Strategies for Documentation in a Fee-For-Service World Laura Williams, Executive Director – Arc Ocean County Kathie Joyce-Medvitz, Quality Assurance - NJID William Placek, Program Supervisor – NJID

Supports Program Overview Supports Program and Community Care Waiver distinction Consumers enrolled in the Supports Program choose a Support Coordination agency Individuals are assigned a Tier rating based on the NJCAT scores All collaboration with the providers will be managed through the individual, their families, and the Support Coordination agency

NJID Supports Program Statistics Participated in Cohort 2 Started with 23 consumers through the Supports Program Approved Medicaid provider in Day Habilitation, Prevocational Training, Transportation, and Community Based Services Now serving 33 consumers through the Supports Program in our Day Programs and Adult Community Support Services Approved Medicaid provider in Day Habilitation, Prevocational Training, Community Based Supports, Behavioral Supports, Transportation, Individual Supported Employment

The Arc Supports Program Statistics Participated in Cohort 1 & 2 Started with 23 consumers through the Supports Program Now serving 58 consumers through the Supports Program in our Day Programs and Community Based Supports Approved Medicaid provider in Day Habilitation, Prevocational Training, Career Planning, Community Inclusion, Community Based Supports, Behavioral Supports, Respite, Transportation, and Individual Supported Employment

Supporting Documentation The New Intake Process Support Coordinator, individuals, or families contact the program directly Request and review any supporting documentation you may need Determine if the provider can meet the individual’s needs within the funding structure of their tier rating Complete a comprehensive assessment Supporting Documentation Current New Jersey Comprehensive Assessment Tool (NJCAT) Tier Rating New Jersey Individual Service Plan (NJISP) Person Centered Planning Tool (PCPT) Service Detail Report (SDR)

Process Development of Templates Tier Days per week Defining Exception Weeks Holidays Staff Training closures Submit Template to Support Coordinator

SC sends draft Service Detail Report Process SC sends draft Service Detail Report Provider Checks SC finalizes plan Family approves plan

Process Irecord generates SDR with Prior Auth and emails to Provider Provider Checks Provider enters into individual record ISP entered into electronic record Provider Service Begins

Documentation Reviewed and approved Process Service Documented Daily Direct Care Staff document service Start and end times/activity/level of performance/comments Outcomes documented Direct care staff document on individualized outcomes Documentation Reviewed and approved Site Supervisor

Service Delivery Service provider will receive the approved ISP and SDR (via email) and a letter from Medicaid authorizing services Provider will develop strategies to assist in reaching the outcomes included in the ISP and document them Provider will deliver the services as detailed in the ISP and SDR Provider will document deliver of services Provider will need to track the units used vs. the units that were prior authorized

Service Detail Report Provided by Support Coordinator Details the consumer’s information including tier and rate Confirm number of units matches the units listed on the ISP

Service Detail Report Provided by the Support Coordinator Send a program calendar to the Support Coordinator who will then design the units to match your program hours

Molina Authorization Mailed through the postal service to the provider Details approved service along with authorized units Develop an internal process to track the authorized units Best suggested practice would have one person identified to manage and track all incoming Molina authorizations

Day Habilitation Strategies Developed by the program with input from the individual and their families All strategies assist the individual achieve their outcome listed in their ISP Individual can work on multiple strategies a day Once developed, send a copy to the family

Day Habilitation Activities Log Start and end time follow your organizations processes Strategy # can be one or multiple strategies worked on Status includes an overall statement detailing the services that align with the strategies Cannot combine multiple days on one activity log

Prevocational Training Strategies Developed by the program with input from the individual and their families All strategies assist the individual achieve their outcome listed in their ISP Individual can work on multiple strategies a day Once developed, send a copy to the family

Prevocational Training Activities Log Start and end time follow your organizations processes Strategy # can be one or multiple strategies worked on Status includes an overall statement detailing the services that align with the strategies Cannot combine multiple days on one activity log

Continuation of Prevocational Training Justification Completed after providing prevocational training for a year Submit to the Support Coordinator to reauthorize prevocational training services Completed every six months after the first year

Community Based Supports Completed by the Service Provider Approved by your organization through internal processes Can have multiple days on one form Submitted through Molina with supporting insurance claim form

Transportation: Catchment Area Program Catchment Area Transportation Billed at $.74 Transportation not Provided

Rate for Transportation DDD is realizing that the rate may not be sufficient. Based on experiences for Cohort 1 and Cohort 2 – there may not be a sufficient network of transportation providers. Potentially may need to address the rate upward to address gaps in service.

