Consumer/Representative Training April 2, 2013

1. Consumer/Representative Training April 2, 2013 Barbara Palmer Director Rick Scott Governor

2. Welcome and Introductions Liesl Ramos, CDC+ Program Administrator Ivonne Gonzalez, Training and Outreach Coordinator Yvonne Luster-Harvey, Curriculum Developer Kelli Michels, Government Operations Consultant Susan Nipper, CDC+ Finance Administrator Submit questions throughout this presentation via chat or to: Liesl Ramos, CDC+ Program Administrator: Liesl_Ramos@apd.state.fl.us

3. Training Objectives • Identify the Five Principles of Self Determination • Describe the roles and responsibilities of Participant, Representative, Consultant, Regional and State Office • Describe different provider types • Demonstrate how to write a Purchasing Plan • Describe how to submit a Purchasing Plan • Describe how to properly manage a CDC+ Budget • Demonstrate how to reconcile the account

4. The Developmental Disabilities Medicaid Waivers Consumer-Directed Care Plus Program Coverage, Limitations and Reimbursement Handbook (CDC+ Rule Handbook) Participant Notebook (Currently undergoing revision) Appendices to Rule Handbook & Participant Notebook All of these documents are available on our website at: http://apd.myflorida.com/cdcplus/participants/index.htm The CDC+ website: apdcares.org/cdcplus CDC+ Tools

5. CDC+ History • 2000: 8-year Research and Demonstration Waiver called- Consumer-Directed Care (CDC) • January 2004: 5-year Demonstration phase (CDC+) • March 2008: Permanent Program - Authorized by Medicaid through the 1915j State Plan Amendment • Fall 2009: Program expansion authorized by Legislature • 2500 new participants • Training and enrollment • Fall 2012: CDC+ Rule Adoption • Completed 11/12/2012 • Any changes that occur will be shared 5

6. What is CDC+ • Long-term care program alternative • Based on principles of Self-Determination andPerson-Centered Planning • Provides opportunities to improve quality of life

7. Self-Determination and Person-Centered Planning • Person-Centered Planning • Principles of Self-Determination • Freedom • Authority • Support • Control • Responsibility

8. How Does CDC+ Work • Consumer driven • Exchange waiver budget for a reduced budget • CHOICE and FLEXIBILITY of supports/services • Not limited to the same services as the waiver • Find and hire your own providers • Submit claims to pay providers • Manage monthly budget responsibly

9. CDC+ Eligibility and Enrollment Requirements • Enrolled in the DD/HCBS waiver • Able to direct own care • Live in family or own home

10. Roles and Responsibilities • Participant • Representative • Consultant • Regional Liaison • State Office

11. Role of Participant (when representative not selected) • Authorized signer • Decision maker • Employer • Examples include: write job descriptions, negotiate pay rates, ensure L2 background screening is complete • Develops Purchasing Plan

12. Role of Participant, continued • Maintains accurate and complete records, and keeps them for at least six years • Spends CDC+ budget responsibly • Complies with training and monitoring requirements • Develops Emergency Backup Plan (CDC+ Rule Handbook pg. 3-3)

13. Role of CDC+ Representative • Same role as Participant • Unpaid Advocate; at least 18 years of age • Sign an agreement with the Participant • Readily available to Participant and Consultant • Responsible for appropriate use of public money • Attends required trainings • Participates in quality assurance reviews

14. Role Consultant • Waiver Support Coordinator • Sign a participant/consultant agreement • Assists with transitioning to and from the waiver • Provides on-going technical assistance • Assists consumer/representative with the development of the Purchasing Plan, but does NOT write it • Reviews and signs off on CDC+ documents

15. Role of Consultant, continued • Responsible for appropriate use of public money • Complies with training and monitoring requirements • Develops, implements, and monitors Corrective Action Plans (CAP) as necessary • Develops and updates support plan • Ensures cost plan is updated and approved • Monitors and reviews participant account activity

