For PD and TBI Systems Targeted Case Managers Presented by: Kansas Department of SRS Michael Deegan Candace M. Cobb July 2011

 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  FMS is only available for services that are self- directed

 Centers for Medicare and Medicaid Services (CMS) requirement;  Separates administrative functions from direct service payment rates.

 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 individual’s representative.  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. (Be careful to utilize TCM time for case management activities.)

 Meet all applicable requirements to be and maintain status as FMS provider.  Develop and implement policies that ensure the delivery of FMS services, and subsequent reimbursement, meeting applicable requirements.  Develop and maintain all applicable agreements.  Provide I&A as requested

 Choose from qualified and available FMS providers.  Participate in the development of all plans including planning, startup, delivery and administration of direct support worker services.  Work collaboratively with the FMS provider to meet shared objectives.

 Recruit, hire, train, and dismiss and schedule direct support workers.  Inform the FMS provider and Targeted Case Manager of any changes in the status of the individual or individual’s representative, within 3 working days.  Verify the time worked by Direct Support Worker(s) was delivered according to the POC.

 Ensure the consumer is aware of the new FMS service.  Revise plan of care timely and appropriately.  Refer the person to resources so they can educate themselves about FMS service and providers such as the self-direct website and the self-direction / KPASS tool kit.  Monitor service provision and POC implementation.

 Choosing an FMS provider for dates of service September 1, 2011 and ongoing shall follow the same process as consumers currently utilize to choose a “payroll” agency.  SRS will maintain lists applicable to each waiver of Medicaid-enrolled FMS agencies who will serve PD and TBI waiver consumers.

 For a self-directed individual the POC has to include both FMS and at least one of the self- directed services: Personal Services self- direct and/or Sleep Cycle Support.  Revising the POC shall follow the same submission and approval process that any other revision to services follows.

 The POC must be signed by the consumer or their representative.  For the September 1, 2011 revision, enter a new POC with a September 1, 2011 start date for all services. (We have asked HP to close all current POCs effective August 31, 2011.)

 The end date shall no longer be the “infinity” of  The end date shall, for all POCs with a start date of September 1, 2011, be the last day of the scheduled annual reassessment month. This could be the month before your scheduled annual reassessment, but NOT the month after.

 FMS = $115 / month  Procedure code = T2040 U2  Consumers may transfer from one FMS agency to another, but only effective the first of a month.  There can be only one FMS provider per month on Plans of Care.

 Personal Services :  Self-directed = S5126 _ _  Non-Self-Directed = S5126 _ _  (Modifiers and POC costs/hour will be announced at a later date.)  MMIS design will change Personal Services from a monthly cost to a system calculated price, i.e. hours as units will be placed on the POC with MMIS calculating the total monthly cost.

 Medication Reminder Services:  Medication Reminder = $ 15.91/mo  Medication Reminder Dispenser = $25/mo.  Medication Reminder Dispenser Installation = $25/installation  Procedure Codes will be announced once finalized with HP.  Home Delivered Meals = $ 5.55/meal  Limited to two meals/day  Procedure Code will be announced once finalized with HP.)

 Why are we making the change to Fiscal Management Services? The change has been brought about by the Centers for Medicare and Medicaid Services (CMS) requiring the State to separate administrative costs from direct service costs.  Will I have to change my attendant care providers? No, you will be able to keep your current attendant care providers.  Will I have to change to a different payroll agent? Maybe. There may be some current payroll agents that choose not to become a provider of Fiscal Management Services.  What will the FMS provider do for me? There will be an agreement between the consumer and the FMS provider which will outline both the responsibilities of the FMS and the consumer of services. Some of examples are processing timesheets, paycheck creation, and filing of taxes, unemployment and liability insurance.  Will this change the amount of services that I receive? No.

 What is I & A? Information and Assistance (I&A) is a service that is incorporated into the definition and requirements of the FMS provider. This service 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. A complete detailed definition is available on the SRS website at or, if you don’t have access to the internet, ask your case manager for a copy of the document.  Will I have to pay the FMS or how is the FMS paid for its work? No. The FMS will bill the State directly for the FMS it provides.  Can I have I & A and Case Management? Who will do what for me? Yes, although the services cannot be duplicative. FMS providers have specific I & A responsibilities which are different than the responsibilities of case managers.  Who should I contact if I have questions? Your Case Manager is required to attend training on this change of service. They should be your primary contact for information. You may also go to our website at….

 Self-Direct Website:  Self-Direction/KPASS tool kit  State of Kansas website: Please PD and TBI questions to either Michael or Candace for later posted Q & A.  PD Waiver Program Manager: Candace M. Cobb:  TBI Waiver Program Manager: Michael Deegan: