Intellectual & Developmental Disabilities Open Enrollment Forum · 2020-02-03 · • Byanka...

transcript

Intellectual & Developmental Disabilities

Open Enrollment Forum

February 3, 2020

Agenda

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

Certificates

Introductions

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

• 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

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

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

DBHDD Values

Collaboration and Teamwork

Person-Centeredness

Creative Problem-Solving

Integrity Mutual Respect

Customer Service

Continuous Improvement

Results-Driven Focus

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.

How do I apply for a license?

http://dch.georgia.gov/healthcare-facility-regulation

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 and training on household activities

Health-related activities

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 Socialization

Assistance and training on CommunicationSkills

Assistance with Mobility Skills

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

• 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 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

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

Intellectual and Developmental Disabilities Enrollment Steps

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

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

The Georgia Collaborative ASO

Policy 02-701

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

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)

LOI Process Review

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

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

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 GA_Enrollment@beaconhealthoptions.com

LOI will be closed if corrections are not received within the time frame allotted.

Applicants have one opportunity to submit corrections!

LOI Submission

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

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

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

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

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

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

www.georgiacollaborative.com

• Individual Provider Letter of Intent

• Agency Provider Letter of Intent

Completed applications can be sent via mail or email:

Georgia Collaborative Enrollment

PO Box 56324

Atlanta, Georgia 30343

GA_Enrollment@beaconhealthoptions.com

Application Process – Steps 3 and 4

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

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

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.

Application Process Flow – Steps 5 and 6

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

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

Providers can request additional services and sites after:

Agency has provided a minimum of twelve (12) months of services from the date of approval

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

DBHDD Regional Field Offices Map

• Regional Field Office 1

Field Offices

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

Budget

Identify Fixed Costs:

Rent / Mortgage

Insurance

Utilities

Licenses / Permits

Equipment / Furnishings

Supplies

Other ?

Budget

Identify Variable Costs

Across possible # of consumers served (Generally 1-4)

Staffing Expense – Detail:

Show wages and fringes

Training costs

Insurance / Bonding

Other ?

Budget

Across possible # of consumers served (Generally 1-4)

For-Profit:

Owner’s Draw

Not-For-Profit

Salaries / Taxes

Budget

Across possible # of consumers served

Other Expenses:

Food and supplies

Transportation

Consumer spending

Other ?

Budget

Across possible # of consumers served

Show ALL expected revenues

Social Security

Medicaid

Wages, pensions, family support

Other ?

Financial Considerations

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?

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

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 GACollaborativePR@BeaconHealthOptions.com

Evaluations completed after 03/30/2020 will not result in a certificate of attendance as open enrollment is closed 3/31/2020.

Resources

Reference Materials

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

Thank youFor Georgia Collaborative ASO general inquiry or questions please email:

GACollaborativePR@beaconhealthoptions.com