Fee-For-Service Agreement for DHHS Networks

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Fee-For-Service Agreement for DHHS Networks

• 2009 Fee-For-Service Agreement More!
• Presented by
• Dennis Buesing DHHS Contract Administrator
• Pamela Erdman Wraparound QA/QI Director
• Diane Krager DHHS QA Coordinator
• Jeannine Maher Wraparound Provider Network
  Coordinator
• Rochelle Landingham Contract Service
  Coordinator (BHD)

2
Overview 2009 Fee-for-Service Agreement and
Summary of Changes
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Summary of Changes
PAGE 2 4 DEFINITION EXPANDED Covered
Services - services identified in this Agreement
that are rendered by the Provider and are subject
to the terms and conditions of this Agreement,
for which the provider may request payment.
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• NEW DEFINITION
• Site Review Visual inspection of Providers
  premise, employee records, service documentation,
  interview of appropriate persons or individuals
  including but not limited to employees,
  participants, service recipients,
  parent/guardians, individuals with knowledge of
  the services recipients receipt of the Covered
  Service. The above may be conducted by Purchaser
  representatives, the Milwaukee County Department
  of Audit and representatives of appropriate
  federal, state or local agencies.

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• PAGES 4-6
• SECTION TWO
• GENERAL OBLIGATIONS OF THE PROVIDER
• Item E, H I New
• Purchaser agrees not to use Direct Service
  Providers in the provision of Covered Services
  who are suspended, debarred, or under
  investigation by Purchaser or other Federal,
  State, or Local entities.
• Provider agrees to provide Covered Services on a
  one on one, face-to-face basis unless otherwise
  specified by Purchaser Policy or Procedure
• Provider agrees to maintain Service Documentation
  as required by this Agreement and Policies and
  Procedures including a consent for services
  signed and dated by the Service Recipient or
  parent/guardian.

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• PAGES 4-6 Continued
• SECTION TWO
• (Section Thirteen of 2008 Combined with Section
  Two)
• GENERAL OBLIGATIONS OF THE PROVIDER
• Items J K Moved here from Service
  Documentation (Section Thirteen in 2008)
• Provider agrees to maintain and retain service
  documentation records as required by all
  applicable Policies and Procedures including the
  following minimum elements the date, time,
  duration, location, intervention, summary of the
  activity engaged in, Participants response to
  the Covered Service, Direct Service Provider
  signature and signature date.
• For Childrens Court Services Network and WIser
  Choice
• For Wraparound Milwaukee and SAIL
• In the case of an adult, records shall be
  retained for a minimum of seven (7) years after
  Covered Services have completed.

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• PAGES 4-6 Continued
• SECTION TWO
• GENERAL OBLIGATIONS OF THE PROVIDER
• Item M New
• Provider agrees to notify purchaser in writing
  within 5 business days of any of the following
  changes or conditions
• Agency name
• Agency ownership Agency director/CEO
• Agency business or billing address(es)
• Telephone or fax number E-mail address
• Federal Employers Tax ID (FEIN) number
• Change of insurance carrier or insurance
  coverage
• Change in or restriction of license(s)
• Discontinuation of agreed upon service(s).

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• PAGES 4-6 Continued
• SECTION TWO
• GENERAL OBLIGATIONS OF THE PROVIDER
• Emergency Preparedness
• pandemic flu added
• to agency requirement for a written plan to
  address the identified emergencies

