NEW CONSULTANT TRAINING November 28 & 29, 2012

Barbara PalmerDirector

Rick Scott Governor

Welcome and Introductions

Ivonne Gonzalez

Training and Outreach Coordinator

Submit questions throughout this presentation to: Liesl_Ramos@apd.state.fl.us

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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

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• 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

CDC+ Tools

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•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

CDC+ History

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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

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Self-Determination and Person Centered Planning

Person-Centered Planning

Principles of Self-DeterminationFreedomAuthoritySupportControlResponsibility

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CDC+ Eligibility and Enrollment Requirements

•Enrolled in the DD/HCBS waiver

•Able to direct own care

•Live in family or own home

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• 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

iBudget Transition

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•Participant

•CDC+ Representative

•Consultant

•Area Liaison

•State Office

Roles and Responsibilities

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Role of Participant (when representative not selected)

•Authorized signer

•Decision maker

•Employer

•Develops Purchasing Plan

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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)

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•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

Role of CDC+ Representative,

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•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

Consultant Requirements

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•Waiver Support Coordinator

•Complies with training and monitoring requirements

•Sign a participant/consultant agreement

•Provides on-going technical assistance

Role of Consultant

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•Reviews and signs off on CDC+ documents

•Responsible for appropriate use of public money

Role of Consultant, continued

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•Develops and updates support plan

•Ensures cost plan is updated

•Monitors and reviews participant account activity

•Ensures Medicaid eligibility

Role of Consultant, continued

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Role of Consultant, continued

•Keeps active contact with ParticipantMonthly – by phone or in personAnnually – two face-to-face per year

•Completes monthly review documentation

•Communicates effectively with Area Liaison

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•Authorizes CDC+ Budget•Reviews Purchasing Plans•Facilitates employee background screening •Liaison between participant, consultant, and State office

Role of Area Liason

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•Administers CDC+ Program•Develops policies•Approves CDC+ Monthly Budget•Develops and provides training•Provides Customer service

Role of State Office

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•Provides Quality assurance

•Assigns Provider ID Numbers

•Pays service claims and employer taxes

•Sends monthly statements

•Monitors consumer spending

Role of State Office, continued

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Quality Assurance Requirement•Consultant

•Participant Person Centered ReviewProvider Discovery Review

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Steps for CDC+ Participant Enrollment

•Expresses interest

•Completes training

•Passes Readiness Review

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•Application Packet•2 page application document•Cost plan service authorization summaries•Budget calculation worksheet

•Enrollment Packet•8821 – IRS •2678 – IRS•Fiscal Informed Consent

Steps for CDC+ Participant Enrollment, continued

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•Area calculates monthly budget

•Participant chooses supports and services

•Participant interviews potential providers

•Providers complete background screening requirements

Steps for CDC+ Participant Enrollment, continued

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•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

Steps for CDC+ Participant Enrollment, continued

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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) 28

ServiceTotal Cost Plan Amt

Number of

months Monthly Cost

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 $ 267.08CMS $ 372.40 12 $ 31.03

Total $ 33,038.18 $ 2,753.18 $ 2,753.18 If more than $4,000.00, use $160 for fees Take the percentages of Col D Total 0.92 0.04 If less than $4,000, use 4% calculation for fees

$ 2,532.93 $ 110.13 $ (160.00)

This is the CDC+ Monthly Budget $ 2,372.90

Consultant services or funds for either OTEs or STEs are not included in the calculation of the monthly budget

$ 2,753.18 0.92 $ 2,532.93 $ (110.13)

This is the CDC+ Monthly Budget $ 2,422.80

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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)

Participant Controls

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•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

CDC+ Program Services

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CDC+ SERVICE CODE CHART

RESTRICTED SERVICESService Name Abbreviation Service Code

Adult dental services DENT 03Behavior Analysis Services BT 06Behavior Analysis Assessment BTA 06ABehavioral Assistant Services BTS 08Dietitian Services DIET 12Occupational Therapy OT 29Occupational Therapy Assessment OTA 29APhysical therapy PT 38Physical Therapy Assessment PTA 38APrivate Duty Nursing/LPN PDL 49Private Duty Nursing/RN PDR 50Respiratory Therapy RT 45Respiratory Therapy Assessment RTA 45ASkilled Nurse/LPN SNL 47Skilled Nurse/RN SNR 48

