FINANCIAL MANAGEMENT SERVICES

mailboxcuckooManagement

Nov 10, 2013 (4 years and 1 month ago)

81 views

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



Email directly to
Krista.Engel@aging.ks.gov




All submitted questions will be compiled
into a Q&A document to be posted at
http://www.aging.ks.gov/HCBSProvider/Pr
ovider_index.html

after the last session is
held

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 65
-
6201 [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,
785
-
296
-
0385 or
Krista.Engel@aging.ks.gov


MRDD waiver


Greg
Wintle
,
785
-
296
-
0935 or
Greg.Wintle@srs.ks.gov


PD waiver


Candace Cobb,
785
-
296
-
0648 or
Candace.Cobb@srs.ks.gov


TA waiver


Kimberly Pierson,
785
-
368
-
6302 or
Kimberly.Pierson@srs.ks.gov



TBI waiver


Michael
Deegan
,
785
-
296
-
5568 or
Michael.Deegan@srs.ks.gov






Thank You!!