How are service authorization requests handled?
All eligible Members who wish to receive OPWDD HCBS waiver services must receive authorization from their local Developmental Disabilities Regional Office (DDRO) before a service can be rendered.
How are services authorized?
Services are first authorized when the individual applies for the HCBS waiver via the Request for Service Authorization (RSA) form. Individuals who are already enrolled in the HCBS waiver services are authorized via the Service Amendment Request Form (SARF).
What is the SARF?
The Service Amendment Request Form (SARF) is completed by the Care Manager when a change must be made to an enrolled member’s HCBS waiver services. This includes a request to add a new waiver service, to increase or decrease the number of approved units for an existing waiver service, and to request a change in service provider for an existing waiver service.
Once a Provider has been identified for a service
A discussion occurs between the Care Manager, the Member, and their representative to determine the number of hours or days the Member seeks to receive services. From there, the Care Manager converts the hours or days into units to prepare the SARF. The Care Manager works to update the consent to include the new provider so that information can be shared.
The provider works with the Care Manager to help provide justification for the request. This information is included when submitting the SARF.
After the necessary discussions have taken place, the Care Management team completes the SARF, sends an email to the appropriate DDRO alert email box, and uploads the SARF to Supporting Documents in CHOICES.
OPWDD reviews the form, contacts the Care Manager and their supervisor if corrections need to be made, and then either approves or denies the request.
When is the NOD.09 issued?
Once the SARF is approved, OPWDD will issue an NOD.09, or Service Authorization Notice of Decision, to the Member, their representative, and the Care Manager. The Care Manager will then notify the provider and send a copy of the NOD.09 for their records. Please be aware if a provider submits the DDP1 and delivers services before receiving the NOD.09; this may jeopardize billing. Medicaid will not reimburse the provider until OPWDD has authorized the service. If the SARF is not approved, the Care Manager should work with the member, their representative, and the provider to obtain additional justification or determine a more appropriate service if necessary.
Ensuring a smooth process
The CCOs are actively developing a tracking and monitoring system to help ensure that the SARF process moves as quickly as possible. Please note that while the life plan is a supporting document for the SARF, directives on how to reflect the requested service in the life plan vary by DDRO.