The following message was emailed to Provider Organization contacts by the six Portland metro area brokerages on 02/02/2019.
IMPORTANT NOTICE TO OREGON PROVIDER ORGANIZATIONS RE: APD-PT-19-003* Policy Transmittal: Agency Billing Activities Effective 2/1/2019
As of Friday, 2/1/19, most eXPRS submissions by provider organizations will automatically be paid by ODDS without case management review. (Service codes OR539, OR570, and OR310 are excluded from this change.) The Oregon Office of Developmental Disabilities Services (ODDS) will conduct post-payment reviews of provider organization documentation. This change may expedite payment to some provider organizations, but it does not change documentation requirements.
Oregon Administrative Rule 411-415-0090 requires Case Management Entities (both CDDPs/counties and Brokerages) to conduct extensive and specific monitoring of services including but not limited to:
Ensuring all services provided align with those authorized in the ISP
Confirming support and progress toward goals
Confirming individual choice is being honored
The review of provider organization progress notes is an invaluable tool in meeting these monitoring mandates. For this reason, the six Portland metro-area brokerages will continue to expect to receive progress notes for all services delivered. Per the state’s transmittal, these notes must include:
Provider of service
Dates of service (the date range is sufficient)
Units of service provided (total number of units for the period is sufficient)
A progress note summarizing the service provided and progress toward goals (weekly or monthly summaries are perfectly acceptable)
As guidance, please review the following from the Indirect Case Management Monitoring Worker’s Guide:
Adequate provider agency progress notes focus on describing the supports a person received to achieve the desired outcome. These include the ADL, IADL, medical and behavioral supports identified on the ISP as being needed. The notes should focus on the specific activities (i.e. “visited a museum”) only insofar as they are important to achieving the desired outcomes as described in the ISP. Simply stating the name of the service associated with the procedure code is not sufficient (i.e. “Provided Day Support Activities” is not an adequate progress note to support a claim by the agency or for the purposes of indirect monitoring.) An adequate note will allow a SC/PA to determine if the services are consistent with those authorized in the ISP. Provider agency progress notes are also a place for the provider to convey observations about possible changes in support needs, challenging behaviors and a wide variety of topics. These reported observations should be reviewed by the SC/PA for their potential impact on risk identification, new person-centered information, and service planning. The SC/PA’s supporting progress note should reflect their assessment of the observations and the actions they will take in response, if any.
This excerpt demonstrates that progress notes are an important tool in monitoring supports and communicating changes in an individual’s needs and choices. As such, we request that providers submit progress notes for all supports no later than one month after the provision of services. For example, notes for services provided in February will be due by the end of March.
In compliance with the transmittal, we will be notifying ODDS when we do not receive progress notes within the 30-day window.
We anticipate that issues with overlapping billings will likely continue. As CDDPs/counties Brokerages are no longer part of the invoicing and payment processes, providers will need to seek resolution of these issues from ODDS.
Finally, we trust that our provider organization partners share our values with regard to continuing to offer customers the authority to review and authorize their services via signature. We will have one-on-one conversations with each of our customers regarding their options, and plan to solicit broad customer and family input on how to ensure choice continues to be offered and honored.
Thank you for your continued partnership and your service to our shared customer base as we work together through this next transition.
ODDS Statewide Employment First Coordinator Acacia McGuire Anderson writes:
The Individuals with Disabilities Education Act (IDEA) states that transition planning must begin at age 16. However, transition planning may begin as early as 14 years of age. The sooner we start transition planning, the better for the young person so they can connect to ODDS (Office of Developmental Disabilities Services) and VR (Vocational Rehabilitation) services and begin the process of exploring career options and skills needed to be successful in the workforce.
In Oregon, we have Transition Network Facilitators (TNFs) who provide outreach, technical assistance, and training opportunities for educators, individuals and families, and collaborate with VR counselors, providers and DD case management entities (such as Brokerages and CDDPs/counties). The TNFs are also launching a podcast series in January aimed at providing information and resources to educators, individuals and families throughout Oregon.
