NYS OPWDD Consolidated Supports and Services (CSS) Support Broker Guidelines

Transcription

1 NYS OPWDD Consolidated Supports and Services (CSS) Support Broker Guidelines CSS SB-01 Table of Contents Section 1 Support Broker Guidelines p. 1 Section 2 The Support Broker Agreement p. 5 Section 3 The Support Broker Payment Process p. 6 Section 4 Agreement Termination p. 7 Section 1 Support Broker Guidelines What is a Support Broker? Consolidated Supports and Services (CSS) is a Home and Community Based Services (HCBS) waiver option that helps individuals with disabilities create a life that is meaningful for them. Through CSS, individuals and their families have more control over their supports and services; individuals self-direct their services and actively manage their own budgets that authorize payments for the supports and services they choose. CSS participants are required to designate someone as their Support Broker, either paid or unpaid. Any cost for this service is included in the participant s approved CSS Plan/Budget. The primary function of the Support Broker is to assure that the CSS Plan/Budget is reviewed every six (6) months and updated as needed so that it remains current and eligible for Medicaid funding. There are many secondary tasks a Support Broker may perform to assist CSS participants with the implementation of their approved CSS Plan/Budget (please see the Support Broker Checklist). Since every CSS Plan/Budget is individualized and designed by the participant and the Circle of Support (COS), the role of and exact tasks performed by the Support Broker may vary and will be determined by the participant, the Circle of Support, and the broker. The Support Broker teaches and assists the participant and the Circle of Support to be as independent as possible in the management of the self-directed services. As a result, Support Broker service hours may be reduced over time as the participant and the Circle of Support learn the skills necessary to manage the services. The Support Broker assists the CSS participant with reviewing, revising, and updating the CSS Plan/Budget, and may assist with maintaining the Circle of Support and facilitating Circle of Support meetings; monitoring CSS expenditures to ensure costs do not exceed the annual CSS Plan/Budget; completing and submitting required Medicaid service documentation to the Financial Management Services agency (FMS); recruiting, interviewing, and assisting with the supervision of selfhired staff and other specific tasks outlined in the approved CSS Plan/Budget. The Support Broker role and the tasks performed should be clearly identified in the CSS Plan/Budget and in the Support Broker Agreement. Support Broker Qualifications, Requirements, and Payment Guidelines: 1. People who work as Support Brokers believe in the philosophy of person-centered planning, self advocacy, and the right and ability of people to self-direct their supports and services. 1 01/02/13 CSS Support Broker Guidelines

2 2. All Support Brokers must successfully complete the OPWDD CSS Broker Training Institute and the following OPWDD Workforce Development courses: Introduction to Person Centered Planning, Self-Advocacy/Self-Determination, and Circles of Support prior to provision of broker services. Other courses such as Advanced Person Centered Planning, Valued Outcomes and HCBS Waiver are strongly recommended. 3. All brokers are required to obtain twelve (12) hours of professional development training annually after the first year of brokerage: six (6) hours of training must be attained through participation in ongoing OPWDD sponsored broker trainings providing technical information and program updates; the other six (6) hours of this requirement may be met through attendance at relevant trainings listed in the OPWDD Catalog of Training and Development Programs. Other trainings may be substituted at the discretion of the Regional Office CSS Liaison based on a determination of course subject matter and its relevance to CSS or individualized services. 4. All Support Brokers must be approved by the Regional Office CSS Liaison in the region in which they intend to provide services. If a support broker is working in more than one region, the broker should notify the liaisons for each of the regions in which they wish to provide broker services. 5. Brokers must have good oral and written communications skills. They must be able to complete a CSS Plan/Budget and must have the ability to access and use software necessary to completing a CSS Plan/Budget. 6. Support Brokers can be parents, family members, human service professionals, and/or self-advocates. However, immediate family members and persons with an established clinical relationship with the participant may not receive payment for any Support Broker service provided to that participant. Parents and family members who wish to act as the individual s broker must meet all broker training requirements. 7. Other parties who may not receive payment for Support Broker services include: Medicaid Service Coordinators (MSCs) who already provide services to the participant, residential or day habilitation staff who provide supports to the participant, and anyone who has a direct professional relationship to the CSS participant. An MSC, clinician, residential or day habilitation staff person may be hired to provide Support Broker services if he/she does not have a professional relationship with the participant. 8. NYS OPWDD employees are prohibited from being paid to provide independent broker services. The NYS Ethics Commission has determined that performing in this capacity may represent a conflict of interest which would not serve in the best interest of the participant. A NYS OPWDD employee may provide Support Broker services if his or her supervisor has designated it as part of his or her regular, standard job duties. 9. Support Brokers must be able to self-manage the work and responsibilities necessary to complete the products that they have committed to produce as specified in their Support Broker Agreement or that Agreement may be terminated. 10. Support Broker Satisfaction Surveys will periodically be solicited from CSS participants to help determine the effectiveness of the broker and the service in general. 2 CSS Support Broker Guidelines 03/07/13