Billing for Transportation Day Habilitation – Identify catchment area. Providers are able to bill for transportation outside of their defined area when approved through the ISP Various other services allow approved vendors to bill for transportation Approved providers bill for transportation directly through Molina

Clinical Needs Form Completed when an individual has an acuity factor Completed annually Support Coordinator generates the form by completing the top portion and sending to the provider Provider completes the bottom half of the form and returns to the Support Coordinator Becomes a component of the iRecord

Supported Employment Services – Intervention Plan and Service Log Used for individuals who are in job development or competitively employed Employment plan is documented here

Supported Employment Services – Intervention Plan and Service Log Used to document the staff interaction with the consumer as it relates to the employment plan

Residential Still waiting for CMS approval to flip to fee for service DDD meeting with Providers to assess readiness for fee-for –service. Many providers – indicating they are ready Currently, analyzing possible cohorts for when they get approval Once approval is obtained – all providers will need to apply for individual supports thru the Medicaid application process.

Residential Process DDD to create cohort All current service providers must be ready for an individual to move into fee for service. Person by person – not program by program Individuals select or auto assigned support coordination agency Important consideration for Residential Providers Support Coordinators develop plans DDD and Provider negotiate bridge funding and payback mechanism. Plans approved Billing begins

Remaining Contribution of Care Funding Tier 30% of Income Housing Subsidy Remaining Contribution of Care Billed directly to Molina Collected from individual Direct Deposit from SHC Collected from individual

Funding the Housing Gap Supportive Housing Connection (SCH) will administer the housing subsidy program for DDD All individuals will contribute 30% of their gross income (ex. Social Security Benefit and/or income from employment) directly to the housing provider (landlord). The SHC will pay the remainder up to the Fair Market Rate

Fair Market Rates for NJ Effective on 11/1/2016** County 0 Bedroom 75% SRO Atlantic $ 912.00 $ 684.00 Bergen $ 1,178.00 $ 884.00 Burlington $ 845.00 $ 634.00 Camden Cape May $ 719.00 $ 540.00 Cumberland $ 809.00 $ 607.00 Essex $ 1,007.00 $ 756.00 Gloucester Hudson $ 1,151.00 $ 864.00 Hunterdon $ 1,054.00 $ 791.00 Mercer $ 947.00 $ 711.00 Middlesex Monmouth $ 951.00 $ 714.00 Morris Ocean Passaic Salem Somerset Sussex Union Warren $ 795.00 $ 597.00

Maximum Rent - Ocean County 75% SRO 0 BR 1 BR 2 BR 3 BR 4 BR $713 $951 $1156 $1484 $2007 $2320 1 BR Apartment 2 Bedroom Apartment 3 Bedroom Apartment 3 Bedroom Group Home $2139 4 Bedroom Group Home $2852 5 Bedroom Group Home $3565 6 Bedroom Group Home

Determining Tenant Rent SRO Rates based on County $713 Multiply by Number of Bedrooms 4 $2852 Divide by Number of Tenants 5 $570.40 Tenant 1 Tenant 2 Tenant 3 Tenant 4 Tenant 5 Total Income $940 $1040 $1065 $815 $4800 - PNA $40 $200 30% Tenant $270 $300 $308 $232 $1380 Total Rent $570.40 $2852 Subsidy $262 $338 $1472

Contribution of Care Regulations go away – except for individuals residing in the developmental centers Providers will determine their own policies regarding Providers can elect to: Increase the Contribution of Care Decrease the Contribution of Care Keep the Contribution of Care the same

Resources DDD Supports Program Webpage http://www.state.nj.us/humanservices/ddd/programs/supports_pro gram.html