There are upcoming trainings where educators, as well as VR staff and DD providers and case managers, can learn more about transition planning. These include the Oregon Statewide Transition Conference, happening March 7-8, 2019, in Eugene. In addition, ODE, ODDS and VR collaborate to put on regional trainings throughout the state.
If you have any questions regarding transition planning beginning as early as age 14, or any questions regarding transition services in general, email: firstname.lastname@example.org. Thank you for all your efforts as we strive to support people with I/DD to live and work in their communities.
Independence Northwest is a proud sponsor again this year for the exceptional All Born (In) Conference.Registration is open now!
The annual All Born (in) Conference is an exciting day for parents, caregivers, and professionals working to end segregation in neighborhood schools and the community. It’s a day of celebrating community and learning how to use Universal Design for Learning and Best Practices to reach and teach every child. Share, learn and make connections so that we can all go forth to open the eyes of the wider community to the fact that our children are all born “in”. The Conference was founded by Northwest Down Syndrome Association in 2006 in partnership with Portland State University’s joint certification program and the Center on Inclusive Education. It has grown to be a cornerstone resource in the Northwest region, engaging many innovative parents, professionals, and community partners to embrace the gifts of every learner.
Brokerage customers with Family Training written into their ISP can use support services funding to pay customer and non-paid caregiver conference costs. Please contact your Personal Agent with any questions.
Full details about the conference can be found here.
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
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:
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
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:
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.)
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.
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 email@example.com
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.
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.
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. (Brokerages 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.)
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
Portland Community College, Cascade Campus, Moriarty Auditorium, 705 N. Killingsworth Street, Portland.
There will be a short presentation followed by a group discussion. This is one in a series of Community Forums throughout the state.
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 firstname.lastname@example.org.
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 email@example.com 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.
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.
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.
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’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.
We, the six metro-area support services brokerages, wanted to send out a quick note regarding the current status of transitioning service codes, amending plans, and adjusting rates given the potential September 1st changes.
First, we’d like to briefly comment on our current understanding of DSA and Attendant Care services. Based on the DRAFT Expenditure Guidelines we received from the Department of Human Services just last week we believe that provider organizations can perform both Day Support Activities (DSA) as well as Attendant Care services. For details, follow this link to their current work-in-progress: August 2014 Expenditure Guidelines
We have been in talks with the state to request a delay of the September 1st implementation of these changes. Our primary reason for the delay request has to do with the impossible time frames we are faced with as a system to implement this latest sea change. Brokerages need appropriate time to do planning and coordination with customers prior to amending Individual Support Plans (ISPs) and service agreements, and Providers need time to evaluate the changes and revise their business plans in order to meet the new regime. We hope to hear back from Interim DD State Director Trisha Baxter within the next day or so regarding our request for delayed implementation. (Please note: we are requesting to delay implementation of DSA, but we are not asking for a delay to implementation of Supported Employment changes.)
Our hope is to work with the State on a reasonable timeline for implementation this fall or winter in a thoughtful process that includes a stakeholder work group charged with leading and influencing the transition.
As always, we appreciate your patience and partnership as we manage such significant systemic change. Your recent and ongoing advocacy is very much appreciated. Surely, we all agree that a thoughtful, proactive approach to transition is key to serving our customers and community in the most respectful and productive way possible.
We know there are scores of unanswered questions out there and we are preparing to gain the understanding necessary to respond to them given our limited resources during this transition. Without clarification and without the full participation of our customers, we are not able as of now to amend goals, plans, or service agreements. Please stay tuned – more details shortly.
Dan (SDRI), Katie (Mentor), Jennifer (CPI), Larry (INW), Rachel (Inclusion), and Sarah (UCP)
The recent announcement that DHS listened to the community and delayed implementation of the eXPRS data system was welcome news to stakeholders across the state. However, in order to meet the terms of the collective bargaining agreement it made with SEIU, the state must collapse all payments to Personal Support Workers (PSWs) into a “single payment system” by July 1st. In order to meet this obligation, DHS is in negotiations to contract with TNT Fiscal Intermediary Services (TNT FI) to make all PSW payments to providers in all DD programs (counties as well as brokerages) statewide.This change affects thousands of providers; brokerages and counties have been charged with making the transition in three weeks and some questions remain unanswered. Time is short and much work will need to be done to ensure every PSW in the state is paid on time in July. Please help us by spreading the word. We will update the FAQ below as more information comes in. Our top priorities remain uninterrupted services to our customers and uninterrupted payment to their providers.
