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Self-Determination

Using

Consolidated Supports and

Services (CSS)

May 9, 20131

Principles of Self-Determination

Self-Determination is a philosophy that is based on:

• Freedom

• Authority

• Support

• Responsibility

• Self-Advocacy

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Consolidated Supports & Services

(CSS)• Individuals must be deemed eligible for OPWDD

services and the HCBS waiver – eligibility

determination is part of Front Door process

• CSS is an HCBS waiver service – most CSS

supports and services are paid for through

OPWDD’s HCBS Waiver (Medicaid)

• CSS participant and/or designee maintains

budget authority and may exercise employer

authorityMay 9, 2013 3

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Features of CSS

• Individuals self-direct and manage their

supports and services based on their own

unique plan and individual, portable budget

• Funding allowed is based on Personal

Resource Allocation (PRA) & available

resources

• Individualized budgets are managed through a

Financial Management Services agency (FMS)

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Features of CSS (con’t.)

• May include housing subsidy as well as

service costs

� Is a partnership between the person and NYS -

wages, income and assets are considered if

individual requests a housing subsidy

• Personal allowance monies are retained

• Regional Office approves individual budgets

• Individual CSS prices are set up by OPWDD

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Most important:

CSS begins with the Person

• “Nothing about us without us!”

• Focus on relationships, contribution &

community

• The person is at the center - chooses Circle,

staff and directs activities:

� Increased sense of control and decision-making

� Increased satisfaction with choices May 9, 2013 7

The Circle of Support (COS)

The key decision-making group in CSS:

• Meets regularly to plan, support, advise the person

• Replaces other system structures

• Is a key to safeguarding

• Medicaid Service Coordinator (MSC) is a required

member

• Mix of professional and natural supports, freely

chosen

• No set number – size relates to needs

• Membership is chosen by the person and may changeMay 9, 2013 8

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Developing a Person Centered Plan

• Based on the person’s interests, preferences,

abilities and life goals

• Requires a group of people committed to a

powerful vision of the person’s future

• Promotes the use of natural supports

• Results in quality of life improvements that

reflect personal outcomes

• Builds in safeguardsMay 9, 2013 9

Brokers

• Why?

� Families and MSCs often don’t have time or

skills to do all the tasks associated with

getting CSS Plan/Budget completed or

maintaining it

• Tasks are separate from those of

Medicaid Service Coordinator (MSC)

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Getting Started:

What is a Broker?

A provider of technical support who assists an

individual to develop and maintain an approvable

Consolidated Services and Support (CSS) Plan/Budget.

The broker:

• Assists person to develop/maintain the Circle of Support

(COS)

• Facilitates Person-Centered Planning (PCP)

• Assists person to develop/maintain CSS service plan &

budget based on resources identified for the person by

the DDRO May 9, 2013 11

Broker Qualifications

• Be committed to person-centered planning and

self-directed supports and services

• Attend Broker Training Institute (BTI) offered by

OPWDD and complete 3 specific workshops. They

are:� Intro to Person Centered Planning

� Self-Determination/Self Advocacy

� Circles of Support

• Obtain twelve (12) hours of professional

development training annually after the first yearMay 9, 2013 12

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Who can be a Broker?

• Parents, family members, human service professionals, and self-advocates.

• However, immediate family members and persons with a clinical relationship with the individual may not be paid to perform this task.

• Medicaid Service Coordinators (MSC) and residential or day habilitation staff who provide direct support to a potential applicant may not be a paid start up broker for that individual.

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Who can be a Broker?

• NYS OPWDD employees may not be

paid to provide broker services.

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A Broker is

• An independent contractor or agency hired broker

� Independent broker

� Independent consultants

� Full or part-time agency staff acting as independent

contractors/consultants in their free time

� Agency broker - Staff of voluntary agency trained in PCP

work and CSS processes may do broker work as part of

their service delivery in that agency

• Hired by person at a negotiated hourly rate for a

number of hours based on person’s needs

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Choosing a Broker

• The broker is chosen by the person or his or her designee, friend, family or advocate

• The person interested in or participating in CSS may want to hire a broker with an advanced degree or training - especially a broker who has experience completing an actual Person Centered Plan or has successfully completed one or more approved CSS Plans/Budgets