16. Role of Consultant, continued • Keeps active contact with Participant • Monthly – by phone • Bi-annually – two face-to-face per year, one of which must be in the participant’s place of residence • Monitors the consumer’s health, safety and welfare • Reports neglect, abuse, or exploitation • Ensures Medicaid eligibility

17. Role of the CDC+ Regional Liaison • Authorizes CDC+ Budget • Reviews Purchasing Plans • Facilitates employee background screening • Liaison between participant, consultant, and State office

18. Role of State Office • Administers CDC+ Program • Develops policies • Approves CDC+ Purchasing Plans • Develops and provides training • Provides Customer service

19. Role of State Office, continued • Provides Quality Assurance • Assigns Provider ID Numbers • Pays service claims and employer taxes • Sends monthly statements • Monitors consumer spending

20. Quality Assurance Requirement • Consultant • Participant • Person-Centered Review • Provider Discovery Review

21. Steps for CDC+ Participant Enrollment • Expresses interest • Completes training • Passes Readiness Review

22. Steps for CDC+ Participant Enrollment, continued • Application Packet • 2 page application document • Cost plan service authorization summaries • Budget calculation worksheet • Enrollment Packet • 8821 – IRS • 2678 – IRS • Fiscal Informed Consent • NOTE: All of these forms are available on our website at: http://apd.myflorida.com/cdcplus/docs/appendix/appendix.pdf

23. Steps for CDC+ Participant Enrollment, continued • Region calculates monthly budget • Region reviews and submits application and enrollment packet to State Office • State Office reviews and approves application and issues a Budget Authorization Form (BAF) • Participant chooses supports and services • Participant interviews potential providers

24. Steps for CDC+ Participant Enrollment, continued • Participant ensures providers complete background screening requirements • Participant develops and submits purchasing plan; CDC+ approves plan • Participant completes and submits employee and vendor packets; CDC+ issues provider ID’s • Participant begins self directing supports and services

25. Morning Break Q & A to follow

26. Calculating the Monthly Budget • Budget calculation worksheet (Participant Notebook Appendix D(3)) • Current approved DD/HCBS Waiver Cost Plan • Discount rate - 8% of the annual cost plan • Administrative fee - 4% or max amount of $160.00 per month

27. Calculating the Monthly Budget, continued • STE-Short Term Expenditure & OTE - One Time Expenditure • Consultant fee is not part of monthly budget (billed directly through FMMIS)

29. Participant Controls • What, when, who, where and how support & services will be provided that best meet their needs & goals • Setting Priorities • CDC+ Program Services (CDC+ Rule Handbook Ch. 4) • Restricted or Unrestricted (CDC+ Rule Handbook pgs. 4-3, 4-4)

30. Restricted/Unrestricted Services • (CDC+ Rule Handbook pgs. 4-3, 4-4) • Restricted Services- Services and supportsthatrequirea licensed provider. The consumer must purchase at least 92% of the units of measure that are approved in the Cost Plan. • Unrestricted services- Services and supports that meet the long-term care needs and goals as identified in the support plan. Does not have to be identical nor have same quantity.

31. OTE/STE Expenditures • One Time Expenditure- The consumer receives100% of the authorized waiver amount. Cannot be spent on any other service. There are only three OTEs: • Durable Medical Equipment • Environmental Modifications • Vehicle Modifications • Short Term Expenditure-Services approved on the waiver cost plan for 6 months or less, or are periodic in nature. Cannot be spent on any other service– ex. Dental, Assessments

32. Critical Services • Services, determined by the consumer orrepresentative as so important that without this service, the consumer’s health, safety, or welfare would be at risk. • Requires two emergency backup providers • Personal Care Assistance (PCA) service is always considered a critical service

33. Allowable & Unallowable Purchases • Allowable purchases (CDC+ Rule Handbook pgs.1-5, 3-8) • Related to long-term care needs and directly related to disability and health condition • Unallowable purchases (CDC+ Rule Handbook pgs.1-19, 3-9) Available through Medicaid, Medicare, at no charge through community resource. Any service not specifically provided under the CDC+ program

