on June 1st, 2025 in order to alert them to alert them with at least one pay period notice. Alex has noted that the subject of this letter is update an hourly wage. The letter reads, "Dear M Jones, this letter is to inform you of an adjustment to your current hourly wage. Effective July 1st, 2025, your hourly rate will be as follows. For personal supports, $30 per hour. Community development services, $3245 per hour. And for personal supports, holiday pay, $3218 per hour. Respectfully, Alex Smith. Next slide. After a participant alerts an employee that their rate per hour will change, they must also follow their financial management and counseling services providers process for changing that employees rate. Each financial management counseling service provider has a process for changing rates for employees. And we will have all three of our financial management and counseling service providers share their processes for changing wage rates for employees later in this presentation. Next slide. For DDA provider rates, the geographical differential rate has decreased for some waiver services. These rate changes will only affect those living in Calvert, Charles, Frederick, Montgomery, and Prince George's counties. If you do not live in those counties, no action is needed. If you live in those counties and your DDA providers are making at or below the new geographical differential rate, no action is needed. If you live in those counties and your DDA providers are making more than the listed new geographical differential rate, their rates will need to be adjusted to at or below that new rate. Next slide. This and the following slides show the updated rate tables. This slide shows that the rates for assistive technology providers and behavior support services DDA providers have not changed. Next slide. The far right column shows where the geographical differential has changed in bold type. The geographical differential for Calbertt, Charles, Frederick, McGomery, and Prince George's counties has been decreased for community development services and dehabilitation services DDA providers. This means action is needed if your community development group or one-to-one provider is currently billing more than $7528 per hour. Action is needed if your community development 2:1 provider is currently billing more than $1507 per hour. Action is needed if your dayhabilitation small group or onetoone provider is currently billing more than $79.90 per hour. And action is needed if your rehabilitation 2:1 provider is currently billing more than $159.81 per hour. Next slide. This slide shows that the geographical differential for Calvert, Charles, Frederick, McGomery, and Prince George's counties has changed for discovery milestones, self-employment development, job development, and followalong employment services for DDA providers. This means action is needed if your employment services discovery milestone one provider is billing more than $975.89 for that milestone. Action is needed if your employment services discovery milestone 2 provider is billing more than $2,927. $2,92767 for that milestone. Action is needed if your employment services discovery milestone 3 provider is billing more than $1,95177 for that milestone. Employment services self-employment development provider is billing more than $629.75 for that milestone. Action is needed if your employment services job development provider is billing more than $121.97 per hour. An action is needed if your employment services followalong support provider is billing more than $800.31 per month. The rates for ongoing job supports and co-worker supports for DDA providers have not changed. Next slide. This slide shows that the rates for environmental assessments, modifications, and family and peer mentoring supports for DDA providers has not changed. Next slide. This slide shows that the geographical differential for Calvert, Charles, Frederick, McGomery, and Prince George's counties has been decreased for housing ser housing support services DDA providers. This means action is needed if your housing support services provider is billing more than $89.28 per hour. The rates for living caregiver, nursing support services, and participant education and advocacy for DDA providers have not changed. Next slide. This slide shows that the geographical differential for Calvert, Charles, Frederick, McGomery, and Prince George's counties have been decreased for personal supports, personal supports enhanced, and personal supports 2:1 DDA providers. This means action is needed. If your personal supports provider is billing more than $5328 per hour, action is needed if your personal supports enhance provider is billing more than $6745 per hour. And action is needed if your personal supports 2:1 provider is billing more than $134.90 per hour. The rates for remote services and respbit care services for DDA providers has not changed. Next slide. This slide shows that the rates for shared living DDA providers have not changed. Next slide. This slide shows that the geographical differential for Calvert, Charles, Frederick, McGomery, and Prince George's counties have been decreased for supported living DDA providers. This means action is needed if your supported living overnight supervision oneperson home provider is billing more than $810.88. 88 per day. If your overnight supervision twoperson home provider is billing more than $52,5.90 per day. If your overnight supervision threeperson home is billing more than $390.75 per day. Action is needed if your overnight supervision four-person home provider is billing more than $44363 cents per day. Action is needed if you're without overnight supervision home provider is billing more than $48182 per day. Action is needed if you're without overnight supervision. Twoerson home provider is billing more than $361.37 per day. Action is needed if you're without overnight supervision. Threeerson home provider is billing more than $2816 per day. And action is needed if you're without overnight supervision. Fourperson home provider is billing more than $361.37 per day. Next slide. This slide shows that the rates for transition services, transportation services, and vehicle modifications for DDA providers have not changed. Next slide. Let's review an example. This example shows a situation where no action will be needed. Blake Steel lives in Frederick County and uses ABC provider for dayhabilitation services. He has agreed to pay ABC provider $75 per hour for dehabilitation small group. Reviewing the rate table, the rate of $75 currently being paid is less than the new geographical differential of $79.90 in Frederick County. Because the provider rate is lower than the new geographical differential rate, no action is needed from Blake. Next slide. Let's review another example. This shows a situation where action will be needed. Lee Walter lives in Calvert County and uses 123 provider for housing support services. Lee has agreed to pay 123 for housing support services at $90 per hour. Reviewing the rate table, the current rate of $90 is higher than the new geographical differential rate of $8928 in Calvert County. Lee must increase 123 provider housing rate services rate to $8928 or lower. Next slide. Participants should follow these steps to update the rates for providers. First, they should review the written service agreement that the participant has with the provider. It may note how much notice the participant should give to change the written agreement. They should send a letter to the provider notifying them of the rate change. The DDA has sample and template letters for participants to use with the support of their team. The letter must be sent out before July 1st, 2025 or earlier based on the service agreement. And finally, the participant should follow the participants financial management and counseling services providers process for changing rates for providers. Each financial management and counseling service provider is present today and we'll share details on their process later in the presentation. Next slide. The DDA has sample letters and templates available to participants who will need to update their rate of providers. Participants may create their own letters as well. The letter should include the following, the date the letter is sent. The provider name, the provider address, the subject, the effective date, the date of change on or before July 1st, 2025, the waiver services that are affected, the new rate for the waiver services, and the participant name and signature. Next slide. Let's review a sample letter. This is a letter from Alex Smith to their personal supports provider, Alpha Personal Supports. Alex has sent this letter to Alpha Personal Supports on June 1st, 2025 because their written agreement requires 30 days notice of a rate change. Alpha Personal Supports address, Alpha Personal Supports address is listed. Alex has noted that the subject of this letter is update an hourly rate. The letter reads, "Dear Alpha personal supports, this letter is to inform you