9.17-DSP Retention Payments- Waiver Services

Guidance from DODD:

Background

The Ohio Department of Developmental Disabilities (DODD) along with the county board-funded Direct Support Professional (DSP) retention payment initiative for independent providers and DSPs of agency waiver providers.  On Tuesday, December 13 2022, the Ohio Legislature amended language to authorize the payments into House Bill 45. The bill passed the Ohio Senate and Ohio House.  On Thursday, December 15 2022, following legislative approval, Governor DeWine signed an executive order which authorized DODD to file an emergency rule. This progress allows DODD to launch the initiative and partner with county boards of developmental disabilities to issue payments in 2023.

How the initiative works

In July, the federal Centers for Medicare and Medicaid Services (CMS) approved the initiative with an effective date of July 1. This allows for these payments to be retroactive to that date. Quarterly payments will be distributed to participating home and community-based waiver providers that opt-in. Participating agency providers must distribute the vast majority of the payment to eligible DSPs. Every quarter, participating agency providers are then required to report certain data elements and attest that the funds were used in accordance with all requirements. Independent providers are eligible for payments and will not need to opt-in or report to participate.  This investment aims to assist Ohio’s developmental disabilities system in addressing the workforce crisis through retention incentives for DSPs. With a federal match, county boards will generate approximately $143 million annually for retention payments to the DSP workforce.

Retention payments will be distributed quarterly from DODD to participating home and community-based waiver providers, and providers will then send retention payments to each eligible DSP. Every quarter, participating agency providers will be required to report certain data elements and attest that the funds were used in accordance with all requirements. Independent providers are eligible for payments and will not need to opt-in or report to participate. Waiver providers, including independent providers, of the following services are eligible for the payments:   

First payment structure 2023

Because the initiative is retroactive to July 2022, initial payments will cover three quarters of payments. This will allow DODD to expedite payments allowing funds to get out sooner and will put the initiative on schedule with rule requirements by April. DODD will stagger the three initial payments to providers, which will assist providers in tracking how funds are passed along to DSPs. The table below shows how the first payments will be issued:

Starting Tuesday, January 3rd 2023, waiver agency providers can enroll online through the eMBS application. Registration will remain open for initial payments until January 16th 2023. Provider agencies and independent providers will receive the first payments in mid-January. Eligible DSPs employed by agency providers will receive payment from their employers by mid-March. To receive a retention payment, an agency provider must opt-in, provide all required data (every quarter), and attest that the funds were used in accordance with all requirements.

Reporting and Payment Timelines 2023

Who are eligible employees per DODD guidance?

To be eligible to receive an employee payment, staff 1) must have provided direct support or otherwise supported the provision of direct support during the applicable calendar quarter and 2) must still be employed at the time the retention payments are processed by the participating agency provider.

Eligible staff for an applicable quarter is defined as a person that has the opportunity to be alone with or exercises supervision or control over one or more individuals with developmental disabilities and engaged in such support for at least 50% of their total hours worked in the applicable quarter. This includes direct support professionals, front-line supervisors, vehicle drivers, and similar employees.

In general, non-staff, contracted workers, administrators, owners, and/or executive staff are not eligible employees.

DODD Guidance: determination of how much to pay each eligible employee

Participating agency providers have only two options for calculating eligible employee payments:

1. Total wages
   1. Each employee gets the same percentage of their total wages (regular and overtime combined)
   2. Total amount available / total wages (regular and overtime) = % adjustment in wages
   3. % adjustment in wages X eligible employee total wages = employee payment
2. Total eligible employees
   1. Each eligible employee gets the same amount
   2. Total amount available / number of eligible employees = employee payment

Open Door Implementation of DSP Retention Payments:

After opting-in to program, Open Door will use the template provided by DODD to determine bonus amounts per employee.  When completing the template, ONLY those DSPs who worked during the specified quarter and are still actively working on the cut-off date when bonus is batched in the payroll system and meet employed status by Open Door in the eligible waiver settings will be included in the bonus calculation.  These distributions will be ran on weeks opposite of typical payroll to assist with separate documentation and audit trail documentation and will be issued to meet deadlines required by DODD.

All frontline supervisors are eligible at Open Door due to them being assigned 100% of their hours working in direct care positions.  For determination of eligibility for other positions, Open Door will include only those not in executive leadership positions that worked at least 50% of their total work hours in direct care services per the template, 82% of paid claims for the quarter will be directly distributed to those eligible employees per the amount determined by automatic calculation through the spreadsheet. 

Per DODD guidance, the remaining 18% of claims paid amount can be used for implementation, additional employee compensation, or activities that enhance the experience of the direct service professional and/or improve service delivery.

Implementation expenses- Additional payroll expenses, tax obligations not covered by the standard formula, increased worker’s compensation expenses, etc.

Additional employee compensation- Paid time off, childcare services, transportation vouchers, health insurance benefits, 401K match, etc.

Employee incentives- Wellness programs, performance/attendance bonuses, employee recognition initiatives, etc.

Training- Employee certification programs, skill-based professional development, competency-based add-on training, etc.

Direct support professional recruitment- Marketing, advertising, hiring/sign-on bonuses, etc.

The withholding allowance may be used for existing retention or workforce enhancement programs if such use results in a net increase in expenses that is equal to or greater than the amount withheld. In other words, these funds should add to the program, not replace funds already dedicated to existing retention or other workforce enhancement programs.

Open Door will ensure that usage of these funds are clearly documented and supported by the guidance above.  Furthermore, Open Door will maintain template copies and payroll journal documentation to support the 82% DSP distributions.  These will be maintained in agency Accounting shared folder for audit purposes.