The Office of Developmental Programs (ODP) is pleased to announce the publication of bulletin 00-26-04 “Handbook for Claim and Service Documentation” (see attachments to this email). Please note the effective date of this bulletin is January 1, 2027. The purpose of this bulletin is to provide guidance on documentation needed to substantiate a claim and guidance on the service documentation processes. There are some new requirements in this bulletin which include:
- The provider’s full name or MPI must be included on service notes.
- For services delivered in a facility-based setting or if there is a staff ratio greater than 1:1, the names of all professionals who delivered services must be documented in the service note.
- Service notes must indicate the general names of locations in the community where services were delivered such as the name of a restaurant, park, or community activity. Documenting “community” or “other” does not meet this requirement.
- Providers of Residential Habilitation, Life Sharing, and Supported Living services in the Consolidated, Community Living or Adult Autism Waivers must include start and end times of when the individual is receiving services or unpaid support that are not included in the residential service in the service note. A description of what occurred during these times is not required to be included in the residential service note.
- Service note and documentation requirements have been updated for Supports Coordination Organizations to align with Performance-Based Contracting changes that will be effective January 1, 2027.
- If there is a discrepancy of more than 25% between utilization of services and authorization of services during the period of time covered by the progress note, there must be an explanation in the progress note that describes the reason for the discrepancy and whether adjustments in the back-up plan and/or service provision will be made to ensure needed and authorized services are provided at the duration and frequency noted in the ISP.
- Services in the attachments have been updated to reflect recently approved waivers such as the addition of the Specialty Telehealth and Assessment Team service and American Sign Language – English Interpreter service.
Attachment 1: Technical Guidance for Claim and Service Documentation