of an adjustment to your current current hourly rate. Effective July 1st, 2025, your hourly rate will be as follows. Personal supports $53.28. Respectfully, Alex Smith. Next slide. After a participant alerts a provider that their rate will change, they must also follow their financial management and counseling services providers process for changing rates for providers. Each financial management and counseling services provider has a process for changing rates for providers. We will have each financial management and counseling services provider share their process for changing rates for providers later in this presentation. Next slide. Similar to provider rates, the geographical differential rate has decreased for vendors for some waiver services. These rate changes will only affect those living in Calvert, Charles, Frederick, McGomery, and Prince George's counties. If you do not live in those counties, no action is needed. If you live in those counties and your vendors are making at or below the new geographical differential rate, no action is needed. If you live in those counties and your vendors are making more than the listed new geographical differential rate, their rates will need to be adjusted to the new rate. Next slide. This and the following slides show the updated rate tables. This slide shows that the geographical differential for Calvert, Charles, Frederick, McGomery, and Prince George's counties has been decreased for community development services and employment services, ongoing job supports, and followalong supports. This means action is needed if your community development group or onetoone vendor is currently billing more than $67.85 per hour. Action is needed if your community development 2:1 vendor is currently billing more than $135.74 per hour. Action is needed if your employment services ongoing job support spender is currently billing more than $858 per hour. An action is needed if your employment services followalong supports spender is currently billing more than $72149 per month. Next slide. This slide shows that the rates for individual and family directed goods and services, recruitment and advertising and internet services and nursing support services for vendors have not changed. This means action is needed if your day-to-day admin administrative supports vendor is currently billing more than $37.32 per hour. This slide shows that the geographical differential Oh, next slide. Apologies, Dr. Smalls. Thank you. This slide shows that the geographical differential for Calvert, Charles, Frederick, McGomery, and Prince George's counties has been decreased for personal supports vendors. This means action is needed if your personal supports vendor is billing more than $48 per hour. Action is needed if your personal supports enhanced vendor is billing more than $60.81 per hour. An action is needed if your personal supports 2:1 vendor is billing more than $12162 per hour. Next slide. This slide shows that the rates for respbit care support broker services and transportation for vendors have not changed. Next slide. Let's review an example. This example shows a situation where no action is needed. Alex Dayne lives in Charles County and uses Omega Personal Supports as a personal supports vendor. Alex has agreed to pay Omega Personal Supports $60 per hour for personal supports enhanced. Reviewing the rate table, the rate of $60 currently being paid is less than the new geographical differential of $60.81 per hour. Because the parider rate because the vendor rate is lower than the new geographical differential rate, no action is needed from Alex. Next slide. Let's review another example. This ses This shows a situation where action will be needed. Hollis Fishman lives in Prince George's County and uses Amarillo Community Supports as a community development services vendor. Hollis has agreed to pay Amarillo Community Support $70 per hour for community development services onetoone supports. Reviewing the rate table, the current rate of $70 per h per hour is higher than the new geographical differential rate of $67.85. Hollis must decrease Amarillo Community Supports's rate to 70 $67.85 per hour or lower. Next slide. Participants should follow these steps to update the rates for vendors. First, they should review the written service agreement that the participant has with the vendor. It may note how much notice the participant should give to change the written agreement. Next, they should send a letter to the vendor notifying them of the rate change. The DDA has sample and template letters that are available online to support the person and their team. The letter should be sent out on or before July 1st, 2025 or earlier based on the service agreement. And finally, the participant should follow the participants financial management and counseling services provers process for changing a vendor rate. Each financial management and counseling services provider will share details on their processes later in the presentation. Next slide. The DDA has sample letters and templates available to participants who will need to update the rates of vendors. Participants may create their own letters as well. The letter should include the date the letter is sent, the vendor name, the vendor address, the subject of the letter, the effective date, which is the date of change on or before July 1st, 2025, the waiver services that are affected, the new rates for the waiver services, and the participants name and signature. Next slide. This sample letter to a vendor will look exactly like the letter sent to DDA providers. For example, this is a letter from Alex Smith to their personal supports vendor, Alpha Personal Supports. AL Alex has sent this letter to Alpha Personal Supports on June 1st, 2025 because their written agreement requires 30 days notice of a rate change. Alpha Personal Supports address is listed. Alex has noted that the subject of this letter is update an hourly rate. The letter reads, "Dear Alpha personal supports, this letter is to inform you of an adjustment to your current hourly rate. Effective July 1st, 2025, your hourly rate will be as follows. Personal supports $5328." Respectfully, Alex Smith. Next slide. After a participant alerts a vendor that their rate will change, they must also follow their financial management and counseling services providers process for changing rates for vendors. Each financial management and counseling services provider has a process and they will be sharing that in the next portion of this webinar. Next slide. We will now move into a time of information sharing from our financial management and counseling services providers. First, the Ark of Central Chesapeake will present, then Public Partnerships LLC or PPL, and finally, GT Independence. Next slide. Now, I'll turn it over to Mark Weinstein from the Ark Central Chesake region to present. Mark. Hi, thanks Christie. Um, I'm Mark Weinstein, senior director of self-directed services at the Arc Central Chesapeake region. Um, and we can go to the next slide, please. So, I'll spend a couple minutes reviewing our employee change form um, that's used to update our employee rates and the employee termination and inactivation form used when employed no longer works for a participant. Next slide, please. The employee change form. This is a form that um most people have used. We're not changing the process there. To change a pay rate for an employee, just complete the employee change form. That's found on the forms and resources page of our website. That's under the employee forms and resources section. Please complete one employee change form per service code for each employee. Uh you can use it if related service codes within the same rate can be included in one form. For example, if you have uh an employee that you're paying for personal supports and they also have personal supports PTO at the same rate, you can put all that on the same form. But if it's different employees or different codes, um use different forms there. Once the employee change form is completed and signed by you and your employee, email the form to FMS employee updates at the rcccr.org for processing. For changes to vendor or provider rates, no additional paperwork is required. Participants should alert their vendors of the new and providers of the new reasonable customer rates like Christy talked about and any invoic any invoices with rates above the new standards will not be processed for payment. Next slide, please. And this is the employee change form. No changes there. Should be real familiar to people. We just ask that the employee and the employer send uh sign it and then send it in. Next slide, please. for employee termination and inactivation. When an employee no longer works for a participant employer, they will complete that form. It's called the employee termination and inactivation form. It can be found on our forms and resources page of our website. It's under the employee forms and resources section. Once that form is completed and signed by the participant