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SERVICES OVERVIEW ofNOVEMBER 1, 2011, CHANGES
For PD and TBI Systems Targeted Case Managers
September 12 and 13, 2011
Presented by: Kansas Department of SRSMichael F. DeeganCandace M. Cobb
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What is happeningNovember 1, 2011?
Addition of additional services for both the Physical Disability and the TBI waivers:
Financial Management Services (FMS) Home-Delivered Meals Service Medication Reminder Services
Medication Reminder Call Medication Reminder Dispenser Medication Reminder Dispenser Installation
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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
FMS is only available for services that are self-directed
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Why change to Financial Management Services (FMS)?
Centers for Medicare and Medicaid Services (CMS) requirement.
Separates administrative functions from direct service payment rates.
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Information and Assistance (I&A)
I&A is a service within FMS that is available to provide information, including independent resources, and assistance 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.
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Information and Assistance (cont.)
The extent of the assistance furnished to the self-directing individual will be determined by the self-directing individual or individual’s representative.
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. (Be careful to utilize TCM time only for case management activities.)
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Overview of FMS Responsibilities
Meet all applicable requirements to be and maintain status as FMS provider.
Develop and implement policies that ensure the delivery of FMS services, and subsequent reimbursement, meeting applicable requirements.
Develop and maintain all applicable agreements.
Provide I&A as requested.
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Overview of Consumer and/or Representative Responsibilities
Choose from qualified and available FMS providers.
Participate in the development of all plans including planning, startup, delivery and administration of direct support worker services.
Work collaboratively with the FMS provider to meet shared objectives.
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Consumer and/or Representative Responsibilities (cont.)
Recruit, hire, train, schedule, and dismiss direct support workers.
Inform the FMS provider and Targeted Case Manager of any changes in status within 3 business days.
Verify that the time worked by the Direct Support Worker(s) was delivered according to the POC and the ACW.
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Overview of PD and TBI TCM Responsibilities
Ensure the consumer is aware of the new FMS service.
Revise the POC timely and appropriately . Refer to resources such as the self-direct
website http://selfdirect.ks.gov and the self-direction / KPASS tool kit so consumers can educate themselves about FMS service and providers.
Monitor service provision and POC implementation.
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Process for Choosing anFMS Provider
Choosing an FMS provider for dates of service November 1, 2011, and ongoing shall follow the same process that consumers currently utilize to choose a “payroll” agency.
SRS will maintain lists applicable to each waiver of Medicaid-enrolled FMS agencies who will serve PD and TBI waiver consumers.
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Plan of Care
For a self-directed consumer, the POC has to include both FMS and at least one of the self-directed services: Personal Services self-direct and/or Sleep Cycle Support.
Revising the POC shall follow the same submission and approval process that any other POC revision to services follows.
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Plan of Care: Important Note!
The POC must be signed and dated by the consumer or the consumer’s representative and in the case file by January 1, 2012.
For the November 1, 2011, revision, enter a new MMIS POC with a November 1, 2011, start date for all services. (We have asked HP to close all current POCs effective October 31, 2011.)
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Plan of Care: End Date!
The end date shall no longer be the “infinity” date of 12-31-2299.
For all POCs with a start date of November 1, 2011, the end date will be the last day of the consumer’s birth month. All annual reassessments shall be completed within the consumer’s birth month. We assure CMS that every PD and TBI consumer has an annual reassessment.
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Plan of Care Details: FMS
FMS Procedure code = T2040 U2Rate = $115 / monthOne unit = one monthPayment method = “Pay System
Calculated Price”
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Plan of Care Details: FMS (cont.)
Current consumers may transfer from one FMS
agency to another, but only effective the first day of
a month.
There can be only one FMS provider per month on
Plans of Care. There is no proration of FMS costs.
For initial waiver consumers, FMS shall be placed
on the POC effective the initial date of self-direct
services.
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PD Personal Services
Self-directed: Procedure code = S5126 U6 Rate = $11.31/hour One unit = one hour
Agency-Directed: Procedure code = S5126 U9 Rate = $13.08/hour One unit = one hour
MMIS design will change Personal Services from a monthly cost (“cap amount”) to a system-calculated price; i.e., hours as units will be placed on the POC with MMIS calculating the total monthly cost.
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TBI Personal Services
Self-directed: Procedure Code = S5126 UB Rate = $ 11.91/hour One unit = one hour
Agency-Directed: Procedure Code = S5126 U9 Rate = $13.52/hour One unit = one hour
MMIS design will change Personal Services from a monthly cost (“cap amount”) to a system-calculated price; i.e., hours as units will be placed on the POC with MMIS calculating the total monthly cost.
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Medication Reminder Services
1) Medication Reminder Calls▪ Procedure Code = S5185 (PD and TBI)▪ Rate = $15.91/month▪ One unit = one month
2) Medication Reminder Dispenser▪ Procedure Code = T1505 U6 (PD); T1505 UB (TBI)▪ Rate = $25/month▪ One unit = one month
3) Medication Reminder Dispenser Installation Procedure Code = T1505 (PD and TBI) Rate = $25/installation One unit = one installation; limited to one installation/year.
Enter on MMIS POC with “Pay System Calculated Price.”
Medication Reminder Services are agency-directed.
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Home-Delivered Meals Services
Procedure Code = S5170 Rate = $ 5.55/meal One unit = one meal Limited to no more than two meals/day
Enter on MMIS POC with “Pay System-Calculated Price.”
Home-Delivered Meals is an agency-directed service.
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PD Waiver Services
Assistive Services S5165 FMS T2040 U2 Home-Delivered Meals S5170 Medication Reminder Calls S5185 Medication Reminder Dispenser T1505 U6 Medication Reminder Disp. Install T1505 Personal Emergency Response (PERS) S5161 PERS Installation S5160 Personal Services – Self-Direct S5126 U6 Personal Services – Agency-Direct S5126 U9 Sleep Cycle Support T2025 Acute Care Costs ACC
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TBI Waiver Services
Assistive Services S5165 Behavior Therapy H0004 Cognitive Rehabilitation 97532 FMS T2040 U2 Home-Delivered Meals S5170 Medication Reminder Calls S5185 Medication Reminder Dispenser T1505 UB Medication Reminder Disp. Install T1505 Occupational Therapy G0152 Personal Emergency Response (PERS) S5161 PERS Installation S5160 Personal Services – Self-Direct S5126 UB Personal Services – Agency-Direct S5126 U9 Physical Therapy G0151 Sleep Cycle Support T2025 Speech/Language Therapy G0153 Transitional Living Skills H2014
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Consumer Frequently Asked Questions and Answers
Why are we making the change to Financial Management Services?The change has been brought about by the Centers for Medicare and Medicaid Services (CMS) requiring the State to separate administrative costs from direct service costs.
Will my consumer have to change his/her attendant care providers?
No, the consumer will be able to keep his/her current attendant care providers. Will my consumer have to change to a different payroll agent?
Maybe. There may be some current payroll agents that choose not to become a provider of Financial Management Services (FMS).
What will the FMS provider do for my consumer?
There will be an agreement between the consumer and the FMS provider which will outline both the responsibilities of the FMS provider and the consumer of services. Some of examples are processing time worked, paycheck creation, and filing of taxes, unemployment and liability insurance.
Will this change the amount of services that my consumer receives?
No.
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Consumer Frequently Asked Questions and Answers (cont.)
What is I & A?Information and Assistance (I&A) is a service that is incorporated into the definition and requirements of the FMS provider. This service 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. A complete detailed definition is available on the Self Direct website at http://selfdirect.ks.gov/CaseManagersAndProviders/Pages/FMS_Information.aspx or, if a consumer does not have access to the internet, please share a copy of the document with the consumer.
Will my consumer have to pay the FMS provider or how is the FMS provider paid for its work?No. The FMS provider will bill the State directly for the FMS it provides.
Can consumers have I & A and Case Management? Who will do what for consumers?Yes, although the services cannot be duplicative. FMS providers have specific I & A responsibilities which are different than the responsibilities of case managers.
Who should my consumer contact if he/she has questions? As a Case Manager, you were required to attend training on this change of service. You should be your consumer’s primary contact for information. You may also go to our website at http://selfdirect.ks.gov for further information.
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Resource Information Self-Direct Website:
http://selfdirect.ks.gov
Self-Direction/KPASS tool kit: http://selfdirect.ks.gov/Pages/Forms_TableofContents.aspx
SRS/CSS Website: http://www.srs.ks.gov/agency/css/Pages/default.aspx
PD Waiver Program Manager: Candace M. Cobb [email protected]
TBI Waiver Program Manager: Michael F. Deegan [email protected]