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PAGES 9 SECTION ELEVEN COMPENSATION Item A
Sentence added in the middle. Purchaser will
only compensate Provider for pre-authorized
Covered Services as defined in this agreement and
Purchaser Policies and Procedures. Item B
Sentences added at the end. Provider may not
bill Participants for Covered Services unless
allowed as identified in a Purchaser Policy and
Procedure or other addendum to this Agreement.
This condition to remain in effect in the event
the Purchaser is unable to provide compensation
for Covered Service.
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PAGES 11-12 SECTION TWELVE INDEMNITY AND
INSURANCE Item D New Provider hereby
certifies that Provider's Direct Service
Providers who use personal vehicles for any
purpose related to the provision of Covered
Services have in effect insurance policies in
companies licensed to do business in the State of
Wisconsin providing protection against all
liability, including public liability and
property damage, arising out of the use of their
automobiles during the course of their
employment. Provider further certifies that said
Direct Service Providers have a Driver's License
valid in the state of Wisconsin.
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PAGE 14 SECTION FIFTEEN SITE AND SERVICE
DOCUMENTATION REVIEW Item B Sentences added at
the end. Purchaser may require submission of
requested documentation prior to payment for
Covered Services.
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PAGE 21 SECTION SEVENTEEN CONDITIONAL STATUS AND
SUSPENSION Item C Suspension Sub-Item 1 -
New Failure to maintain in good standing
required licenses, permits, certifications and/or
insurance required by this Agreement. Sub-Item 7
Language Added Findings resulting from a Site
Review/audit by Purchaser representatives, the
Milwaukee County Department of Audit and/or
representatives of appropriate federal, state or
local agencies that document quality concerns
related to all applicable Policies and
Procedures.
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PAGE 23 SECTION TWENTY REVISION TERMINIATION OF
AGREEMENT Item B New Language Added Failure
to maintain in good standing required licenses,
permits, certifications and/or insurance as
required by this Agreement, may, at the option of
Purchaser, result in immediate termination of
this Agreement
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APPLIES TO WRAPAROUND ONLY(Not in Sample
Agreement) ATTACHMENT D WRAPAROUND SPECIFIC
REQUIEMENTS Payment For Day Treatment, Group
Home And Residential Care Requires Progress
Entries in Synthesis
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Service Description Details

• Agency administrative staff and direct service
  providers familiar with current service
  description for service being provided
• Agree to provide service per this description and
  all relevant policies and procedures

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2009 Fee for Service Agreements
Each Milwaukee County operated program will send
out their own copy of the agreement.

• Individual Programs will
• Identify any requirements that need to be met in
  order to renew the agreement with that Program
• Establish time frame for when the signed
  agreement must be returned
• Work with Contract Administration regarding
  agencies that will be unable to renew their
  Agreement because of pending Audit issues

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DHHS Provider Networks/Contract Administration
Interface

• Engage in Centralized QA Committee
• Discuss/approve audit/review indicators
• Assist with site audits/reviews
• Dialogue regarding audit/review agency reports
• Collaborate regarding FFS Agreement yearly
  revisions

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Insurance RequirementsAudit and Accounting
RequirementsMaintaining Financial
RecordsGeneral Information on Allowable
CostsAudit Requirements and Waiver Procedures
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Insurance Requirement

• Auto Liability required for all agency vehicles
  (owned, non-owned, and/or hired). Coverage 1
  million per accident
• Employees of Providers using personal vehicles to
  transport participants, or for any other reason
  related to the provision of Covered Services
  shall have Automobile Insurance providing the
  same liability limits as required of the Network
  Provider
• Commercial General and/or Business Owners
  Liability Required of ALL Providers and must
  include premises and off premises liability
  coverage (may include Umbrella policy)

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Insurance (Professional Liability)

• Professional Liability If the services provided
  constitute professional services, Provider shall
  maintain Professional Liability coverage (i.e. if
  a license or certification is required to perform
  the service). Includes Certified/Licensed Mental
  Health AODA Clinics and Providers and
• 1MM/3MM

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Insurance (Professional Liability)

• Hospital, Licensed Physician or any other
  qualified healthcare provider under Sect 655
  1MM/3MM
• Changed last year
• Other Licensed Professionals, CPAs,
• Engineers, Attorneys, etc., 1,000,000 per
  Occurrence
• 2,000,000 Annual aggregate or
• Statutory limits whichever is higher

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Insurance (contd)

• Additional Insured Milwaukee County shall be
  named as, and receive copies of, an additional
  insured endorsement, for general liability,
  automobile insurance (except for hired or
  non-owned vehicles), and Umbrella/excess
  insurance
• Exceptions of compliance with additional
  insured endorsement are
• 1. Transport companies insured through the State
  Assigned Risk Business (ARB).
• 2. Professional Liability where additional
  insured is not allowed.

