FINANCIAL MANAGEMENT SERVICES For Self-Directed Waiver Services
in Kansas Presented by: Kansas Department on Aging March - April
2011 Slide 2 Overview What is Financial Management Services (FMS)?
Requirements to be an FMS provider Responsibilities of the:
Self-Directing Individual Agency with Choice FMS Information &
Assistance (I&A) Payment for FMS Enrollment Slide 3 Questions
Please submit questions in writing via: Chat on the webinar Email
directly to [email protected]@aging.ks.gov All
submitted questions will be compiled into a Q&A document to be
posted at http://www.aging.ks.gov/HCBSProvider/Pr ovider_index.html
after the last session is held
http://www.aging.ks.gov/HCBSProvider/Pr ovider_index.html Slide 4
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 Slide 5 Why change to Financial
Management Services (FMS)? Centers for Medicare and Medicaid
Services (CMS) new requirement Separates administrative functions
from direct service payment rates Incorporates more stringent
requirements Slide 6 Important Terms Direct Support Worker (DSW):
the person hired to provide direct care paid through HCBS.
Employment Services Agreement an agreement between the
self-directing individual and the DSW that identifies the
responsibilities/duties of all parties. Slide 7 Important Terms
Service Agreement an agreement between the FMS provider and the
self- directing individual. This authorizes the FMS provider to
accept timesheets, bill Medicaid, process payroll, distribute
paychecks; withhold, file, and pay taxes. Also identifies the
responsibilities/duties of all parties. Slide 8 Important Terms
SRS/KDOA Provider Agreement - an agreement between the State of
Kansas (SRS and/or KDOA) and a provider organization. It authorizes
a provider to function as a FMS provider agency. Slide 9
Requirements to be an FMS provider Each potential Agency With
Choice Financial Management Services (FMS)entity must meet the
following requirements: SRS/KDOA Provider Agreement Medicaid
Provider Agreement Registration with the Secretary of States
Office, if required. Slide 10 Requirements to be an FMS provider
Each potential Agency With Choice Financial Management Services
(FMS)entity must meet the following requirements: Insurance defined
as: Liability insurance Workers Compensation Insurance Unemployment
Insurance, if applicable Other Insurances, if applicable Annual
Independent Financial Audit Demonstrate financial solvency Maintain
required policies/procedures Slide 11 Policies and Procedures shall
include but are not limited to: Billing Medicaid with approved
rates, and for services as authorized by POC. Billing FMS
administrative fee Receive and disburse Medicaid funds, track
disbursements and provide reports Semi-annual reports to
self-direct individuals for billing/disbursements on their behalf
Report to the State of Kansas as requested Slide 12 Policies and
Procedures shall include but are not limited to: Ensure
proper/appropriate background checks are conducted Ensure that
self-directing individuals follow the pay rate procedures Clear
identification of how this will occur Prohibition of wage/benefit
setting by FMS provider Prohibition of recruitment practices (HCBS
waiver customers and/or DSW staff) Slide 13 Policies and Procedures
shall include but are not limited to: Ensure proper/appropriate
process of timesheets, disbursement of pay checks, filing of taxes
and other associated responsibilities The provision of Information
& Assistance services Grievance Procedures Slide 14
Responsibilities - Individual Decision making authority over
certain services and manages their services with the assistance of
a system of available supports. Choice of qualified and available
FMS providers when choice is made to self-direct and annually
thereafter. Slide 15 Responsibilities - Individual Direct the
services in the individuals approved Plan of Care (POC) and the
Direct Support Workers Access and participate in the development of
all plans including planning, startup, delivery and administration
of providers services. Informed of the roles and responsibilities
related to the FMS provider. Slide 16 Responsibilities - Individual
Work collaboratively with their FMS provider to meet shared
objectives: Receive high quality services Receive needed services
from qualified workers Tasks are provided in accordance with state
law governing self-direction, Medicaid and the State of Kansas
requirements, and are approved and authorized in the POC Slide 17
Responsibilities - Individual Act as the employer for Direct
Support Workers Negotiate a FMS Service Agreement with the chosen
FMS provider Select Direct Support Worker(s) Refer Direct Support
Workers to the chosen FMS provider Slide 18 Responsibilities -
Individual Negotiate an Employment Service Agreement with the
Direct Support Worker Provide or arrange for appropriate
orientation and training of Direct Support Worker(s). Determine