employer, please email to FMS employee relations at the arcr.org. Next slide, please. And that is a look at the employee termination inactivation form. Um it's signed by the employer and it just lists the reason why the part the employee left the participant. Next slide please. Um and we did a webinar um a few months ago for that. So, if you want to have more information on using these forms, um you can go to the webinar recording and presentation and it's called important employee forms found and it's found on the forms and resources page of our website under the webinars and presentation section. Um again, if you have any questions, you can please call us at 1866252-6871 or please place a help desk ticket and we'll get the help that you need to go through the process. Next slide. That's it. Thank you. Thank you so much, Mark. Uh, now we'll turn it over to Shantel Tally from Public Partnerships LLC or PPL. Shantel. Good morning, everyone. Um, as Christy said, I'm Chantel Tally Lisi with Public Partnerships or PPL as most people know. We can go to the next slide. So, we're going to be talking about the services and rates updates for participant employees. Um, and we term providers as anyone that's a vendor, an employee, or a DDA provider. We can go to the next slide, please. We can go to the next slide. So the services and rate changes for all employee services. In order to change their rate, they will need to complete an employee services and rates sheet. That employee services and rate sheet can be submitted to by email to PPL's customer service email bin. That is ppl m d a d- cs at pplfirst.com. Next slide, please. This is a view of our employee services and rates form. In that form, you will need to complete all sections. I do like to call out that the employees PO identification number does start with an PA and the employee employer or PR excuse me and the participants PO identification number does start with a PA. So again the PR starting ID number is for employees. The PAL ID number um is is the start for a participant identification number. we would need to have everyone complete the employer's first and last name. Um they will need to read the reminder section. So that does include reminders on um if there's an hourly rate change, taxes, all of those things need to be taken in consideration when changing rates. There also is a requirement to check the box if that is an hourly rate change in that section. So there there's a request type and then the W code will need to be entered. W service code and the updated hourly rate would need to be entered. We do ask that the employee and the participant review the agree and sign section and then each of those individuals will need to sign and date the document. And again, the form for services and rates for employees can be emailed to ppl MD dda-cs at pplfirst.com. Next slide. Next, we're going to talk about vendor services and rates updates. Next slide, please. Vendor services and rates can be updated on our order purchase request form. So when a vendor submits their actual invoice to PPL on the order purchase request form, they will need to add that new rate and ensure that their invoice includes the new rate. The order purchase request forms can be submitted by email to PO's customer service. similar to the employees and that email address is ppl md dda-csppplfirst.com. Next slide, please. This is a copy of the order purchase request form. The document at the top has a purchase request type. So, it would be checking the box for purchase request, filling in the participant detail section. Again, remembering that you'll fill in the PPL ID number, and that ID number starts with a PR for participant. And then filling in the vendor detail section, entering the service description, which would be the name of the service and the service code, which begins with a W, and then entering the amount of the service and the date of the service. the W codes. Just as a reminder, the PPL customer service team as well as our enrollment specialists do provide those W codes to all participants for any services that they receive. So, if you have a question, you can reach out to PPL's customer service team or the enrollment specialist that's supporting you. We can go to the next slide. Next, I'm going to talk about our customer service information. We can go to the next slide. PPL's customer service can be contacted at our number here 8336602509. We can also be contacted at our customer service email box. Our team does respond within 24 hours to all emails that are sent. And then for any calls that come into our customer service bin, the team usually will pick up immediately. If we're having a high call volume day, that would mean that you can hold your place in line and someone will give you a call back within that day. Next slide. Thank you. Thank you so much, Chantel from PPL. Now we will turn it over to Megan Singh Back Babcock to present from GT Independent. Hello, my name is Megan Singh Babcock. I am the director of operations for GT Independence. We can go to the next slide. Today we're going to talk about the wage change process for employees, vendors, and providers. We can go to the next slide. Step one is to contact customer service. You can contact customer service by sending an email to customer service gtsd.org. org or by phone you can call customer service at 877-659-4500. Next slide please. Step two is to request the the forms that are needed for employees. Wage change forms can be requested by the participant, their authorized representative, the CCS or the support broker. Weight change forms are sent via docuine and automatically returned to GT once completed. For vendors and providers, a purchase of service agreement can be requested by the participant, their authorized representative, the CCS, the support broker, or the vendor. Purchase a service agreements are sent via docuign and automatically returned to GT once completed. Next slide, please. Step three, completing the forms for employee wage change forms. Wage change forms are sent to the participant first. Participants input their name, the employees name, the service code, the old rate, the new rate, and the effective date. The participant must sign the form. Employees will then receive the form after the participant completed completes their sections. The employee must sign the form. Wage change forms cannot be backdated. The form is then returned to GT for processing. Next slide, please. Step three, completing the forms for purchase of service agreements. Purchase of service agreements are sent to the vendor or provider first. The vendor provider will input their name, the agreement start date, what services will be provided. The vendor and provide or provider must sign the agreement. The participant will input their own name, review the agreement, and sign the agreement. The form is then returned to GT for processing. Next slide slide, please. In conclusion, it may take two to four weeks to see the rate change on a payub depending on the effective date. Rates can be within reasonable and customary standards. Corrected forms may be required. GT will contact you for any corrections that are needed. If a rate is changing, MD labor law requires that a full pay period notice is given to the affected employee before the rate is lowered. This is the participant's responsibility as the employer. Next slide, please. Thank you. Thank you so much, Megan. And thank you to all of our financial management and counseling services providers for sharing this information. These providers will be available to answer your questions at the end of this presentation during our question and answer section. Please note provider, vendor, and employee rates must be within the new reasonable and customary standards on or before July 1st, 2025. If a participant does not update their rates and wages, their financial management and counseling services provider will automatically decrease the rate or the rate or wage to the reasonable and customary maximum for each waiver service. Next slide. We now have a few updates related to our self-directed services manual. This week, the support broker code of conduct in the self-directed services manual was updated based on stakeholder feedback. Support brokers may provide direct support to participants who have not hired them as a support broker. So I will say that again in other words. This means that this week effective this week with our new update to the manual support brokers may provide direct sort direct support and support broker services just not to the same participant. One more one more time. Support brokers may provide direct support and support broker services just not to the same participant. Next, based on stakeholder feedback, the DDA has updated the self-directed services manual and wage exception form process to add clarity and to provide flexibility, including flexibility related to financial management and counseling services transfers and justifications and standards for wage exception