Presentation on theme: "FINANCIAL MANAGEMENT SERVICES"— Presentation transcript:
1FINANCIAL MANAGEMENT SERVICES For Self-Directed Waiver Services in KansasPresented by: Kansas Department on AgingMarch - April 2011Welcome! Announce waiver related people in the room.
2Overview What is Financial Management Services (FMS)? Requirements to be an FMS providerResponsibilities of the:Self-Directing IndividualAgency with Choice FMSInformation & Assistance (I&A)Payment for FMSEnrollmentThis training session is for current payroll agent providers that bill for self-directed waiver services. If you are not currently doing this the information will not be applicable to your entity and you may sign off. Any targeted case managers on the call will need to sign off and attend the session specific to TCM in May.
3Questions Please submit questions in writing via: Chat on the webinardirectly toAll submitted questions will be compiled into a Q&A document to be posted at ovider_index.html after the last session is held
4What is Financial Management Services (FMS)? FMS is a new waiver service for the administrative and information & assistance functions for self-directing individualsReplaces current payroll agent processKansas has elected to operate FMS as an Agency with Choice (AWC) employer modelThis training will focus on the definition; responsibilities; and new enrollment requirements for FMS. The Medicaid Reform team at the Governors level in cooperation with CMS is looking at all Medicaid programs including the waivers therefore specific payment rates and implementation dates will not be known until the Medicaid Reform team has finalized their process.
5Why change to Financial Management Services (FMS)? Centers for Medicare and Medicaid Services (CMS) new requirementSeparates administrative functions from direct service payment ratesIncorporates more stringent requirementsThis has been a multi year process involving many providers and stakeholders input. Today’s session is not for debating the requirements/etc but rather to notify you of the information and what the upcoming requirements will be so you can make a solid decision as to whether or not to move forward in enrolling.
6Important TermsDirect 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.
7Important TermsService 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.
8Important TermsSRS/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.The agreement will be with both agencies if doing both SRS and FE waivers. Agreement would be only with SRS if only doing SRS waivers and only with KDOA if only doing FE waiver.
9Requirements to be an FMS provider Each potential Agency With Choice Financial Management Services (FMS)entity must meet the following requirements:SRS/KDOA Provider AgreementMedicaid Provider AgreementRegistration with the Secretary of State’s Office, if required.SRS/KDOA application must be completed and signed by all parties and included with Medicaid Provider Agreement.If registered with Secretary of State’s Office:Be in good standing with all Kansas laws/business requirements.Owners/Principles/Administrators/Operators have no convictions of embezzlement, felony theft, or fraud.Owner, primary operator and administrator of FMS business must live in a separate household from individuals receiving services from the FMS business.Business is established to provide FMS to more than one individual.
10Requirements to be an FMS provider Each potential Agency With Choice Financial Management Services (FMS)entity must meet the following requirements:Insurance defined as:Liability insuranceWorkers Compensation InsuranceUnemployment Insurance, if applicableOther Insurances, if applicableAnnual Independent Financial AuditDemonstrate financial solvencyMaintain required policies/proceduresAnnual liability with a $500,000 minimum.Evidence that 30 days coverage of operation costs are met for Financial solvency – see manual for what qualifies as evidence
11Policies and Procedures shall include but are not limited to: Billing Medicaid with approved rates, and for services as authorized by POC.Billing FMS administrative feeReceive and disburse Medicaid funds, track disbursements and provide reportsSemi-annual reports to self-direct individuals for billing/disbursements on their behalfReport to the State of Kansas as requested
12Policies and Procedures shall include but are not limited to: Ensure proper/appropriate background checks are conductedEnsure that self-directing individuals follow the pay rate proceduresClear identification of how this will occurProhibition of wage/benefit setting by FMS providerProhibition of “recruitment” practices (HCBS waiver customers and/or DSW staff)Prohibit “recruitment” by promises/enticements of higher pay or benefits
13Policies 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 responsibilitiesThe provision of Information & Assistance servicesGrievance ProceduresThe grievance policy is designed to assure a method for Direct Support Workers to utilize to address hours paid that differ from hours worked, lack of timely pay checks, bounced pay checks, and other FMS related issues.
14Responsibilities - 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 providerswhen choice is made to self-direct and annually thereafter.Review of Customer responsibilities.
15Responsibilities - Individual Direct the services in the individual’s approved Plan of Care (POC) and the Direct Support WorkersAccess 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.
