intellectual & developmental disabilities open enrollment forum · 2020-02-03 · • byanka...
TRANSCRIPT
Intellectual & Developmental Disabilities
Open Enrollment Forum
February 3, 2020
Agenda
2
Welcome and Introductions
Overview of NOW and COMP Waivers
Georgia Collaborative ASO
Recruitment and Application to Become a Provider of IDD Services
Letter of Intent
Application Submission
Resources
DBHDD Regional Field Offices
ASO resources
RISKS
Certificates
Q & A
Introductions
3
Department of Behavioral Health and Developmental Disabilities
• Mary Price, CFO
• Camille Richins, Director, Provider Enrollment and Contracts
• Genevieve McConico, Director, DD Provider Enrollment
• Ashleigh Henneberger, IDD, Director of Waiver Services
Georgia Collaborative ASO
• Jessica Willhite, AVP, Operations
• Jenny DeLoach, Director, Provider Relations
• Jennifer Hunt-Manchester, Provider Relations Manager/Trainer
• Byanka Tucker, Provider Relations Manager/Trainer
• Tamika Jones, Provider Relations Specialist
4
Who is DBHDD
The Georgia Department of Behavioral Health and Developmental Disabilities provides treatment and support services to people with mental health challenges and substance use disorders, and assists individuals who live with intellectual and developmental disabilities
Who is DBHDD
Offices:• Central Office
• Located in Atlanta• Field Office
• 6 Field Offices throughout the state• Divisions
• 5 Divisions• Division of Accountability and Compliance• Division of Hospital Services• Division of Performance Management and Quality
Improvement• Division of Behavioral Health• Division of Developmental Disabilities
• Numerous offices
Vision
Easy access to high-quality care that leads to a life of recovery and independence for the people we serve
7
Mission
Leading an accountable and effective continuum of care to support Georgians with behavioral health challenges, and intellectual and developmental disabilities in a dynamic health care environment
8
DBHDD Values
Collaboration and Teamwork
Person-Centeredness
Creative Problem-Solving
Integrity Mutual Respect
Customer Service
Continuous Improvement
Results-Driven Focus
9
Goals For Today
• To learn about the IDD services available
• To understand the enrollment requirements and processes to become a provider of services for individuals
• To be able to submit a successful application
DBHDD’s Expectations
The Department expects a Provider Network with these characteristics:
Easy Access for Individuals to Receive Services
Experience and Skills to Provide High Quality Services
Strong Organizational Structure
Financial Stability
DBHDD Obligations
The Department will support the Provider Network by:
• Providing Policies, Guidelines, Training and Technical Assistance
Monitor Provider Performance for Safety, Quality, and Services Outcomes
Provide Support to Providers to resolve Service Delivery Issues
DBHDD PROVIDER TYPES
• Agency Applicant – Agency applicant refers to a Corporation, Partnership, Limited Liability Corporation (LLC), or other entity with the legal authority to make application to become a provider of Developmental Disability Services as allowed by policies set forth by DBHDD and the Department of Community Health.
• Individual Applicant – A single individual making application to provide a New Options Waiver or Comprehensive Supports Waiver home and community based service(s) for the specific services that are allowed to be delivered by an individual practitioner.
Georgia Department of Behavioral Health & Developmental Disabilities
NOW & COMPWaiver Services Overview
What is a Medicaid Waiver?
• Medicaid Waiver programs help provide services to people who would otherwise be in an institution, nursing home, or hospital to receive long-term care in the community.
• Prior to 1981, the Federal Medicaid program paid for services only if a person lived in an institution.
• Medicaid Waivers effectively waive the requirement that the individual live in an institution, thereby allowing him or her to receive community based services.
1915(c) Waivers
• All Home and Community Based (HCBS) 1915 waiver programs:
• Are authorized under Section 1915 of the Social Security Act.• Are fee-for-service programs, meaning that the provider is paid for
each service the individual receives • Require individuals to meet criteria that are set by the state and based
on a person's level of need• May be limited to a certain medical diagnosis (e.g., mental health, developmental
disability)• Require application submission by the State Medicaid Agency and
approval by CMS.