requirements. for most wage exception requests, job postings, and interview requirements are no longer required for staff unless the position is new or vacant. I'll say that again. For most of the wage exception form requests, job postings, and interview requirements are no longer required for staff unless the position is new or vacant. If postings are required, the position will only need to be posted for two weeks and the participant will only be required to interview three applicants. This update has been made to the current online wage exception form. So, if teams go to that form today, they will see these flexibilities listed there. These flexibilities also apply to the family of staff overtime request form. If postings are required, the position will only need to be posted for two weeks and the part participant will only be required to interview three applicants. Next slide. We know that this is a lot of information. This webinar has been recorded for you so that you'll be able to review it later. It will be available on the DDA's website. This and the following slides include a summary of this presentation. The recently passed fiscal year 2026 budget bill, which is House Bill 350, requires that the Maryland Department of Health implement changes that will reduce wages and rates for self-directed services to assist the Maryland Department of Health in its efforts to sustain sustain its DDA operated Medicaid waiver programs. These changes include caps on other limitations on dedicated hour rates, geographical differentials for services, and wages and rates for certain self-directed services. Next slide. The wage rate and standards are effective July 1st, 2025. For wages and rates within these new standards, no action is needed. For wages and rates that are currently above the new standards, immediate action is required. Participants may need to decrease wages for employees that have a wage exception and may need to decrease provider and vendor rates with a geographical differential rate. Participants must work with their financial management and counseling services provider to update these wages and rates. Next slide. The support broker code of conduct has been updated to note that support brokers may provide direct support to participants who have not hired them as a support broker. Additional flexibilities have also been added to the wage exception form and family as staff form overtime the family as staff overtime form processes. If you have previously been denied for one of these forms, you may now meet the requirements. We encourage you to review the updated documentation requirements with your team, especially with your coordinator of community services and your support broker to see if you now meet the requirements. You can submit new requests at any time and they will be they will be reviewed with these new flexibilities. Next slide. This slide contains resources related to this topic, including links to the self-directed services comprehensive comprehensive policy and manual and other sample and template resources that are available to you on the DDA's website. Next slide. Now, I'll turn it over to Rhonda Workman, the DDA's director of federal programs to facilitate our question and answer session. Rhonda, thank you. Thank you, Christie. Thank you so much for all that information. And thank you also to our financial management and counseling services providers for joining us today as we share this important information and actions that's needed. Um, we have several questions. So, we're going to go through the questions. Um, I'm going to start with some of the common themes at the beginning and work our way through it. Um we again appreciate everybody joining us and we'll start with the questions. So Christie, in regards to employees and staff, if they are already receiving a higher rate um than the upcoming lower rate, can they keep that higher rate that they've been paid? So this is a really important question. All employees on July 1st, 2025 must have rates within the updated reasonable and customary chart. So that means that if an employee was making a wage exception over the new wage exception rate maximum that's listed uh beginning on slide 13, Dr. Smalls, if we could go there. If an employee is making more than the new exception rate maximum, they will need to change their rate. That that rate will need to be changed by their employer. Yep. Slide 13 shows that that right hand slide that that right hand column right there, any employee making above that rate will have to have their rate changed to this rate, that rate there or lower. Thank you. That's clear. And so we've got some questions. So some people um may have a rate that's above that through a wage exception um form process etc. They want to know um will that be automatically adjusted? Do they need to take action um to reduce um that? Do they need to submit a new wage exception form? That's a really great question. So first is if rates are being reduced for employees, employers should take immediate action to alert their employees through writing. Uh we we noted this. It's because there is a Maryland law that requires employers to update their employees of any rate wage reductions within one pay period. So that needs to be done in writing to the employer. If an employee is currently making a wage exception rate and the they're going to the employer is going to bring that rate down to the new exception rate, another wage exception form does not need to be completed. The change just needs to be made up to the new exception rate maximum. Thank you, Christine. Next question. Can a coordinator of community services assist the participant in writing and sending the letters to their staff about the wage change? Yes, we believe that um this is an HR, this is a human resources role. So if a person has a support broker, it is well within that support broker's role to support the person to complete these for these letters to get out to employees. But the coordinator of community service can also support the participant in those efforts. Thank you Christie. Can an individual who has family as staff also receive respit services. Say that one more time. Sure. That's a that's a different question. Okay. Right. It's it's kind of different from our what we're talking about. But can an individual who has family as staff receive respit services? Um I absolutely right. Absolutely. Yeah. That um as long as the person has an assessed need for respit services uh and those respit services cannot be provided by the participant's primary caregiver. Thank you Christie. Our waiverss. Um we had a question about getting a copy of the manual like a printed copy. So, absolutely, please reach out to your coordinator of community services, your team, or you can um send a request to the SDS um email. We're happy to send you one in the mail. Going down um for staff that have received an enhanced rate for personal supports that was part of the exception maximum um but now the rate no longer qualifies because of the rate changes. Will action be needed? Dr. Smalls, if you could go to slide 14 so we can look at those rates. Well, in general, Christy, right, if if the rate is higher, whether it's an enhanced rate, um, any rates, right? Yep. I just wanted us to see it. So if the rate for personal supports if an employee is currently making more than $43.54 that rate needs to come down to $43544 or lower. Thank you Christie. This one relates to vendors. If a community development service vendor charges the maximum amount on the reasonable customary wage chart, is action needed for that? Great question, Dr. Smalls. We can go to slide 23 to look at those rates. So, there are two different I'm so sorry. I apologize. It is slide 38. We're looking at vendors. I apologize. Thank you. um community development group and onetoone rates are listed here on the first row. If that community development services vendor is charging more than $67.85 in those counties, Calvert, Charles, Frederick, McGomery, or Prince George's, those rates do need to come down to the new geographical differential. However, if there are if this vendor is providing services in another county, the standard rate maximum for vendors of $6168 remains unchanged. So, no action would be needed. But action would be needed if you live in a geographical differential county and a CDS uh vendor was charging more than $67.85. Thank you, Christie. We also had a question about being able to get a copy of the slides. Um, absolutely. Um, information is available, so we're happy to share that. Um, there'll be followup from the the um this webinar. Um, to include, we will be sending out weekly reminders about action that is needed to be taken, including the link to the webinar. Another question is, if your annual budget was submitted in February under the former wage exception rules, the former standard standards, do you need to complete a revised annual budget or complete a budget modification? That's a great question. So, when rates and wages are