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Two Broker Roles

• Start-up Broker - helps person with initial design of CSS Plan & Budget – is paid by FMS through SUB price with 100% NYS funds

• Support Broker - helps person maintain and update approved CSS Plan/Budget – is paid by FMS through CSS price with Medicaid funds

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Start-up Broker - Steps to Get StartedStep 1. Individual is determined eligible for OPWDD and HCBS

waiver services, and completes the assessment process

Step 2. Individual requests Consolidates and Supports and Services

Step 3. When the DDRO identifies available funding for the CSS

Plan/Budget, DDRO notifies individual and MSC, and provides

individual with a list of available brokers

Step 4. Individual selects a broker; individual and broker complete

and sign a SUB Agreement and submit to DDRO for review and

approval

Step 5. The DDRO notifies individual, SUB and FMS when SUB may

begin to provide services to individual

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Start-up Broker Tasks

• Complete a SUB Agreement with participant

&/or designee

• Assist in the identification of COS members

• Assist in facilitation of COS meetings

• Ensure that COS members understand their roles

and responsibilities

• Work with individual and COS to develop Person

Centered Plan

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Start-up Broker Tasks• Assist individual and COS to identify community

connections & resources

• Help design weekly schedule & supports

• Discuss staffing options - hiring own staff or

purchasing agency provided services or both

• Develop CSS plan for services and individualized

budget based on resources identified for the

person by the DDRO

• Work with Regional Office CSS Liaison to ensure

submission of approvable CSS Plan/Budget

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SUB Payment Process

• SUB must comply with fingerprint and criminal background check regulations in order to provide services

• SUB may not be paid prior to the “Effective Start Date” in the approval letter or on the price sheet

• SUB may bill the FMS monthly by sending completed invoices to the FMS once services have been delivered. The invoice must be signed by the broker and the individual or designee

• Once appropriate documentation is received by the FMS, the invoice is paid

May 9, 201321

Support Brokers

• CSS participants must have a support broker

• Support brokers assists participants with:� Updating and revising the CSS Plan/Budget

and may assist with:� Interviewing, hiring & training self-hired staff and

vendors or consultants

� Helping the individual understand responsibilities

� Training and maintaining the Circle

� Developing and maintaining community connections

� Understanding and completing CSS documentation

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MSC may help broker with:

• Circle development and

maintenance

• Planning

• Health and safety

decisions

• Budgeting, paperwork

• Working with Financial

Management Services

agency (FMS)

• Assisting with hiring and

firing support staff

• Brokering individual

service agreements with

self-hired staff

• Working with generic

community resources

• Monitoring quality and

satisfaction

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Developing the CSS Plan• Starts with person centered planning

• Individual puts together the plan/budget with

assistance of start-up broker, Circle of Support, and

MSC

• Plan/budget identifies what the person wants to do

and all the supports and services needed to achieve

outcomes

• Identifies areas where safeguards are needed and

how they will be addressed

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Developing the CSS Plan• Broker acts as link between individual/COS and

DDRO, and ensures that DDRO is provided with all

required documents that support the CSS

Plan/Budget, such as:

� the ISP,

� the IEP (if plan is developed before individual leaves

school) and

� the person-centered plan

so that CSS Plan/Budget can be approved

• Regional Office is available to assist throughout the

process May 9, 2013 25

Three Types of CSS Plans

� Residential Only (RES)

� Other Than Residential (OTR)

� BOTH

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Typical RES Supports May Include:

• Training & development in

independent living skills

� Personal & health

management

� Hygiene and grooming

� Day planning & organization

• Skill building related to household

management

� Meal prep/cooking

� Grocery shopping

� Laundry

� Cleaning

� Household budgeting

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• Getting to know &

navigating your

community

• Home safety & accident

prevention (evacuation)

• Using adaptive

equipment in the home

• Home-based

communication skills

development

Typical OTR Supports May Include:

• Job development

• Job coaching

• Adult education (nonmatriculated college

courses, adult ed)

• Transportation

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• Community inclusion

• Social skills development

• Exercise/wellness

• Entrepreneurship

• Personal care

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Typical Both Plan Supports Include:

• Any support or service that can be

included in an OTR or RES plan

• All of the supports and services the

individual is receiving through OPWDD � Note: Some supports/services are listed on but not funded

through the CSS Plan/Budget, such as e-mods/adaptive

technologies and Intensive Behavioral Services (IBS)

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The Individual Budget

• Participant has budget authority and may choose to

exercise employer authority

• Funds are administered by Financial Management

Services (FMS) agency

• Budget pays for supports and services appropriate to

fund by Medicaid and/or NYS

• CSS funds are not used to pay for personal expenses

related to entertainment/recreation (can pay up to

$1200 in personal transportation costs)

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The Individual Budget (cont.)

