TANGUAYppt - Managing a Non-Traditional Workforce Using by maclaren1


									  Managing a Non-Traditional
Workforce: Appendix E: Participant
      Direction of Services
                            Scott Pelham, CES
                        NASDDDS Mid-Year
                      Rapid City, South Dakota
                                  May 11, 2007
      Topics within Appendix E:

• What types of Financial Management
  Services are available today
• Budget and employer authority for
    Factors that limit the choices States
     make on Appendix E: Participant
          Direction of Services:
- Concerns that participants cannot be supported to exercise
  adequate decision-making authority to be able to hire/manage
  their own workers
- Concerns that the State cannot provide the support and
  protection needed for participants to have more decision-making
  authority over their budgets
- Concerns that available Financial Management Services are
  insufficient to ensure legal compliance and fund accountability
- Concerns that overall information management and reporting
  will be unmanageable in a multiple FMS environment
   Services offered by CES that address
    these concerns for South Dakota:
- Online and manual time card and invoice controls with
  participant approval and Personal Agent/Support Coordinator
  or FMS closing features
- Automated Plan of Care management from
  authorization/amendments to payment for services (code, rate,
  time and cost controls; pre- and post-authorization)
- Real-time Service Code level budget utilization reporting (up to
  the last transaction)
- Controls minimize error and fraud and increase auditability
- Single statewide database and reporting system; allows States to
  offer both Fiscal/Employer Agent and Agency with Choice
  models to meet participant’s needs
  Managing a Non-Traditional
Workforce: Using Organized Health
     Care Delivery Systems
                                 Jean E. Tuller
                       NASDDDS Mid-Year
                     Rapid City, South Dakota
                                 May 11, 2007
    Origins of the OHCDS Approach
State Medicaid Director Letter: December 20, 1993
  “ Many states established systems under which single
  providers subcontracted with providers of other waiver
  services and were paid by the state for furnishing the
  entire “package” of care to an individual. However,
  this rendered the waivers vulnerable to problems with
  the statutory requirement of free choice of provider,
  direct payment and provider agreement.”
             Provider Payment Methods
• Traditional Method: Each provider furnishes service directly and each
  provider has a Medicaid provider agreement. Medicaid pays the provider
  directly or uses a fiscal agent
• Voluntary Reassignment to a Governmental Agency: Providers reassign their
  rights to direct Medicaid payment to a governmental agency; e.g., a county, a
  state DD agency. The provider and Medicaid sign an agreement and the
  governmental agency may be a co-signatory to that agreement. 42 CFR
• Limited Fiscal Agency: A payment and tracking system separate from that
  used for State Plan services. This is a subsystem of the state’s MMIS and thus
  75% may be available.
• OHCDS: “…a public or private organization for delivering health services.
  It includes, but is not limited to, a clinic, a group practice prepaid capitation
  plan, and a health maintenance organization.” 42 CFR 447.10(b)
                 OHCDS Defined
          Instructions: Version 3.4 HCBS Waiver Application

• An organization that provides at least one Medicaid
  service directly (utilizing its own employees) and
  contracts with other qualified providers to furnish other
• Medicaid agreement executed between state and the
• The OHCDS acts as the Medicaid provider
• The OHCDS subcontracts with other providers
                 OHCDS Defined
          Instructions: Version 3.4 HCBS Waiver Application

• Subcontractors must meet the standards under the
  waiver to provide waiver services under the OHCDS
• When OHCDS provides waiver services, payment is
  made directly to the OHCDS
• The OHCDS reimburses the subcontractor
• The contractual arrangement must be voluntary
• Participants may not be required to secure services
  exclusively through the OHCDS
          Waiver Application I-3-g-ii
                       CMS Review Criteria

The state:
1. Describes the types of entities that are designated as an
2. Has a methodology to designate entities as OHCDS and these
     entities meet the regulatory definition of an OHCDS
3. Ensures that there are adequate safeguards to ensure that
     OHCDS subcontractors possess required qualifications
4. Ensures that the OHCDS arrangement provides for
     appropriate financial accountability safeguards
                  Waiver Options
•    1915(c):
1.   Non-capitated arrangements
2.   No prepaid enrollment
3.   Individuals may not be restricted to providers within
     the OHCDS
•    1915(b)/1115:
1.   Pre-paid capitation
2.   Individuals are enrolled within the system and receive
     services from the system, its employees and
                State Examples
• NY: OMRDD functions as an OHCDS
• MA: DMR functions as an OHCDS
• MD: Community Pathways waiver for people with DD
• NC: Community Alternatives waiver program for
  aged/disabled administered by DMA
• VT: DD’s “Designated Agencies”
  Excellent contract example available that specifies
    DDD Standards for the Fiscal Employer Agent
•    HIPAA compliant information security with SSL 128-bit encryption;
•    Systems that are mirrored, redundant, housed in Class 5 facilities
     and supported with daily tape back-ups;
•    Web interfaced log-in portal for all authorized system users with
     individualized permissions/functions access;
•    All required forms and reports needed to facilitate self-directed
•    Initial and ongoing training to system users;
•    Ongoing customer service and support;
•    Plan of care based software that serves as a check and balance
     system for authorized services;
•    Real-time spending and forecasting reports at the individual, service
     coordinator, program and state level;
•    Checks and balances for time card submission and approval;
•    Options for payroll checks to include direct deposit, paper checks or
     pay cards.
   Managing a Non-Traditional
Workforce: Web Based Approach for
  Financial Management Services
                           Dan Tanguay, CES
                       NASDDDS Mid-Year
                     Rapid City, South Dakota
                                 May 11, 2007
What Challenges Do States Face Today?
• Distance between employers and the FEA
• I-9 Verification
• Time Card Processing and Verification
• Communication Around Employee
  Performance issues
• Documentation Requirements
• Ease of Administration
   What Are The Benefits of Using an
     On-Line Web Based System?
• Access to information and the ability to take action
  from any computer with an internet connection
• One Single Database of information that can only be
  updated by individuals with the appropriate security
• Elimination of “Waiting Time” between Actions or
• Ability to Audit Information “On Demand” from
• Accountability Controls are built into the service to
  eliminate the majority of errors associated with 1500
  claim form submission.
      What Are Your Pain Points?

• Questions and Comments from Attendees
• Live demonstration of CES services
  after conference closing remarks
• Thank You!

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