3 11. All paid Support Brokers must comply with the criminal background check regulations in order to provide Support Broker services. All unpaid brokers should contact their Regional Office Liaison to determine if a criminal background check is required. Criteria for Consideration When Choosing a Support Broker: 1. The Support Broker is freely chosen by the CSS participant and/or the designated representative. 2. Often times, a Start-up Broker who assisted the participant in successfully completing the initial CSS Plan/Budget may be interested in continuing on as the participant s Support Broker. This may be preferred by the participant if the two have already established a good working relationship. In this event, a signed Support Broker Agreement will still be needed. 3. Participants may give preference to Support Brokers who have successfully supported others in managing their approved CSS Plan/Budget or who have a college degree or advanced training in a related field or who have significant training in some form of person-centered planning. This experience may be verified by references. Sources of Support Brokers: The following is a list of people who may provide Support Broker services: 1. Full-time consultants dedicated to person-centered and individualized supports. 2. Individuals who work other full or part-time jobs and wish to provide Support Broker services as independent consultants (on their own time). 3. Voluntary agencies that are committed to person-centered, individualized supports and services that have elected to provide Support Broker services as part of their service delivery options. All Support Brokers identified by the agency must also go through the required trainings specified on page CSS participants should contact their Regional Office CSS Liaison if they need assistance in locating a Support Broker. Support Broker tasks: 1. The primary function of the support broker is to maintain the CSS Plan/Budget. This includes: - working with the CSS participant and COS to review and update the CSS Plan/Budget every six (6) months, and more often as needed, so that it meets the needs of the individual and remains current and eligible for Medicaid funding, and - attending the participant s Individualized Service Plan (ISP) review and CSS Plan/Budget review as requested. Other Support Broker tasks may include: 2. Assisting the CSS participant to develop and maintain the circle of support. This includes assisting the CSS participant to identify members, to identify and assign roles and tasks 3 CSS Support Broker Guidelines 03/07/13

