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FINANCIAL MANAGEMENT SERVICE - Self Direction Home

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					 SERVICES OVERVIEW of
   NOVEMBER 1, 2011,
       CHANGES
   For PD and TBI Systems Targeted Case Managers
             September 12 and 13, 2011

Presented by: Kansas Department of SRS
               Michael F. Deegan
               Candace M. Cobb
          What is happening
          November 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
                                                2
   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
                                                3
Why change to Financial
Management Services (FMS)?
 Centers for Medicare and Medicaid
  Services (CMS) requirement.


 Separates administrative functions from
  direct service payment rates.



                                            4
 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.                     5
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.)
                                                6
          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.

                                             7
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.
                                                8
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.             9
  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.
                                                  10
     Process for Choosing an
          FMS 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.
                                               11
            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.
                                             12
  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.)
                                                13
    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.                                 14
 Plan of Care Details: FMS

 FMS Procedure code = T2040 U2
 Rate = $115 / month
 One unit = one month
 Payment method = “Pay System
  Calculated Price”


                                  15
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.
                                                    16
       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.                     17
      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.                     18
  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.
                                                                        19
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.

                                             20
         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

                                                    21
          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

                                                    22
         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.  

                                                                                     23
         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.           24
         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  
    candace.cobb@srs.ks.gov
TBI Waiver Program Manager:  Michael F. Deegan  
     michael.deegan@srs.ks.gov
                                                               25

				
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