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Insurance (contd)

• Upon Renewal, Provider shall furnish County
  annually on or before the date of renewal,
  evidence of a Certificate indicating the required
  coverage (with the Milwaukee County Department of
  Health and Human Services named as the
  Certificate Holder )
• CERTIFICATE HOLDER
• Milwaukee County Department of Health and Human
  Services
• Contract Administrator
• 1220 W. Vliet Street, Suite 109
• Milwaukee, WI 53205

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Insurance (contd)

• Binders are not acceptable except during
  preliminary application period
• Failure to comply with insurance requirements may
  result in suspension or non-renewal of contract

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Who Must Have an Audit?

• Audits are required by State Statute if the care
  service purchased with State funding exceeds
  25,000 per year
• Statutes allow the Dept. to waive audits. Audits
  may not be waived if the audit is a condition of
  state licensure, or is needed to claim federal
  funding (e.g. Group Foster Care or CCIs)
• Standards for audits are found in DHFS/DWD/DOC
  Provider Agency Audit Guide, 1999 Revision (on
  line at www.dhfs.state.wi.us/grants)
• Non-profit providers that receive 500,000 or
  more in federal awards must also have audit
  performed in accordance with OMB Circular A-133
  Audit of State, Local Governments, and Non-Profit
  Organizations.

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What Must the Audit Contain?

• Items Frequently Omitted
• Summary of Auditors Results and Schedule of
  Findings and Questioned Costs
• Copy of Management Letter, if any
• Corrective action plan for all current-year audit
  findings related to County funded programs
  Managements response to each audit comment and
  item identified in the Management Letter.
• Schedule of Federal and State Awards

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What Other Schedules are Required?

• Per contract, Schedule of Program Revenue
  Allowable Cost by Contract (program), or
  program/facility within a contract. If program
  receives revenue from more than 1 funding source,
  all funding sources must be listed separately.
• If applicable, Incorporated Group Home/Child
  Caring Institution Supplemental Schedule
• Nonprofit providers paid on a unit-times-unit-pric
  e contract, Reserve Supplemental Schedule
• For-profit providers, Schedule of Allowable
  Profits

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Allowable Costs Allowable Profits or Reserves

• Per State Statute, ultimately, all agreements
  with Milwaukee County DHHS for care services
  paid with dept. funding are cost reimbursement
  contracts
• For-profit providers may retain up to 10 in
  profit per contract 7½ of allowable costs, plus
  15 of net equity (Allowable Cost Policy Manual,
  Section III.16)
• Nonprofit providers paid on a unit-times-unit-pric
  e contract may add up to 5 of contract amount in
  excess revenues to reserves each yr., up to a
  cumulative maximum of 10.

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Allowable Costs Allowable Profits or Reserves

• The County does not have to allow either a profit
  or reserves to providers who do not include a
  Schedule of Allowable Profits, or Reserve
  Supplemental Schedule with their audit

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Other Allowable Cost Issues

• Generally interest expense, except for
  purchase-money mortgages to purchase real estate,
  or equipment is not an allowable cost. Interest
  paid under Working Capital Loans, a line of
  credit or refinancing to pull money out of a
  property is not an allowable cost.
• Generally, advertising expense, except for costs
  associated with hiring and recruiting, is not an
  allowable cost
• Alcohol, Entertainment, Contributions Donations
  and repayment of audit recoveries and other debt,
  are never an allowable cost

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Special Allowable Cost Rules for S Corporations

• Distributions to Shareholders are not an
  allowable cost, and will be treated as a
  distribution of profits or dividends, not as
  wages.
• Per 48 CFR part 31, for costs to be allowable,
  the cost must be deductible on the entity's
  federal income tax return per IRS regs.
• To be allowable, salaries accrued for 2 or more
  shareholders must be paid in the current contract
  year

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Allowable Cost Related Party Issues

• Allowable Cost Rules under rental agreements with
  Related Parties contain additional restrictions
• Allowable rent expense under related party leases
  may not exceed the actual costs to the related
  party that owns the property. (Generally,
  mortgage interest, RE taxes, insurance,
  maint./utilities depreciation)
• Per contract, the auditor must disclose related
  party rental arrangements, rent paid to the
  related party, the related partys actual
  expenses on the property, the amount of
  unallowable rent on each property charged to any
  contract with Milwaukee County

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Maintaining Financial Records

• Both Federal and State contracting guidelines
  require provider agencies to maintain proper
  books and adequate financial records
• Providers should maintain an accurate and
  up-to-date general ledger and timely financial
  statements for management board members
• Financial Statements must be prepared in
  conformity with generally accepted accounting
  principles (GAAP) and on the accrual basis of
  accounting. Contractor must request, and receive
  written consent of County to use other basis of
  accounting in lieu of accrual basis of
  accounting.

