Transcript Title Subtitle Date

NEW CONSULTANT TRAINING
November 28 & 29, 2012
Rick Scott
Governor
Barbara Palmer
Director
Welcome and Introductions
Ivonne Gonzalez
Training and Outreach Coordinator
Submit questions throughout this presentation to:
[email protected]
2
Training Objectives
•Identify the Five Principles of Self Determination
•Describe the roles and responsibilities of Participant,
Representative, Consultant, Area and State Office
•Describe different provider types
•Demonstrate how to write a Purchasing Plan
•Describe how to properly manage your CDC+ Budget
•Demonstrate how to Reconcile the account
3
CDC+ Tools
• The Developmental Disabilities Medicaid Waivers
Consumer-Directed Care Plus Program
Coverage, Limitations and Reimbursement
Handbook (CDC+ Rule Handbook)
• Participant Notebook
• Appendix to Handbook & Participant Notebook
4
CDC+ History
•In 2000- Consumer-Directed Care(CDC)- Pilot Program
•Demonstration phase January 2004 (CDC+)
•Permanent Program March 2008, authorized by Medicaid
through the 1915j State Plan Amendment
•Expansion Fall 2009
•2500 new participants
•Training and enrollment
•CDC+ Rule
•Adopted as of 11/12/12 -Any changes that occur will be
shared
5
5
What is CDC+
•Long-term care program alternative
•Based on principles of Self-Determination and
Person-Centered Planning
•Provides opportunities to improve quality of life
6
Self-Determination and
Person Centered Planning
Person-Centered Planning
Principles of Self-Determination
Freedom
Authority
Support
Control
Responsibility
7
CDC+ Eligibility and Enrollment
Requirements
•Enrolled in the DD/HCBS waiver
•Able to direct own care
•Live in family or own home
8
iBudget Transition
• Tier Waiver to iBudget by (July 1, 2013)
• Authorized iBudget funds determine CDC+ Monthly Budget
• CDC+ participants will still manage their iBudget funds in
accordance with the CDC+ Rule Handbook
More information regarding iBudget on iBudgetFlorida.org
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Roles and Responsibilities
•Participant
•CDC+ Representative
•Consultant
•Area Liaison
•State Office
10
Role of Participant
(when representative not selected)
•Authorized signer
•Decision maker
•Employer
•Develops Purchasing Plan
11
Role of Participant, continued
•Maintains accurate and complete records
•Spends CDC+ budget responsibly
•Complies with training and monitoring requirements
•Develops Emergency Backup Plan (CDC+ Rule Handbook pg
3-3)
12
Role of CDC+ Representative,
•Same role as Participant
•Unpaid Advocate; at least 18 years of age
•Readily available to Participant and Consultant
•Responsible for appropriate use of public
money
13
Consultant Requirements
•Be a Waiver Support Coordinator in good standing
•Complete CDC+ New Consultant Training
•Pass Readiness Review
•Enroll as a Medicaid provider for consultant services
•Complete CDC+ registration forms
•Sign Memorandum of Agreement
14
Role of Consultant
•Waiver Support Coordinator
•Complies with training and monitoring requirements
•Sign a participant/consultant agreement
•Provides on-going technical assistance
15
Role of Consultant, continued
•Reviews and signs off on CDC+ documents
•Responsible for appropriate use of public money
16
Role of Consultant,
continued
•Develops and updates support plan
•Ensures cost plan is updated
•Monitors and reviews participant account activity
•Ensures Medicaid eligibility
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Role of Consultant,
continued
•Keeps active contact with Participant
Monthly – by phone or in person
Annually – two face-to-face per year
•Completes monthly review documentation
•Communicates effectively with Area Liaison
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Role of Area Liason
•Authorizes CDC+ Budget
•Reviews Purchasing Plans
•Facilitates employee background screening
•Liaison between participant, consultant, and
State office
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Role of State Office
•Administers CDC+ Program
•Develops policies
•Approves CDC+ Monthly Budget
•Develops and provides training
•Provides Customer service
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Role of State Office, continued
•Provides Quality assurance
•Assigns Provider ID Numbers
•Pays service claims and employer taxes
•Sends monthly statements
•Monitors consumer spending
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Quality Assurance Requirement
•Consultant
•Participant
Person Centered Review
Provider Discovery Review
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Steps for CDC+ Participant
Enrollment
•Expresses interest
•Completes training
•Passes Readiness Review
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Steps for CDC+ Participant
Enrollment, continued
•Application Packet
•2 page application document
•Cost plan service authorization summaries
•Budget calculation worksheet
•Enrollment Packet
•8821 – IRS
•2678 – IRS
•Fiscal Informed Consent
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Steps for CDC+ Participant
Enrollment, continued
•Area calculates monthly budget
•Participant chooses supports and services
•Participant interviews potential providers
•Providers complete background screening
requirements
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Steps for CDC+ Participant
Enrollment, continued
•Participant develops and submits purchasing plan;
CDC+ approves plan
•Participant completes and submits employee and
vendor packets; CDC+ issues provider ID’s
•Participant begins self directing supports and
services
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Calculating the Monthly Budget
•Budget calculation worksheet – Participant Notebook Appendix
D(3)
•Current approved DD/HCBS Waiver Cost Plan
•Discount rate- 8%
•Administrative fee- 4% or max amount of $160.00
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Calculating the Monthly Budget,
continued
•PCA for children under 21 (use different Budget
Calculation Worksheet) paid through Medicaid State
Plan-(procedure code S9122TJ)
•STE-Short Term Expenditure & OTE-One Time
Expenditure
•Consultant fee is not part of monthly budget (billed
directly through FMMIS)
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Total Cost
Plan Amt
Service
Number
of
Monthly Cost
months
Plan
PCA
$
7,200.00
12 $
600.00
Respite
$
8,870.40
12 $
739.20
PT
$
5,340.80
12 $
445.07
Trans
$
8,049.60
12 $
670.80
ST
$
3,204.98
12 $
267.08
CMS
$
372.40
12 $
31.03
Total
$ 33,038.18
$
2,753.18
Take the percentages of Col D Total
0.92
$
This is the CDC+ Monthly Budget
2,532.93
$
(160.00)
$
$
2,372.90
2,753.18
0.92
2,532.93
(110.13)
$
$
This is the CDC+ Monthly Budget
$
$
2,753.18
0.04
$
If more than $4,000.00, use $160 for fees
If less than $4,000, use 4% calculation for fees
110.13
Consultant services or funds for either OTEs or STEs are not
included in the calculation of the monthly budget
2,422.80
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Participant Controls
What, when, who, where and how support & services
will be provided that best meet their needs & goals
•Setting Priorities
•CDC+ Program Services (CDC+ Rule Handbook Chapter 4)
•Restricted or Unrestricted (CDC+ Rule Handbook pgs. 4-3, 4-4)
•Allowable purchases (CDC+ Rule Handbook pgs.1-5, 3-8)
•Unallowable purchases (CDC+ Rule Handbook pgs.1-19, 3-9)
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CDC+ Program Services
•Every service contains a definition to include:
Descriptions, limitations, special conditions,
provider qualifications and service type.
(CDC+ Rule Handbook Chapter 4)
•Service codes and abbreviations can be found in
the Service Code Chart
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CDC+ SERVICE CODE CHART
RESTRICTED SERVICES
Service Name
Adult dental services
Behavior Analysis Services
Behavior Analysis Assessment
Behavioral Assistant Services
Dietitian Services
Occupational Therapy
Occupational Therapy Assessment
Physical therapy
Physical Therapy Assessment
Private Duty Nursing/LPN
Private Duty Nursing/RN
Respiratory Therapy
Respiratory Therapy Assessment
Skilled Nurse/LPN
Skilled Nurse/RN
Specialized Mental Health Services/ Therapy and Assessment
Speech Therapy
Speech Therapy Assessment
Environmental Modification Assessment
Durable Medical Equipment and Supplies
Environmental Modifications
Vehicle Modification
Abbreviation
DENT
BT
BTA
BTS
DIET
OT
OTA
PT
PTA
PDL
PDR
RT
RTA
SNL
SNR
Service Code
03
06
06A
08
12
29
29A
38
38A
49
50
45
45A
47
48
MHT
51
ST
STA
ENVA
EQUIP
ENV
VMOD
53
53A
14A
83
14
80
Abbreviation
ADT
ADV
CAMP
COMP
CMS
EMP
GYM
IHS
OTC
PCA
PERS
PERSI
PARTS
RHAB
RSPD
RSPH
SLC
TRNG
TRAN
XTHER
Service Code
02
89
85
11
63
55
88
22
65
32
33
33A
82
43
58
46
56
61
60
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UNRESTRICTED SERVICES
Service Name
Adult Day Training
Advertizing
Seasonal Camp
Companion Services
Consumable Medical Supplies
Supported Employment
Gym Membership
In-Home Supports
Over-The-Counter Medications
Personal Care Assistance
Personal Emergency Response System (PERS)
PERS Installation
Parts and Repairs Therapeutic or Adaptive Equipment
Residential Habilitation Services
Respite Care- Day
Respite Care- Hour
Supported Living Coaching
Specialized Training
Transportation
Other Therapies
FOR CONSUMERS PARTICIPATING IN THE FLORIDA FREEDOM INITIATIVE (FFI) ONLY
Service Name
Microenterprise
Vehicle
Abbreviation
MICRO
VEH
Service Code
75F
70F
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Provider Types
•Directly Hired Employee (DHE)
•Agency/Vendor (A/V)
•Independent Contractor (IC)
33
How to Find, Hire and Manage
Providers?