New Options Waiver Program (NOW)/ Comprehensive Supports (COMP) Waiver Programs
• Collaboratively administered by the Georgia Department of Community Health (Medicaid) and the Georgia Department of Behavioral Health and Developmental Disabilities
• GA DBHDD serves as the Operating Agency for the two waiver programs
• DBHDD manages a network of approximately 450 DD providers
• Approximately 13,000 Georgians receiving NOW and COMP waiver services
• Provides 24 distinct services, some with self-directed options
NOW/COMP Waiver Services Include:
• Community Residential Alternative[COMP]
• Community Living Support• Additional Staffing • Community Access• Prevocational Services• Supported Employment• Respite Services• Transportation• Natural Support Training• Community Guide • Financial Support Services
Individual Directed Goods and Services
• Interpreter Services [COMP]• Behavioral Support Services• Nursing Services• Specialized Medical Equipment• Specialized Medical Supplies• Adult Physical Therapy• Adult Occupational Therapy• Adult Speech and Language
Therapy• Nutrition Services• Environmental Accessibility
Adaptation• Vehicle Adaptation
Community Residential Alternative(CRA)
*COMP only
Community Residential Alternative (CRA)
Provides 24/7 support
Community Living Arrangement or Host Home
Assistance with and training on ADL’s
Assistance and training on household activities
Oversight of medical care
Implement Behavioral Support Plans
Shopping, Recreation, Community Activities
Provide Transportation as needed
Community Residential Alternative
Community Living Arrangement (CLA)
Host Home
3 or 4 individuals served per home
1 or 2 individuals served per home
24/7 shift staff on site An individual, couple or family also resides in the home and provides 24/7 support
Community Residential Alternative
• CRA• CLA (group home) must be licensed by HFR.• Host Homes are unlicensed, new providers are not eligible to apply for host
homes• Staffing is based on assessment level of each individual and
licensure capacity of the home.
• Must have at least one staff present whenever any resident is home.
• Housemate-matching process must take place prior to any moves into a CRA.
Community Living Support Services(CLS)
Community Living Support (CLS)
Provided in family home or individual’s own home
Provided up to 42 hours weekly
Assistance with and training on ADL’s
Assistance and training on household activities
Health-related activities
Implement Behavioral Support Plans
Shopping, Recreation, Community Activities
Provide Transportation as needed
Community Living Support
• CLS services assists individuals to acquire, retain, or improve skills in order to successfully live in their own or family home.
• CLS provider agencies under COMP/NOW must provide a current Private Home Care Provider License from the Department of Community Health, Healthcare Facility Regulation Division (HFR)
• Personal care/assistance may be a component of CLS services, but the focus of personal assistance should be teaching the skills related to activities of daily living in the context of person-centered goals.
• Can be provided by traditional providers or participant-directed.
Community Living Support
• CLS Services are designed for people who require support and supervision to be safe in the home and community and do not have natural supports available to provide support during certain hours due to other obligations.
• Determination of number of hours of CLS approved is dependent on:• Parent/caregiver work schedules or other responsibilities• Time spent in other services• Supervision needs of the individual
• Equivalent service in other waiver programs: Personal Support Services and Extended PSS
Community Access Services (CAG/CAI)
Community Access Services
Oversight and supervision
Assistance with and training on ADL’s
Assistance with and training on Socialization
Assistance and training on CommunicationSkills
Assistance with Mobility Skills
Implement Behavioral Support Plans
Recreation and Community Activities
Transportation included
Community Access Group
• Assistance in acquiring, retaining, or improving self-help, socialization, and adaptive skills for active community participation and independent functioning outside the person’s own or family home.
• Assistance in acquiring, retaining, or improving access to and use of community resources that increases participation in integrated community activities.
CAG can include training on:
• ADL skills• Money management• Using banks/ATMs• Shopping skills• Nutrition and diet• Using public transportation
• Dining out
• Volunteering• Self-advocacy• Socialization skills• Communication skills• Self admin of meds• Reducing maladaptive
behaviors• Participation in
recreational activities
Community Access Group
• Typically provided within day center and community-based settings
• Direct care staff to individual ratio for CAG cannot exceed 1 staff to 10 participants and is determined based on individual need level of the participants in the group
Community Access Individual
• Provided one-on-one
• Not provided in a facility or within the person’s own home. Must be delivered in the community.