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Maintaining Financial Records

• Amounts recorded in the books should be supported
  by invoices, receipts or other documentation
• Providers should maintain a separate cost center
  for each contract, or program/facility within a
  contract
• Whenever possible, costs should be charged
  directly to a contract, all other costs should be
  allocated using a reasonable and consistent
  allocation method and supported by an Indirect
  Cost Allocation Plan
• Providers must not commingle personal and
  business funds. A separate checking account
  should be established providers should not use
  personal credit cards for agency business
• All Provider agencies should maintain and adhere
  to a board approved, up-to-date Accounting Policy
  Procedures Manual and bonus policy

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Audit Waiver

• Statutes allow the Dept. to waive audits. Audits
  may not be waived if the audit is a condition of
  state licensure, or is needed to claim federal
  funding (e.g. Group Foster Care or CCI).
• Waiver request can only be entertained if agency
  does not need to have an audit according to
  Federal Audit requirement.
• Waivers need to be approved on case by case basis
  by regional office based on a risk assessment (
  Funding lt75,000 is considered low risk)
• Waiver Request S/B submitted DHHS Contract
  Administration prior to audit due date

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Audit Waivers

• DHHS has been approving Audit Waivers for Fee for
  Service contracts mainly on basis of economic
  hardship
• In case of small residential care providers (
  Family group home and AFH) county has the
  authority to grant a waiver.
• Waiver Form is available at http//www.milwaukeec
  ounty.org/contractmgt15483.htm
• 2007 Audit Waiver Form

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Common Errors or Omissions

• Nonprofits - Failure to provide Supplemental
  Reserve Schedule for all programs or contracts
• Failure to submit audit in a timely manner
  (results in Admin. Probation inability to renew
  contract)
• Failure to submit written Extension requests
• Failure to submit written Waiver requests
• Failure to submit evidence of Insurance renewal
  in a timely manner
• Audits are sent to wrong address
• Audit confirmation are sent to wrong address

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Names Address for Submissions

• Submit Audits to
• Dennis Buesing
• DHHS Contract Administration
• 1220 W. Vliet St., Suite 109
• Milwaukee, WI 53205 Ph414-289-5853
• Wraparound Confirmation Requests to
• Janet Friedman
• Wraparound Milwaukee Finance
• 9201 W. Watertown Plank Rd., Room 255
• Milwaukee, WI 53226 Ph414-257-7597

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Submissions (contd)

• Wiser Choice Confirmation Requests to
• Paul Neymeyr
• Behavioral Health Division
• 9201 W. Watertown Plank Rd., Room 607
• Milwaukee, WI 53226 Ph414-257-7912
• All Other Confirms (Purchase of Service,
  Childrens Court Services Network DSD)
• Stanley Dyett
• DHHS Accounting
• 1220 W. Vliet St., Suite 109
• Milwaukee, WI 53205 Ph414-289-6866

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BREAK
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Quality Assurance Policies and ProceduresClient
Chart MaintenanceAudit/Review Indicators
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Quality Assurance Policies and Procedures

• Refer to the applicable Divisions policies and
  procedures as they may differ.
• Agency is responsible for inservicing all Direct
  Service Providers on all relevant policies and
  procedures, i.e. Mentors should be inserviced
  on the Mentor Policy and Procedure.

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Noncompliance with Policies and Procedures

• Will be reflected in agency review report
• Can result in
• Fiscal recoupments
• Suspension
• Termination from Network
• Restriction of future contracts with Milwaukee
  County
• Corrective Plan of Action required

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Client Chart Maintenance

• 1 chart per client/family
• If sibling or caregiver of identified enrollee,
  must be clearly indicated
• Separate file into sections, i.e. Referral,
  Consents, Plans of Care/Service Plans/Treatment
  Plans, Notes, Correspondence, etc.
• Most recent correspondence and notes on top in
  each section
• See Provider Bulletin 1-09 (Wraparound only)

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Client Chart Maintenance (cont.)