4 for circle members, to schedule circle of support meetings, ensuring that the CSS participant is aware that circle meetings must occur at least every three months; and assisting the participant to facilitate circle of support meetings. The broker assists with the overall functioning of the circle of support, ensuring that members are freely chosen by the participant and that the circle is operating in the participant s best interest and within the principles of self-determination. 3. Providing education and training to the participant and his/her circle of support in implementing the CSS Plan/Budget according to Medicaid and New York State standards, and providing other technical supports as needed to keep the CSS Plan/Budget functioning effectively. 4. Monitoring CSS expenditures to ensure that expenditures do not exceed the CSS budget by assisting the participant to review the Monthly Spending Detail Report provided by the FMS and working with the participant and circle of support to ensure monthly spending is within budget. 5. Assisting the CSS participant to review, revisit and update his/her person-centered plan on a regular basis. 6. Assisting the participant to properly document CSS services according to Medicaid and OPWDD regulations and policy. This includes assisting the CSS participant to review and submit to the FMS employee time sheets, the monthly summary note, mileage and expense reimbursement forms, and all other required documentation. Timeliness is necessary to ensure Medicaid compliance and also for billing purposes. 7. Assisting the CSS participant to maintain appropriate support staff. This includes assisting the CSS participant in recruiting, interviewing, hiring, scheduling and supervising selfhired staff supports as well as assisting the individual to identify and retain adequate back-up staffing to ensure availability as needed by the participant. 8. Working with the individual, the COS and the MSC to help identify and develop connections in the community that support aspects of the CSS Plan/Budget. Guidelines for Maximum Number of hours of Support Broker Agreements: In order to ensure that Support Broker services maintain the highest degree of quality, OPWDD has guidelines which establish the recommended number of hours a Support Broker may provide in total: Full time Broker: 40 Hours per week Part time Broker*: up to 30 hours per week * A Support Broker with other employment and only provides broker services on a part-time basis. Broker agreements with agency brokers are assigned to the agency, not to the individual broker. Workload and assignments of agency brokers are at the discretion of their agency. Independent brokers work as consultants paid by the FMS agency, and, as a result, are not limited in the number of hours they may choose to work in a week. 4 CSS Support Broker Guidelines 03/07/13

5 Approval of Support Broker Agreements is at the discretion of the Regional Office CSS Liaison and should be based on the capability and performance of the support broker. Approval of additional Support Broker Agreements if a broker s current weekly hourly commitment is at the maximum listed above is also at the discretion of the Regional Office CSS Liaison and is based on the capability and performance of the support broker. Brokers approaching their maximum hours should check with their Regional Office CSS Liaisons prior to signing a new agreement. Guidelines for Maximum Number of Hours of Support Broker Services in the CSS Plan OPWDD has established guidelines to use when determining how many annual hours of Support Brokerage a CSS participant may receive. The number of hours depends on what amount of supports the participant is requesting from the Support Broker, as outlined in the Agreement, and are separated into three categories (Light, Medium, and Intensive) as described below. These guidelines will be used by the Regional Office CSS Liaison when reviewing and approving Broker Agreements. In extenuating circumstances, at the discretion of the Regional Office CSS Liaison, additional hours may be approved. Note: when determining the number of hours, the participant should keep in mind that the funding for this service comes from the participant s CSS Plan/Budget. Light: The Broker reviews the CSS Plan/Budget every 6 months, updates the plan as needed and attends ISP meetings and CSS Plan/Budget reviews. In addition, the Broker may attend Circle of Support meetings. The allowable Support Broker hours in this category are 12 to 29 hours per year. Medium: In addition to the above tasks, the Support Broker assists with the recruitment of staff and communicates regularly with the participant or representative. The allowable Support Broker hours in this category are hours per year. Intensive: In addition to the above tasks, the Support Broker supervises and coordinates CSS staff, assists with monthly documentation, meets frequently with participant and COS. The allowable Support Broker hours in this category are hours per year. It is recommended that this level be reserved for participants with complicated plans, shared staffing situations, unique circumstances, etc. Allowing this level of brokerage is determined by the Regional Office CSS Liaison and is based on person specific information. Section 2 Support Broker Agreement Process Step 1: Step 2: Step 3: The Support Broker role, including job description, hours of service and hourly rate, must be included in the approved CSS Plan/Budget. The total dollar amount of the Agreement may not exceed the amount in the approved CSS Plan/Budget. After ensuring the above and selecting the Support Broker, the CSS participant and/or designee meets with the Support Broker and together they complete the Support Broker Agreement. This includes signing and dating the Agreement. The Agreement is then sent to the Regional Office CSS Liaison for review and approval. 5 CSS Support Broker Guidelines 03/07/13