updated, a budget modification is not needed if those rates are being lowered. And in these situations that we are sharing it, most participants are going to have to do action that is a lowering rates. So if you are lowering a rate for an employee or for a vendor or for a provider, a new budget form and a budget modif budget modification form are not required. You will need to follow the process of your financial management and counseling services provider to alert them of the change. If you are for some reason increasing a rate that's not in your budget sheet, an updated budget sheet or a budget modification would be required. Thank you, Christie. And as we're answering these questions, please note that these questions are coming from individuals that may be in a different situation than some of the other callers on the phone. So, we want to make sure that you understand we're answering based on what information we're provided um at this time. If you have any questions, please send um your question to the SDS email account. We're happy to um follow up and support you. Um your coordinators of community services and support brokers are available in addition to the regional office um self-directed service leads. Okay. Um, more questions similar to what we've had, but will the current approved wage exception form stay in effect or just adjust to the the new standards? If a participant is paying an employee a rate that is a current wage exception, a new wage exception form will not be required. However, the rates will need to be adjusted to be within the new reasonable and customary standards to the new wage exception maximum. Thank you, Christie. And as Christie shared um and the FMS have been sharing, there are templates and letters you can use and then specific forms for your financial management and counseling service provider to complete. Next question. Will there still be an enhanced rates for employees? Let's say personal supports enhanced. Will there still be those rates? Personal support enhanced is listed separately from personal supports on slide 14. So there are um there is a wage maximum without a wage exception for personal supports and personal supports enhanced and a exception maximum for both of those services. and that will continue. Thank you, Christie. Um, another question is, um, do you need to include the cost for nursing support services for the nurse to complete their work, let's say review of an HRST, the health risk screening tool, in your budget, you should include the services that you need in your person- centered plan. So, yes, if you um if you need nursing support services, you should account for all of those services when budgeting. Um I recommend that you connect with your coordinator of community service to ensure that your budget sheet and your person center plan match. Absolutely. Mhm. The next question is asking um does this information we're sharing impact family members working as staff through a vendor? Vendor rates are affected here. So beginning on page 38, uh there are the listing of vendor rates. So if a vendor is charging more than the reasonable and customary geographical differential in those counties, those rates will need to be adjusted. Um the rules regarding family as staff in the self-directed services manual apply to family members who are providing services directly and to family members who are providing services through a vendor. Thank you, Christie. Will new wage exceptions forms be needed for those needing their wages dropped for them to continue to receive these rates in future plans? It's a great question. So if a participant is paying an employee above the reasonable and customary rate right now through a wage exception, a new form is not required, but those rates need to meet the new standards that are listed in the chart. If an employee if a person hires another employee, the wage exception form process as listed in the manual applies to that new employee. Thank you, Christie. We had a question about example one um with Elliot. Okay. Did Elliott have a currently approved wage exception? If he did not, would the employee still be able to receive the exception maximum rate? So, maybe we can go to that slide. Go to slide 15. So Elliot is paying a personal support employee $34 an hour which is a wage ex he which he so he was paying within a wage exception and $36 for CDS which is also a wage exception. So yes, but those wage exceptions would have already been processed and they are under the new wage exception rate, so no action is needed. It's a great question, a good point, and I apologize for not making that clear in the notes. Thank you, Christie. If an employee makes higher than the new exception rate maximum and has a wage exception form on file, do they need a new wage exception form to decrease the rate to the new exception rate maximum? So the answer to that question is no. If they have a current wage exception form on file for a higher wage exception and the rate comes down to the new exception, a new wage exception form is not required. Thank you. But they do need to take action to notify the employee, right, of the change and the decrease and to notify the financial management counseling service provider? Correct. Absolutely. Next question. Is the July 1st rate change effective date for plans effective 712025 or does it include current plans that expire um during the course of the year? That's a great question. These reasonable and customary standards that are effective on July 1st, 2025 are effective for every participant who self-directs their service regardless of when their plan is effective. So, all participants who self-direct their services are subject to these reasonable and customary wage standards on July 1st, 2025. Thank you. This question says, if an employee makes the maximum reasonable customary wage and the employer wants this employee to get a wage within the exception rate range, does the employer need to fill out a wage exception form? One more time that question. Yep. If an employee makes the maximum reasonable and customary wage and the employer wants this employee to get a wage within the exception rate range, does the employer need to fill out a wage exception form? So, it sounds like the employee I think there might be some data missing. I really encourage um teams to reach out to their financial management and counseling services provider and their CCS to go through the rate tables and look through exactly what their employees are making just to make sure that no action is needed. And our self-directed services team is available um to provide any support as needed. You can email [email protected]. Thank you Christie. What happens if a person does not notify their employees about a wage decrease? Will the wage still be decreased? That's a great question. If a participant does not notify their employees of the rate change on July 1st, the financial management and counseling services provider of that participant will decrease the rate to the maximum wage exception rate. that will happen if the participant has not notified their employees of that rate decrease. They are in violation of Maryland labor law. This means that an employee could reach out to the Maryland Department of Labor and alert them to this violation of that law. We really encourage all participants and anyone on the line who supports people who self-direct to ensure that written letters are submitted to any employee who's having their rate decreased. Great. Thank you, Christine. We have some questions that relate to the geographical differential um and they relate to um how they're being um determined and applied. We have Robert White on the call today who's going to be able to share some information related to the geographical differential. Sure. Thank you uh Rhonda for that. So yes, we we've received several questions related to um having a geographical differential for the wage exception maximum. Um I did uh seek clarity as to the intent of the the language that is in the budget bill during this call. And so um based on that we will be updating that chart to include a geographical differential for wage exception that will be 10% above what it is for the the rest of states. So, currently in the manual and in the presentation, there's a wage exception that is 15% above the standard maximum wage. Um, so we'll have one that will go next to it that will be 10% above that 15% maximum rate. Thank you, Robert. Um so based on this information um the DDA will work to update the manual to reflect the new column that Robert's talking about and we will send out a communication um to stakeholders um alerting them to the updated manual and the addition of that chart. Thank you so much Robert for sharing that. Okay, going back to our questions. Um, for GTI, um, so Megan, um, they note it seems like, um, GTI is going to be sending the wage change form via docuign. Um, but wanted to see if they were also available in the portal. Um, Megan, do you want to review again your process in terms of