• Includes person-specific training/coaching on skill building to promote independence based on the individual’s goals.
• CAG/CAI Equivalent service in other waiver programs: Adult Day Health Services
Prevocational Services
Prevocational Services
• Intended for individuals who desire to work, but are unlikely to be prepared to join the general work force within one year
• Provided in a facility-based “sheltered workshop” setting (1:10 ratio) or community-based mobile work crews (1:6 ratio)
• Focus is not on direct employment skills, but more indirect skills.
• Teaches concepts such as rule compliance, attendance, task completion, problem solving, endurance, work speed, work accuracy, increased attention span, motor skills, safety, and appropriate social skills.
• Equivalent service in other waiver programs: Adult Day Health Services
Supported Employment Services
Supported Employment Services
• Supported Employment services are provided in partnership with the Georgia Vocational Rehabilitation Agency (GVRA) through a Memorandum of Understanding (MOU).
• GVRA provides funding for initial supports (job development, job placement, and job stabilization).
• NOW/COMP provides funding for long-term support to maintain employment.
• Georgia is an “Employment First” State – meaning employment in the general workforce should be the first and preferred option for individuals with disabilities receiving assistance from publicly funded systems.
• Supported Employment can be recommended by any clinician at any time, based on individual’s stated desire to work.
• No equivalent service in Georgia’s other waiver programs
Respite Services
Respite Services
Provide brief periods of support or relief for family or other unpaid caregivers of individuals with disabilities. Models of Respite Care:• In Home Respite-providers are required to have a Private Home
Care License. • Out of Home Respite-providers are required to have a permit in
one of the following categories- PCH, CLA, or Child Caring Institution
Respite Staff Duties Include:
• Assisting with ADL’s, self-administration of medications, health maintenance activities, personal care and protective oversight.
• Assisting and training on independent living skills• Personal hygiene, light housework, laundry, meal preparation,
transportation, grocery shopping, using the telephone, money management
• Facilitating engagement in community social, recreational and leisure activities during absence from the family or natural home (including transportation)
• Implementing BSP to reduce maladaptive behaviors and to acquire alternative adaptive skill/behaviors
Behavioral Supports Services
Behavioral Support Services
Behavior Support Services includes:
• Development of person-centered training curriculum specific to the positive behavior support plan
• Training provided to paid and unpaid supporters on recommended interventions, replacement behavior and outcomes tracking
• Ongoing coaching as needed for staff/family reinforcement• Intervention modalities related to the person’s identified
behavioral needs
Nursing Services(LPN/RN)
Nursing Services
• Clinical nursing services are indicated when the individual has a clinical diagnosis which requires ongoing complex assessment and intervention for the purpose of health restoration or prevention of further deterioration of the health of the individual.
• Nursing services are approved when required to meet the healthcare needs of the individual and may be delivered in a variety of settings, including but not limited to the person’s home, relative’s home, or other location where no duplicative serves are available.
Nursing Services
• A DBHDD nursing assessment is needed to validate the need for nursing services and is conducted annually for anyone receiving nursing services.
• Approval of specific hours is determined by use of a standardized methodology for determination of skilled nursing support.
• Cannot use participant direction model for nursing services
Adult Therapies- Occupational Therapy- Physical Therapy- Speech and Language Therapy
Nutrition Services
Visit NOW and COMP Part III Waiver Manuals on www.mmis.georgia.gov/ for more information. Visit DBHDD at https://dbhdd.georgia.gov/be-connected for more information on policies and provider questions
Georgia Department of Behavioral Health & Developmental Disabilities
IDD Enrollment Forum Overview
49
Intellectual and Developmental Disabilities Enrollment Steps
50
Step 1 New Provider Enrollment Forum
Step 2 Letter of Intent & Pre-Qualifiers
Step 3 DBHDD/GA Collaborative ASO Application
Step 4 DCH Application
Step 5 New Provider Orientation
Step 6 DBHDD Letter of Agreement
2020 IDD Enrollment Forums/Open Enrollment – Step 1
51
The Georgia Collaborative will host 3 IDD forums each fiscal year, followed by an open enrollment period.
Attendance of the enrollment forum is required for NEW providers. A certificate of attendance will be emailed to providers following forum, which must be submitted with LOI to enrollment services for processing.
