The Choice Voucher System in the Children s Waiver Program
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1 The Choice Voucher System in the Children s Waiver Program Audrey Craft, Specialist, Federal Compliance, MDHHS Rebecca Craft, Case Manager, Macomb County CMH Services Terri Nekoogar, Program Supervisor, Specialized Children and Family Services, Macomb County CMH Services Rebecca Wilson, parent, Macomb County
2 What We Plan to Cover Today Services that can and can t be vouchered Involuntary termination Advantages of Vouchering How the System Works PIHP/CMHSP, FI and Parent responsibilities Implementation issues The experience of a family
3 The Fundamentals CMHSPs must offer Choice Voucher option to families of children on the CWP and HSW. The CMHSP can not require that families use the Choice Voucher option. The CMHSPs are responsible for providing information about participant directed opportunities. The CMHSPs are responsible to ensure contracts are established and contractual obligations are met.
4 The Fundamentals CWP consumers can direct a single service or all of their services for which consumer direction is an option. Hourly care staff are hired under employer authority and professional staff are hired under budget authority. Resources to support the chosen consumer-directed services are transferred to a fiscal intermediary which administers the funds and makes payment upon authorization of the consumer s representative.
5 The Fundamentals The fiscal intermediary must meet requirements as identified in the MDHHS/CMHSP Managed Mental Health Supports and Services Contract Attachment C3.4.4 Monthly all-inclusive code T2025
6 Services That Can Be Vouchered Home care training, non-family Home care training, family Community Living Supports Respite Specialty Services (Music, Art, Rec and Massage Therapy) Mental Health State Plan services except Targeted Case Management
7 Services That Can t Be Vouchered Two waiver services are considered provider managed services only: 1. Environmental accessibility adaptations/specialized medical equipment/supplies. 2. Financial management services. Private Duty Nursing May Not Be Vouchered
8 Involuntary Termination of Choice Voucher System A CMHSP may terminate a Choice Voucher Arrangements when the health and welfare of the consumer is in jeopardy due to the failure of the responsible parent to direct services and supports or when the responsible parent consistently fails to comply with contractual requirements.
9 Advantages Control over resources allocated to the child s IPOS. Pay for staff may be higher than those staff hired through an agency. Ability to choose and manage providers
10 How the System Works 1. Family & CMHSP, using the PCP process, develop child s IPOS identifying needed services and supports 2. Parent implements arrangements through the Choice Voucher System (for one or more service) 3. A Choice Voucher Agreement between the CMHSP and Parent is signed. 4. The funds in the CWP budget are lodged with a fiscal intermediary.
11 How the Choice Voucher System Works, (cont.) 5. Parents directly employ qualified workers or contract directly with providers to provide services identified in the child s IPOS and CWP budget 6. Parent enters into an Agreement with each person or agency hired 7. Required criminal background checks and training of staff completed prior to the beginning of work
12 What is a Fiscal Intermediary? A Fiscal Intermediary (FI) is an independent legal entity that acts as a fiscal agent of the CMHSP for the purpose of assuring financial accountability for the funds comprising a child s CWP budget.
13 FI Functions The FI has three basic areas of performance: to ensure compliance with requirements of management of public funds. to function as the employer agent and ensure compliance with the legal requirements of being an employer. to otherwise facilitate a smooth relationship between the parties and meet the needs of the CMHSP and families.
14 FI Administrative Functions Safeguard, manage and account for funds disbursed from the CMHSP Disburse funds to vendors and providers after obtaining Purchase of service and employment agreements verification that the Medicaid Provider Agreement has been signed by each provider Timesheets, datasheets and/or invoices have been approved by responsible parent
15 FI Employer Agent Functions Issue payroll payments to workers hired directly by the family Withhold income, Social Security, and Medicare taxes from paychecks and make payments to the appropriate authorities for taxes withheld Make payments for unemployment taxes and worker s compensation insurance to the appropriate authorities, when necessary
16 The Role of the Parent Provide all necessary information to the Fiscal Intermediary to ensure that all required documentation and written agreements are in place Authorize disbursement of funds for services and supports (timesheets, datasheets and invoices) Provide documentation that providers meet CMHSP requirements (criminal background checks, trainings)
17 The Role of the Parent If FI serves as their Employer Agent, provide FI with the information and documentation necessary to perform Employer Agent duties Communicate with the FI and CMHSP and seek assistance from these entities as needed Provide feedback to FI to enable it to improve its service delivery
18 The Role of the PIHP/CMHSP Provide Case Manager services to the family Develop IPOS and allocate funds for services that will be implemented through CVS Contract with a FI to handle disbursements of funds and other support functions Monitor the system to ensure successful use, implementation, and compliance with federal regulations Ensure provider qualifications
19 How Parties Work Together Agreements Choice Voucher Agreement Agreement between CMHSP and Parent Describes the Choice Voucher Arrangement Describes the responsibilities of the parties Describes how services and funds are used and any limitations on their use Describes the conditions for voluntary or involuntary termination of the CV Arrangement
20 How Parties Work Together Agreements Fiscal Intermediary Agreement Between the CMHSP and the Fiscal Intermediary (FI) Sets forth the scope of FI Services The Responsible Parent is not a party to this agreement The responsible parent may have a choice of FI if the CMHSP contracts with more than one
21 How Parties Work Together Agreements with Providers Between the Responsible Parent and Providers Written Agreements Required Employment Agreement With a directly employed worker Purchases of Services Agreement With a directly contracted professional provider or agency Medicaid Provider Agreement Must be signed by all providers
22 Implementation Issues Informing families of all implementation issues along with discussing the pros and cons of using the Choice Voucher System is key to a good outcome
23 Implementation Issues Staff Training Parental responsibilities Emergency staff back up
24 Implementation Issues Details, details, details: splitting hours between voucher and agency, noncompete clauses, length of time it will take to get staff trained Ethics: - Transitioning from agency to voucher
25 Keys To Success Relationship Based Option - Acceptance / Gentleness / Encouragement - Family Focused Establishing Parameters - Roles / Expectations
26 Keys To Success IPOS Training - Development / Independence / Safety - CLS & Respite - Documentation
27 The Family Story Benefits of the Choice Voucher System Recruiting and maintaining staff Communication with staff and valuing staff Organization is the key!
28 References (1)Mental Health and Substance Abuse Administration, Michigan Department of Community Health, Choice Voucher System, Self- Determination Technical Advisory, Version 3.0, December 2015 at R_SYSTEM_for_Children_12_2015_515803_7.pdf. (2) Fiscal Intermediary Technical Requirement. Found in the PIHP contract at: 28
29 Contact information Audrey Craft, Kelli Dodson, dodsonk@michigan.gov
30 QUESTIONS????
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