Specialized Mental Health Services/ Therapy and Assessment MHT 51

Speech Therapy ST 53Speech Therapy Assessment STA 53AEnvironmental Modification Assessment ENVA 14ADurable Medical Equipment and Supplies EQUIP 83Environmental Modifications ENV 14Vehicle Modification VMOD 80

UNRESTRICTED SERVICESService Name Abbreviation Service Code

Adult Day Training ADT 02Advertizing ADV 89Seasonal Camp CAMP 85Companion Services COMP 11Consumable Medical Supplies CMS 63Supported Employment EMP 55Gym Membership GYM 88In-Home Supports IHS 22Over-The-Counter Medications OTC 65Personal Care Assistance PCA 32Personal Emergency Response System (PERS) PERS 33PERS Installation PERSI 33AParts and Repairs Therapeutic or Adaptive Equipment PARTS 82Residential Habilitation Services RHAB 43Respite Care- Day RSPD 58Respite Care- Hour RSPH 46Supported Living Coaching SLC 56Specialized Training TRNG 61Transportation TRAN 60Other Therapies XTHER 39

FOR CONSUMERS PARTICIPATING IN THE FLORIDA FREEDOM INITIATIVE (FFI) ONLY

Service Name Abbreviation Service CodeMicroenterprise MICRO 75FVehicle VEH 70F

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•Directly Hired Employee (DHE)

•Agency/Vendor (A/V)

•Independent Contractor (IC)

Provider Types

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•Identify service/support being purchased

•Type of provider needed•Provider requirements

•Hiring packet – (Appendix E of the Notebook)

How to Find, Hire and Manage Providers?

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Background ScreeningsLevel 2 for all providers listed on a Purchasing PlanValid for 5 years- provided there is not a break in service of 90 days or more.

How to Find, Hire and Manage Providers, continued

Employee Packets- (Appendix G Notebook)

Vendor Packets- (Appendix H Notebook)

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•The Participant decideswhat will be done and create job descriptionhow services will be performedthe hours per week/month workedhourly rate of pay (negotiable)

Companion- only service exempt from minimum wage requirements

•The Participant mustreview, approve, & submit timesheetbudget for applicable employer taxes

Directly Hired Employee Services

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•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

Agency/Vendor and Independent Contractor

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Hiring an A/V, IC or DHEAgency/Vendor (A/V) or

Independent Contractor (IC)

• Vendor/Independent Contractor Information Form

• Internal Revenue Service (IRS) Form W-9

• Background Screening Letter

Directly Hired Employee

• Employee Information Form

• Internal Revenue Service (IRS) Form W-4

• Department of Homeland Security (DHS) Form I-9

• Background Screening Clearance 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 RepresentativeConsultant may provide technical assistance

and guidance (CDC+ Rule Handbook Appendix E)

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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

Purchasing Plan – Timelines

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Purchasing Plan Types

•New Purchasing Plan

•Purchasing Plan Change

•Purchasing Plan Update

•Quick Update

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•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

OTE/STE Expenditure

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•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.

Restricted/Unrestricted Services

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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

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Navigating the Template

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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

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Purchasing Plan Instructions

• Open blank Purchasing Plan • Follow along slide by slide• Reference tools

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CDC+ Purchasing PlanPage 1 - Top

Provide the required information

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Purchasing Plan - Page 1

Section A – Participant Information

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Purchasing Plan - Page 1

Section A – Participant Information (continued)

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Purchasing Plan - Page 1

Section A – Reason for Submitting Purchasing Plan

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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)

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Purchasing Plan - Page 2

Section B – Needs

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Purchasing Plan - Page 2

Section B – Needs – Column 1

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Purchasing Plan - Page 2

Section B – Needs – Column 2

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Purchasing Plan - Page 2

Section B – Needs – Column 2 (continued)

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Purchasing Plan - Page 2

Section B – Needs – Column 3

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Purchasing Plan - Page 2

Section B – Needs – Column 3

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Purchasing Plan - Page 3

Section C.1 – Budget Details – Services

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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 3 = Spouse

4 = Person under 18 currently in high school (not participant’s child or stepchild) 5 = All others

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Purchasing Plan - Page 3

Section C.1 – Budget Details – Services (continued)

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Purchasing Plan - Page 3

Section C.1 – Budget Details – Services (continued)

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Purchasing Plan - Page 3

Section C.1 – Budget Details – Services – EBU Added Cost

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Purchasing Plan - Page 3

Section C.1 – Budget Details – Services – Totals

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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)

