Brokerage Services are Medicaid Services and Funding is at Risk

You may have heard that Brokerages and CDDPs/counties are facing serious cuts.

Locally, we expect a pretty significant hit to disability services, primarily in the case management and crisis arenas. At the federal level, not only is case management in the cross hairs, but so are your in-home brokerage supports. When you hear politicians talking about healthcare reform, it’s not only about medical care with your doctor or at a hospital. It’s important to understand that Brokerage services are Medicaid services. Most county/CDDP services are Medicaid services. The K Plan is a Medicaid service. For the past four-plus years, the vast majority of services for thousands of children and adults with disabilities in Oregon has been funded through the Affordable Care Act (Obamacare) – a Medicaid program. And the Senate proposal (now called the Better Care Reconciliation Act of 2017) led by Mitch McConnell directly targets the reduction of home and community based services for people with disabilities (including brokerage services.)

This message is a simple ask: please contact your legislators and tell them your story as soon as possible. You can send an email or make a call. A vote is possible following Independence Day.

The great folks at the Oregon Developmental Disabilities Coalition have created easy-to-use advocacy instructions to help you get started. This is a key moment in the history of services for people with disabilities. Please take a moment to share your story and let your voice be heard.

WHAT CAN YOU DO?
Everyone has a story, and there is power in sharing it. If Medicaid matters in your life, NOW is the time to share your Medicaid story with members of the United States Senate. They need to understand the positive impact Medicaid has in lives of millions of Americans with disabilities each and every day.

WHAT DO YOU SAY?

  • I am your constituent.
  • I am a person with a disability [or I am a family member of someone with a disability or I am a professional in the disability field].
  • “Please do NOT allow cuts or caps to Medicaid.”
  • “Because of Medicaid, I have healthcare and supports to live in my community. For example, I use my services to _____________________________________.”
  • “If I don’t have these Medicaid-funded supports, my life will be harder because _____________.”

HOW TO CONTACT UNITED STATES SENATORS
Oregon’s Senators, Senator Ron Wyden and Senator Jeff Merkley, are both very supportive of the disability community and will not be voting for this bill. However, they still need to hear your story because they can share it with their Senate colleagues and they are keeping tallies of the contacts they have with their constituents so each contact you make is extremely important. Even if you have reached out to them already, please share your story again and ask for their support in stopping this legislation that would have a devastating impact on the disability community. Reach out to them by phone or email or via their website or on social media – whatever modes work best for you. Make calls to their offices in Washington DC at 202-224-3121

Send them an email at:

Share your personal story about Medicaid in their story banks: www.merkley.senate.gov/share-your-aca-story and www.wyden.senate.gov/trumpcare-story

Reach out to your family and friends across the nation to support your advocacy efforts to save Medicaid by contacting their United States Senators and urge them to vote NO on the BCRA! Please encourage your family and friends to call their United Senators via the Congressional Switchboard at 202-224-3121 to reject the current draft of the BCRA.

We want all U.S. Senators to be urged to reject Medicaid Cuts & Caps, including:

  • Alabama:  Shelby
  • Alaska:  Murkowski & Sullivan
  • Arizona:  Flake
  • Colorado:  Gardner
  • Florida:  Rubio
  • Georgia:  Isakson
  • Indiana:  Young
  • Louisiana:  Cassidy
  • Maine:  Collins
  • Missouri: Blunt
  • Montana:  Daines
  • Nebraska:  Fischer & Sasse
  • Nevada:  Heller
  • North Dakota: Hoeven
  • Ohio:  Portman
  • Pennsylvania:  Toomey
  • South Carolina: Graham
  • South Dakota: Rounds & Thune
  • West Virginia:  Capito
  • Wisconsin: Johnson

Thank you for your continued support and advocacy for essential services for Americans with intellectual and developmental disabilities! And thank you to the I/DD Coalition for the materials to share.

 

 

Important Message for Independent Contractors Who Work with INW Customers

Please note that this message applies only to contractors who have current contracts with Independence Northwest customers.