wage change and vendor changes um and how that process works with the docuign? Sure. If you want to go to slide 70, that would be great. For employee wage change forms, a participant, their representative, support broker or CCS can contact GT um via 877-659-4500. The form is then sent out through docuign to the participant first. The participant will input their name, the employees name, the service code, the old rate, the new rate, the effective date. The participant must then sign the form. Once the participant signs the form, the form is then sent to the employee to review, complete any any section assigned to them, and then sign the form as well. The form is automatically sent back to GT. Then for vendor, next slide please. For vendors, if a vendor rate change needs to occur, the purchase of service agreement can be requested by calling GT at 877-659-45000 or emailing customer service at gtsd.org. The purchase service agreement will be sent to the vendor or provider first. They will complete their portion. They will sign the agreement and then the purchase of service agreement is then sent to the participant for review. The participant will then sign the agreement as well and then the form is automatically sent back to GT for processing. Thank you Megan Christie. Another question um the person is wondering um how they can get a copy of the templates. Um, Yanja, can you go to the resource slide? So, our our templates are available on the DDA's self-directed services forms page. Uh, that link is available on this resources slide. At the there are a listing at the very end of that page. There's a listing called resources and tools. Um, and there you'll find Word document versions of the samples and templates, so you're able to download those directly and write into them and and edit them accordingly. Thank you, Christie. And as some of the previous questions again, if you need support, your coordinator of community services and your support broker um could assist you um with those letters. We had several questions um related to um the different terms we're using. Um we use words like employees, vendors, and providers. And um our FMCS or financial management counseling service um providers also um shared information. I believe PPL shared with us that they call everybody a provider. Um and then um some of the other f uh financial management counseling service providers use the words employees and vendors. So employees are the people that are directly hired by the participants. So they're employees of the person. Um the vendors are um different they're not direct employees but they're people that are contracted through agreement to provide supports. And then we have DDA providers who are um community providers that have been um licensed or certified by DDA to meet those standards. In general, we consider all um these categories employees, vendors, and DDA providers as Medicaid providers under the Medicaid operated waiver programs. Um so we call them in general providers, but those are different terms that people may use a little bit differently. Um, but they're all providers under the self-directed service model as Medicaid providers. Christy, did you want to add anything to that? That was great. Okay. The next question, Christie, is what if someone uses the older or use a previous wage exception form, and you've shared with us today, we've updated some of the forms. Do they need to redo it the form if they're still within the new standards? So, if a participant has been denied a wage exception, if we've sent a denial letter to the participant regarding um their wage exception because their request did not meet the standards that were listed in the manual, uh we really recommend that the team review those updated standards and see if they are now within they now have the documents to meet the standards since the flexibilities have changed. So that's what I would say about that is if you've been denied, we recommend taking a look at it and re-requesting. Great. Thank you so much. Um, a few people had some person specific questions, so we're happy to follow with you offline related to that. Um, several questions are are um similar to the ones we've just um shared. So, I'm just scanning through for additional ones. Um there um was a question related to slide 33. So if we go to slide 33, updating a provider rate, it states participants should review provider written service agreements. The question was does this refer to participant agreements? What is a um written service agreement? That's a really great question. So, um, the DDA encourages participants who contract with vendors and providers that they enter into a written agreement with participants with with their providers and vendors. Um, the the DDA actually covers a lot of this in the self-directed services training series titled vendors and providers. It is module seven if that is familiar to you. So we recommend uh that written agreements be created between the participant and the vendor or provider as a separate agreement from the participant agreement. Um there are sample and template versions of those service agreements and a real outline of how to complete one of those in the module seven of the self-directed services series. Thank you. And I'm going to um ask each of our FMCS's um to share the terms that they use because I know I heard GT I use a different term but I think it's referring to the same thing. So U Mark from the Ark of um Central Chesape region um do you want to clarify the terms you use for the service agreements with vendors and providers? Yeah, we we that's the term we use. Great. Thank you. And then uh Megan, do you want to share for GTI? GT uses uh the term employee for employees. We use vendors for vendors and providers. And employees should complete a wage change form. Vendors and providers should should complete a purchase of service agreement. Great. So that's purchase of service agreement. And then Chantel, do you want to share this the terms you use for the service agreements? for employees that we use the employment agreement and employee services and rates change form or rates form. And then for um DDA providers and vendors, they would use the purchase order form. Okay, great. And then today we talked about template letters that individuals can use to inform their employees um and vendors. Um the question um someone asked was um do these letters also need to be shared with the financial management counseling service providers? So Mark um from the ARC, do you want individuals to share with you in addition to your forms that you use to change wages or rates a copy of the letter that they sent to the the employee or the vendor provider? They certainly can send the letter. The most important thing for us is the employee change form. Great. Thank you. Um Megan from GT, um would you like a copy of those letters? Yes, that would that would be great. Great. And then Chantel from PPL. Yes, a copy of the form can be sent. Um it is not a requirement. We just need to ensure that we have that rate change form. Great. So, what I've heard today is that yes, you can absolutely share those letters with your financial management and counseling service provider, but the key thing that they need is for you to complete their process and forms so that they can make the adjustments in their system. Okay. Um, question Christy, are these changes to rates also applicable for staff services that are not provided by vendors? So the DDA issues reasonable and customary standards for employees for vendors and providers. So the new standards for each of those groups of people apply to those groups of people. Thank you Christie Mark. Um the question is who in the ark should the change in rate letters be sent to? that gets sent to FMS employees, FMS employee updates at the arcr.org. Great. And why don't we go ahead and ask GT um where where would they send the letters? Documents mdgtindependence.com. Great. And then Chantel, all communications go through PPL's customer service team. That's ppl MD dda-cs at pplfirst.com. Great. Thank you, Christie. Question. If an employee is getting lower than the maximum hourly rate, is any action needed? That's a great question. So if the employee is making a rate that is not a wage exception rate, it's very simple. No action is needed. Um if the employee is making an exception rate and that exception rate is above the new exception rate, maximum action will be required. Thank you. This is a repeat question, but we're just going to go ahead and and ask it again. Do coordinators of community services need to complete a budget modification when decreasing rates for staff, vendors, or providers? One more time, do coordinators of community services need to complete a budget modification when decreasing the rates for the staff, vendors, or providers? Great question. If rates are being decreased, a budget modification is not required. Thank you, Christie. Um, another similar question. What happens for those who got wage forms um submitted prior to