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Services Facilitator Overview of ConsumerDirected Services


Conduct a comprehensive in-home visit prior to the start of care and before an ... Develop the POC with the recipient and conduct required reviews of the POC. ... – PowerPoint PPT presentation

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Title: Services Facilitator Overview of ConsumerDirected Services

Services Facilitator Overview of
Consumer-Directed Services
Division of Long-Term Care Department of
Medical Assistance Services March 19, 2007
To Keep Us On The Same Page Today
  • This training will provide an overview of the
    process of supporting recipients in
    self-directing their care.
  • Consumer-direction is an option for services in
    multiple waivers.
  • For specific details consult the specific waiver
  • For todays training we will use the term
    services facilitator (SF).

Recipient Eligibility
Who is Eligible?
  • Services may be furnished only to Medicaid
    Recipients who
  • Meet financially eligibility as determined by the
    local department of social services (The
    application process, by regulation, may take up
    to 45 days.)
  • Meet the criteria as defined by the waiver.

Who determines eligibility?
Receiving approval for some waivers means
placement on a wait list.
Waiver Alternative Placement
Patient PayDMAS-122
Patient Pay Facts
  • Some recipients may have a patient pay amount
    which is determined by DSS and noted on the
    Patient Information Form (DMAS-122).
  • The SF must send the DMAS-122 with the patient
    pay information to the fiscal agent, PPL via fax
    to (866) 706-3319.
  • The patient pay amount is paid by the recipient
    to an attendant.
  • MUST Do's
  • If the recipient employs more than one attendant
    they must complete a hierarchy form and submit it
    to the fiscal agent.
  • The fiscal agent will deduct the patient pay
    amount from the attendants check.
  • The recipient must pay the attendant the patient
    pay once the check-stub is received by the

Services Facilitators Qualifications and
Services Facilitator Responsibilities
Services Facilitators (SF) are vital to the
success of Consumer-Directed services. The role
of the Services Facilitator is to assist waiver
  • The (SF) will
  • Initiate services with the recipient.
  • Conduct a comprehensive in-home visit prior to
    the start of care and before an attendant begins
  • Develop the POC with the recipient and conduct
    required reviews of the POC.
  • Train and support the recipient to hire, train,
    and dismiss attendants. SF will train the
    recipient to serve in the role as employer and to
    coordinate the employer and employee enrollment
    activities with the Fiscal Agent (PPL).
  • Conduct the required visits to support the
    recipient and ensure the health, safety, and
    welfare of the recipient.
  • SF must maintain records of all contacts on
    behalf of the recipient. These contacts must be
    documented and filed in the recipient record.

Qualifications Services Facilitator
  • Preferred SF possess an undergraduate degree in a
    human services field or be a registered nurse
    currently licensed to practice in Virginia.
  • Preferred that the SF have two years of
    satisfactory experience in the human services
    field working with the elderly or persons with
  • The SF must have the knowledge, skills, and
    abilities set forth in the waiver manuals.

SF Responsibilities
  • Availability
  • By telephone to the recipient.
  • (In IFDDS Waiver, an approved back-up SF must be
  • During normal business hours, have voicemail
    capability. (EDCD)
  • Return phone calls within 24 business hours.

Services Provided
Services by Waivers
The requirements for these visits will vary by
waiver. It is important you check the manual to
be sure your documentation meets the requirements.
Service Limits
Quarterly review, semi-annual reassessments and
routine follow visits cannot be duplicated in the
same month.
Initial/Comprehensive Visit
  • Definition
  • Initial/Comprehensive Visit is an assessment of
    the recipients current medical, functional,
    social support status, and a complete summary of
    all services to be received.
  • Documents to Complete (this will vary with the
  • DMAS-99 Complete full assessment to ensure the
    recipient meets waiver criteria.
  • DMAS-122 Complete Patient Information Form.
  • DMAS-97A/B Complete Plan of Care.
  • For MR forms consult your manual.

Initial/Comprehensive Visit - continued
  • To ensure that the recipient understands
    his/her rights and
  • responsibilities in the program and signs all
    of the participation
  • agreements found in the Employee Management
    Manual .
  • Identify the Employer of Record.
  • All forms must be completed, signed, and dated
    before the
  • recipient can begin employing an attendant in
    the program.