Note: While there is much overlap in how things will work for providers working with different brokerages, the information in this post is specific to providers who work with Independence Northwest’s customers. The requirements of the transition to a single payer (TNT FI) are different depending on the provider type.
PERSONAL SUPPORT WORKER – DOMESTIC EMPLOYEE Because TNT already processes payroll for domestic employee PSWs who work with Independence Northwest’s customers, this group of providers will experience the least impact during the transition. If you’re a domestic employee, the changes you can expect are the following:
Timesheet due dates and pay days may change. Due dates, processing time, and pay dates are part of the state’s agreement with SEIU, but as of this writing the state has been unable to tell us what those dates are. We will let you know as soon as we know.
Reduced frequency of payroll: Independence Northwest has historically run DE payroll three (sometimes four) times a month. Under the collective bargaining agreement this number is reduced to twice a month. If you are someone who submits timesheets later in the month this may mean you will wait longer to be paid than you have in the past.
DON’T FORGET: You will still need to get a provider number for when the state rolls out eXPRS later in the year. If you don’t have a provider number yet contact the state immediately: 1-800-241-3013 or SPD.ProviderNumber@state.or.us
PERSONAL SUPPORT WORKER – INDEPENDENT CONTRACTOR
Effective July 1 all payments to PSW independent contractors will no longer originate from INW offices but will be processed by TNT FI from their office in Salem. In order to make this happen, all ICs will need to fill out a TNTFI_VENDOR ENROLLMENT PACKET. ICs must fill out a separate packet for each customer they work with.Please note that the packet includes a direct deposit form. Unfortunately the direct deposit form you have on file with INW will not transfer to TNT. The packet must be signed by the customer or the customer’s legal guardian. If you want to continue using direct deposit after July 1 you must fill out this new one and provide all the documentation it requires. Below are some changes PSW-ICs who work with INW customers should expect:
Changes to invoice due dates and pay dates: Because INW cuts checks for independent contractors on a weekly basis, we do not expect ICs to adhere to any invoice deadline. However, under the new system, due dates, processing time, and pay dates are determined by the state’s agreement with SEIU, and as of this writing the state has been unable to tell us what those dates are. We will let you know as soon as we know.
Reduction in pay frequency and flexibility: INW cuts checks on a weekly basis for vendors so that a vendor can invoice us at any time during the month and expect timely payment. Under the collective bargaining agreement payment is reduced to twice a month. This may mean you will need to change the timing of your invoicing in order to avoid delays in payment. With payment no longer occurring in-house, INW unfortunately loses the flexibility to accommodate same-day check runs and other special requests as we have in the past.
PROVIDER ORGANIZATIONS, NON-PSW INDEPENDENT CONTRACTORS, AND OTHER VENDORS
Payments to all entities not covered by the collective bargaining agreement (provider organizations, non-PSW ICs) will continue to be paid by INW until eXPRS is implemented. If you are the rare IC who provides both PSW services and non-PSW services you will receive separate payments from TNT FI and TNT FI.
FAQ: July 1 Changes to Provider Billing and Payment
Note: Most of this information is brand new and as such is subject to change. We will update this FAQ as we get new information so please check back frequently.
Q. What is changing about how provider payments are made?A. All payments to Personal Support Workers (PSWs) across the state are being consolidated so that they are paid by a single entity, TNT Fiscal Intermediary Services (TNT FI). This affects thousands of providers.
Q. Why is this change happening? A. Under the collective bargain agreement DHS made with the Service Employees International Union (SEIU), the state agreed that it would adopt a centralized payment system for all of SEIU’s PSW members in Oregon.