IDD Provider Forum IDD Open EnrollmentFebruary 3, 2020 March 1 – 30, 2020June 10, 2020 July 1 – 31, 2020October 14, 2020 November 1 – 30, 2020
Georgia Collaborative ASO
53
Administrative Services Organization contracted with DBHDD to complete Provider Credentialing
Follows DBHDD Policy 02-701 to credential providers for DBHDD Provider Network
• Completes Letter of Intent (LOI) Review
• Completes Application Review
• Works in partnership with DBHDD and DCH
• Delivers Provider Orientation Training
• Activates approved provider in system
Process for joining DBHDD Provider Network
54
DBHDD recruits providers who have the required clinical knowledge, financial stability and successful experiences in serving individuals with intellectual/developmental disabilities as outlined in policy 02-701. The review process is accomplished through the use of a prequalification process and an application process. The Georgia Collaborative, on behalf of DBHDD, is responsible for these reviews.
Letter of Intent (LOI)
55
Intellectual and Developmental Disabilities Enrollment Steps
56
Step 1 New Provider Enrollment Forum
Step 2 Letter of Intent & Pre-Qualifiers
Step 3 DBHDD/GA Collaborative ASO Application
Step 4 DCH Application
Step 5 New Provider Orientation
Step 6 DBHDD Letter of Agreement
LOI Process Review
57
Submit Letter of Intent (LOI)
• Receive Acknowledgement Letter and tracking number within 5 business days
Georgia Collaborative Review of LOI
• 30 Calendar days to review
• Review Summary sent out to provider
Provider has 1 opportunity to correct; must respond within 10 business days.
LOI Approval
• Invitation to submit Application within 15 business days
Letter of Intent
58
All items on the checklist must be submitted.
All fields must be completed
Handwritten Documents will be rejected
Contract must contain contents outlined in Recruitment Policy 02-701
Right to request additional information
NOTE: If all items are not submitted the LOI will be closed.
Rejection v. Deficiencies LOI
59
Rejected/Closed Deficient
Handwritten License or other documents nearexpiration
Blank Spaces in body Incomplete/Insufficient Documentation
Documentation not attached/Missing Documentation (ex. Financials)
Applicants have 10 business days from the date of the initial outreach notifying them of deficiencies to submit the corrections. The information can be sent via US Postal Service certified return receipt of mail or email [email protected]
LOI will be closed if corrections are not received within the time frame allotted.
Applicants have one opportunity to submit corrections!
LOI Submission
60
Letter of Intent and supporting documents must be mailed via USPS to
Georgia Collaborative Enrollment
PO Box 56324
Atlanta, Georgia 30343
Pre – Qualification Elements Examples
61
Agency IndividualLOI LOI
Resume of IDD Director, Clinical Services Supervisor, and/or DDP
Individual Resume
Signed attestations – IDD Director, Clinical Services Supervisor, and DDP
Current Applicable Professional License or Certification
Copy of current Georgia Secretary of State Registration Transcripts or evidence of continuing education (Behavioral Support Services {BSS} Only)
Evidence that applicant has provided same or similar community based IDD service(s) for a minimum of 1 year.
If not professionally licensed, waiver services should be provided for one – year through self direction.
Most Recent year of Tax Returns or Audited Financials
Copy of current applicable license (RN, PHC, CLA, therapist)IRS exempt Status, if applicable
Agency and Director Pre-qualifiers & Requirements
62
Qualifications
Director Degree Bachelor’s Degree
Director Experience • Five years of direct service delivery experience to persons with IDD
• At least two years in an IDD community services supervisory capacity
DDPRequirements
• See Section I of Community Service Standards for IDD Providers• Same individual may serve as agency IDD Director, Clinical Services
Supervisor, or DDP• Attestations
Agency • Secretary of State registration• Valid County /City Business License for Site• Explanation for any “Yes” responses on Professional General Liability form• Current applicable HFR licenses or permits, if required
Allied Health Providers
63
Allied Health Services Providers – Providers of skilled clinical supports services delivered by professionals holding a relevant license in the fields of Occupational Therapy, Physical Therapy, Speech and Language Therapy Services, Nursing, Nutrition Services, or a professional qualified to provide Behavior Support Services
Clinical Services SupervisorCSS Type A • An individual with a current license to practice in a discipline associated
with the allied health services offered by the agency • Must hold professional license in Georgia (ex. OT, PT, Speech)• At Least two (2) years' experience in allied health service delivery, with
at least one year of these years serving in a supervisory capacity.