Initial/Comprehensive Visit continued
  • Special conditions
  • Completed once the recipient is enrolled into the
    waiver and
  • consumer-directed services.
  • - Unless the recipient is terminated from
    waiver services and is being reenrolled.
  • If the recipient requests additional services,
    such as respite,
  • another comprehensive visit is not required.
  • This assessment initiates services for the
    recipient upon accepting
  • the referral of service from the
    Pre-Admission Screening.
  • This must be completed before the attendant
    begins services.

Recipient/Management Training
  • Definition
  • Management Training - is training provided by the
    SF upon the recipients request to prepare the
    recipient for their role as the employer.
  • Documents to complete (this will vary with the
  • Recipient/management training must be documented
    on the DMAS-99 in the notes section.
  • For MR forms consult your manual.

Recipient/Management Training(continued)
  • The SF must provide the recipient with training
    within seven days of the completion of the
    comprehensive visit.
  • The SF can complete the comprehensive visit and
    recipient training on the same day.
  • During the recipient training, the SF must train
    the recipient or caregiver, on his/her duties as
    an employer.

Recipient/Management Training(continued)
  • The SF follows an outline checklist for
    consumer-directed recipient training to ensure
    that the training content meets the minimum
    acceptable requirements.
  • The SF checks each subject on the form after it
    has been covered, and have the required
    signatures and dates.
  • The training checklist must be maintained in the
    recipients file and available for QMR.

(this check list will vary with the waiver)
Recipient/Management Training(continued)
  • Upon request by the recipient, there may be
    additional management training for the recipient.
  • Regardless of the method of training,
    documentation must indicate that training was
  • Each hour of training is billed as one unit.

Routine FollowUp
  • Definition
  • Routine Follow-Up - is a visit to the recipient's
    home to provide ongoing support.
  • Documents to Complete (this will vary with each
  • DMAS-99.
  • For MR forms consult your manual.

Routine Follow-up
  • After the comprehensive visit and management
    training, the SF must conduct two routine onsite
    visits within 60 days of the initiation of care
    (once per month) to monitor the recipients POC
    and ensure both the quality and appropriateness
    of services.

Routine Follow-up (continued)
  • Once the first two routine visits have been
    completed, the SF and the recipient can adjust
    the frequency of the routine onsite visits.
    Documentation can be on the DMAS-99 or in
    progress notes for the MR Waiver.
  • Routine visits must be conducted at the
    recipients home. An evaluation of the
    recipients environment and support system is
    important to evaluate his/her needs.

Routine Follow-Up (continued)
  • A face-to-face visit must be conducted with the
    recipient if they are receiving personal care
  • And every six months when respite is the sole
    service being provided.
  • After the initial 90 day review, the SFs review
    of the plan of care will be performed in the
    recipients home on an as-needed basis.

Routine Follow-Up - continued
  • During routine visits, the SF
  • Observes, evaluates, and documents the adequacy
    and appropriateness of the attendant services
  • Reviews the attendants time sheets, if
  • Discusses the recipients satisfaction with
  • Reviews medical and social needs
  • Reviews the established POC and
  • Other documentation as listed in the waiver

Reassessments Visits
  • Definition
  • Reassessment Visit - is a visit to conduct a full
    assessment of the recipient's current medical,
    functional, and social support status and a
    complete summary of all services received. It
    updates and summarizes the activity of the last 6
    months and updates the plan of care as needed.
  • Documents to complete (this will vary with the
  • DMAS-99 must include a complete review of the
    recipient's needs, available supports, and a
    review of the Plan of Care.
  • For MR forms consult your manual.

Reassessments Visit
  • Conducted every six months or upon the use of 300
    respite hours, whichever comes first.
  • Conducted for recipients who are transferring
    from another SF or who requests a change in their
    Consumer Directed services documented on a

SF (B) Reassessment
SF (A)
Reassessment Visits
  • Special factors to consider?
  • It is appropriate for the attendant to document
    tasks that are not included in the recipients
    POC if there is a need for the task to be done.
  • The recipient should note why this task was
    performed and whether the need for this task
    continues to exist. It is then the responsibility
    of the SF to determine whether there is a need
    for the task to be included in the POC on an
    ongoing basis and make appropriate changes.