16Responsibilities - Individual Work collaboratively with their FMS provider to meet shared objectives:Receive high quality servicesReceive needed services from qualified workersTasks 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
17Responsibilities - Individual Act as the employer for Direct Support WorkersNegotiate a FMS Service Agreement with the chosen FMS providerSelect Direct Support Worker(s)Refer Direct Support Workers to the chosen FMS providerRefer Direct Support Workers to the FMS provider for completion of required human resources and payroll documentation. In cooperation with the FMS provider, all employment verification and payroll forms must be completed.
18Responsibilities - Individual Negotiate an Employment Service Agreement with the Direct Support WorkerProvide 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 whenDetermine when/where tasks are to be performed in accordance with the approved and authorized POC /CSW.
19Responsibilities - 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 timesheetsAssure submission of Direct Support Worker timesheets and all other required documents to the FMS provider for processing and paymentReport work-related injuries incurred by Direct Support Worker(s) to the FMSDevelop an emergency worker back-up planTimesheets must be reflective of actual hours worked in accordance with the approved CSW and POC.Back up plan is for in case a substitute Direct Support Worker is ever needed on short notice or as a back-up (short-term replacement worker).
20Responsibilities - Individual Assure all appropriate service documentation is recordedInform 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 daysInform the FMS provider and Targeted Case Manager of any changes in the status of the individual or individual’s representative, within 3 working daysParticipate in required quality assurance visitsChanges - such as address or telephone number, in a timely fashion.Quality checks - with Targeted Case Managers, and State Quality Assurance Staff, or other appropriate and authorized reviewers / auditors.
21Responsibilities – 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.Switch gears to review FMS responsibilities.
22Responsibilities – FMS Must negotiate, review, and sign a FMS Service AgreementThe 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].
23Responsibilities – 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 proceduresThe SRS/KDOA agreement will be with both agencies if doing both SRS and FE waivers. Agreement would be only with SRS if only doing SRS waivers and only with KDOA if only doing FE waiver.
24Responsibilities – 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).Must include at a minimum the information on the following three slides.
25Responsibilities – 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.
26Responsibilities – 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.Conditions of work, for example, no smoking in the home, conditions under which a worker might be dismissed from working with the individual or individual’s representative.
27Responsibilities – 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
28Responsibilities – 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.
29Responsibilities – 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).Criminal record checks continue to not required for the FE waiver but rather done upon the customers request.
30Responsibilities – 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.End of year tax filing - IRS forms W-2 and W-3, state income tax forms and reporting.
31Responsibilities – 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 andInforms 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.
32Responsibilities – 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.
33Responsibilities – 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 providerMaintain a listing of Direct Support Workers that are available and desire additional employment.Important for everyone to be on the same page and know who is responsible for what.
34Responsibilities – FMS Develop, implement and maintain an internal quality assurance program that monitors for:Self-directed individuals satisfactionDirect Support Worker satisfactionCorrect timesheet submissionCorrect payroll distributionDevelop, 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.Agreements required by policy - e.g. CDDO affiliation agreements for DD services.
35Information 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.Examples of skills training include providing information on recruiting and hiring personal care workers, managing workers and providing information on effective communication and problem-solving.The extent of assistance – daily tasks performed and amount of time must still fall within the approved CSW and POC.
36Information 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.e.g. the participation in the development of ACW’s; CSW’s; and/or other planning documents; assessments; etc.
37Information 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.); andOther areas related to managing services and supports.Provide assistance with… soon there will be a s/d website available.
38Information 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.Provide information about… Reduce injuries/worker’s comp claims - This may include participation in training as directed by the self-directing individual.
39Information 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; andSuch 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.Provide information about…
40Payment for FMSThe 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.
41Payment for FMSThe billing/procedure code for FMS regardless of waiver program is T2040 U2FMS is authorized only once per POC regardless of how many self-directed services are neededTherefore, if the case opens or closes mid-month the FMS service will begin or end on the specific date with the full monthly amountIf the case transfers to another FMS provider that must occur at the start of the following month
42FMS Rate: Accounts for the following: Unemployment Insurance Other InsurancesFiling and paying taxesWriting / paying checksW-2; garnishments; other administration (criminal record checks)Audits; reportingDirect and indirect operating costsInformation & AssistanceOperational overhead
43Service Rates: Accounts for the following: Workers Compensation SUTA FUTAFICA
44Enrollment March – April 2011 April 2011 – ongoing Training conducted FMS Provider Manual publishedEnrollment application updatedProviders begin enrolling as FMS providersThere will be one FMS manual for the service that applies to all waiver programs. Details of the definition, enrollment qualifications will be in the FMS manual once published to the KMAP website.
45Contact Information:FE waiver – Krista Engel, orMRDD waiver – Greg Wintle, orPD waiver – Candace Cobb, orTA waiver – Kimberly Pierson, orTBI waiver – Michael Deegan, or