schedules of Direct Support Worker(s) Determine tasks to be
performed by Direct Support Worker(s) including where and when
Slide 19 Responsibilities - Individual Manage and supervise the
day-to-day HCBS activities of Direct Support Worker(s) Verify time
worked by Direct Support Worker(s) was delivered according to the
POC; approve and sign timesheets Assure submission of Direct
Support Worker timesheets and all other required documents to the
FMS provider for processing and payment Report work-related
injuries incurred by Direct Support Worker(s) to the FMS Develop an
emergency worker back-up plan Slide 20 Responsibilities -
Individual Assure all appropriate service documentation is recorded
Inform the FMS provider of any changes in the status of Direct
Support Worker(s) Inform the FMS provider and Targeted Case Manager
of the dismissal of a Direct Support Worker within 3 working days
Inform the FMS provider and Targeted Case Manager of any changes in
the status of the individual or individuals representative, within
3 working days Participate in required quality assurance visits
Slide 21 Responsibilities FMS When an individual or individuals
representative chooses an FMS provider, they must be fully informed
by the FMS provider of their rights and responsibilities to: Choose
and direct support services, Choose and direct the workers who
provide the services, Perform the roles and responsibilities as
employer, Understand the roles and responsibilities of the FMS
provider, and; Receive initial and ongoing skills training as
requested. Slide 22 Responsibilities FMS Must negotiate, review,
and sign a FMS Service Agreement The FMS Service Agreement will
identify the negotiated role / responsibilities of both the
individual and the FMS provider. Comply with the provisions of KSA
39-7,100 [Home and community based services program] and KSA
65-6201 [Individuals in need of in- home care; definitions]. Slide
23 Responsibilities FMS Execute a SRS/KDOA Provider Agreement with
the appropriate State agency. Execute a Medicaid Provider Agreement
with State Medicaid Agency. Comply with State Regulations, Provider
Agreement requirements, policies, and procedures Slide 24
Responsibilities FMS Develop and implement procedures, internal
controls and other safeguards to ensure individuals or an
individuals representative, rather than the FMS provider, have the
right to choose, direct, and control services and the Direct
Support Worker(s). Slide 25 Responsibilities FMS The procedures,
internal controls and other safeguards must be written and include,
at a minimum: A mechanism to process Direct Support Worker human
resource documentation and payroll in a manner that is efficient
and supports individuals or the individuals representatives
authority to select, recruit, hire, manage, dismiss, and train
Direct Support Workers. Information for Direct Support Worker that
outlines completion of timesheets, wages, benefits, pay days, work
hours, and individual self- direct customer preferences. Slide 26
Responsibilities FMS An assurance that the individual or
individuals representative, and not the FMS provider, determines
the terms and conditions of work (when and how the services are
provided, such as establishing work schedules, determining the
conditions of work, and the tasks to be performed). Internal
controls to ensure individuals or individuals representative are
afforded choice and control over workers without excessive
restrictions or barriers. Slide 27 Responsibilities FMS A process
to respond, within a reasonable timeframe, to contact from any
individual or individuals representative informing the FMS provider
of the decision to dismiss a particular Direct Support Worker. A
process for individuals or the individuals representative to pay
the Direct Support Worker(s) by direct deposit, first class
mailing, or other means through the FMS Slide 28 Responsibilities
FMS Ensure the individual or individuals representative and the TCM
have the name and contact information of FMS provider agency staff
who can address issues. Assume responsibilities in providing the
following administrative services: Establish and maintain all
required records and documentation, including a file for each self-
directing individual. All files must be maintained in a
confidential, HIPAA compliant manner. Slide 29 Responsibilities FMS
Obtain authorizations to conduct criminal background checks, child
abuse and adult registry checks in accordance with applicable
waiver requirements. Verify citizen and legal status of potential
Direct Support Workers. Collect and process all required federal,
state, and local human resource forms required for employment and
the production of payroll. Help individuals or the individuals
representative set the correct pay rate for each Direct Support
Worker. Collect and process timesheets of Direct Support Worker(s).
