1. Agency for Persons with Disabilities Consumer-Directed Care Plus Program 13 th Annual Family Café Conference June 3, 2011 Rhonda Sloan Operations Review Specialist/ Training Coordinator

2. Presentation Overview  What is the Consumer-Directed Care Plus Program (CDC+)  Essential CDC+ Responsibilities  Critical CDC+ Program Updates 1

3. What is the CDC+ Program 1915(j) State Plan Amendment for Florida Medicaid Waiver Recipients?  The CDC+ program empowers recipients of Home and Community-Based Medicaid Waiver services with the ability to self-direct or independently decide:  Payment for services within an allocated monthly budget  Employment, management, and termination of their own directly hired employees, including family members  Permission to use their service budget to pay for items that increase personal independence 2

4. Essential CDC+ Responsibilities Participant Responsibility  With choice comes responsibility – The CDC+ participant and his/her CDC+ representative (if one is selected to work with the participant) are responsible for learning how to operate the CDC+ program within state and federal rules and guidelines and to stay informed of all changes.  The CDC+ participant and his/her CDC+ representative are responsible for managing the Medicaid funds provided to the participant and this responsibility must be taken seriously. 3

5. Essential Responsibilities APD as DD CDC+ Fiscal Agent APD serves as the fiscal agent for the DD waiver population enrolled in the CDC+ Program.  Reviewing and entering consumer purchasing plans  Processing provider paperwork for state and federal tax reporting  Verification and processing of employee timesheets, invoices, and requests for reimbursement  Maintaining a customer service call center 4

6. Available CDC+ Resources  Consumer Notebook  Representative  Consultant  APD Area CDC+ Liaison  Fiscal/Employer Agent  Toll-Free Customer Service Line 1-866-761-7043  APD CDC Internet apd.myflorida.com/cdcplus 5

7. APD CDC+ Program Updates 6

8. Background Screening Changes 7 Reminders Background Screening Law Change: Effective August 2010, Florida's background screening laws changed to require that all employees of CDC+ participants pass a level 2 background screening before they can begin working for the CDC+ participant who is their employer. Who: This includes everyone providing direct care to consumers, all minors and emergency back-ups (EBUs) who are listed on a Purchasing Plan as natural support. Background screening expenses are the responsibility of the provider, not the participant or representative. Medicaid or CDC+ funds cannot be used for screening or rescreening providers.

9. Background Screening Changes (continued) 8 What about Medicaid providers that you may want to hire? If your provider is already a Medicaid-enrolled provider who underwent a background screening at the time of their enrollment into the Medicaid program and has remained in good standing, then the provider does not have to be screened, but the CDC+ participant may always request a copy of their clearance letter. Background screenings are valid for five (5) years. When time for rescreening, the participant/representative must allow enough time to process the screening prior to the expiration date. Existing providers with Level 1 Background Screening must pass a Level 2 Background Screening prior to their Level 1 expiration date. Sharing copies of clearance letters: CDC+ employers can share copies of the clearance letter with other CDC+ employers. The new employer must ensure there has not been a break in employment of more than 90 days. However, an updated local name check and a notarized Affidavit of Good Moral Character will be needed.

10. Background Screening Tips  Background screening - Make copies of anything you send (even fingerprint card)  Retain documentation, keep everything  Make sure you have everything for every person/vendor you employ  Track 5-year re-screening and initiate at least 3 months prior  FAQ CDC+ Website apd.myflorida.com/background-screening/docs/cdcfaq.pdf 9

11. CDC+ Training  Participant Refresher Training  Annual Requirement  Readiness Review  Certificate  Readiness Review New participants/representatives are required to complete a Readiness Review prior to enrolling in the CDC+ program with at least a score of 85%. Review is open-book and self-directed.  Consultant (new and refresher) Training  New consultant ongoing as needed  Refresher annual requirement 10

12. CDC+ 1915(j) Quality Assurance  What recipients, representatives, consultants, and directly hired employees need to know about quality assurance monitoring ▪ The DD waivers and the 1915(j) programs must be monitored for quality assurance as a requirement of the federal government for Medicaid services. AHCA contracted with Delmarva Foundation to conduct the discovery for the quality assurance review. It includes conducting Person-Centered Reviews (PCR) with recipients and Provider Discovery Reviews (PDR) with consultants and representatives/consumers including documentation review of vendors and directly hired employees who participate in the CDC+ program. 11

13. Person-Centered Reviews  To conduct a Person-Centered Review (PCR), recipients are asked to meet with a Delmarva reviewer to determine if services are meeting needs and/or goals of the recipient, to monitor health and safety of the recipient, and to assess the program for satisfaction and needed improvement.  The PCR is used to gather information for measuring the quality of care, as required by the federal government, to monitor service delivery and recipient satisfaction of their Medicaid program. Average consumer PCR scores are 89.5% (compared with DD waiver at 83.1%).  The PCR is an easy way for recipients and families to receive technical assistance regarding rules and regulations for the program.  The recipient will not lose their place in the CDC+ program based on a single PCR review.  PCR is an optional review. 12

14. Provider Discovery Reviews  A Provider Discovery Review (PPR) is conducted with the representative and consultant to ensure that the recipient’s care meets the required qualifications for the service rendered, based on DD handbook requirements for waiver service provision and CDC+ program rules for other goods and services. The average consultant score is 98%, and the average rep score is 86.6%.  PDRs will be conducted after a PCR review to evaluate provider performance, based on service delivery measures and program standards, to ensure that the consultant or representative is:  Helping the recipient to meet their expressed needs and/or goals determined in PCR review;  Meeting required qualifications for service provision;  Ensuring that the health and safety of the recipient are being met during service provision.  PDRs are mandatory, if selected, and not participating will result in non- compliance. Consultant and representative tools are on the website. 13

15. CDC+ APD Quality Assurance Outcome The most recent 2010 DD Waiver recipient Satisfaction Surveys show:  95.7% of consumers said their ability to direct their own services in the CDC+ program has improved their quality of life.  95.7% said they have more control over the quality of services  97.4% are satisfied with the CDC+ Program  97% of consumers would recommend CDC+ to others.

16. Peer Support Groups 15 Networking Resources Join NOW!

17. Contact Information APD CDC+ Customer Service, toll free 1-866-761-7043 Liesl Ramos, Program Administrator 1-850-921-3785 Agency for Persons with Disabilities liesl_ramos@apd.state.fl.us 16

18. Q & A Session