• Budget captures all the costs needed to support the

plan

• Typically includes staffing costs, staff training,

transportation

• Independent contractors may be hired to help

individual/COS implement CSS Plan/Budget or

provide specialized supports

• Collaborative use of personal resources and benefits

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Financial Management Services

(FMS)Who is the FMS?

• A voluntary, not-for-profit agency that acts as the fiscal and employer agent for the person enrolled in CSS

• The “Employer of Record” for the person’s self-hired staff

• The provider of record responsible for ensuring that service documentation is appropriate and accurately completed and for maintaining documentation

• The agency that bills Medicaid/OPWDD for funds to pay for the supports and services identified in the person’s CSS Plan/Budget

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Financial Management Service

(FMS)

• Assists the participant to manage budget

• Tracks expenditures

• Pays staff, vendors and bills based on current

approved plan/budget

• Provides monthly reports detailing expenditures

and budget status to participant and DDRO CSS

Liaison

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Financial Management Service

(FMS) • Acting as employer of record, co-managing self-

hired staff, is responsible for:

� Assisting the individual to recruit (if requested) and hire

employees, including completing background

checks/fingerprinting

� Assisting individual to manage self-hired staff as requested

� Providing required training & other training as agreed

upon

� Providing human resources functions, including payroll,

fringe benefits, including health insurance

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Managing Your CSS Plan/Budget

(Managing Employer vs. Employer of Record)

MANAGING EMPLOYER(CSS Participant)

� Is responsible for hiring and training self hired staff

� Is the “managing employer” of self hired staff – determines job duties and schedule for self hired staff based on services and supports included in CSS Plan/Budget

� Signs off on time sheets for self hired staff

EMPLOYER OF RECORD(FMS)

� Is “employer of record” for CSS participant’s self hired staff; may assist with hiring and training self hired staff

� Completes hiring requirements including criminal background checks and required trainings

� Collects time sheets and service documentation

� Maintains payroll for staff and administers benefits

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FMS Administrative Supports &

Responsibilities

Broker Training Institute36

• Conducts necessary meetings once plan/budget is

approved, e.g., launch meeting, CSS Plan (hab plan)

review

• Participates in annual and/or semi-annual ISP

meetings to discuss issues related to self-directed

staffing and budget expenditures

• Participates in Circle of Support (COS) meetings as

requested, as a budget resource

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FMS - Administrative Supports &

Responsibilities

Broker Training Institute37

• Coordinates updating of DDP-2 as needed, at

least every two (2) years

• Maintains communication with OPWDD

regarding participant and services

• Is also responsible for � Medicaid fraud investigations

� Incident Management - reporting & investigating

• And for travel time to address CSS responsibilities

FMS Training Tasks

• Assists/trains participant as “managing

employer” as requested

• Trains participant’s staff in required areas -

ensures incident reporting and other required

trainings are completed

• May train participant’s staff in other areas as

agreed upon with participant and Circle of

Support

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FMS - Billing

• Ensures adequate documentation to

support billings

• Bills eMedNY for Medicaid portion

identified in CSS Plan/Budget

• Bills OPWDD for the state share funding

identified in CSS Plan/Budget

Broker Training Institute 39

FMS - Maintains Medicaid

Documentation

Per ADM #2013-02, monitors and maintains:• Current signed ISP (must identify CSS)

• Current signed CSS Plan and amendments

• Current FMS-Participant agreement

• Documentation that billing standard is met - 4

face-to-face countable services, provided on a

separate day during the month

• Monthly Summary Note

• Maintains Medicaid records for 7 years

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Quality, Satisfaction, and Oversight

• Everyone has a role – ensuring quality is the

responsibility of:� the person,

� the broker,

� the Circle of Support members,

� the MSC, and

� all who provide supports and services

• Focus on participant’s personal satisfaction

• Emphasize balance: health, safety, risk

• Existing rules and regulations apply

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