Q. I thought eXPRS was going to be the payment system. Is TNT replacing eXPRS?A. Yes and no. The state has delayed implementation of eXPRS, in part, as a result of questions about its readiness voiced by the community. However, that delay did not absolve the state of its collectively-bargained mandate to adopt a centralized payment system by July 1. Moving PSW payments to TNT FI is a transition plan to meet that mandate.
Q. Will eXPRS make PSW payments in the future?A. To the best of our knowledge TNT will continue to handle all PSW payments for the foreseeable future because eXPRS lacks the complexity to handle payroll under the brokerage customer-as-employer model. Once implemented, eXPRS will act as a “front-end” interface for billing data entry; TNT will process payments using the data entered into eXPRS.
Q. Is there paperwork I need to fill out for this change?A. If you are a PSW-DE there is no additional paperwork for you at this time. If you are a PSW-IC you need to fill out a TNT FI Vendor Enrollment Packet immediately and return it to INW.
Q. Will my direct deposit remain in place?A. It depends on whether you are a PSW-DE or a PSW-IC. Domestic employee direct deposits will be unaffected by this change. PSW independent contractors will need to fill out the new direct deposit form included in the TNT FI Vendor Enrollment Packet if they want to continue using direct deposit.
Q. Who do I sent my invoices or timesheets to?A. Nothing changes in the short run. Continue to submit your bills to Independence Northwest as you always have.
Q. Will the day my timesheets or invoices are due change?A. Probably. Due dates, processing time, and pay dates are determined by the state’s agreement with SEIU, and the state has been unable to tell us what those dates are. We will let you know as soon as we know.
Q. Will my pay day change?A. Probably. See answer to previous question and check back here often.
Q. What if I need an out of cycle check or if my check is lost or stolen?A. The state has not yet shared how it plans to handle out of cycle checks and other special exceptions after July 1.
Q. What if I am overpaid or underpaid?A. The state has not yet shared the details of how error corrections will occur after July 1.
Q. Does the July 1 change affect me if I am not a PSW?A. The most current information we have is that non-PSW payments will not change on July 1.
Q. Will INW continue to verify my income and employment for housing and other credit applications?A. Because we are not privy to the details of the contract negotiations between TNT FI and DHS, we are unsure whether this duty will remain with INW or will be taken over by TNT FI. Once we have the answer to this question, we will update you.
Q. Will INW continue to respond to unemployment claims?A. We have not been told by DHS if this will remain our responsibility. Stay tuned.
The Oregon of Office of Developmental Disabilities (the state) is putting on a series of training for brokerage PSW providers. The training is called “Using eXPRS for DD Personal Support Workers and DD Independent Contractor PSWs.”
Per the state, “Use of the eXPRS Payment System will begin July 1st, 2014. This training is a repeat of the April 22nd webinar training session and will cover the information PSW or IC-PSWs need to know to get ready for July 1st. These trainings are online, computer-based trainings.
Training participants will need a computer and internet to view the training materials AND access to a phone to listen to the discussion. Pre-registration for these trainings is required as each session has a limit to the number of participants.”
Once registered, participants will receive an email with the training site link, conference phone number and instructions on how to connect to the training on the date you are registered to participate. If you have questions, contact Julie Harrison at JULIE.A.HARRISON@dhsoha.state.or.us.
You might have heard that there are some changes to the way brokerage services are administered and funded. One of the most significant changes is that all brokerage customers must now have a formal functional needs assessment at least once a year.
A functional needs assessment is a series of questions that asks what kinds of living supports a person needs to live independently in the community. Oregon has chosen the Adult Needs Assessment as its current tool. You may view the tool by clicking here. The assessment asks questions about what kinds of independent living supports you need, why you need them, and how often you need them. Once the assessment is completed, it determines certain services you are eligible for and how often you can access those services.