CSS Type B • Bachelor's Degree • Five (5) years' experience in allied health service delivery, with at least
Two (2) of these years serving in a supervisory capacity
CSS Type C –Behavioral Supports Services
• Current state of Georgia license to practice as a psychologist, professional counselor, clinical social worker, or psychiatrist
• Board-Certified Behavior Analyst (certified through Behavior Analyst Certification Board); with advanced behavior analytic training, with at least one (1) year in direct service delivery of behavior supports.
Financial Requirements for Agencies
64
The following documents must be in the name of the agency and not the individual owner:
Most recent year of Tax Returns or Audited Financials
Most recent 6 months of bank statements
$50,000 credit line per Community Residential Alternative (CRA) site.
The line of credit is required in the application phase not with the LOI.
Response to Pre qualifiers and Letter of Intent
65
Within 5 business days you will receive correspondence from enrollment with notification that your LOI was received.
Within 30 calendar days of receipt of LOI and pre-qualifiers, the GA Collaborative will send correspondence to notify of any deficiencies of information.
If the LOI is complete, an Invitation to Apply letter will be sent to the provider and will include:
o Instructions on completing the Agency/Individual Application for New Providers
LOI Review
66
www.georgiacollaborative.com
• Individual Provider Letter of Intent
• Agency Provider Letter of Intent
Application Submission
67
Intellectual and Developmental Disabilities Enrollment Steps
68
Step 1 New Provider Enrollment Forum
Step 2 Letter of Intent & Pre-Qualifiers
Step 3 DBHDD/GA Collaborative ASO Application
Step 4 DCH Application
Step 5 New Provider Orientation
Step 6 DBHDD Letter of Agreement
Application Submission
69
Completed applications can be sent via mail or email:
Georgia Collaborative Enrollment
PO Box 56324
Atlanta, Georgia 30343
Application Process – Steps 3 and 4
70
Application submission• Within 30 days of invitation to apply
ASO Application review• Acknowledgement Letter and Tracking number sent to provider within 5
business days• ASO has 15 business days to review• Deficiency Notice sent out to provider Provider has 1 opportunity to correct; must respond within 10 business
days
Application approval• Provider invited to complete and submit DCH application online• Individual providers are required to complete background checks during this
phase. (Refer to DBHDD Policy 04-104).
Response to Correction of Incomplete Application
71
Once corrections are received and reviewed, the GA Collaborative will inform the applicant via email of recommendation to DBHDD.
Any incomplete applications as well as those not received during correction period will result in closure of application. If application is closed and applicant is still interested in becoming a provider, the applicant must resubmit a new LOI in an upcoming enrollment cycle
If DCH denies the application, DCH will inform provider of next steps. Please note that per DCH policy, the provider must wait one (1) year before submitting another application.
Intellectual and Developmental Disabilities Enrollment Steps
72
Step 1 New Provider Enrollment Forum
Step 2 Letter of Intent & Pre-Qualifiers
Step 3 DBHDD/GA Collaborative ASO Application
Step 4 DCH Application
Step 5 New Provider Orientation
Step 6 DBHDD Letter of Agreement
Application Process Flow – Steps 5 and 6
73
DCH Approval
Provider notified by DBHDD of approval and Medicaid Provider Number(s) issued
Provider must register and attend a provider orientation session within 30 days.
Orientation sessions will be held on a bi-weekly basis. Registration details will be sent to provider via email.
Completion of provider orientation
A Letter of Agreement (LOA) will be issued by DBHDD.
The LOA will be sent to the provider for signature via email.
Provider must return the signed original LOA via mail to the Department within ten (10) days.
DBHDD notifies the Collaborative to add the provider to the Network.
Things to Remember
74
Services may not be provided without a fully Executed LOA.
All services must receive Prior Authorization (PA) from the DBHDD Regional Field Office designee.
Notification of periodic Provider Meetings will be announced to providers who are expected to attend per LOA.