Annual Visits
  • Annual visits occur in the MR Waiver

Visit Time Line
  • Initial 12 month view
  • Months 1 2 3
    4 5
    6 7 8
    9 10
    11 12

Employer / Management/ Recipient training
Initial Comprehensive Visit
Routine Visit/
Routine Visit
Routine Visit
Routine Visit
Routine Visit
Reassessment Visit
Reassessment Visit
Waiver received
Services Begin
2 visits are required within 60 days of beginning
Visit Time Line
  • Renewing 12 month view
  • Months 13 14
    15 16 17
    18 19
    20 21
    22 23 24

Services Provided
Routine Visit/ Quarterly
Routine Visit / Quarterly
Routine Visit / Quarterly
Routine Visit / Quarterly
Reassessment Visit
Reassessment Visit
Waiver Documentation
Who Does What When
Overview of Process
Become Eligible for Medicaid and Waiver Become
Medicaid a Recipient, receive assessment and
receive approval for a Waiver service
Choose/Contact Services Facilitator Recipient
chooses from local agency list SF completes a
Fiscal Agent Services Request Form and faxes it
to the fiscal agent
Submit Time Sheets Bi-Weekly Recipient faxes
to fiscal agent based on assigned payment
Completion of Paperwork Services Facilitator
completes the initial/comprehensive visit and
develops the Plan of Care
Services begin/ Attendant Begins Work Attendant
must begin work only after the start of care date
on the approved plan of care and Authorization is
Starting Consumer Direction
Conduct Recipient Training Facilitator provides
CD employer training. Recipient sends initial PPL
enrollment paperwork.
Recipient Provides Training to
Attendant Recipient trains attendant based on
Plan of Care, and job description. Work schedule
is finalized
Recipient Employs Attendant Recipient
Advertises, interviews, and employs attendant.
Send Employee packet to PPL.
Quality Management
CMS Establishes Quality Management Functions
QMR Process
What Generates a QMR
  • Need and Priority
  • Complaints
  • High Risk Indicators
  • New Providers
  • Statewide Sample
  • Computer generated lists are created
  • QMRs are scheduled randomly

Types of QMRs
  • Most are Unannounced (You must be available)
  • May be on-site or desk QMR
  • May include
  • Observation of recipients and service delivery
  • Face to face or telephone interviews with the
    recipient and caregivers
  • Recipient satisfaction surveys
  • Usually 1 3 days in length
  • depends on size of QMR sample

The QMR can and will be expanded if concerns are
General Information
  • Keep all documents organized
  • Keep the documents available for QMR
  • Keep all documents current
  • Have your own QMR Process
  • Regulations require all documentation be kept for
    a minimum of 5 years except for anyone under 18
    years of age, regulations require all records
    must be kept for 5 years past their 18th
  • (it may vary depending on waiver)

Preparation Hints
  • Specific Information to keep
  • Assessments
  • Plans of Care
  • Individual Service Authorization Request (ISAR)
  • Prior Authorizations (PA)
  • Current DMAS-122
  • Document all contacts
  • Quarterly Reviews (face to face)
  • Any APS complaints filed with Outcome Action
  • Provider Qualifications
  • Credentials
  • Changes to Organization Leadership/Ownership
  • Set forth Policies Procedures to meet all
    regulatory provider requirements
  • Staff Qualifications
  • Training
  • Credentials
  • Evidence that Criminal Record checks are completed

Available Training
  • Web sites for more information on the waivers
  • WebEx information
  • Overview of Consumer Direction
  • Overview of Services Facilitators Role
  • Overview of what it means to be Employer
  • Overview of what it means to be Employee
  • Explanation of completing forms
  • Contact Office of Mental Retardation Community
    Resource Consultant for SF training for
    the MR Waiver.

PPL Website for VA DMAS Recipients, Attendants,
and Staff
  • Recipients, Attendants, and Services Facilitators
    can retrieve key information from this website.
  • It contains forms and training materials.
  • It includes payroll schedules and timesheets.
  • When you want enter the site use the following to
    log in
  • The username is vaclient
  • The password ispcgva67
  • NPI numbers are obtained by the provider through
    a national registering agent.
  • NPI - National Provider Identifier (medical
  • New API numbers have been assigned to each
    non-medical Provider February 19, 2007.
  • API - Atypical Provider Identifier (non medical
  • Dual use will begin on March 26, 2007.
  • All billing submissions will be on the new
    CMS-1500 form including API numbers.

Without the NPI or API number after May 23, 2007
you will not be eligible for payment.
Rate Changes
  • As of July 1, 2007 there will be a 3 rate
    increase on all SF services. There will also be a
    3 increase in the attendants pay.
  • The Northern Virginia differential will continue.

This differential is applied based on the
recipients home address.
  • your time
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