Brokerages have been actively involved in conversations with the state and other stakeholders regarding the implementation of the assessment. Since summer of 2013, brokerages were instructed that we would have a year from the time we received the assessment tool to implement the changes. The state spent several months developing what was to be a brand new needs assessment, but the tool was abandoned for myriad reasons. We received a final tool in November 2013 and immediately began conducting assessments as our customers’ plan years rolled over. Because we typically plan with our customers up to six weeks in advance of a plan’s start date, the first assessments we completed were for customers whose plan years began in January of this year.
Under the original plan, brokerages expected to complete all assessments by October of 2014 for the approximately 7,500 customers receiving our services statewide.
However, we were informed in February 2014 that an agreement between the state and federal oversight entities would force a significant shortening of that timeline. The Centers for Medicare and Medicaid Services (CMS) insisted that all assessments be completed within one year of when Oregon began receiving Community First Choice Option/K Plan dollars (July 1st, 2013.) Leadership in Oregon argued for more time. It wasn’t granted and the deadline was shortened. Instead of October, Oregon was now instructed to have all assessments completed by the end of June 2014 or risk losing its federal funding.
Brokerages expressed ample concern about this change – we would need to complete nearly 2,000 additional assessments in less than five months – and requested additional funding to add staff, hire contractors, or pay overtime to existing staff to meet the charge. Instead of funding brokerages, the state decided to deploy its own staff to complete the additional assessments.
Which brings us to the present.
As a system, we are faced with a June 30, 2014 deadline to complete all assessments. Last week, we sent out letters informing some of our customers that they would be receiving an assessment from a non-Independence Northwest assessor. We have been assigned three state employees (Rachel, Kay and Ana) to complete the assessments in Multnomah and Washington counties. For our Clackamas county customers, Robyn Hoffman (a Clackamas county employee) will be the primary assessor. If you didn’t receive a letter, you won’t be affected.
The staff of INW have met with the assessors and they all carry a great amount of experience working with people with intellectual and developmental disabilities. Independence Northwest is providing designated office space, workstations, and meeting rooms for them and they have begun calling customers and scheduling assessments.
Here at Independence Northwest, we estimate that somewhere around 125 customers will receive their assessments from state or county staff. INW Personal Agents are responsible for conducting the remaining 300+ assessments. Additionally, a plan revision must be completed after each assessment. INW Personal Agents will be completing revisions for all 435 customers in our services, in addition to any necessary job description or contract amendments. The workload for our organization is significant and we are working hard to meet the charge.
Once this implementation phase is completed, your Personal Agent will meet with you at least annually to complete a needs assessment – usually right before your ISP meeting. The state and county involvement is a one-time situation to allow the state to catch up and meet the terms of their agreement with CMS. Moving forward, it becomes a part of our regular service delivery. We’ve posted a set of frequently asked questions. Check them out here.
The functional needs assessment implementation is one of many, many changes occurring in our system right now. Since last August, we have been holding community forums at least twice a month to update the community on what’s changing, why, and how. If you would like to learn more, join us for one of our upcoming sessions.
“WE HAVE GOOD NEWS!!!! Today our federal partner, the Centers for Medicare and Medicaid Services (CMS) informed Oregon that guardians can be paid to provide care to their loved ones with the right processes in place. We are working quickly with CMS to clarify those processes and to develop a new notice for beneficiaries, but we wanted to share this information with you as soon as possible. When those details are worked out, we will provide you with an update and more information about next steps.
Thank you for your patience as we have been working through this difficult issue. We know that this issue is important and that the uncertainty about how we are moving forward is stressful for families and their loved ones. We appreciate the care and concern we have heard these past weeks and we remain committed to providing you with the most up-to-date, accurate information that we have.” Patrice Botsford Director, DHS Office of Developmental Disabilities Services
As mentioned in last week’s piece, Oregon’s Department of Human Services has chosen to change its primary funding source from Title XIX Waiver services to the new Community First Choice Option/K Plan. This change increases federal revenue for Oregon and expands services for seniors, people with physical disabilities, and children and adults with intellectual and developmental disabilities. With the additional revenue comes new mandates and expectations.
