Retainer payment limits for adult day care centers
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Defines Simply Healthcare Plans' application of CMS guidance limiting retainer payments to home- and community-based providers (adult day care centers) participating in iBudget waiver and long-term care programs; affects providers seeking monthly retainer payments from Simply.
Retainer payments are limited to no more than three 30-day periods per provider in accordance with recent CMS guidance.
Retainer Payment Coverage Criteria
Retainer payment criteria
Covered when ALL of the following are met:
Coding and Duration Limits
| No codes listed |
What Providers Must Know / Do
Retainer payment limit — max 3 months
Providers may not receive retainer payments from Simply for more than three months. Providers who have already received approvals and have not yet reached the three-month limit will continue to receive payments only until the three-month cap is reached; no retainer payments will be made for months beyond the three-month limit.
- Limit equals three 30-day periods (three months).
- If a provider already received three months of retainer payments, Simply will not make additional payments.
- Existing approvals continue only until the total three-month limit is reached.
Definitions
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