The new Collective Bargaining Agreement (CBA) between The Service Employees United International (SEIU) and The Oregon Department of Human Services (DHS) eliminates independent contractors as a support option for brokerage customers effective 03.31.2016. (IMPORTANT NOTE: Behavior consultants are not subject to the collective bargaining agreement and should disregard this post unless they also provide PSW supports.)

Existing independent contractors have two options:

  • Become PSW Specialists: This is a new designation that is limited to currently-qualified independent contractors. ICs who choose this option will become the employees of customers or customer designates.
  • Become Provider Organizations: A provider organization is a business licensed and certified by the state or Oregon.

This post addresses only the process for Independent Contractors who are becoming PSW Specialists.

How do we get from here to there? There are number of moving parts to this transition and there isn’t a lot of time to get it done. The state expects all paperwork to be completed and turned in by 02.02.2016. That doesn’t leave us many working days to get things done. The state’s transmittal covers a lot of ground and I recommend you read it carefully, but please note that it contains a significant error as well as an important omission. In a moment we’ll walk through what steps an IC needs to take to make sure he or she is ready to go when we get to 04.01.2016, but first I want to offer a correction and an amendment to the state’s memo. Understanding these is crucial to making the transition smooth.

Correction to the State’s Transmittal
The state’s transmittal says “If PSW’s existing PEAA and CHC expires after June 30, 2016, a new PEAA and CHC is not necessary. The documents for renewing PEAA and CHC must be submitted at least 55 days prior to the current credentials expiring.”

The problem with this statement is that it’s true ONLY if the IC has been operating his or her business using his or her social security number and has used that social security number on his or her Provider Enrollment Agreement (PEAA) with the state. Any IC who has used a federal tax ID number (FEIN) in lieu of a personal social security number MUST fill out a new PEAA regardless of when their current one expires.

Omission in the State’s Transmittal
Because a PSW Specialist will now be an employee rather than a contractor, a federal form I-9 has to be completed for everyone making the transition. This is a huge deal because the feds require a face to face meeting to complete this form. That means every person making the transition has to make an appointment to see us. The appointments will only take a few minutes each but we have to do a lot of them before February 2nd.

What You Need to Do

  1. Any IC working with our customers need to fill out a TNT employee packet for each customer with whom you work. You can download the packet here or you can request one from Rachel Kroll in our office. The packet contains the following items:
    • Demographic page (Name, address, employer name, etc.)
    • 2016 W-4 (IRS form for tax withholding)
    • Declaration of Relationship (identifies the relationship between the employer – usually the customer- and you as the employee)
    • Direct Deposit form (Yes, you’ll be filling out these yet again.)
  2. Any IC who has used a Federal Tax Identification Number (FEIN) as a contractor will need to fill out a new PEAA (download one by clicking here.) We have no record of who used a Social Security Number and who used an FEIN on their existing PEAAs and neither the state nor TNT has provided us with a list. If you have ANY doubt about it I strongly suggest you fill a new one out using your SSN. I also strongly suggest you turn your PEAA in to us so that we can keep a record of its submission to the state.
  3. All ICs need to make an appointment to come by our office so that we can fill out an I-9 with you. Unfortunately the feds (The Department of Homeland Security to be exact) require a face to face meeting for this. There is no way around it. When you come to the meeting you will need to bring either:
    • An unexpired passport OR
    • An unexpired state-issued ID AND your social security card
    • Please note: All documents must be originals. No copies please.

We have a lot of work to do on the customer side but that shouldn’t affect you as a provider. However, we may ask for your assistance if we’re having trouble getting paperwork returned by a customer you see regularly. Customer paperwork also has a 02.02.2016 deadline.

The contact for all these paperwork in our office is Rachel Kroll. You can reach her by phone or email starting on December 31st at 503.546.2950 or rkroll@independencenw.org

Rachel will be available to make appointments starting on December 31st. Please do not delay in calling to make an appointment. Time is of the essence on this project. Anyone who does not have their paperwork turned in by February 2nd may have to quit working starting on April 1st. The state has been very clear that there will be no exceptions.