Perhaps the most controversial change thus far is the mandate that legal guardians no longer be paid as care providers through brokerages. Keep in mind that legal guardianship requires a court order and is not something that automatically occurs when an individual with a developmental disability turns eighteen. Guardianship also requires annual renewal action by the guardian.
Per ODDS (Oregon Office on Developmental Disability Services), CMS (Centers for Medicare and Medicaid Services) views payment to a legal guardian as a conflict of interest (see CFR 441.505.) When the funding was coming primarily through waivers, guardianship payment was permitted, but because Oregon has chosen to change its primary funding to Community First Choice Option/K Plan, the expectation has changed. It is now consistent with the regulations for how services are implemented for seniors and people with physical disabilities.
Statewide, well over 400 guardians are paid to provide services, the majority of them supporting people served by brokerages. At present, brokerages and CDDPs (Community Developmental Disabilities Programs) have been directed by the state (ODDS) to begin conversations with our customers and their legal representatives about how to come into compliance with the new standards. We have requested clear, written materials to be shared with families and individuals regarding this directive.
As you can imagine, there has been a lot of concern and discussion on this topic. There’s quite a bit at risk here and clear, direct communication from all parties is key right now.
In a recent mailer to its members, SEIU (Service Employees International Union)claimed “some brokerages and CDDPs have incorrectly informed parent providers that they can no longer be their child’s guardian if they want to be paid as a provider. This is not true.” We share SEIU’s concerns on this change, but their mailer is misleading. ODDS has clearly and publicly stated this is their policy and has instructed brokerages and CDDPs to share this mandate and begin the conversation on this planned change. If one follows the directive up the chain, its genesis is with the government, not brokerages and CDDPs.
Two weeks back, ODDS Director Patrice Botsford released an extensive statement explaining the state’s position. “Families must make a decision whether the guardian will remain in place and not continue as the paid service provider and a new service provider chosen, or the guardianship may be terminated or transferred… We are asking that their decision be relayed to us via their case manager no later than December 1, 2013 for January 1, 2014 implementation.“Read her entire statement here.
Long-time disability rights advocate Representative Sara Gelser (D-Corvallis District 16) has become involved in the discussion. She recently began requesting stories through posts on her Facebook page. Per a post on August 7th, Rep. Gelser had met with Patrice Botsford and others at ODDS. Wrote Gelser: ” I had a very good meeting today with Patrice Botsford and her Deputy (Director) from the Office of Developmental Disabilities. I am feeling hopeful that we can find a solution that will meet everyone’s needs and will cause minimal disruption. Thank you for your stories. Please keep sending them, as they are very helpful.” She went on to thank Patrice and her team for partnering for a solution. Sara Gelser is beginning to look at potential legislative action that could influence the future.
At present, ODDS is developing an exception policy that will potentially allow for some guardians to be paid under the K Plan. The exception policy is still in draft format and will be reviewed by CMS in the next week or so.
Advocates throughout the system continue to comb through federal regulations and state law to see if there are other approaches that can be taken to address the situation. In the meantime, if you would like to be involved in the discussion and share your story, you have a few options.
Later this week, we’ll send out another missive on the Designated Representative piece. The representative issue is linked to the guardianship discussion, but deserves its own attention due to its complexity. For the sake of clarity, we’ll address it separately.
DD Director Patrice Botsford shared the following new information on ODDS’ Facebook page: “I wanted to quickly update you on where we are on our request for exception on guardians as paid caregivers. Our request is currently in the hands of CMS and their attorneys. We have near daily communication with them, and are looking forward to the best possible outcome. We are as anxious as you are, and we will post here as soon as we have any updates. Keep up the good work, and thank you all again for your advocacy and support.”
Disability Scoop is the first and only nationally focused online news organization serving the developmental disability community including autism, cerebral palsy, Down syndrome, fragile X and intellectual disability, among others.
Five days each week Disability Scoop sifts through the clutter to provide a central, reliable source of news, information and resources. Plus, Disability Scoop is the only place to find original content and series like “Scoop Essentials” that take an in-depth look at what lies beyond the day’s headlines.