prior wage forms that were denied? Will they now be approved for current employees? What action will they need to take? Great question. These updated flexibilities are effective today, May 16th, 2025. So, if you've previously been denied or if you've submitted a request before today, we ask that you submit a new request so that we can review it based on those new standards. Thank you, Christie. We have a question about holiday pay differential rates. Can you tell us what a holiday pay differential rate is and whether or not it must also be within the reasonable and customary standards? Holiday pay differential is a benefit that participants can provide to their employees. It means paying a higher rate for employees who gosh who work holidays determined by the participant. So, but we note in the manual beginning on page 41 that holiday pay differential must be paid within the DDA's established reasonable and customary standards. So, a holiday differential cannot be more than the wage exception maximum. If a holiday pay is to be paid at a wage exception maximum, the wage exception form needs to be completed for that holiday pay per our guidance on page 41. Thank you, Christine. So, we have a number of individuals that are um just now applying to DDA. Some of them are referred to as transitioning youth and others that may be just starting services. Um do these standards apply to them? Do they have to be within the um reasonable and customary standards if they're starting services um July 1st? A great question. Our reasonable and customary standards, as listed in the self-directed services manual, apply to all participants who self-direct their services, including participants who will be self-directing on July 1st, 2025. Thank you. Will the financial management counseling services be reducing hourly rates to align with other reductions in the participant employee vendor wage rates? So I guess this is saying if no action is taken will the um standards that will the wages and rates that are higher than the standards be adjusted to the new standards? Yes they will. Um can a person increase an employees hourly wage up to the maximum exception wage rate? Yes, if the participant h a participant would need to request a wage exception if increasing a rate above the wage maximum. So our wage exception form process as listed in our manual still applies but the flexibilities associated with them are new. So the standards are different for which we would approve them. Thank you, Christie Chantel. There's a question for PPL. Who submits the order of purchase request form? It seems like the vendor did them themselves. That should be submitted by the participant or an employer. Okay, great. Mark um someone noted um the ARC did not provide information regarding vendors. Can you talk about the process for vendor updates? Sure. We don't need a new form or employee change form for that. Um you just update your rate, tell your your vendor or your provider and then when the invoice comes in, just make sure that rate is within the exception um range and we'll process. If it's only thing is if it's if it's above the range we will reject it and return to you to for adjustment. Thank you Christie. With this information we're sharing today about reasonable and customary wages vendor and provider rates. How will this affect the existing plan and the budget? Sure. So um participants will need to review their employee vendor and provider rates to ensure that on July 1st their uh employees vendors and providers are making within the reasonable and customary rights. If a participant is decreasing rates for participants for employees, providers or vendors, no budget modification would be needed because the participant has already budgeted budgeted enough for a higher rate. Great. Thank you. Question. Will all this information be on the DDA website? It is currently the updated manual is updated on the DDA form site right now. Great. So just to add to that um for everybody the um the manual has been updated with a date of May 16th that includes those additional flexibilities for support brokers um and the um additional um information related to whether or not advertisement documentation is required for wage exceptions for positions filled. Um, the template letters that we've been talking about are also on the dedicated self-directed services web page. We have also updated the self-directed services um, training series with this information. And then lastly, I will say based on the um information shared um by Robert White today, we will be updating the manual um to include the chart related to the geographical differential. We'll be working on that and sharing that um early next week and then making any additional adjustments as needed to the training series um documents. But the information we're sharing with you today is available and live on our website and the wage exception form and family and staff overtime form have been updated with the new flexibilities that can be used today. Just going through some additional questions. Question about How does a support broker request an update for all of their participants to ensure that they're up to date? Oh my goodness. Okay, so support brokers should support participants directly in these actions to ensure that they are up to date. We do not recommend that support brokers try to connect with the financial management and counseling services providers for multiple participants at once. It does need to be done on an immediate bas on a individual basis. Thank you, Christie. What does it mean for a position to be vacant when we're talking about these new wage exception form um posting and interviewing requirement? What does vacant mean? It's a great point. The question, the vacant means that for the position in which you are requesting a wage exception form, there is not currently an employee providing that work. They're not currently providing it. So for that role that you're requesting a wage exception for, there is no employee. Great. Thank you. We have some other questions that relate to um other topics that we're not talking about today. Um we will um be reviewing that information and be sharing additional information with you on those items in the near future. question about how can we get the outline. Again, just a reminder that this PowerPoint presentation is available as a handout um and will also be posted to the DDA website including the recording of the PowerPoint presentation. Christie, is it mandatory to hire a support broker? Great question. Support workers are required to be hired by participants who employ family members as direct support professionals or employ anyone to provide individual and family directed goods and services day-to-day administrative supports. Yep. And then depending on your the type of employee, if they're legally responsible person, legal guardian, there may be some additional requirements um for the support broker. It is outlined in the self-directed services manual. Thank you, Dr. Smalls, for going to this slide. The arrow is pointing at where you can um download and get a copy of the PowerPoint presentation. Thank you so much for helping us with that. Um just reading some of the questions. Um for our financial management and counseling service providers, if providers submit invoices without the required information, will that prevent payment? Mark from the ARC. If a provider submits an invoice without the required information, will that prevent payment? Well, the short answer is yes, and we'll provide feedback specifically about what's missing so it can be resubmitted and paid out. Thank you, Megan from GT. Same question. If the provider submits an invoice without the required information, will that prevent payment? Yes. Okay. And Chantel for PPL, if the provider submits an invoice without the required information, will that prevent payment? Yes, our team will document, our invoice team will document what the required information is that's missing and our system and our customer service agents will be able to alert that participant and provider of what is missing. Thank you, Chantel. Christy, the wage exception form asks if the participant has a support broker and then ask for the name in the email. Can you talk about that? And with the person's um option to, you know, include that information and and by including that, what does that do? Absolutely. Um our forms, our smart sheet forms are created in order to quickly alert teams, especially when things are approved um based on stakeholder feedback that we had in the past. So our wage exception form in particular asks if the person has a support broker and then to share the person the support broker's email address so that the support broker can be alerted when and if that wage exception form was approved along with the rest of the team. Thank you Christie. Next question. If I already have a wage exception rate within the new rates, do I need another wage exception form? No. We encourage you to reach out to the SDS email if you have