•Identify service/support being purchased
•Type of provider needed
•Provider requirements
•Hiring packet – (Appendix E of the Notebook)
34
How to Find, Hire and Manage
Providers, continued
Employee Packets- (Appendix G Notebook)
Vendor Packets- (Appendix H Notebook)
Background Screenings
Level 2 for all providers listed on a Purchasing Plan
Valid for 5 years- provided there is not a break in
service of 90 days or more.
35
Directly Hired Employee
Services
•The Participant decides
what will be done and create job description
how services will be performed
the hours per week/month worked
hourly rate of pay (negotiable)
Companion- only service exempt from minimum wage
requirements
•The Participant must
review, approve, & submit timesheet
budget for applicable employer taxes
36
Agency/Vendor and
Independent Contractor
•A person or business that provides
services/supports
•Participant controls/directs only the result
of work performed, and not the means
and methods of accomplishing the result
•Participant pays from submitted invoice
•No Taxes withheld or paid
37
Hiring an A/V, IC or DHE
Agency/Vendor (A/V) or
Independent Contractor (IC)
Directly Hired Employee
• Vendor/Independent
• Employee Information
Form
• Internal Revenue Service
(IRS) Form W-4
• Department of Homeland
Security (DHS) Form I-9
• Background Screening
Clearance Letter
Contractor Information
Form
• Internal Revenue Service
(IRS) Form W-9
• Background Screening
Letter
• Optional- Direct Deposit Form (EFT)- include a copy of a pre-printed voided check
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Purchasing Plan –
Appendix E
•Describes how CDC+ monthly budget will be
spent to meet needs and goals
 Authorizes services/supports
 Authorizes providers
•Developed by Participant or Representative
Consultant may provide technical assistance
and guidance (CDC+ Rule Handbook Appendix E)
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Purchasing Plan – Timelines
Person
Responsible
Activity
Due Date
Participant
(Representative)
Complete Purchase Plan;
submit to Consultant
By the 5th of the month
Consultant
Review and sign; submit
to Area Liaison
By the 10th of the month
Area Liaison
Review and sign; submit
to State Office
By the 20th of the month
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Purchasing Plan Types
•New Purchasing Plan
•Purchasing Plan Change
•Purchasing Plan Update
•Quick Update
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OTE/STE Expenditure
• One Time Expenditure- 100% of authorized
amount - only 3 services:
• Equipment/Devices DME
• Environmental Modifications
• Vehicle Modifications
• Short Term Expenditure-Services authorized in
waiver cost plan that are approved for 6 months or
less, or are periodic in nature – ex. Dental,
Assessments
42
Restricted/Unrestricted Services
• Restricted Services-requires a licensed
provider, 92% of the units of measure that are
approved in the Cost Plan must be utilized
• Unrestricted services-services and supports
that a CDC+ Participant may purchase provided
the service meets needs and goals as identified in
the support plan.
