Service Coordinator Orientation & Training PA OLTL Vendor Fiscal/Employer Agent Financial Management Services Participant Directed Model of Service October 2017
Agenda What this Training will Cover • Program Background • Principles of Self Direction • PPL Background • Roles & Responsibilities • Enrollment Process • Authorization Creation, Modification, and Troubleshooting • Managing Participant Services What this Training will not Cover • Transition to MLTSS www.publicpartnerships.com 2
Questions Attendees phones have been muted. We encourage you to reach out to your Regional Enrollment Manager to ask questions following this presentation. PPL will be recording this training session to make it available for future reference on our website; www.PublicPartnerships.com/Programs/Pennsylvania/Index.html www.publicpartnerships.com 3
Program Background Home and Community-Based Services (HCBS) offer persons with disabilities and Pennsylvania’s Seniors a choice on how their services are delivered. The PA DHS OLTL models of service are as follows: • The Agency Model which allows participants to select a provider from an approved list of agencies to provide services. • Self-Directed Services (or Participant-Directed Services) which enable participants to take more control of services giving them the power to manage their own workers as the common law employer. • Employer authority – participants employ their own workers to provide services based on the hours and activities specified in an individual service plan. • Budget authority (or Services My Way) – available in Aging and Attendant Care waivers only -is a model of services that gives participants the option to manage a flexible budget (Individual Spending Plan) and decide for themselves the type of goods and services that best meet their service needs. Participants may utilize a combination service plan where they receive some services from an agency and some through one of the self-directed models. www.publicpartnerships.com 4
Principles of Self Direction • Self Direction is a service delivery model that gives participants choice and control over their services so they may live as independently as possible in the community. Self Direction is also referred to as Consumer Direction or Participant Direction. • Participants will recruit, select, hire, and manage their own employees including friends and family to help with activities of daily living as defined in their service plan or under their budget. • To use Self Direction, participants must be willing to do the following: • Accept the risks, rights and responsibilities of self-direction • Accept the responsibilities as an employer or appoint a representative to serve as the employer. www.publicpartnerships.com 5
PPL Background • PCG Public Partnerships (PPL) acts as the Fiscal/Employer Agent providing the Financial Management Services (FMS) needed to assist Common Law Employers with the responsibilities of self direction, such as processing payroll and performing required tax functions. • PPL maintains two offices in Pennsylvania: • Harrisburg • Philadelphia (by appointment) • PPL Regional Enrollment Managers, located throughout PA, assist with participant concerns and enrollment and educate Service Coordination Entity staff on using PPL’s BetterOnline Web Portal, program processes, and program rules. • PPL Enrollment Specialists, located throughout PA, provide in-home and telephone visits to new participants to assist with the initial enrollment paperwork and provide orientation and training to the CLE. www.publicpartnerships.com 6
Recent Year Updates • CLE Welcome to PDS Letter • Enrollment Specialists • Provider Directory • Mobile Timesheet Application • FLSA Overtime Rules • Difficulty of Care Federal Income Tax Exclusion www.publicpartnerships.com 7
8 Home Page www.publicpartnerships.com
MyChoice4Care.com What is it? • Online directory that allows participants to post jobs and find care workers. Who is it for? • New participants considering self-direction or existing participants who need new workers Why is it needed? • Participants worry about finding care on their own. The directory enables them to hire someone that fits their needs. Available resources: • “Using MyChoice4Care.com” – overview information for you • “MyChoice4Care.com” – overview information for participants • “MyChoice4Care Website Guide” – step-by-step guide for you and participants www.publicpartnerships.com 9
10 Search Page www.publicpartnerships.com
Roles and Responsibilities
Roles and Responsibilities • PPL Roles & Responsibilities • PPL Enrollment Manager Roles & Responsibilities • Service Coordinator Roles & Responsibilities • Participant/CLE Roles & Responsibilities • Direct Care Worker Roles & Responsibilities www.publicpartnerships.com 12
PPL Roles and Responsibilities General responsibilities: • Provide pre-populated Common Law Employer (CLE) enrollment forms and Direct Care Worker (DCW) enrollment packets • Provide over-the-phone enrollment for DCWs • Provide assistance in completing CLE and DCW paperwork • Process and review completed CLE and DCW paperwork including perform all necessary record checks on prospective DCW’s • Issue payments to DCW’s bi-weekly following the receipt of properly submitted timesheets • Provide payments to vendors through Services My Way program www.publicpartnerships.com 13
PPL Roles and Responsibilities General responsibilities cont.: • Complete all payroll duties including withholding and depositing payroll taxes and filing payroll tax returns. • Issue a W-2 statement to each DCW in January • Operate a customer service phone line for participants and DCWs during regular business hours • Provide 24/7 on-line access to information via PPL Web Portal • Provide training and user guides on how to use PPL Web Portal www.publicpartnerships.com 14
Enrollment Manager Roles and Responsibilities • Serve as main point of contact for Service Coordinators (SC) and Service Coordination Entities (SCE) • Respond to day-to-day participant direction issues identified by SCs • The primary support system available to participants and DCWs is PPL Customer Service • Support the training and education need of the SCs and SCEs • Work with SC Administrators to maintain web portal access for SCs • Communicate significant changes and updates, including billing (denied claims) and authorization issues. • Inform SCs of errors causing participants not to receive services • Missing authorizations • Gap in Service Issues www.publicpartnerships.com 15
Service Coordinator Roles and Responsibilities • Determine suitability, for participation in the Participant Directed Services program, of waiver eligible individuals– assisting with the designation of an alternate CLE where necessary and allowed • Present the Participant Directed Services option to all suitable individuals • Make referrals to PPL using the PPL Better Online web portal • Develop and update the ISPs through HCSIS/SAMS • Initiate informal supports or agency services until the participant is ready to receive services through PPL and DCW is good to go • May assist participants with completing enrollment forms • Help participants develop and implement a backup plan www.publicpartnerships.com 16
Service Coordinator Roles and Responsibilities • Monitor the delivery of services and supports: • Review PPL utilization reports and the Service Plan with participant to ensure services are being provided in accordance with the Service Plan. • PPL does not have access to the ISP to determine schedule • Note: HCSIS is not a good indicator of utilization; it will only show SCs what PPL has billed, not what PPL has paid out. • Provide PPL with any temporary gaps in service in a timely fashion. • Keep participant demographics up to date in HCSIS/SAMS www.publicpartnerships.com 17
Common Law Employer Roles and Responsibilities • Recruit, hire, train, schedule, manage, and dismiss DCWs • Verify DCW and vendor qualifications • Ensure that DCWs complete the enrollment requirements • Train DCWs in providing services described in the ISP • Decide how much to pay DCW, within state guidelines • Monitor adherence to Service Plan and budget • Develop and implement a backup plan • Approve and submit all timesheets to PPL • Report suspicions of Medicaid fraud or financial abuse related to the delivery of participant-directed services • Designate a representative to assist with CLE duties, as necessary www.publicpartnerships.com 18
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