• Chart should be orderly, neat, accessible
• Keep files in alphabetical order
• Separate current files from disenrolled files.
• Maintain file until youth turns age 19 or until 7
  years after service is completed, whichever is
  longer

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QUALITY ASSURANCEWhat we look for during a Site
Review

• 1. Network Provider cooperation.
• 2. Compliance with Requirements
• Fee-For-Service Agreement
• Policies and Procedures
• Provider Bulletins (Wraparound only)
• HFS 12 Wis. Adm. Code State of Wis. Caregiver
  Program
• Other applicable Federal, State, and County
  regulations

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Basic Review Indicators

• Agency Indicators
• Required Licenses i.e. Current Outpatient Clinic
  Mental Health State Certification, AODA Clinic
  License, etc.
• Required Insurance Coverage's i.e. Gen.
  Commercial Liability (1MM min. w/ MC named as
  addit. insured), Professional Liability, Wisc.
  Workers Compensation, etc.
• Required Training Manuals (service
  specific-Wraparound only)

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Basic Review Indicators(contd)

• Provider Indicators
• Current Professional Licenses or Certifications
• Evidence that Counselors meet Minimum Credential
  Requirements
• Evidence of Minimum Training Prior to Provision
  of Service (service specific)
• Compliance with 3 components of Background Check
  and Wisc. Caregiver Law and Milwaukee County
  Resolution
• Valid Drivers Licenses, Auto Insurance, Driving
  Abstracts on File

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Criminal Background Checks

• Your agency is required to complete a State-wide
  criminal background check through the Department
  of Justice Crime Information Bureau (CIB) on all
  prospective direct service providers
• When hiring direct service providers/employees
  that lived outside the state of WI within the
  prior 3 years Obtain out of state background
  check within state employee resided and a Federal
  criminal background check
• Three parts to Caregiver Background Checks
• 1. Background Information Disclosure (BID) Form
• 2. Response from Dept of Justice
• 3. Letter from Dept of Health and Family
  Services (DHFS)

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Criminal Background Checks (continued)

• Repeat every 4 years for ongoing Providers (or at
  any time within that period when an agency has
  reason to believe a new background check should
  be obtained).

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Reporting of Criminal Background Checks

• Before requesting to add a new Provider to the
  Network, agency must follow-up on any charges
  without dispositions
• Contact
• Milwaukee County Clerk of Courts
• Milwaukee County Courthouse
• 901 North Ninth Street
• Report convictions to Network (submit criminal
  
• background check with Add Sheet for new
  providers Wraparound only)
• Must be completed before service provider is
• authorized to provide services.
• If a current/authorized Provider is arrested
  and/or has been charged with or convicted of any
  crime specified in the Caregiver Law/ County
  Resolution, the Provider must notify the Network
  within two (2) business days.

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Basic Audit/Review Indicators(contd)

• Client Indicators
• Provider Referral Form/Service Plan on File Prior
  to Provision of Services, clearly identifying
  each Service being requested.
• Consents (Consent for Service/Treatment /or
  Transportation Consent) Signed/Dated by Legal
  Guardian/Client Prior to Provision of Services.

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Basic Review Indicators(contd)

• Client Indicators
• Plan(s) of Care (POC) /or Treatment Plan(s) in
  File for Duration of Service.
• Monthly Logs/Reports/Sign-In Logs and/or Progress
  Notes in File for each month billed.
• Logs and/or Progress Notes Contain all Required
• Elements.
• Discharge Summary in File, if applicable.

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Documentation

• Agency is responsible to ensure adequate and
  accurate documentation is maintained in the
  client file.
• Client files/records must be kept in secure,
  fireproof cabinet or room.
• Documentation reflective of service provision
  must be in file before a service is billed.