Thank you,

Ron Spence, Operations Director

 

 

 

State Hosts Community Forum on Future of Disability Services – PCC Portland December 15 and 16, 2015

Press Release from the State of Oregon:

The Office of Developmental Disability Services (ODDS) is hosting two Community Forums in Portland to discuss the vision for the future of services for people with intellectual and developmental disabilities. Ensuring the principles of self-determination is the core of our vision.

Who:
People with intellectual and developmental disabilities who receive services and their families, as well as providers, Community Developmental Disability Programs (CDDPs) and Support Service Brokerages are encouraged to attend. (Brokerage​s provide services to eligible adults living in their own or their family’s home to help them remain in their homes and be engaged in their communities.)

When:

  • Tuesday, Dec. 15, 5:30 to 8:30 p.m., for people with intellectual and developmental disabilities who receive services and their families
  • Wednesday, Dec. 16, 1 to 4 p.m., for CDDPs, Brokerages and Providers

Where:
Portland Community College, Cascade Campus, Moriarty Auditorium, 705 N. Killingsworth Street, Portland.

What:
There will be a short presentation followed by a group discussion. This is one in a series of Community Forums throughout the state.

For information about upcoming Community Forums: www.oregon.gov/dhs/DD/Documents/ODDS%20Statewide%20Community%20Forums%20Schedule.pdf.

For more information about the Office of Developmental Disabilities Services: www.oregon.gov/DHS/dd/Pages/index.aspx.

If you have a disability and need this document in another format, please send an email to DHS.Forms@state.or.us or contact the Office of Document Management at 503-378-3523;

TTY at 503-378-3523.

To find the closest DHS office, go to www.oregon.gov/dhs or contact 211Info for help. You can contact 211Info by dialing 2-1-1, visiting 211info.org online, texting your zip code to 898211, or e-mailing to help@211info.org.

“Did You Get My Timesheet?”

Since the State of Oregon Department of Human Services began taking on Personal Support Worker and provider payment through its eXPRS system, one of the most common questions brokerages have received from providers is “Did you get my timesheet?”

There’s a relatively easy way for providers to access this information via eXPRS. ODDS’ Julie Harrison and her team have created a How To guide entitled “How to Find/View Plan of Care Service Claims”. Check out the guide by clicking here. You’ll learn how to read the eXPRS screens and determine where your payment claim is in the process. Be sure to bookmark this guide for future reference. (Of note: eXPRS refers to hours or miles keyed into its system as SDEs – Service Delivered Entries.)

One additional note: If you are sending invoices or timesheets via email, please be sure to use the billing@independencenw.org email address. If you are faxing invoices or timesheets, please be sure you receive a return confirmation that the fax was received.

Thanks for your continued partnership through the ongoing systemic changes. Your work is very much appreciated.

didyougetmytimesheet

Five Things That Are Working Well in Brokerage Support Services Today

By Larry Deal, Executive Director of Independence Northwest

Over the past year and a half, so much time has been spent deconstructing and reconstructing Oregon’s Intellectual and Developmental Disabilities system, there’s been little opportunity to sit back and celebrate some of the successes. Here are five things that are currently working well – and that deserve their moment in the sun.

People are getting more services. With the change from 100% Title XIX Waiver to a mix of K Plan and Waiver funding, Oregonians with intellectual and developmental disabilities are getting more services than ever before. This is a wonderful thing. Historically, people in crisis situations had limited resources and little option other than out of home placement (group homes and foster care homes) whether that was their preference or not. In the new system, many Oregonians now have the resources to continue living at home; the current design supports true individual and family choice. The importance of this change cannot be overstated. (That said, there’s still a very real fiscal sustainability discussion that must be had to support these efforts long-term.)

Providers are beginning to expand capacity. This one’s a slower burner, but it’s beginning. Customers, families, and professionals have all been highly concerned about the increase in funding since it came without an ounce of provider capacity expansion planning or incentives. Oregon put the funding before the resources. In recent weeks and months, many agencies have begun reaching out to brokerages and are expanding their services to our community in everything from in-home to employment supports; in 2015, I believe we will see a tangible increase in options for our customer base.

