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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Managing a Non-Traditional Workforce:,Appendix E:Participant Direction of Services,Scott Pelham,CES,NASDDDS Mid-Year,Rapid City,South Dakota,May 11,2007,Managing a Non-Traditional Wo,1,Topics within Appendix E:,What types of Financial Management Services are available today,Budget and employer authority for Consumers,Topics within Appendix E:What,2,Factors that limit the choices States make on Appendix E:Participant Direction of Services:,Concerns that participants cannot be supported to exercise adequate decision-making authority to be able to hire/manage their own workers,Concerns that the State cannot provide the support and protection needed for participants to have more decision-making authority over their budgets,Concerns that available Financial Management Services are insufficient to ensure legal compliance and fund accountability,Concerns that overall information management and reporting will be unmanageable in a multiple FMS environment,Factors that limit the choices,3,Services offered by CES that address these concerns for South Dakota:,Online and manual time card and invoice controls with participant approval and Personal Agent/Support Coordinator or FMS closing features,Automated Plan of Care management from authorization/amendments to payment for services(code,rate,time and cost controls;pre-and post-authorization),Real-time Service Code level budget utilization reporting(up to the last transaction),Controls minimize error and fraud and increase auditability,-Single statewide database and reporting system;allows States to offer both Fiscal/Employer Agent and Agency with Choice models to meet participants needs,Services offered by CES that a,4,Managing a Non-Traditional Workforce:Using Organized Health Care Delivery Systems,Jean E.Tuller,NASDDDS Mid-Year,Rapid City,South Dakota,May 11,2007,Managing a Non-Traditional Wo,5,Origins of the OHCDS Approach,State Medicaid Director Letter:December 20,1993,“Many states established systems under which single providers subcontracted with providers of other waiver services and were paid by the state for furnishing the entire“package”of care to an individual.However,this rendered the waivers vulnerable to problems with the statutory requirement of free choice of provider,direct payment and provider agreement.”,Origins of the OHCDS ApproachS,6,Provider Payment Methods,Traditional Method:Each provider furnishes service directly and each provider has a Medicaid provider agreement.Medicaid pays the provider directly or uses a fiscal agent,Voluntary Reassignment to a Governmental Agency:Providers reassign their rights to direct Medicaid payment to a governmental agency;e.g.,a county,a state DD agency.The provider and Medicaid sign an agreement and the governmental agency may be a co-signatory to that agreement.42 CFR 447.10(e),Limited Fiscal Agency:A payment and tracking system separate from that used for State Plan services.This is a subsystem of the states MMIS and thus 75%may be available.,OHCDS:“a public or private organization for delivering health services.It includes,but is not limited to,a clinic,a group practice prepaid capitation plan,and a health maintenance organization.”42 CFR 447.10(b),Provider Payment MethodsTradit,7,OHCDS Defined,Instructions:Version 3.4 HCBS Waiver Application,An organization that provides at least one Medicaid service directly(utilizing its own employees)and contracts with other qualified providers to furnish other services,Medicaid agreement executed between state and the OHCDS,The OHCDS acts as the Medicaid provider,The OHCDS subcontracts with other providers,OHCDS DefinedInstructions:Ve,8,OHCDS Defined,Instructions:Version 3.4 HCBS Waiver Application,Subcontractors must meet the standards under the waiver to provide waiver services under the OHCDS,When OHCDS provides waiver services,payment is made directly to the OHCDS,The OHCDS reimburses the subcontractor,The contractual arrangement must be voluntary,Participants may not be required to secure services exclusively through the OHCDS,OHCDS Defined Instructions:,9,Waiver Application I-3-g-ii,CMS Review Criteria,The state:,Describes the types of entities that are designated as an OHCDS,Has a methodology to designate entities as OHCDS and these entities meet the regulatory definition of an OHCDS,Ensures that there are adequate safeguards to ensure that OHCDS subcontractors possess required qualifications,Ensures that the OHCDS arrangement provides for appropriate financial accountability safeguards,Waiver Application I-3-g-iiCM,10,Waiver Options,1915(c):,Non-capitated arrangements,No prepaid enrollment,Individuals may not be restricted to providers within the OHCDS,1915(b)/1115:,Pre-paid capitation,Individuals are enrolled within the system and receive services from the system,its employees and contractors,Waiver Options1915(c):,11,State Examples,NY:OMRDD functi
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