Check out Partners in Education, a self-study course designed by the fine folks at Partners in Policymaking to help parents of children with developmental disabilities navigate the special education system and help their children make the most of their potential.
Schools are places where children learn new information and skills. But they also are places where children are exposed to a multitude of life lessons…lessons like respecting each other as individuals, personal responsibility and the importance of contributing to the community.
This course has been developed to give you the practical skills you need to create an inclusive, quality education for your child. After completing this course, you will:
Understand the history of education of children with developmental disabilities;
Know and understand the key laws governing special education and how they protect your child’s rights;
Understand your role in your child’s educational experience;
Recognize the elements of an individualized education program and the role parents play in its creation and implementation;
Know how to advocate for your child to ensure a positive, quality educational experience;
Understand your rights to due process if you feel your child’s educational rights have been violated.
One of the most common questions we hear at brokerages is “What can I use my support services funds for?”
Each customer enrolled in a brokerage has a certain benefit level (an amount of support services funds to which they are entitled and may use to purchase needed services). Before any support services funds can be accessed, we first must look for natural supports in the community. This means we look to services like Vocational Rehabilitation, school districts, the Oregon Health Plan, Independent Living Resources and other organizations who offer services to individuals with disabilities first. This allows for maximum benefit to you, the customer and ensures the appropriate use of brokerage services, a taxpayer funded program.
All services purchased with Support Services dollars are what is known as a “social benefit”. A social benefit is a service “solely intended to assist an individual with disabilities to function in society on a level comparable to that of an individual…who does not have a disability”. The benefit can never:
Duplicate services and benefits otherwise available to citizens, regardless of disability (such as paying for a college class since people with or without disabilities must pay college tuition.)
Provide financial assistance with food, shelter or clothing
Replace any other service that is available elsewhere in the community (also known as “natural supports”) like Vocational Rehabilitation or services from a school district
Exceed the amount in the authorized Individual Support Plan.
To read more about specific types of support services options, check out the list below. Your Personal Agent can assist you with better understanding services available to you.
The Oregon Council on Developmental Disabilities has posted all of its policy statements online. These statements are intended for use in advocating for improved services and supports for people with disabilities and their families.
TriMet LIFT is establishing a recertification every three years for everyone, regardless of disability. The exact language is “While a person’s disability may be permanent, other factors which impact the determination of eligibility may change over time.”
Existing active LIFT riders will be recertified over an initial three-year period starting in 2010.
Public comment period is currently open August 17th through September 17th.
LIFT Riders may be asked to complete a functional assessment evaluating their mobility skills. All riders will have to fill out a new application and most riders will be expected to participate in in-person interviews and in-person recertification meetings.
Check out TriMet’s recent statement for information on public comment contact information and detail on their process thus far.
Carter was a mother and community volunteer before she became the first African American woman to be elected to the Oregon Legislature in 1984.
Carter said Sunday that she intends to submit a letter to the Senate president Monday making her resignation official as of Aug. 31. She will start work as the state’s Deputy Director for Human Services Programs on Sept. 1.
“It is my desire in life to make a difference for our children, our seniors and the disabled,” Carter said. “Those are the areas that I worked in in the Legislature. That is what I want to continue to do.”
The Multnomah County Commission will appoint a replacement to represent Carter’s Northeast Portland district in the state Senate. By law, the commission must consider names submitted by the local Democratic precinct committee.
In her nearly 25 years as a state lawmaker, Carter moved from the House to the Senate, rising in the Democratic leadership ranks. This year, Carter served a pivotal role in writing the state’s 2009-11 budget as co-chair of the Joint Ways and Means Committee.
Senate President Peter Courtney credits Carter for bringing “a lot of wisdom to the Senate because of her age, her ethnicity, her background and her struggles in life.”
“She is the heart and soul,” said Courtney, D-Salem.
My name is Sally O’Neill. I am 17 years old. Like most girls my age, I love animals, going to the theatre with my friends on the weekend, and skiing in the winter. I dream of traveling after high school. I want to see places like Ireland, Italy, and India. Unfortunately, an accessible airplane ride is not an option for me.