Agencies should refer to DBHDD Policy 04-104 Criminal Record Check for Contracted Providers, before staff can work with any individuals.
Additional Services and/or Sites
75
Providers can request additional services and sites after:
Agency has provided a minimum of twelve (12) months of services from the date of approval
AND
Achieved a successful compliance review with the Community Standards Quality Review Unit or obtained Accreditation
**Please note that when a provider has not used their provider number for 12 months, the number will be suspended and then the provider number will be terminated four months after the suspension. This is automatically done by DCH.
DBHDD Regional Field Offices
76
DBHDD Regional Field Offices Map
77
• Regional Field Office 1
• Regional Field Office 2
• Regional Field Office 3
• Regional Field Office 4
• Regional Field Office 5
• Regional Field Office 6
Field Offices
78
t
Field Office 1
RSA – Elise Beumer1230 Bald Ridge Marina Road, Suite 800Cumming, GA 30041Phone – (678) 947-2818
Field Office 2
RSA – Vivia N. Black3405 Mike Padgett Highway, Bld 3Augusta, GA 30906Phone – (706) 792-7733
Field Office 3
RSA – Daphne Rosalis3073 Panthersville Road, Building 10, Decatur, GA 30034Phone – (404) 244-5059
Field Office 4
RSA –Tim Hester400 S. Pinetree BoulevardThomasville, GA 31792Phone – (229) 225-5099
Field Office 5
RSA – Vacant1915 Eisenhower Drive,Bld2Savannah, GA 31406Phone – (912) 303-1670
Field Office 6
RSA – Valona Baldwin3000 Schatulga RoadColumbus, GA 31907Phone – (706) 565-7835
RISKS
Budget
80
Identify Fixed Costs:
Rent / Mortgage
Insurance
Utilities
Licenses / Permits
Equipment / Furnishings
Supplies
Other ?
Budget
81
Identify Variable Costs
Across possible # of consumers served (Generally 1-4)
Staffing Expense – Detail:
Show wages and fringes
Training costs
Insurance / Bonding
Other ?
Budget
82
Identify Variable Costs
Across possible # of consumers served (Generally 1-4)
For-Profit:
Taxes
Owner’s Draw
Not-For-Profit
Salaries / Taxes
Budget
83
Identify Variable Costs
Across possible # of consumers served
Other Expenses:
Food and supplies
Transportation
Consumer spending
Other ?
Budget
84
Identify Variable Costs
Across possible # of consumers served
Show ALL expected revenues
Social Security
Medicaid
Wages, pensions, family support
Other ?
Financial Considerations
85
Has this applicant demonstrated an awareness of the financial risks involved in becoming a Provider?
Has this applicant demonstrated an understanding of the full costs involved in becoming a Provider?
As an applicant, do you have a budget which appears to be adequate to support the expected levels of care?
Have you assessed the risk?
86
Has this applicant demonstrated that they have planned adequately for contingencies?
Does the overall financial presentation reflect a reasonably robust fiscal outcome to suggest ongoing viability at the required service/care level ?
Does the overall financial presentation suggest adequate management skill and experience?
Certificates
87
Certificates
88
The link to complete your evaluation will be emailed to you at the email you used to register for this forum.
Required documentation to complete the LOI process.
Will be auto-generated and delivered via email within 10 days of completion.
If you have not received a certificate within 10 days of completion email [email protected]
Evaluations completed after 03/30/2020 will not result in a certificate of attendance as open enrollment is closed 3/31/2020.
Resources
89
Reference Materials
90
Department of Behavioral Health and Developmental Disabilities, Policy 02-701: Recruitment and Application to Become a Provider of Developmental Disabilities Services https://gadbhdd.policystat.com/policy/1198761/latest/
Department of Behavioral Health and Developmental Disabilities – Provider Information – Provider Toolkit www.dbhdd.georgia.gov
http://gadbhdd.policystat.com
Georgia Department of Community Health/Georgia Health Partnership – Georgia Web Portal www.mmis.georgia.gov
Healthcare Facility Regulation – Licensing Body http://dch.georgia.gov/healthcare-facility-regulation-0
Questions and Feedback
91
92
Thank youFor Georgia Collaborative ASO general inquiry or questions please email: