1 CHILDREN S PERSONAL CARE SERVICES (CPCS): OVERVIEW & UPDATE VERMONT FAMILY NETWORK WEBINAR OCTOBER 28, 2015
2 PROGRAM OVERVIEW: WHAT CPCS IS Medicaid benefit for children diagnosed with verifiable longterm disability or health condition which impacts ageappropriate development of activities of daily living (ADLs) ADLs: dressing, bathing, grooming, toileting, eating/feeding, mobility/transfers Provides supplemental assistance to the primary caregiver Individualized (1:1) support for the identified recipient Administered by Vermont Department of Health Children with Special Health Needs on behalf of the Department of Vermont Health Access VT Medicaid Covered Services Manual Personal Care Services: 7406
3 PROGRAM OVERVIEW: WHAT CPCS ISN T Not intended to provide: early intervention supports, respite, behavior intervention/supports, specialized services, age appropriate or specialized child care, parent/family supports CPCS is not designed to address issues of safety, supervision, community integration and skills building Challenges with instrumental activities of daily living (IADL) are considered only in relation to activities of daily living; challenges with IADLs alone do not support an authorization of CPCS CPCS cannot be authorized to supplement a lack of funding or availability of other services
4 ELIGIBILITY Under age 21 Actively enrolled in Medicaid Have a medical condition, disability or cognitive impairment as documented by a physician, psychologist, psychiatrist, physicians assistant, nurse practitioner or other licensed clinician Qualify for medically necessary personal care services based on functional limitations in age-appropriate ability to perform ADLs Based on individualized review of IFS Intake, CPCS Functional Ability Screen, Care Plan and supplemental documentation Medical Necessity is determined by a clinician and considers the overall above-average needs related to age appropriate personal care
5 CPCS MEDICAL NECESSITY For EPSDT-eligible beneficiaries, medical necessity includes a determination that a service is needed to achieve proper growth and development or prevent the onset or worsening of a health condition Not diagnosis-based Requires verifiable long-term disability or health condition that impacts ability to perform or develop self-care skills Specific long-term disability/health conditions do not drive eligibility or authorization level. Review of totality of information contained in application Considers direct care needs related to activities of daily living (ADLs) as well as the interaction of instrumental activities of daily living (IADLs) to specific ADL needs No minimum threshold Needs must be related to child s ability to perform self-care tasks Expectations must be age-appropriate
6 HOW TO APPLY FOR CPCS There are a couple of requirements when applying for CPCS, you and your child must: 1) Work with a trained assessor 2) Submit supplemental documents 3) Have your child participate in the assessment (in part)
7 WORK WITH A TRAINED CPCS ASSESSOR Children s Personal Care Services staff maintains a directory of trained assessors Over 150 trained assessors state-wide Local Designated Agencies (Developmental Services/ Mental Health organizations) and Children with Special Health Needs have available staff to assist families complete assessments
8 SUBMIT SUPPLEMENTAL DOCUMENTS Clinical and/or educational documents must be submitted to increase the CPCS clinical reviewers understanding of needs across settings An application is not considered complete until these materials are received Without these documents, applications can be delayed and are subject to administrative closure Administrative Closure : without complete information, an application can become too old for the information to be considered currently and the application is closed without a decision. This is not a denial and not reflective of need. Supplemental Documents include (but are not limited to): Doctor s Notes (Well Child Check); Psychological Evaluation; Child Development Clinic Evaluation; Psycho-Social Evaluation; Discharge Planning documents; Adaptive Functioning Evaluation; IEP/504 Plan
9 CHILD S PARTICIPATION The child must participate, in part, in the application This should feel authentic (as much as possible) to both the child and assessor There is no requirement or expectation that the child participate in the entire assessment unless the child/family feels that this is appropriate
10 REVIEW AND PROCESSING Once the application is complete, application materials are forwarded to CPCS office for review. EVERY child receives a clinical review to determine Medical Necessity. Notification of Decision is made in writing and families is provided appeal rights CPCS is an almost exclusively family/surrogate managed services Information about service authorizations are shared with and for new families CPCS requests information to connect them with ARIS for the first time
ARIS SOLUTIONS Financial and Fiscal Management Services Maryann Willson, MSW Fiscal Agent Director www.arissolutions.org
Presentation Objectives Understanding of Fiscal Agent Services and the role of Understanding the new Fair Labor Standards Act and how it applies to Children s Personal Care Services How to access online budget reports Electronic time sheets! How to easily submit timesheets without the challenges of the US postal system, faxes, or emails! What is an EIN and why is it necessary for ARIS Solutions to obtain one for employers?
History and Mission Established in 1996 as a collaboration between two provider agencies non-profit 501(c)3 corporation Expanded to Fiscal Agent work in Vermont in 1998 Currently the Fiscal/Employer Agent for Vermont 4500 Vermont Participants 13,000 Employees & Vendors $63 Million Annual Payroll 95% Medicaid
What Does Do? Acts as the agent for each employer for the purposes of assisting employers through: Processing employee payroll and assuring compliance with Dept. of Labor laws Reporting and paying payroll taxes (including state and Federal income taxes, Social Security and Medicare taxes, Unemployment and Workers Compensation taxes Billing Medicaid to pay for each child s services Issuing annual IRS form W-2 to employees (issuing more than 13,000 W-2 forms annually) Interfacing with the Vermont Dept. of Labor to report new hires of employees and providing wage verification and reason for job separation reasons for unemployment claims Completing background checks as required by the Vermont Agency of Human Services Background Check Policy (processes checks for more than 8,000 new employees annually) Verifies that all children have active Medicaid coverage Provision of technical assistance by phone and web site for employers
New Overtime Rules Effective October 13, 2015 the Federal Department of Labor Home Care Rule requires overtime payments for eligible home care employees working more than 40 hours in a work week. will automatically pay employees overtime for each hour worked over 40 hours in each work week beginning on Sunday and ending on Saturday. Overtime wages are paid at time and a half for each overtime hour worked. If an employee works with two children for the same employer, the hours worked for both children combined counts toward overtime payments. Employers must monitor budgets carefully to assure that the funds in the budget do not run out. If all funds are used in a budget, cannot pay the employee. In these situations the employer must pay the employee with their own funds. Unless directed otherwise by employers, will take funds for overtime out of the budget of the child for whom the employee hours go into overtime. Questions about completing time sheets, understanding what funds remain in the child s budget, or for new paperwork? Call at 1-800-798-1658
On Line Budget Reports Employees may review budget reports on line through the web site; www.arissolutions.org To access on line budget reports, employers must follow these instructions: On the home page banner, click on Services Click on Children s Personal Care Services Scroll down the page to Click Here For Your Budget Report, click there Enter your Company ID : Your Company ID can be found on any paper budget report, on the upper right hand side, under Agency Enter your PIN, which is the last four digits of your Social Security number Enter the Code Text and click Log In Click View Report Reports are updated weekly, every Thursday following payroll
On Line Budget Reports
On Line Budget Reports Vermont Participant, Family, or Surrogate Directed Payroll Services Adult Family Care Respite Attendant Services (PDAC) *******Children s Personal Care Services Choices for Care Developmental Services * Pre-Service Training For Developmental Services Employees Flexible Choices (A Choices for Care Program) Integrated Family Services Respite Moderate Needs Program Traumatic Brain Injury (TBI) Veterans Payroll Services Vermont Washington DC Alaska
On Line Budget Reports Children s Personal Care Services If you are becoming an employer and will be hiring employees to provide services, please call our office at 1-800-798-1658 to request a New Employer Start Up Folder. You may not download new employer paperwork. If you are already an employer and will be hiring employees to provide services funded through the Children s Personal Care Services system please download and print (do not print pages back to back) the following: Employee Hiring Packet* Direct Deposit Authorization Form Federal and Vermont Forms W-4 (to update or change tax withholding status) Children s Personal Care Services Hour Based Services Time Sheet* Children s Personal Care Services Dollar Based Services Time Sheet* C3 Time Sheet* State of Vermont, Agency of Human Services, Background Check Policy Payroll Schedule How To Manage Children s Personal Care Services Dollar Based Budgets Forms must be completed and submitted to *CLICK HERE FOR YOUR BUDGET REPORT To access your budget report you will need your Company ID (found on the right side of your paper report) and your PIN (the last four digits of your Social Security Number)
On Line Budget Reports
Submitting Time Sheets? Submitting time sheets can be a frustrating process! Employers report experiencing multiple difficulties using the US Postal Service to mail time sheets, including time sheets which arrive at well after the due date for payroll. Faxed time sheets some times do not go through, leaving the employer unaware that has not gotten the employee s time sheet. E-mailed time sheets some times do not print automatically and must be in a PDF format or may not be able to be read. Driving a time sheet to White River Junction is just not reasonable.
Try Electronic Time Sheets! Benefits of on-line submission of electronic time sheets: No more paper No more reliance on the post office, email or fax Time sheets may be completed at any time Employers may review and approve time sheets remotely (great when employers are on vacation!) Time sheets remain on the secure web site indefinitely. No more missing time sheets! As time sheets remain on the web site indefinitely, there is no need for employers and employees to maintain or store copies of paper time sheets
Electronic Time Sheets Submitting electronic time sheets is easy! Each employer and employee mush register to gain access to the on line time sheet portal. Once registered the employer and employee will be provided with their own user names and PIN to access the portal. From there: 1. The employee logs onto the portal 2. The employee enters hours worked in a two week period 3. Once finished entering hours, the employee affirms that hours and services were provided as entered 4. The employee clicks on the submit to employer button
Electronic Time Sheets, cont. Once the employee has submitted the time sheet, an email is sent to the employer telling them that their employee s time sheet is ready for review and approval The employer logs on to the time sheet portal The employer reviews the time sheet. If ok, the employer clicks Submit, which authorizes to issue payment. If the time sheet is not correct, the employer will click reject, and enter a reason for the rejection. The employee will then receive an email advising that they must correct and resubmit their time sheet. Once the employee has corrected and re-submitted the time sheet, the employer may approve the time sheet and submit it for payment.
Electronic Time Sheets, cont. Once the employer has submitted the approved time sheet, will download the time sheet and process payment on the next regular pay week. All time sheets remain on the portal so that employers and employees may go back and review them at any time. At any point during the process, may view each time sheet, and can assist the employer and employee with problems. Unfortunately, electronic time sheets cannot process mileage or other non-wage expenses.
Employer Identification Number (EIN) An Employer Identification Number s are now required for all employers managing Medicaid funded services in Vermont EIN s are federal numbers which identify each individual for the purpose of IRS employer wage and tax reporting Employers in Medicaid funded services in Vermont are assigned special EIN s, for House Hold Care Service Recipients. This designation helps the IRS understand that the wages paid by employers are related to Medicaid funded services and not to for profit companies. All employers must have an EIN obtained for them by by December 31, 2015, or will no longer be able to process employee payroll.
Questions?