really specific questions. We're happy to take a look at it to confirm, but no. Christie, can you share your thoughts or some information about how the role of the coordinator of community services and the role of the support broker can help with these changes? Absolutely. Coordinators of community service and support brokers work at the direction of the participant to support person- centered planning. And with support brokers in particular, they support human resources, human resources. So that means um hiring employees, firing employees, adjusting those employees rates alongside vendors and providers. So we see the role of both team members to be involved as they would normally be under their own agreements with the participant. So if a participant receives certain support from their support broker in this area, we anticipate support brokers to provide support. uh coordinators of community service of course are responsible to ensure that health and safety are maintained and that participants have what they need in order to live out their person center plan and their good life. So we expect that to continue as well through this process. Great. Thank you. We had some questions about different services um differences between personal supports personal supports and hands. We had some questions about nursing support services earlier and also respit. So I just wanted to share with everybody that your coordinator of community services um can provide some additional support related to waiver specific questions. The DDA has also developed a um plain language um guide to services um that was developed in partnership with um various um advocacy groups and the developmental disabilities council um that provide some general information about our services. In addition, we have dedicated um websites related to the federally approved DDA operated Medicaid waiver programs that has information. So in general um if you have questions please um reach out to the coordinator of community services that can assist you and then there's various information tools um a plain language easy to read guide to service an easier uh version to read from that and then in addition to the actual federally approved waiver document on our programs. Just reviewing some of the [Music] questions. Um, someone noted, so if a wage forms were submitted and denied, no new form is needed and the wage exception rate will be granted. Correct? Okay. So, if a wage exception form was denied, we encourage teams to look at the updated standards and resubmit wage exception forms. Thank you. If you were denied, you can resubmit. There's some new flexibilities. So, there's an opportunity for that to be approved under the new requirements. If your wage except if your wage or rate currently is within the standards and don't exceed that requires a wage exception form, you do not need to submit one. Right? And if your wage um currently exceeds it, then you're going to need take action to include notifying your employee and vendors and providers with the template letters or letter that you use that you'd like to use and also following your financial management and counseling services process. There are a number of people that are giving us some specific examples um that um we're happy to um get back to you if you want to send them directly to the SDS um email account or talk it through with your team. Um it's just it will be difficult to go through some of these narratives that we've got shared here. Next question. Christine, please clarify whether wage exception approvals follows a participant through a financial management and counseling service change. That's a great question. We did update some flexibilities in our manual to account for this. Wage exception forms do follow an employee if a participant changes financial management and counseling services providers. Now there are a couple of eccentricities related to this area. So, if someone is transitioning between an between financial management and counseling services providers um and is concerned about a wage exception form, we really request you reach out to the SDS email. We're happy to take a look to ensure that the the the new financial management and counseling services provider has that approved wage exception. Great. Thank you. Yeah, we hope this new flexibility will support individuals um and the teams. We have um a question. Will the ARC or we could say the financial management counseling service provider inform me of my new wage rate? So Christie, can you um again share and remind us um responsibility as the employer, so the participant in the program in terms of communicating wage rates etc. Yep. Participants as the employer of record are responsible for alerting their employees to the rates that they make. If a rate is being decreased, participants are responsible for alerting those employees of that rate decrease. If participants do not do that, they may be subject to that Maryland labor law. So, we really encourage participants to take immediate action to take a look at these rates to make sure that their employees will be in compliance with these new rates July 1. Thank you, Christie. And the rates need to be within the reasonable and customary standards that are noted in the manual. And just a reminder, we'll be updating information for that geographical situation. Do wage exception requests need to be submitted each budget year? No, they do not. The wage exceptions, wage exception forms when they are approved are effective for that employee as long as they're within the reason as long as they're within the reasonable and customary standards. So wage exception forms do not need to be completed annually, but they do need to be within the reasonable customary standards. Correct. Okay. Um there's a question about the maximum rate for holiday pay. Um remember um Christy did share with us earlier that holiday pay is an option that employers can consider. We have information in our manual um but it must be within the reasonable and customary um standards. More questions about whether budget modifications are needed. Um Christy has shared that they are not required. You do need to take action related to notifying your employee and your vendor and completing the financial management and counseling service process. Just reading to see if there's any new questions or different types of questions. Um, more questions about um, where to find the slides. um some of the FMCS questions we've reviewed. Just trying to see if there's a new one as we're wrapping up our time together. I want to make a note in the chat. There is an email address. It is [email protected]. That is the best email to email regarding questions regarding this webinar today. If you email me directly, I will be responsive, but our DDA SDS team will be far more responsive. So, we really encourage you to use the DDA. SDSaryland.gov email. Thank you. All right, this will be our last question and then I'll do some closing. Um Christie, do you need to send a letter to family as staff who live with the employer if the rates need to change? It's a really great question. Participants are the employer of record of all of their employees, including employees who they are related to and employees that live with them. So if employers do not alert their employees of a wage reduction, they are in violation of that labor law. So we strongly encourage employers to send letters to all employees regardless of their familial relationship or a friendship or that they live with someone. We've really encouraged that to be in writing. Excellent. Thank you. On behalf of the Developmental Disabilities Administration, we want to thank you for joining us today. Um, as we shared information related to the updates of reasonable and customary standards. Um, we appreciate your time and hope that the information that we have provided in partnership with our financial management and counseling services providers provides um, information to help you in terms of action that you may need to take. Um each of the FMCS's have um shared information related to customer service um information that you can reach out to them for questions you have. And Christie has again shared with us um the email for the SDS um dedicated DDA account. We've also shared today some additional flexibilities that are reflected um in our presentation in addition to the U manual that was posted today. They include some additional flexibilities related to support brokers, additional flexibilities related to wage exception forms transitioning um from financial management counseling services providers and additional flexibilities um related to wage exception forms no longer requiring um advertisement um if a position is currently filled. um we will make those additional updates related to the geographical differential and we will um consider all the comments and feedback that we received today. Again, we appreciate you and wish you a good weekend and look forward to any additional assistance that we can provide for you. Thank you.