There’s a recent willingness for course correction when things aren’t working. If you haven’t heard of DSA (Day Support Activities,) consider yourself lucky. In short, DSA was an exercise in rushed change implementation. Ultimately, it changed rates, it changed processes, and it changed the definition of certain services. The process upended Brokerage, CDDP (Community Developmental Disabilities Program) and provider organization operations and damaged the integrity of reporting systems statewide. However, collaborative efforts (led by ODDS)  amongst brokerages, CDDPs (counties), providers, and state has made a real difference. Recent changes in leadership have assured a common sense, customer-first approach to problem solving. In other words, there’s strong collaboration happening again in Oregon. This is a very good thing – let’s do more of it.

We’re sticking with our current needs assessment tool. One of the major concerns brokerages have been facing while implementing the still-new functional needs assessment has been knowing full well we’d have to change assessments again at the beginning of 2015. Recent actions from the state suggest that we will be working to make the current brokerage tool (the Adult Needs Assessment) work well into the future. For brokerage customers, this is promising. We need consistency, stability, and some time to do some in-depth analysis on the efficacy of the current tool first. This decision deserves kudos.

Perhaps most significantly, Oregon is focusing on individual goals – again. If you have been working in the system or receiving services for the last year and a half, you’ve no doubt noted the troubling focus on deficits-based language and approach. I remember being in a meeting very, very early on in the K Plan implementation when it was announced by someone with significant influence that “this is no longer about goals, it’s about needs.” Soon, that refrain began to echo. Fortunately, that interpretation is no longer alive and well. What some people didn’t understand early on in the transition process was this: Brokerages have always addressed disability-related support needs. And we have done so while helping people reach their goals. You don’t provide publicly-funded services without making sure needs are documented and necessary. A sophisticated, supportive, holistic system addresses health and safety while placing a premium on the wants, needs, and goals of the individual. We know it can work because we’ve been doing it for thirteen years. I can’t say enough how pleasing it is to hear high-ranking leaders in our state stating that goals matter.

There are many issues we must continue wrestling with: the eXPRS payment system and pending Personal Support Worker entry, the monthly versus annual services issue, the ongoing review of Behavioral Supports, changes to supported employment, and many more. But as we inch ever closer to the new year,  it’s safe to say that we all hope for continued positive developments in the Oregon I/DD service delivery system. We’re a resilient, engaged, and growing community. Fingers crossed we can focus the coming year’s efforts on enhancing, expanding, and enriching the lives and experiences of the individuals, families, and communities we support. Oregon was once at the forefront of community-based services in our country; with continued focus, effort, and partnership there’s no reason that can’t be a reality again.

 

Sept 2014 Changes to Provider Organization Day Support Activities (DSA) and Employment Services

Effective 09.01.2014, the State of Oregon Office of Developmental Disabilities has made significant changes to day program, sheltered workshop, and supported employment services offered by provider organizations. Please see below for some Frequently Asked Questions related to the September 2014 transition and translation of Day Support Activities and Employment Activities.

What is DSA? DSA stands for Day Support Activities. This is a new title (with new rates) for a subset of services offered exclusively by provider organizations.  DSA includes both attendant services and skills training and may be provided in either a facility or the community.

Why is this change being made? The State is aligning rates and service descriptions across both brokerage and 24/7 comprehensive services. Unfortunately, brokerages and brokerage-specific providers weren’t included in the planning for this change, which has resulted in a rocky implementation process.

What’s changing? Effective September 1st, 2014, many traditional services (like Community Inclusion and Skills Training,)  when provided by provider organizations, will be collapsed into the new DSA heading. There are rate changes associated with this change. Further, these services must now be billed through Oregon’s online payment system, eXPRS.

What’s happening with Employment Services? Employment services and rates have been adjusted and amended as well. As with DSA services, billing will now go through eXPRS for services provided September 1st, 2014 forward.

Where did the new rates come from? The rates were determined by the State of Oregon Office on Developmental Disabilitiesas part of its ReBAR efforts.

