1. 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

2. 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

3. 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

4. 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

5. 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)

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

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

8. 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

9. 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

10. Service Delivery
Service provider will receive the approved ISP and SDR (via ) 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. 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.

22. 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

23. 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

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

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

26. 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.

27. 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

28. 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

29. 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

30. Fair Market Rates for NJ Effective on 11/1/2016**
County
0 Bedroom
75%
SRO
Atlantic $ $
Bergen
$ ,178.00 $
Burlington $ $
Camden
Cape May $ $
Cumberland $ $
Essex
$ ,007.00 $
Gloucester
Hudson
$ ,151.00 $
Hunterdon
$ ,054.00 $
Mercer $ $
Middlesex
Monmouth $ $
Morris
Ocean
Passaic
Salem
Somerset
Sussex
Union
Warren $ $

31. 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

32. 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

33. 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

34. Resources DDD Supports Program Webpage
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