Presentation on theme: "FINANCIAL MANAGEMENT SERVICES For Self-Directed Waiver Services in Kansas Presented by: Kansas Department on Aging March - April 2011."— Presentation transcript:
FINANCIAL MANAGEMENT SERVICES For Self-Directed Waiver Services in Kansas Presented by: Kansas Department on Aging March - April 2011
Overview What is Financial Management Services (FMS)? Requirements to be an FMS provider Responsibilities of the: ◦ Self-Directing Individual ◦ Agency with Choice FMS Information & Assistance (I&A) Payment for FMS Enrollment
Questions Please submit questions in writing via: ◦ Chat on the webinar ◦ directly to All submitted questions will be compiled into a Q&A document to be posted at ovider_index.html after the last session is held ovider_index.html
What is Financial Management Services (FMS)? FMS is a new waiver service for the administrative and information & assistance functions for self-directing individuals Replaces current payroll agent process Kansas has elected to operate FMS as an Agency with Choice (AWC) employer model
Why change to Financial Management Services (FMS)? Centers for Medicare and Medicaid Services (CMS) new requirement Separates administrative functions from direct service payment rates Incorporates more stringent requirements
Important Terms Direct Support Worker – (DSW): the person hired to provide direct care paid through HCBS. Employment Services Agreement – an agreement between the self-directing individual and the DSW that identifies the responsibilities/duties of all parties.
Important Terms Service Agreement –an agreement between the FMS provider and the self- directing individual. This authorizes the FMS provider to accept timesheets, bill Medicaid, process payroll, distribute paychecks; withhold, file, and pay taxes. Also identifies the responsibilities/duties of all parties.
Important Terms SRS/KDOA Provider Agreement - an agreement between the State of Kansas (SRS and/or KDOA) and a provider organization. It authorizes a provider to function as a FMS provider agency.
Requirements to be an FMS provider Each potential Agency With Choice Financial Management Services (FMS)entity must meet the following requirements: ◦ SRS/KDOA Provider Agreement ◦ Medicaid Provider Agreement ◦ Registration with the Secretary of State’s Office, if required.
Requirements to be an FMS provider Each potential Agency With Choice Financial Management Services (FMS)entity must meet the following requirements: ◦ Insurance defined as: Liability insurance Workers Compensation Insurance Unemployment Insurance, if applicable Other Insurances, if applicable ◦ Annual Independent Financial Audit ◦ Demonstrate financial solvency ◦ Maintain required policies/procedures
Policies and Procedures shall include but are not limited to: ◦ Billing Medicaid with approved rates, and for services as authorized by POC. ◦ Billing FMS administrative fee ◦ Receive and disburse Medicaid funds, track disbursements and provide reports Semi-annual reports to self-direct individuals for billing/disbursements on their behalf Report to the State of Kansas as requested
Policies and Procedures shall include but are not limited to: ◦ Ensure proper/appropriate background checks are conducted ◦ Ensure that self-directing individuals follow the pay rate procedures Clear identification of how this will occur Prohibition of wage/benefit setting by FMS provider Prohibition of “recruitment” practices (HCBS waiver customers and/or DSW staff)
Policies and Procedures shall include but are not limited to: ◦ Ensure proper/appropriate process of timesheets, disbursement of pay checks, filing of taxes and other associated responsibilities ◦ The provision of Information & Assistance services ◦ Grievance Procedures
Responsibilities - Individual Decision making authority over certain services and manages their services with the assistance of a system of available supports. Choice of qualified and available FMS providers ◦ when choice is made to self-direct and annually thereafter.
Responsibilities - Individual Direct the services in the individual’s approved Plan of Care (POC) and the Direct Support Workers Access and participate in the development of all plans including planning, startup, delivery and administration of providers’ services. Informed of the roles and responsibilities related to the FMS provider.
Responsibilities - Individual Work collaboratively with their FMS provider to meet shared objectives: ◦ Receive high quality services ◦ Receive needed services from qualified workers ◦ Tasks are provided in accordance with state law governing self-direction, Medicaid and the State of Kansas requirements, and are approved and authorized in the POC
Responsibilities - Individual Act as the employer for Direct Support Workers Negotiate a FMS Service Agreement with the chosen FMS provider Select Direct Support Worker(s) Refer Direct Support Workers to the chosen FMS provider
Responsibilities - Individual Negotiate an Employment Service Agreement with the Direct Support Worker Provide or arrange for appropriate orientation and training of Direct Support Worker(s). Determine schedules of Direct Support Worker(s) Determine tasks to be performed by Direct Support Worker(s) including where and when
Responsibilities - Individual Manage and supervise the day-to-day HCBS activities of Direct Support Worker(s) Verify time worked by Direct Support Worker(s) was delivered according to the POC; approve and sign timesheets Assure submission of Direct Support Worker timesheets and all other required documents to the FMS provider for processing and payment Report work-related injuries incurred by Direct Support Worker(s) to the FMS Develop an emergency worker back-up plan
Responsibilities - Individual Assure all appropriate service documentation is recorded Inform the FMS provider of any changes in the status of Direct Support Worker(s) Inform the FMS provider and Targeted Case Manager of the dismissal of a Direct Support Worker within 3 working days Inform the FMS provider and Targeted Case Manager of any changes in the status of the individual or individual’s representative, within 3 working days Participate in required quality assurance visits
Responsibilities – FMS When an individual or individual’s representative chooses an FMS provider, they must be fully informed by the FMS provider of their rights and responsibilities to: ◦ Choose and direct support services, ◦ Choose and direct the workers who provide the services, ◦ Perform the roles and responsibilities as employer, ◦ Understand the roles and responsibilities of the FMS provider, and; ◦ Receive initial and ongoing skills training as requested.
Responsibilities – FMS Must negotiate, review, and sign a FMS Service Agreement The FMS Service Agreement will identify the “negotiated” role / responsibilities of both the individual and the FMS provider. Comply with the provisions of KSA 39-7,100 [Home and community based services program] and KSA [Individuals in need of in- home care; definitions].
Responsibilities – FMS Execute a SRS/KDOA Provider Agreement with the appropriate State agency. Execute a Medicaid Provider Agreement with State Medicaid Agency. Comply with State Regulations, Provider Agreement requirements, policies, and procedures
Responsibilities – FMS Develop and implement procedures, internal controls and other safeguards to ensure individuals or an individual’s representative, rather than the FMS provider, have the right to choose, direct, and control services and the Direct Support Worker(s).
Responsibilities – FMS The procedures, internal controls and other safeguards must be written and include, at a minimum: ◦ A mechanism to process Direct Support Worker human resource documentation and payroll in a manner that is efficient and supports individuals or the individual’s representatives’ authority to select, recruit, hire, manage, dismiss, and train Direct Support Workers. ◦ Information for Direct Support Worker that outlines completion of timesheets, wages, benefits, pay days, work hours, and individual self- direct customer preferences.
Responsibilities – FMS ◦ An assurance that the individual or individual’s representative, and not the FMS provider, determines the terms and conditions of work (when and how the services are provided, such as establishing work schedules, determining the conditions of work, and the tasks to be performed). ◦ Internal controls to ensure individuals or individual’s representative are afforded choice and control over workers without excessive restrictions or barriers.
Responsibilities – FMS ◦ A process to respond, within a reasonable timeframe, to contact from any individual or individual’s representative informing the FMS provider of the decision to dismiss a particular Direct Support Worker. ◦ A process for individuals or the individual’s representative to pay the Direct Support Worker(s) by direct deposit, first class mailing, or other means through the FMS
Responsibilities – FMS Ensure the individual or individual’s representative and the TCM have the name and contact information of FMS provider agency staff who can address issues. Assume responsibilities in providing the following administrative services: ◦ Establish and maintain all required records and documentation, including a file for each self- directing individual. All files must be maintained in a confidential, HIPAA compliant manner.
Responsibilities – FMS ◦ Obtain authorizations to conduct criminal background checks, child abuse and adult registry checks in accordance with applicable waiver requirements. ◦ Verify citizen and legal status of potential Direct Support Workers. ◦ Collect and process all required federal, state, and local human resource forms required for employment and the production of payroll. ◦ Help individuals or the individual’s representative set the correct pay rate for each Direct Support Worker. ◦ Collect and process timesheets of Direct Support Worker(s).
Responsibilities – FMS ◦ Compute, withhold, file and deposit federal, state, and local employment taxes for Direct Support Worker(s). ◦ Compute and pay Workers Compensation as contractually and statutorily required. ◦ Approve and pay wages to Direct Support Worker(s) in compliance with federal and state labor laws. ◦ Perform all end-of-year federal, state, and local wage and tax filing requirements, as applicable.
Responsibilities – FMS ◦ Have policies and procedures in place for the reporting of fraud and abuse, neglect, or exploitation by a Direct Support Worker, to the appropriate authority and ◦ Informs the individual or individuals representative that if the Direct Support Worker continues to work for the individual that they will no longer be able to serve as the FMS provider.
