NEW CONSULTANT TRAINING February 5 & 6, 2013

1. NEW CONSULTANT TRAINING February 5 & 6, 2013 Barbara Palmer Director Rick Scott Governor

2. Welcome and Introductions Ivonne Gonzalez Training and Outreach Coordinator Submit questions throughout this presentation to: 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, Area and State Office • Describe different provider types • Demonstrate how to write a Purchasing Plan • Describe how to properly manage your 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 Appendix to Handbook & Participant Notebook CDC+ Tools

5. CDC+ History • In 2000- Consumer-Directed Care(CDC)- Pilot Program • Demonstration phase January 2004 (CDC+) • Permanent Program March 2008, authorized by Medicaid through the 1915j State Plan Amendment • Expansion Fall 2009 • 2500 new participants • Training and enrollment • CDC+ Rule • Adopted as of 11/12/12 -Any changes that occur will be shared 5

6. What is CDC+ • Long-term care program alternative • Based on principles of Self-Determination and • Person-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. CDC+ Eligibility and Enrollment Requirements • Enrolled in the DD/HCBS waiver • Able to direct own care • Live in family or own home

9. iBudget Transition • Tier Waiver to iBudget by (July 1, 2013) • Authorized iBudget funds determine CDC+ Monthly Budget • CDC+ participants will still manage their iBudget funds in accordance with the CDC+ Rule Handbook • More information regarding iBudget on iBudgetFlorida.org

10. Roles and Responsibilities • Participant • CDC+ Representative • Consultant • Area Liaison • State Office

11. Role of Participant (when representative not selected) • Authorized signer • Decision maker • Employer • Develops Purchasing Plan

12. Role of Participant, continued • Maintains accurate and complete records • 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 • Readily available to Participant and Consultant • Responsible for appropriate use of public money

14. Consultant Requirements • Be a Waiver Support Coordinator in good standing • Complete CDC+ New Consultant Training • Pass Readiness Review • Enroll as a Medicaid provider for consultant services • Complete CDC+ registration forms • Sign Memorandum of Agreement

15. Role of Consultant • Waiver Support Coordinator • Complies with training and monitoring requirements • Sign a participant/consultant agreement • Provides on-going technical assistance

16. Role of Consultant, continued • Reviews and signs off on CDC+ documents • Responsible for appropriate use of public money

17. Role of Consultant, continued • Develops and updates support plan • Ensures cost plan is updated • Monitors and reviews participant account activity • Ensures Medicaid eligibility

18. Role of Consultant, continued • Keeps active contact with Participant • Monthly – by phone or in person • Annually – two face-to-face per year • Completes monthly review documentation • Communicates effectively with Area Liaison

19. Role of Area Liason • Authorizes CDC+ Budget • Reviews Purchasing Plans • Facilitates employee background screening • Liaison between participant, consultant, and State office

20. Role of State Office • Administers CDC+ Program • Develops policies • Approves CDC+ Monthly Budget • Develops and provides training • Provides Customer service

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

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

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

24. 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

25. Steps for CDC+ Participant Enrollment, continued • Area calculates monthly budget • Participant chooses supports and services • Participant interviews potential providers • Providers complete background screening requirements

26. Steps for CDC+ Participant Enrollment, continued • 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

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

28. Calculating the Monthly Budget, continued • PCA for children under 21 (use different Budget Calculation Worksheet) paid through Medicaid State Plan-(procedure code S9122TJ) • STE-Short Term Expenditure & OTE-One Time Expenditure • Consultant fee is not part of monthly budget (billed directly through FMMIS)

30. 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 Chapter 4) • Restricted or Unrestricted (CDC+ Rule Handbook pgs. 4-3, 4-4) • Allowable purchases (CDC+ Rule Handbook pgs.1-5, 3-8) • Unallowable purchases (CDC+ Rule Handbook pgs.1-19, 3-9)

31. 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

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

34. How to Find, Hire and Manage Providers? • Identify service/support being purchased • Type of provider needed • Provider requirements • Hiring packet – (Appendix E of the Notebook)

35. How to Find, Hire and Manage Providers, continued Employee Packets- (Appendix G Notebook) Vendor Packets- (Appendix H Notebook) • 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.

36. 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 requirements • The Participant must • review, approve, & submit timesheet • budget for applicable employer taxes

37. 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

38. Hiring an A/V, IC or DHE Agency/Vendor (A/V) or Independent 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

39. 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 and guidance (CDC+ Rule Handbook Appendix E)

40. Purchasing Plan – Timelines

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

42. OTE/STE Expenditure • One Time Expenditure- 100% of authorized amount - only 3 services: • Equipment/Devices DME • Environmental Modifications • Vehicle Modifications • Short Term Expenditure-Services authorized in waiver cost plan that are approved for 6 months or less, or are periodic in nature – ex. Dental, Assessments

43. Restricted/Unrestricted Services • Restricted Services-requiresa licensed provider, 92% of the units of measure that are approved in the Cost Plan must be utilized • Unrestricted services-services and supports that a CDC+ Participant may purchase provided the service meets needs and goals as identified in the support plan.

44. Critical Services • Critical Services- require two emergency backup providers who are ready and able to drop everything and come to work as an emergency backup, ex. PCA

45. The CDC+ purchasing plan consists of: Page 1 – Section A – Basic Information Page 2 – Section B – Needs and Goals Page 3 – Section C.1 and C.2 – Services and Supplies Page 4 – Section D – Cash (no longer available) Page 5 – Sections E and F – Savings Plan and OTEs/STEs Page 6 – Budget Summary and Signatures 45 Purchasing Plan Sections

46. 46 Open blank purchasing plan Follow along slide by slide Reference tools Purchasing Plan Instructions

47. 47 The CDC+ Purchasing Plan To move from page to page on the purchasing plan, click on a page tab in the blue bar on the bottom of the Excel page frame. Each page contains a section of the purchasing plan Extra pages in Section C.1 and C.2 are provided in the Excel file for participants who need additional space to enter services and supports

48. 48 Provide the required information CDC+ Purchasing PlanPage 1 - Top Enter the day the Purchasing Plan will be effective Participants on the Florida Freedom Initiative (FFI) check “Yes”, otherwise check “No”. Enter the participant’s approved CDC+ Monthly Budget amount Enter the number of the APD area in which the participant lives

49. 49 Section A – Participant Information Purchasing Plan - Page 1 Enter the participant’s legal first name, middle initial and last name as found on birth certificate Enter the participant’s ID number Enter the participant’s age as of the effective date of the Purchasing Plan

50. 50 Section A – Participant Information (continued) Purchasing Plan - Page 1 Enter a valid phone number for the participant or representative Enter a valid cell phone number for the participant or representative Enter the representative’s legal first name, middle initial and last name