NEW CONSULTANT TRAINING November 28 & 29, 2012

1. NEW CONSULTANT TRAINING November 28 & 29, 2012 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. Navigating the Template

46. 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 Page 5 – Sections E and F – Savings Plan and OTEs/STEs Page 6 – Budget Summary and Signatures Purchasing Plan Sections

47. Open blank Purchasing Plan Follow along slide by slide Reference tools Purchasing Plan Instructions

48. Provide the required information CDC+ Purchasing PlanPage 1 - Top

49. Section A – Participant Information Purchasing Plan - Page 1

50. Section A – Participant Information (continued) Purchasing Plan - Page 1