Provider Rates and Rate Settings
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As a service provider, knowing your rate and understanding how rates are set is critical. Rate setting rules are established both by the statute (Lanterman Act) and regulation (Title 17) and dictate the type of rate needed for a particular service type. Following are key terms associated with rates and rate setting, information related to various processes used for rate changes, as well as ongoing rate reform efforts.
Types of Rates
Schedule of Maximum Allowances (SMA): Medi-Cal reimbursement rates which are established by Department of Health Care Services (DHCS) and generally applied to medically related services. If a service provider rate is less than the SMA, Lanterman pays the service provider rate.
Usual and Customary(U&C): If at least one-third of the individuals served by the provider are not served by the regional center then the regional center is allowed to pay the same rates charged to the general public.
Negotiated/Median Rate: The regional center may negotiate a rate up to the regional center’s current median rate or the statewide median rate, whichever is lower.
Rates set by DDS: DDS sets rates of reimbursement by either cost statement, statute or regulation.
More information about rates is available on the DDS website.
Do you still have rate questions? Please use the contact form on this page and submit your inquiry to Lanterman’s Community Services department.
Statewide Minimum Wage Changes
Effective January 2025, The Department of Developmental Services (DDS) and regional centers will no longer use an excel workbook process to adjust minimum wages for services providers with DDS and Negotiated/Median Rates. Instead, moving forward DDS will automatically adjust rates as needed in order for service providers to pay employees the new minimum wage.
Local Wage Rate Exceptions
Many cities in the Greater Los Angeles area have local minimum wages that are higher than the state minimum wage. Service providers operating in those locales for which the current rate doesn’t allow them to provide services may request a health and safety waiver. More information can be found on the DDS website. If you believe you are eligible, use the contact form to submit your rate-related inquiry.
Other Rate Exceptions
Other exceptions may exist under the health and safety waiver and are considered on a case-by-base basis (See DDS website). If you believe you are eligible, use the contact form to submit your rate-related inquiry.
Rate Reform Implementation
The Department of Developmental Services (DDS) is preparing for full implementation of rate reform in alignment with Welfare and Institutions Code (WIC) section 4519.10.
The Governor’s 2024 Budget proposes to return full implementation to the original date of July 1, 2025 from the accelerated date of July 1, 2024. The budget proposal includes the continuation of the quality incentive program funding outside of the rate models through fiscal year 2024/25. More information regarding the quality incentive program can be found here.
DDS is currently hosting workgroups with regional center, service provider and other community stakeholders to review service codes which need to come into alignment with the rate study rate models. Written guidance and resource materials will be developed to support service providers’ understanding about what is expected and training, and technical assistance will be provided as needed.
DDS will continue to share information as it becomes available. If you would like to receive rate reform implementation updates directly from DDS you can be added to the DDS distribution list here.
Please note that the first two of three rate reform increases have already taken place via a worksheet process at the regional center level, the first in April 2022 and the second in January 2023. If you believe you did not receive previous increases, use the contact form to submit your rate-related inquiry.
More information pertaining to the Rate Study Implementation can be found here.
FAQ
Get Answers
How do I become a Lanterman service provider?
Service providers must be vendored by a regional center before they can provide and be reimbursed for services. Please see our “How to Become a Service Provider” page, which provides detailed instructions.
How can I make a change to the services I provide?
Any change to your existing vendorization needs to be reviewed and processed by Lanterman’s Community Services Unit.
- Organizational changes require submission of a letter in advance of the change consistent with the parameters and process found here.
- If you are interested in providing additional services, use the contact form to connect with one of Lanterman’s Resource Developers.
How can I renegotiate my rate?
Rate setting rules are established both by the statute (Lanterman Act) and regulation (Title 17) and dictate the type of rate needed for a particular service type. Providers with negotiated/median rates or DDS set rates can adjust rates based on minimum wage ordinances, Health and Safety Waiver needs or statutory/regulatory changes. Providers with Medi-Cal set rates, can see rate changes consistent with Medi-Cal rate changes. Usual and Customary Services providers can request rate adjustments consistent with changes to their general fee schedule. Please click here for a full description of different rate types and a description of rate changes.
What is FDLRC’s service provider insurance requirement?
All service providers, whether vendored by Lanterman or another regional center that serve Lanterman individuals, must carry liability insurance and name Frank D. Lanterman Regional Center as additional insured consistent with the following insurance memo. Additionally, updated insurance certificates must be submitted to Irma Padilla at ipadilla@lanterman.org.
What is a DS1891 and why do I need to resubmit?
The DS1891 Disclosure Statement is a Department of Developmental Services (DDS) form which must be completed at the time of vendorization and subsequently every 2 years moving forward unless requested by the regional center sooner. In short, this statutory requirement (WIC Code § 4748.12) does not allow individuals or organizations convicted of fraud, abuse or neglect to be vendored. Regional centers are required to monitor vendorization requirements biennially per California Code of Regulations Title 17 § 54332(b).
How can I get help with e-billing?
Every regional center service provider has an assignment Accounting Associate who can help with all payment and billing issues. You can find your assigned Accounting Associate here and by logging into your e-billing portal.
How can I let service coordinators know about my services?
At the time of vendorization, Community Services notifies all of service coordination staff of the newly vendored service provider. Capacity and availability can be communicated to Quality Assurance Manager Sonia Garibay at sgaribay@lanterman.org or Director of Community Services Pablo Ibañez at pibanez@lanterman.org. In turn, Community Services will notify service coordination of your services.
How do I find out who is the service coordinator assigned to the individual we are serving?
For school aged individuals and younger, please contact Associate Director of Client and Family Services Rose Chacana at rchacana@lanterman.org. For adults served by the regional center, please contact Associate Director of Client and Family Services, Megan Mendes, at mmendes@lanterman.org.