6 Step 4: Step 5: Step 6: Once the Agreement is approved by the Regional Office CSS Liaison, the Liaison enters the Effective Date of Agreement, signs and dates the Agreement and sends the original Agreement to the CSS participant s FMS and copies to the CSS participant and the Support Broker. Once the FMS receives the Agreement and determines the Agreement is in accordance with the CSS Plan/Budget, the FMS may begin making payments to the Support Broker according to the payment procedures described below. The Support Broker Agreement should be reviewed at the time of the CSS Plan/Budget review. The Agreement remains in place until it is terminated. Section 3 The Support Broker Payment Process Billing procedures for Support Brokers: 1. A Support Broker may not be paid for Support Broker services unless there is an approved Support Broker Agreement on file with the CSS participant s FMS that is in accordance with a current and approved CSS Plan/Budget. In order to receive payment, the service must be identified in the Support Broker Agreement. Services provided but not identified in the Support Broker Agreement will not be reimbursed. 2. Each month, the Support Broker completes an Invoice/Service Record for Contracted/Vendor Services (CSS-03) and sends it to the CSS participant s FMS. The invoice details the activities conducted on behalf of the CSS participant for that month, including the number of hours provided, the date and times the hours were provided, and whether the services provided were face-to-face with the CSS participant. 3. To receive reimbursement, Support Brokers must send completed invoices directly to the appropriate FMS. Invoices should be signed by the participant or by the participant s designee before payment can be made. 4. Invoices (CSS-03) are forwarded for payment no earlier than the 1 st of the month and no later than the 10 th day of the month following the month that the service was provided. Once the invoice is received by the FMS, payment may be made. Maximum Hourly Pay Rates for Support Brokers:* Note: The rate of reimbursement is negotiable between the participant and broker. The rates below reflect maximums a broker may charge for broker services. Remember that the funding for this service comes from the participant s CSS Plan/Budget. Qualifications A Support Broker who has completed the necessary training but has had no experience as a Support Broker and may require mentoring. $20 A Support Broker with limited experience and has brokered one approved OPWDD CSS Plan/Budget for at least six months. $25 Rate 6 CSS Support Broker Guidelines 03/07/13

7 A Support Broker who has brokered two approved OPWDD CSS Plan/Budgets for at least six months. $30 A Support Broker who has brokered three or more approved CSS Plan/Budgets for at least six months. $35 Agency provided Support Broker services. $40 Agency providing Support Broker services and also provides FMS services $35 *Support Brokers who also function as Start-up Brokers may be paid at their Start-up Broker rate. Section 4 Support Broker Contract Termination Occasionally, there may be circumstances which result in the need to terminate the Support Broker Agreement. For example, the participant may not be satisfied with the Support Broker or the Support Broker may no longer be able to perform the duties of the Agreement. Whatever the reason, if the CSS participant is continuing in CSS, he/she requires a new Support Broker. In order to hire a new Support Broker, a new Support Broker Agreement must be completed. The new Agreement cannot be put into effect until the former Agreement is terminated. Common reasons to terminate the Agreements include: 1. The participant s health or other life circumstances have changed and the participant leaves CSS. In this instance, the participant, the designee, or Support Broker should notify the Regional Office CSS Liaison and indicate that the person has chosen to withdraw from CSS. 2. The CSS participant may choose to terminate the Agreement. In this instance, the CSS participant will discuss the termination of the Agreement with the Regional Office CSS Liaison and will complete a copy of the OPWDD Consolidated Supports and Services (CSS) Termination of Service Provider form (CSS-12). A copy will be forwarded to the Support Broker and FMS. 3. A Support Broker may choose to terminate the Agreement. In this instance, the Support Broker must immediately notify the CSS participant and the Regional Office Liaison so that arrangements can be made to find a suitable replacement. The Support Broker will complete the OPWDD Consolidated Supports and Services (CSS) Termination of Service Provider form (CSS-12). A copy will be forwarded to the participant and FMS. To the extent possible and appropriate, the former Support Broker is encouraged to assist the participant in locating a replacement Support Broker before Agreement termination. * A copy of the OPWDD Consolidated Supports and Services (CSS) Termination of Service Provider form (CSS-12) may be obtained from your Regional Office CSS Liaison. 7 CSS Support Broker Guidelines 03/07/13