Slide 30 Responsibilities FMS Compute, withhold, file and deposit
federal, state, and local employment taxes for Direct Support
Worker(s). Compute and pay Workers Compensation as contractually
and statutorily required. Approve and pay wages to Direct Support
Worker(s) in compliance with federal and state labor laws. Perform
all end-of-year federal, state, and local wage and tax filing
requirements, as applicable. Slide 31 Responsibilities FMS Have
policies and procedures in place for the reporting of fraud and
abuse, neglect, or exploitation by a Direct Support Worker, to the
appropriate authority and Informs the individual or individuals
representative that if the Direct Support Worker continues to work
for the individual that they will no longer be able to serve as the
FMS provider. Slide 32 Responsibilities FMS Ensure that each
self-directing individual; Maintains control and oversight of their
Direct Support Worker; Is made aware of the benefits/services
available to them; Is made aware of the
requirements/responsibilities of self-directing individual to the
FMS provider; Is made aware of the requirements/responsibilities of
the self-directing individual to the Direct Support Workers: In
language/format that is understandable to the individual; Signed
Employment Service agreement that specifies the responsibilities of
the parties. Slide 33 Responsibilities FMS Ensure each Direct
Support Worker hired by the individual: Is made aware of the
benefits/services available to them; Is made aware of the
employment requirements/and job responsibilities of: The
self-directing individual; The FMS provider Maintain a listing of
Direct Support Workers that are available and desire additional
employment. Slide 34 Responsibilities FMS Develop, implement and
maintain an internal quality assurance program that monitors for:
Self-directed individuals satisfaction Direct Support Worker
satisfaction Correct timesheet submission Correct payroll
distribution Develop, implement and test an adequate backup plan
that assures records are preserved, and fiscal functions are
replicated in case of a natural disaster/or state of emergency.
Maintain evidence of certifications, agreements and affiliations as
required by waiver or policy. Slide 35 Information and Assistance
(I&A) I&A is a service within FMS that 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.
Practical skills training is offered to enable self-directing
individuals, their families and/or representative to independently
direct and manage waiver services. The extent of the assistance
furnished to the self-directing individual will be determined by
the self-directing individual or individuals representative. Slide
36 Information and Assistance (I&A) 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. Slide
37 Information and Assistance (I&A) I & A services may
provide assistance to the self-directed individual or individuals
representative with: Defining goals, needs and resources,
identifying and accessing services, supports and resources as they
pertain to self-directed activities; Practical self-direction
management skills training (e.g., hiring, managing and terminating
workers, problem solving, conflict resolution); Recognizing and
reporting critical events (e.g. fraudulent activities; abuse and
etc.); and Other areas related to managing services and supports.
Slide 38 Information and Assistance (I&A) I&A services may
provide information to the individual or individuals representative
about: Individual centered planning; The range and scope of
individual choices and options; Grievance and appeals processes;
Risks and responsibilities of self-direction; Individual rights;
Importance of ensuring Direct Support Workers health and safety
during the course of their duties to reduce potential injuries and
workers compensation insurance claims. Slide 39 Information and
Assistance (I&A) I&A services may provide information to
the individual or individuals representative about: (contd)
Reassessment and review schedules; The importance of keeping the
FMS provider and TCM informed as to current contact information and
planned absences; and Such other subjects pertinent to the
participant and/or family in managing and directing services and
living independently and safely in the community in the most
integrated setting. Slide 40 Payment for FMS The State of Kansas
has established a Per Member Per Month (PMPM) payment methodology
to be paid for the administrative and I&A services provided.
The administrative fee cannot reduce or cause any loss of
authorized waiver services to self-directing individuals. The FMS
provider is required to bill for all provided self- direct services
that are on an individuals plan of care. The individual client
obligation, if assigned to the FMS, is a required payment to the
FMS and must be applied to applicable service(s). If an individual
becomes past due in these obligations, a remedial payment plan will
be developed in coordination with the Targeted Case Manager in
order to meet past due obligations. Slide 41 Payment for FMS The
billing/procedure code for FMS regardless of waiver program is
T2040 U2 FMS is authorized only once per POC regardless of how many
self-directed services are needed Therefore, if the case opens or
closes mid-month the FMS service will begin or end on the specific
date with the full monthly amount If the case transfers to another
FMS provider that must occur at the start of the following month
Slide 42 FMS Rate: Accounts for the following: Unemployment
Insurance Other Insurances Filing and paying taxes Writing / paying
checks W-2; garnishments; other administration (criminal record
checks) Audits; reporting Direct and indirect operating costs
Information & Assistance Operational overhead Slide 43 Service
Rates: Accounts for the following: Workers Compensation SUTA FUTA
FICA Slide 44 Enrollment March April 2011 Training conducted April
2011 ongoing FMS Provider Manual published Enrollment application
updated Providers begin enrolling as FMS providers Slide 45 Contact
Information: FE waiver Krista Engel, 785-296-0385 or
[email protected]@aging.ks.gov MRDD waiver Greg
Wintle, 785-296-0935 or
[email protected]@srs.ks.gov PD waiver Candace
Cobb, 785-296-0648 or
[email protected]@srs.ks.gov TA waiver Kimberly
Pierson, 785-368-6302 or
[email protected]@srs.ks.gov TBI waiver
Michael Deegan, 785-296-5568 or
[email protected]@srs.ks.gov Slide 46 Thank
You!!