Responsibilities – FMS Ensure that each self-directing individual; ◦ Maintains control and oversight of their Direct Support Worker; ◦ Is made aware of the benefits/services available to them; ◦ Is made aware of the requirements/responsibilities of self-directing individual to the FMS provider; ◦ Is made aware of the requirements/responsibilities of the self-directing individual to the Direct Support Workers: In language/format that is understandable to the individual; Signed Employment Service agreement that specifies the responsibilities of the parties.
Responsibilities – FMS Ensure each Direct Support Worker hired by the individual: ◦ Is made aware of the benefits/services available to them; ◦ Is made aware of the employment requirements/and job responsibilities of: The self-directing individual; The FMS provider Maintain a listing of Direct Support Workers that are available and desire additional employment.
Responsibilities – FMS Develop, implement and maintain an internal quality assurance program that monitors for: ◦ Self-directed individuals satisfaction ◦ Direct Support Worker satisfaction ◦ Correct timesheet submission ◦ Correct payroll distribution Develop, implement and test an adequate backup plan that assures records are preserved, and fiscal functions are replicated in case of a natural disaster/or state of emergency. Maintain evidence of certifications, agreements and affiliations as required by waiver or policy.
Information and Assistance (I&A) I&A is a service within FMS that is available to provide information, including independent resources, and assist in the development of options to ensure that individuals understand the responsibilities involved with directing their services. Practical skills training is offered to enable self-directing individuals, their families and/or representative to independently direct and manage waiver services. The extent of the assistance furnished to the self-directing individual will be determined by the self-directing individual or individual’s representative.
Information and Assistance (I&A) I&A services may include the performance of activities that nominally overlap the provision of targeted case management services. However, such overlap does not constitute duplicate provision of services.
Information and Assistance (I&A) I & A services may provide assistance to the self-directed individual or individual’s representative with: ◦ Defining goals, needs and resources, identifying and accessing services, supports and resources as they pertain to self-directed activities; ◦ Practical self-direction management skills training (e.g., hiring, managing and terminating workers, problem solving, conflict resolution); ◦ Recognizing and reporting critical events (e.g. fraudulent activities; abuse and etc.); and ◦ Other areas related to managing services and supports.
Information and Assistance (I&A) I&A services may provide information to the individual or individual’s representative about: ◦ Individual centered planning; ◦ The range and scope of individual choices and options; ◦ Grievance and appeals processes; ◦ Risks and responsibilities of self-direction; ◦ Individual rights; ◦ Importance of ensuring Direct Support Worker’s health and safety during the course of their duties to reduce potential injuries and worker’s compensation insurance claims.
Information and Assistance (I&A) I&A services may provide information to the individual or individual’s representative about: (cont’d) ◦ Reassessment and review schedules; ◦ The importance of keeping the FMS provider and TCM informed as to current contact information and planned absences; and ◦ Such other subjects pertinent to the participant and/or family in managing and directing services and living independently and safely in the community in the most integrated setting.
Payment for FMS The State of Kansas has established a “Per Member Per Month (PMPM)” payment methodology to be paid for the administrative and I&A services provided. The administrative fee cannot reduce or cause any loss of authorized waiver services to self-directing individuals. The FMS provider is required to bill for all provided self- direct services that are on an individual’s plan of care. The individual client obligation, if assigned to the FMS, is a required payment to the FMS and must be applied to applicable service(s). If an individual becomes “past due” in these obligations, a remedial payment plan will be developed in coordination with the Targeted Case Manager in order to meet past due obligations.
Payment for FMS The billing/procedure code for FMS regardless of waiver program is T2040 U2 FMS is authorized only once per POC regardless of how many self-directed services are needed ◦ Therefore, if the case opens or closes mid-month the FMS service will begin or end on the specific date with the full monthly amount ◦ If the case transfers to another FMS provider that must occur at the start of the following month
FMS Rate: Accounts for the following: Unemployment Insurance Other Insurances Filing and paying taxes Writing / paying checks W-2; garnishments; other administration (criminal record checks) Audits; reporting Direct and indirect operating costs Information & Assistance Operational overhead
Service Rates: Accounts for the following: ◦ Workers Compensation ◦ SUTA ◦ FUTA ◦ FICA
Enrollment March – April 2011 ◦ Training conducted April 2011 – ongoing ◦ FMS Provider Manual published ◦ Enrollment application updated ◦ Providers begin enrolling as FMS providers
Contact Information: FE waiver – Krista Engel, or MRDD waiver – Greg Wintle, or PD waiver – Candace Cobb, or TA waiver – Kimberly Pierson, or TBI waiver – Michael Deegan, or