43
Critical Services
• Critical Services- require two emergency backup
providers who are ready and able to drop
everything and come to work as an emergency
backup, ex. PCA
44
Navigating the Template
45
Purchasing Plan Sections
The CDC+ Purchasing Plan consists of:
Page 1 – Section A – Basic Information
Page 2 – Section B – Needs and Goals
Page 3 – Section C.1 and C.2 – Services and Supplies
Page 4 – Section D – Cash
Page 5 – Sections E and F – Savings Plan and OTEs/STEs
Page 6 – Budget Summary and Signatures
46
Purchasing Plan Instructions
• Open blank Purchasing Plan
• Follow along slide by slide
• Reference tools
47
CDC+ Purchasing Plan
Page 1 - Top
Provide the required information
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Purchasing Plan - Page 1
Section A – Participant Information
49
Purchasing Plan - Page 1
Section A – Participant Information (continued)
50
Purchasing Plan - Page 1
Section A – Reason for Submitting Purchasing Plan
51
Purchasing Plan - Page 1
Section A – Reason for Submitting Purchasing Plan (continued)
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Purchasing Plan - Page 1
Section A – Reason for Submitting Purchasing Plan (continued)
53
Purchasing Plan - Page 2
Section B – Needs
54
Purchasing Plan - Page 2
Section B – Needs – Column 1
55
Purchasing Plan - Page 2
Section B – Needs – Column 2
56
Purchasing Plan - Page 2
Section B – Needs – Column 2 (continued)
57
Purchasing Plan - Page 2
Section B – Needs – Column 3
58
Purchasing Plan - Page 2
Section B – Needs – Column 3
59
Purchasing Plan - Page 3
Section C.1 – Budget Details – Services
60
Purchasing Plan - Page 3
Section C.1 – Budget Details – Services (continued)
•
Direct Hire Employee (DHE) provider relationship numbers:
1 = Parent or step-parent
2 = Participant’s child or stepchild under age 21
4 = Person under 18 currently in high school (not participant’s child or stepchild)
3 = Spouse
5 = All others
61
Purchasing Plan - Page 3
Section C.1 – Budget Details – Services (continued)
62
Purchasing Plan - Page 3
Section C.1 – Budget Details – Services (continued)
63
Purchasing Plan - Page 3
Section C.1 – Budget Details – Services – EBU Added Cost
64
Purchasing Plan - Page 3
Section C.1 – Budget Details – Services – Totals
65
Purchasing Plan - Page 3
Section C.2 – Budget Details – Supplies
•
Only two (2) supply types can be listed:
CMS – Consumable Medical Supplies (63)
NUTR – Nutritional Supplements (66)
66
Purchasing Plan - Page 3
Section C.2 – Budget Details – Supplies (continued)
•
List all supply providers and detailed descriptions for each supply including quantity
Examples:
Adult Large Diapers (96)
Adult Large Diapers (96), 1 case Wipes (6), 2 boxes Bed Pads (24) = 1 unit
67
Purchasing Plan - Page 3
Section C.2 – Budget Details – Supplies (continued)
68
Purchasing Plan - Page 3
Section C.2 – Budget Details – Supplies (continued)
69
Purchasing Plan - Page 4
Section D – Budget Details – Purchases to be made with Cash
•
Only four (4) service codes can be purchased with cash:
TRANS – Transportation (60)
NUTR - Nutritional Supplements (66)
CMS – Consumable Medical Supplies (63)
OTC – Over-the Counter Medications (65)
70
Purchasing Plan - Page 4
Section D – Budget Details – Cash Purchases (continued)
71
Purchasing Plan - Page 4
Section D – Budget Details – Cash Purchases – Total
72
Purchasing Plan - Page 5
Section E – Savings Plan – Authorizations for Use of Accumulated,
Unrestricted Funds
73
Purchasing Plan - Page 5
Section E – Savings Plan – Authorizations for use of Accumulated,
Unrestricted Funds (continued)
74
Purchasing Plan - Page 5
Section E – Savings Plan – Authorizations for use of Accumulated,
Unrestricted Funds (continued)
75
Purchasing Plan - Page 5
Section E – Savings Plan – Authorizations for use of Accumulated,
Unrestricted Funds (continued)
76
Purchasing Plan - Page 5
Section E – Savings Plan – Authorizations for use of Accumulated,
Unrestricted Funds (continued)
77
Purchasing Plan - Page 5
Section E – Savings Plan – Authorizations for use of Accumulated,
Unrestricted Funds (continued)