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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

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Purchasing Plan - Page 3

Section C.2 – Budget Details – Supplies (continued)

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Purchasing Plan - Page 3

Section C.2 – Budget Details – Supplies (continued)

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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) CMS – Consumable Medical Supplies (63)

NUTR - Nutritional Supplements (66) OTC – Over-the Counter Medications (65)

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Purchasing Plan - Page 4

Section D – Budget Details – Cash Purchases (continued)

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Purchasing Plan - Page 4

Section D – Budget Details – Cash Purchases – Total

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Purchasing Plan - Page 5

Section E – Savings Plan – Authorizations for Use of Accumulated, Unrestricted Funds

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Purchasing Plan - Page 5

Section E – Savings Plan – Authorizations for use of Accumulated, Unrestricted Funds (continued)

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Purchasing Plan - Page 5

Section E – Savings Plan – Authorizations for use of Accumulated, Unrestricted Funds (continued)

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Purchasing Plan - Page 5

Section E – Savings Plan – Authorizations for use of Accumulated, Unrestricted Funds (continued)

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Purchasing Plan - Page 5

Section E – Savings Plan – Authorizations for use of Accumulated, Unrestricted Funds (continued)

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Purchasing Plan - Page 5

Section E – Savings Plan – Authorizations for use of Accumulated, Unrestricted Funds (continued)

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Purchasing Plan - Page 5

Section F – Budget Detail – One Time and Short Term Expenditures

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Purchasing Plan - Page 5

Section F – Budget Detail – OTEs and STEs (continued)

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Purchasing Plan - Page 5

Section F – Budget Detail – OTEs and STEs (continued)

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Purchasing Plan - Page 5

Section F – Budget Detail – OTEs and STEs (continued)

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Purchasing Plan - Page 5

Section F – Budget Detail – OTEs and STEs (continued)

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Purchasing Plan - Page 6

Budget Summary

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Purchasing Plan - Page 6

Budget Summary (continued)

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Purchasing Plan - Page 6

Signatures – Participant or CDC+ Representative

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Purchasing Plan - Page 6

Signatures – Consultant

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Purchasing Plan - Page 6

Signatures – APD Staff

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Purchasing Plan - Page 6

Signatures – APD Staff (continued)

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Purchasing PlanSubmission Process

Participant Responsibilities:• Double-check all information• Minimum six (6) completed pages• Submit all required paperwork• Retain copies• Submit by 5th of the month

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Purchasing PlanSubmission Process

Consultant Responsibilities:• Review for accuracy• Signs the Purchasing Plan• Submit by 10th of the month

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Purchasing PlanSubmission Process

Area Office Responsibilities:• Review for accuracy and signatures• Ensures all documents enclosed• Submit by 20th of the month

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Purchasing PlanApproval 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

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Developing a Purchasing PlanGROUP ACTIVITY

• Developing a Purchasing Plan using a Training Scenario• Developing a Quick Update• Signing off on both

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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)

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•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

Getting Claims Paid, continued

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Managing Monthly Budget

•Spend within CDC+ Monthly BudgetUse Calendar – Participant Notebook Appendix O (2)

Spend consistent with Purchasing Plan

•OvertimeNot good use of funds

•Reconcile Monthly Statements •Participant Notebook Appendix M (2)•Track current account balance between statements

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Budget Mismanagement

•Budget mismanagement will lead to either

Corrective Action Plan (CAP) orNot “entitled” to a CAP before other sanctions can occur

Disenrollment and return to the Waiver

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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

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•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

Corrective Action Plan (CAP) Appendix N,

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Corrective Action Plan (CAP), continued

The CAP plan addresses

WHAT has happened/caused the problemHOW the participant/representative plan to correct the problemWHEN the problem will be correctedWHO is responsible for each step

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•Voluntarily or involuntarily

•CDC+ Participant Information Update Form – (Participant Notebook Appendix D(XV11)

•CDC+ Account Close-Out Procedure- (Participant Notebook Appendix M(3)

Disenrollment from CDC+

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Closing Activities

Final Q and A’s

Readiness Review

Evaluations

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Thank you

Ivonne GonzalezIvonne_m_gonzalez@apd.state.fl.us

850-417-8270

CDC+ Customer Service1-866-761-7043

CDC+ Website http://apdcares.org/cdcplus/ 104