Transcript Integrated Long Term Care Improving services for Florida

Agency for Persons with Disabilities
Consumer-Directed Care Plus
Program
13th Annual Family Café Conference
June 3, 2011
Rhonda Sloan
Operations Review Specialist/ Training Coordinator
Presentation Overview
 What is the Consumer-Directed
Care Plus Program (CDC+)
 Essential CDC+ Responsibilities
 Critical CDC+ Program Updates
1
What is the CDC+ Program
1915(j) State Plan Amendment
for Florida Medicaid Waiver Recipients?
 The CDC+ program empowers recipients of Home and
Community-Based Medicaid Waiver services with the
ability to self-direct or independently decide:
 Payment for services within an allocated monthly budget
 Employment, management, and termination of their own directly
hired employees, including family members
 Permission to use their service budget to pay for items that
increase personal independence
2
Essential CDC+ Responsibilities
Participant Responsibility
 With choice comes responsibility – The CDC+ participant
and his/her CDC+ representative (if one is selected to
work with the participant) are responsible for learning how
to operate the CDC+ program within state and federal
rules and guidelines and to stay informed of all changes.
 The CDC+ participant and his/her CDC+ representative
are responsible for managing the Medicaid funds provided
to the participant and this responsibility must be taken
seriously.
3
Essential Responsibilities
APD as DD CDC+ Fiscal Agent
APD serves as the fiscal agent for the DD waiver population
enrolled in the CDC+ Program.
 Reviewing and entering consumer purchasing plans
 Processing provider paperwork for state and federal
tax reporting
 Verification and processing of employee timesheets,
invoices, and requests for reimbursement
 Maintaining a customer service call center
4
Available CDC+ Resources
 Consumer Notebook  Fiscal/Employer
Agent
 Representative
 Toll-Free Customer
 Consultant
Service Line
1-866-761-7043
 APD Area CDC+
Liaison
 APD CDC Internet
apd.myflorida.com/cdcplus
5
APD CDC+ Program Updates
6
Background Screening Changes
Reminders
• Background Screening Law Change: Effective August 2010, Florida's
background screening laws changed to require that all employees of CDC+
participants pass a level 2 background screening before they can begin
working for the CDC+ participant who is their employer.
• Who: This includes everyone providing direct care to consumers, all minors
and emergency back-ups (EBUs) who are listed on a Purchasing Plan as
natural support.
• Background screening expenses are the responsibility of the provider, not
the participant or representative. Medicaid or CDC+ funds cannot be used for
screening or rescreening providers.
7
Background Screening Changes (continued)
• What about Medicaid providers that you may want to hire? If your provider is
already a Medicaid-enrolled provider who underwent a background screening at the
time of their enrollment into the Medicaid program and has remained in good
standing, then the provider does not have to be screened, but the CDC+ participant
may always request a copy of their clearance letter.
• Background screenings are valid for five (5) years. When time for rescreening,
the participant/representative must allow enough time to process the screening prior
to the expiration date. Existing providers with Level 1 Background Screening must
pass a Level 2 Background Screening prior to their Level 1 expiration date.
• Sharing copies of clearance letters: CDC+ employers can share copies of the
clearance letter with other CDC+ employers. The new employer must ensure there
has not been a break in employment of more than 90 days. However, an updated
local name check and a notarized Affidavit of Good Moral Character will be needed.
8
Background Screening Tips
 Background screening - Make copies of anything you
send (even fingerprint card)
 Retain documentation, keep everything
 Make sure you have everything for every person/vendor
you employ
 Track 5-year re-screening and initiate at least 3 months
prior
 FAQ CDC+ Website
apd.myflorida.com/background-screening/docs/cdcfaq.pdf
9
CDC+ Training
 Participant Refresher Training
 Annual Requirement
 Readiness Review
 Certificate
 Readiness Review
New participants/representatives are required to complete a
Readiness Review prior to enrolling in the CDC+ program with at
least a score of 85%. Review is open-book and self-directed.
 Consultant (new and refresher) Training
 New consultant ongoing as needed
 Refresher annual requirement
10
CDC+ 1915(j) Quality Assurance
 What recipients, representatives, consultants, and directly hired
employees need to know about quality assurance monitoring
▪ The DD waivers and the 1915(j) programs must be monitored for
quality assurance as a requirement of the federal government for
Medicaid services. AHCA contracted with Delmarva Foundation to
conduct the discovery for the quality assurance review.
• It includes conducting Person-Centered Reviews (PCR) with
recipients and Provider Discovery Reviews (PDR) with consultants
and representatives/consumers including documentation review of
vendors and directly hired employees who participate in the CDC+
program.
11
Person-Centered Reviews
 To conduct a Person-Centered Review (PCR), recipients are asked to
meet with a Delmarva reviewer to determine if services are meeting needs
and/or goals of the recipient, to monitor health and safety of the recipient,
and to assess the program for satisfaction and needed improvement.
 The PCR is used to gather information for measuring the quality of care, as
required by the federal government, to monitor service delivery and
recipient satisfaction of their Medicaid program. Average consumer PCR
scores are 89.5% (compared with DD waiver at 83.1%).
 The PCR is an easy way for recipients and families to receive technical
assistance regarding rules and regulations for the program.
 The recipient will not lose their place in the CDC+ program based on a
single PCR review.
 PCR is an optional review.
12
Provider Discovery Reviews
 A Provider Discovery Review (PPR) is conducted with the representative
and consultant to ensure that the recipient’s care meets the required
qualifications for the service rendered, based on DD handbook
requirements for waiver service provision and CDC+ program rules for
other goods and services. The average consultant score is 98%, and
the average rep score is 86.6%.
 PDRs will be conducted after a PCR review to evaluate provider
performance, based on service delivery measures and program standards,
to ensure that the consultant or representative is:
 Helping the recipient to meet their expressed needs and/or goals
determined in PCR review;
 Meeting required qualifications for service provision;
 Ensuring that the health and safety of the recipient are being met
during service provision.
 PDRs are mandatory, if selected, and not participating will result in noncompliance. Consultant and representative tools are on the website.
13
CDC+
APD Quality Assurance Outcome
The most recent 2010 DD Waiver recipient Satisfaction Surveys
show:
 95.7% of consumers said their ability to direct their own services
in the CDC+ program has improved their quality of life.
 95.7% said they have more control over the quality of services
 97.4% are satisfied with the CDC+ Program
 97% of consumers would recommend CDC+ to others.
Peer Support Groups
• Networking
• Resources
• Join NOW!
15
Contact Information
APD CDC+ Customer Service, toll free
1-866-761-7043
Liesl Ramos, Program Administrator
1-850-921-3785
Agency for Persons with Disabilities
[email protected]
16
Q & A Session