78
Purchasing Plan - Page 5
Section F – Budget Detail – One Time and Short Term Expenditures
79
Purchasing Plan - Page 5
Section F – Budget Detail – OTEs and STEs (continued)
80
Purchasing Plan - Page 5
Section F – Budget Detail – OTEs and STEs (continued)
81
Purchasing Plan - Page 5
Section F – Budget Detail – OTEs and STEs (continued)
82
Purchasing Plan - Page 5
Section F – Budget Detail – OTEs and STEs (continued)
83
Purchasing Plan - Page 6
Budget Summary
84
Purchasing Plan - Page 6
Budget Summary (continued)
85
Purchasing Plan - Page 6
Signatures – Participant or CDC+ Representative
86
Purchasing Plan - Page 6
Signatures – Consultant
87
Purchasing Plan - Page 6
Signatures – APD Staff
88
Purchasing Plan - Page 6
Signatures – APD Staff (continued)
89
Purchasing Plan
Submission Process
Participant Responsibilities:
•
•
•
•
•
Double-check all information
Minimum six (6) completed pages
Submit all required paperwork
Retain copies
Submit by 5th of the month
90
Purchasing Plan
Submission Process
Consultant Responsibilities:
• Review for accuracy
• Signs the Purchasing Plan
• Submit by 10th of the month
91
Purchasing Plan
Submission Process
Area Office Responsibilities:
• Review for accuracy and signatures
• Ensures all documents enclosed
• Submit by 20th of the month
92
Purchasing Plan
Approval Process
CDC+ Central Office:
•
•
•
•
•
•
Reviews submitted documents
Returns if revisions are needed
Approves and processes documents
Assigns provider identification (ID) numbers
Contacts new participant with ID numbers and start date
Provides approved Budget Summary copy
93
Developing a Purchasing Plan
GROUP ACTIVITY
• Developing a Purchasing Plan using a
Training Scenario
• Developing a Quick Update
• Signing off on both
94
Getting Claims Paid
•Directly
Hired Employees
•Time Sheets –(CDC+ Rule Handbook Appendix G-2)
•Vendors (AV, IC)
•Invoice
•Must be tracked – (Participant Notebook Appendix K (3,4)
•Rep Reimbursements (Savings, OTE/STE)
•Receipt
•Must be tracked – (Participant Notebook Appendix K (6)
95
Getting Claims Paid, continued
•Bi-weekly payroll
•Pay Schedule – (CDC+ Notebook Appendix O (4))
•CDC+ work week (12:00am midnight Monday - 11:59pm Sunday)
•Payroll submission
•Secure Payroll System – Web based
•Interactive Voice Response – IVR
•Call in – Customer Service
96
Managing Monthly Budget
•Spend within CDC+ Monthly Budget
Use Calendar – Participant Notebook Appendix O (2)
Spend consistent with Purchasing Plan
•Overtime
Not good use of funds
•Reconcile Monthly Statements
•Participant Notebook Appendix M (2)
•Track current account balance between statements
97
Overspending
•Purchasing supports or services greater than
the amount that is authorized
•Insufficient funds in a consumer’s account
result in claims being held until additional funds
become available.
•Once held, claims will be reviewed in the
following order: timesheets, invoices,
reimbursements and cash payments
98
Corrective Action Plan (CAP)
Appendix N,
•A tool to assist participants or representatives to correct
problems with mismanagement of the program as required by
the 1915j State Plan Amendment.
•Developed and signed by participant and consultant
•To be developed immediately when participant/representative:
•
•
•
•
Purchases inconsistently with the approved Purchasing Plan
Overspends
Does not produce receipts upon request
Puts health and safety at risk
99
Corrective Action Plan (CAP),
continued
The CAP plan addresses
WHAT has happened/caused the problem
HOW the participant/representative plan
to correct the problem
WHEN the problem will be corrected
WHO is responsible for each step
100
Disenrollment from CDC+
•Voluntarily or involuntarily
•CDC+ Participant Information Update
Form – (Participant Notebook Appendix D(XV11)
•CDC+ Account Close-Out Procedure- (Participant
Notebook Appendix M(3)
101
Closing Activities
Final Q and A’s
Readiness Review
Evaluations
102
Thank you
Ivonne Gonzalez
[email protected]
850-417-8270
CDC+ Customer Service
1-866-761-7043
CDC+ Website http://apdcares.org/cdcplus/
103