Are these rates and definitions permanent? We don’t know. The state has pulled together a workgroup, set to begin meeting in late September and through October 2014. The workgroup has provider organization, county, brokerage, customer, and family representation. The group will give recommendations for everything from rates to service definitions. The first meeting is on September 29th, 2014.

Do provider agencies charge the same rate for every customer? No. Each customer has an individual rate based on his/her assigned Tier. The Tier is determined by the Adult Needs Assessment his/her Personal Agent conducts prior to ISP planning.

Can Personal Support Workers or Independent Contractors provide DSA? No. DSA is a provider organization-specific service. Similar services are provided by other provider types, but they are labeled differently and have a different set of rates.

What if my agency isn’t in eXPRS? You should contact Julie Harrison or Acacia McGuire Anderson directly. You need to ensure you have a properly set up provider number.

What’s a Medicaid provider number? A Medicaid provider number is assigned to you by the State. You must have a Medicaid provider number in order to bill in eXPRS and be paid for certain services provided September 1st, 2014 forward. If you provide DSA or Employment services to brokerage customers, you need a provider number ASAP. Brokerages can no longer pay you directly for these services. Nate Deeks and Acacia McGuire Anderson are responsible for assisting provider organizations having trouble with this particular issue.

What services to brokerage customers will be billed through eXPRS? For services PROVIDED September 1st, 2014 forward, all DSA, employment and employment path related services will be billed and paid through eXPRS. This includes: Day Support Activities, Individual Supported Employment, Small Group Supported Employment, Discovery/Career Exploration, and Employment Path Services.

What are the steps a provider agency needs to take to get paid for DSA and/or employment services?
The provider agency must log into eXPRS, find the specific customer for whom services was provided, locate their active Plan of Care, then bill against that Plan of Care. At the same time, the provider organization must send a copy of their customer-approved invoice and progress notes to the Personal Agent (as you always have.) From there, brokerage staff will review your invoice, go into eXPRS and give the state the thumbs up to release payment.

How do I know if my agency and customers are affected? We have been in direct contact with many provider organizations over the past month. Additionally, INW sent out mailers in the last week of September, notifying provider organizations directly of what we believe the translation will look like. However, if you have questions or believe we should make adjustments to the changes, Larry Deal (503.546.2950 x10) or Ron Spence (503.546.2950 x12.)

Will provider organizations receive new service agreements from INW? INW will not be sending new service agreements, but will send you a translation document which amends the current agreement. If you require additional documentation, please call us directly.

Do I have to submit an invoice to the brokerage anymore? Yes. You should submit your customer-approved invoices and progress notes to your Personal Agent as you always have. Nothing has changed there. Brokerages are not a pay and chaseenvironment.

Can I bill for two different services on the same invoice? Yes, you can, but you’ll need to itemize and clearly spell out the differences in services.

Are there changes to what provider organizations can/cannot bill for?
One large change is that provider organizations cannot bill for miles driven while concurrently providing Day Support Activities.

Are DSA services pro-rated? No. DSA services are never pro-rated, regardless of the number of people served at one time.

Why are services in eXPRS limited to a monthly allotment when brokerage plans are written at an annual allotment? We hope this will be corrected in eXPRS very soon as it is already causing issues for providers and customers. We have a commitment from the new DD Director that annual authorizations are allowable in the system. In the meantime, the monthly limit in eXPRS creates a false restriction of services (counter to how plans were written.) If you see that the monthly restriction is too tight for a customer’s actual utilization (but keeps within the customer’s annual contracted agreement with you) give us a call and we will work towards correction in eXPRS. Thanks for your patience while this gets sorted out.

What happens if I submit “old” invoices for services provided before September 1st, 2014? Those services will not be billed through eXPRS. So, you can skip going into eXPRS and just send the bill directly to your PA. Payment will come via direct deposit or paper check from Independence Northwest.

What if I run into issues with billing? Please call Larry Deal (503.546.2950 x10) or Ron Spence (503.546.2950 x12.) We will respond to provider organization issues within 1 working day. Our aim is to work with providers to clear up issues as soon as possible.

 

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