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Documentation (contd)

• Unless indicated by specific policy, Bulletin,
  statute, etc., documentation must include minimum
  elements
• Client/Recipient Name
• Date of Service i.e. 6/11/06
• Times and Duration i.e. 200-400 p.m., 2 Hrs.
• Location of Service i.e. Office
• Summary of activity/interaction/intervention,
  including clients response to activity.
• Signature of provider.

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Basic Review Indicators(contd)

• Fiscal Indicators
• Documentation must be reflective of the service
  provided and billed.
• Documentation must include all Required Elements.
• Hours (units) billed must match hours (units)
  documented.

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PLEASE NOTE

• Progress Notes must be specific to client served
  and descriptive of the session provided
  including the clients response to the treatment.
  PNs can not be simply copied and pasted from
  session to session.
• Service Logs or Sign-In Logs (if applicable)
  signatures must be obtained at the time the
  client receives the service and match the
  corresponding PN (date, time/duration). Any
  pre-signing of Logs by provider or client is
  considered fraudulent and grounds for termination
  from Network and future contracting with DHHS.
• PNs and Logs must be fully completed.
• Referral Forms must clearly identify service
  being referred (i.e. should read In-Home Therapy
  (5160) not Family Therapy, unless if
  Individual/Family Therapy (5100)
• REVIEW FILES/RECORDS ON REGULAR BASIS FOR
  ACCURACY COMPLETENESS

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Risk Assessment Criteria

• Factors to determine which agencies are
  audited/reviewed
• Prior Audits identifying problems
• Agencies receiving combined billings in auditable
  services equal to or gt 100,000 in prior 12 month
  period within 3 DHHS FFS Provider Networks
• Agencies with billing patterns above the average
  utilization for each respective service within a
  program will be reviewed for that program
• Agencies for which DHHS or program staff have
  received recent grievances, complaints, or
  evidence of health safety concerns or client
  reports non-delivery of service
• Agencies in the network less than 2 years, with
  billings equal to or gt 50,000.

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Civil Rights Compliance PlanRequirements
Presented by Dennis Buesing, DHHS Contract
Administrator
60
Civil Rights Compliance (CRC)
All recipients of Federal and/or State funds are
required to submit either a Civil Rights Letter
Of Assurance (LOA) or a Civil Rights Plan for
their agency The Equal Employment Opportunity
certificate is a separate requirement and does
not qualify as a CRC document.
61
CRC (Contd)..

• Agencies with 25 or more employees AND awarded at
  least 25,000 in federal, state county funds
  are required to submit a full CRC plan
• Agencies with fewer than 25 employees AND/OR
  receive less than 25,000 in funding may opt to
  submit a Letter of Assurance instead, which
  includes AA, EO and LEP policies
• Agencies who subcontract are also required to
  ensure the subcontractor maintains CRC
  requirements

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OTHER REQUIRED ITEMS (ATTACHMENTS) FOR SUBMITTING
WITH THE CRC LOA

• Required Items
• Attachment 1
• AA EO in Employment Policy
• Attachment 2
• Form DOA-3607
• Approval to be in Vendor Directory
• Form DOA-3024
• Request for Exemption for Submitting AA
  Strategies for achieving a balanced workforce
• Form DOA-3023
• Vendor Subcontractor List

• Profit Nonprofit Entities
• Required
• Not Required
• Not Required
• Not Required

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CRC (Contd)..

• New CRC plan requirements for years 2007-2009
• have been posted at DWD and DHFS web sites.
• LOA Instructions Templates are available at
  http//dwd.wisconsin.gov/dws/civil5Frights/plans0
  708/loa_contents_page.htm
• CRC Plan Requirements Templates are available
  at http//dwd.wisconsin.gov/dws/civil_rights/plan
  s0708/doc/plan_07_09.doc
• Plan instruction and resources are available at
  http//dwd.wisconsin.gov/dws/civil_rights/plans_in
  structions.htm
• Training webcasts are available at
  http//dhfs.wisconsin.gov/civilrights/Index.HTM

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Wisconsin Civil Rights Compliance Officer
Questions may also be directed to David Duran,
CRC Officer PO Box 7850 One West Wilson Street,
Room 561 Madison, WI 53707-7850 durand_at_dhfs.state.
wi.us Phone [phone] Fax (608)
267-2147
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Thank you for your participation!Have a Great
Day!?