34. CDC+ Program Services • Every service contains a definition to include: Descriptions, limitations, special conditions, provider qualifications and service type. (CDC+ Rule Handbook Chapter 4) • Service codes and abbreviations can be found in the Service Code Chart Appendix I of the Participant Notebook: http://apdcares.org/cdcplus/docs/appendix/service-codes.xls

36. Provider Types • Directly Hired Employee (DHE) • Agency/Vendor (A/V) • Independent Contractor (IC)

37. How to Find, Hire and Manage Providers? • Identify service/support being purchased • Type of provider neededProvider requirements • Finding employees to work for you (Appendix E of the Notebook) • Advertising can be paid by CDC+

38. How to Find, Hire and Manage Providers, continued • Background Screenings • Level 2 for all providers listed on a Purchasing Plan • Valid for 5 years - provided there is not a break in service of 90 days or more • Employee Packets (Appendix G Notebook) • Vendor Packets (Appendix H Notebook)

39. Directly Hired Employee Services • The Participant decides • what will be done and create job description • how services will be performed • the hours per week/month worked • hourly rate of pay (negotiable) Companion – only service exempt from minimum wage requirement • The Participant must • review, approve & submit timesheet • budget for applicable employer taxes (SS & Medicare & unemployment taxes)

40. Agency/Vendor and Independent Contractor • A person or business that provides services/supports • Participant controls/directs only the result of work performed, and not the means and methods of accomplishing the result • Participant pays from submitted invoice • No taxes withheld or paid

41. Hiring an A/V, IC or DHE Agency/Vendor (A/V) orIndependent Contractor (IC) • Vendor/Independent Contractor Information Form • Internal Revenue Service (IRS) Form W-9 • Background Screening Letter Directly Hired Employee • Employee Information Form • Internal Revenue Service (IRS) Form W-4 • Department of Homeland Security (DHS) Form I-9 • Background Screening Clearance Letter Optional- Direct Deposit Form (EFT)- include a copy of a pre-printed voided check

42. Hiring an Employee Directly Hired Employee • Telephone screening • Suggested Interview questions • Basic job duties • Explain the way you want the job done • Have them bring picture I.D. & SS card • Have forms ready

43. Hiring Friends and Family Benefits to consider • More dependable relationship • Easier to find • Safer • Live-ins Risks to consider • Firing may be harder to do • It may be more difficult to direct their work • And…

44. CAUTION!!! • Public Assistance could be affected • Consumers are employers • If you hire your parents, your spouse, your child (under the age 21), or anyone under age 18, they do not earn eligible wages that will count toward Social Security or Medicare benefits. • If you hire your parent, your spouse, or your child (under age 21), to work for you as a DHE in CDC+, they do not earn eligible wages and do not qualify for unemployment compensation.

45. Caution, continued • This is a decision that needs to be carefully considered by the employee. • Visit IRS.gov to look at the Household Employer's Tax Guide, IRS Publication 926 and www.myflorida.com/dor to look at the Employer Guide to Unemployment Tax, UCT- 800002

46. Offering Benefits at No Additional Cost • Value your employees • Pay at fair wage • Be flexible if they need time off-sick • Use your backup providers • Spread the hours between two (2) employees • Compliment your employees • Make the job interesting and fulfilling

47. Q & A (time permitting) Lunch Break

48. Purchasing Plan – Appendix E • Describes how CDC+ monthly budget will be spent to meet needs and goals • Authorizes services/supports • Authorizes providers • Developed by Participant or Representative;Consultant may provide technical assistance andguidance (CDC+ Rule Handbook Appendix E)

49. Purchasing Plan – Timelines

50. Purchasing Plan Types • New Purchasing Plan • Purchasing Plan Change • Purchasing Plan Update • Quick Update