I am writing this because I believe the airline industry should have to comply with the mandates of the Americans with Disabilities Act of 1990. I have cerebral palsy. That means although I have a normal mind, I still have uncontrollable spastic limb movement. I cannot talk or hold my own body upright. I need my wheelchair to keep me in the right posture, and to restrain my arms and legs. The problem is the airline companies make all disabled people check their wheelchair with other baggage. I have visited my grandparents in Ohio and Florida many times. My parents have spent up to 7 hours trying to keep me seated between them. I don’t have the motor function to sit upright on my own. The airplane chairs are not big enough for a seat insert and do not support my upper body. When my shoulders are not in front of my hips, I go into an extension pattern. Due to my spastic limb movement, my parents have to physically restrain my arms and legs. I have strong tone, so this is not easy. None of us can eat, drink, read, or make ourselves comfortable in any other way. As I get older and bigger, each flight gets more difficult.
There are many other disabilities that have this same need for different reasons. I don’t think it makes sense that all other places open to the public are made accessible to every type of disabled person, especially transportation companies, but the airline industry is allowed to force the disabled into able-bodied standards or medical transport. I’ve heard of an airline removing a whole row of seats to accommodate a Sumo wrestler. If they can do that for a special athlete, why can’t they do it for a person with special needs? Have you ever wondered why you see so few people with cerebral palsy on airplanes? I think it’s because the airlines do so little to accommodate their needs to ensure their comfort. It’s discrimination. I looked up online how easy it is to remove any seat on the plane. I’m not asking for the bathrooms to be made accessible.
I am proposing that the first seat in the first row of the airplane be removable and tie downs be inserted. These tie downs are used in automobiles to keep the chair in place during crashes. They are as strong as anything on a plane.
I really believe with some small modifications airplane transportation can be made accessible to everyone. I hope you see the need and join me in this change.
Here is a proposed petition:
We petition the airline industry to better accommodate travelers who use wheelchairs. We propose that the first seat in the first row of the airplane be removable with the capability to have tie downs inserted when needed to accommodate a wheelchair, or that the airlines develop a solution to this urgent need.
If you’d like a copy of the Petition emailed to you, please send an email to the address listed below. We’d appreciate your help in collecting signatures. The important issue here is accessibility. There are a lot of people who cannot comfortably ride in an airplane, or who simply cannot ride at all. We also want to collect stories of your experiences riding in an airplane. Please call or write or send an email. The more stories, the better. And the more signatures, the better!
Susan Blanchard, UCP Family Support
Phone: 503-777-4166, toll-free within Oregon: 1-800-473-4581
Building Futures is for anyone who has an interest in supporting individuals with disabilities as they transition from school to life. This includes Secondary Educators, Post Secondary Educators, Vocational Rehabilitation Counselors, Special Educators, therapists, counselors, service providers, job developers, and other rehabilitation specialists, and especially secondary students with disabilities and their families. Throughout the two-day event there will be presentations by regional and national experts on issues surrounding secondary transition and assistive technology. Check out the agenda here.
Apply now for the PIP class of 2010! OCDD is now accepting applications for the Partners in Policymaking Class of 2010.
Oregon Partners in Policymaking (PIP), is an intensive 5-month leadership course for adults with developmental disabilities and parents of children with developmental disabilities. The program is operated by The Arc of Oregon and funded by the Oregon Council on Developmental Disabilities. It is free to participants.
The PIP program provides participants with the information to understand the past, the present, and the future for people with developmental disabilities and their families. It provides PIP members with the practical skills to positively affect their own lives and influence broader disability policy. Many of the over 180 Oregon Partners in Policymaking Graduates since 1994, have found participating in PIP has been a life-changing experience.
The website of the Oregon Council on Developmental Disabilities has more information about the program and comments from graduates. There is an application which can be completed on line and emailed or downloaded and mailed in.
Oregon Partners graduates have made a huge difference in our state on behalf of people with developmental disabilities. We hope that the Class of 2010 will continue to lead the fight for equality of opportunity, inclusion, and community participation.