OLTL Participant Directed Models of Service

1 Public Partnerships4/15 of PennsylvaniaVendor Fiscal/Employer Agent Financial Management ServicesOLTL Participant Directed Models of ServicePPL/ Service Coordinator Roles and Responsibilities Authorizations Pay Rate Program Policies Partnerships4/15 AND RESPONSIBILITIES3 Common Law Employer Roles and Responsibilities Recruit, hire, manage and dismiss DCWsRecruit, hire, manage and dismiss DCWs Verify DCW and vendor qualifications Ensure that DCWs complete the enrollment requirements Train DCWs in providing services described in the ISP Decide how much to pay DCW Develop and implement a backup plan Approve and submit all timesheets and invoices to PPL Report suspicions of Medicaid fraud or financial abuse related to the delivery of Participant - Directed services4 Public Partnerships4/15 Law Employer Roles and ResponsibilitiesEmployer ResponsibilitiesSupporting RolepypppgRecruit, hire, manage and dismiss DCWsPPL/ Service CoordinatorVerify DCW and vendor qualificationsPPL/ Service CoordinatorEnsure that DCWs complete the enrollment requirementsPPL/ Service CoordinatorTrain DCWs in providing services described in the ISPS ervice CoordinatorDecide how much to pay DCWPPL5 Develop and implement a backup planService CoordinatorApprove and submit all timesheets and invoices to PPLPPLR eport suspicions of Medicaid fraud or financial abusePPL (who reports suspicions to the SC)PPL Roles and ResponsibilitiesGeneral responsibilities.

2 P Provide pre-populated Common Law Employer tax forms and DCW enrollment packets Provide assistance in completing CLE and DCW paperwork Process and review completed CLE and DCW paperwork including perform all necessary record checks on prospective DCW s Issue payments to DCW s bi-weekly with the receipt of properly submitted timesheetssubmitted timesheets Provide payments to vendors through Services May Way program6 Public Partnerships4/15 Roles and ResponsibilitiesGeneral responsibilities cont.:p Withhold appropriate taxes at the local, state and federal level File monthly, quarterly, and annual forms and tax deposits with state and federal agencies Issue W-2 statements to each DCW in JanuaryJanuary Provide 24/7 on-line access to information via PPL Web Portal Provide training and user guides on how to use PPL Web Portal7 PPL Roles and ResponsibilitiesCustomer Service Responsibilities:p Provide toll -free customer Service via phone, fax and email Provide translation and interpreter Service Provide assistance in completing CLE and DCW paperwork Notify participants of missing or incorrect paperworkpaperwork Notify participants of issues that may be pending payroll to DCWs8 Public Partnerships4/15 Roles and ResponsibilitiesEnrollment Manager Responsibilities.

3 Gp Serve as main point of contact for Service coordinators and Service coordination organizations Respond to day to day Participant direction issues identified by SCs Support the training and education need of the SC s and SCO s The primary support system available to participants and DCWs is PPL customer Coordinator Roles and Responsibilities Facilitates transition into Participant Directed servicespp Helps the Participant determine who will serve as the CLE Makes referrals to PPL using web portal Handout provided giving instructions for online referral Develops and updates the ISP with the Participant Initiates informal supports or agency services until the Participant is ready to receive services and DCW is approved May assist Participant in completing enrollment forms May assist Participant in completing enrollment forms Supports the consumer in: Training DCWs in providing services described in the ISP Developing and implementing a backup plan10 Public Partnerships4/15 Coordinator Roles and Responsibilities Monitors the delivery of services and supportsypp Oversees any transition to and from Participant direction Reports temporary stops in services Keeps Participant s demographicsup to date in HCSIS/SAMS11 AUTHORIZATIONS12 Public Partnerships4/15 PPL routinely receives timesheets for participants without authorizations.

4 The authorizations are missing because: They were incorrectly entered They were not entered in a timely manner SCs can help by: Asking for training if they are uncertain about the requirements for adding Service plans to HCSIS/SAMS Adding authorizations, particularly monthly authorizations, in a timely manner13 Authorizations Process for adding Service plan information into SAMS/HCSIS is unchanged. The begin dates of Service for FMS should be:ServiceBegin Date of ServiceFMS Start-Up Fee (W7341 U4)Date the SC made the referralFMS Admin Fee (W7341/W7341 U2)First day of the month after the FMS Start Up-FeePAS(W179214 PAS(W179230 days from the date the plan was submitted to OLTL and referral was made to PPLR espite (S5150)Part. Directed Community Supports (W1900)Part. Directed Goods and Services (W1901)Public Partnerships4/15 RATE15 Pay Rates PPL did not receive wage rates for all DCWs when the data was transferred fiFEAfrom prior FEAs PPL temporarily defaulted those missing wage rates to the regional maximum wage rate We contacted all CLEs with missing rates asking them to submit wage rates SCs can help by: Educating CLEs about their ability to set wage rates Encouraging CLEs to send in wage rate information 16 Public Partnerships4/15 Rate Rules For transitioning participants, the pay rate is not just the hourly amount paid to the worker!))

5 It is The pay rate must be lower than or equal to the regional maximum wage rateHourly DCW RateState Unemploy-mentInsurance experience ratingEmployer Ta x e sPay Ratewage rate A CLE who wants to increase or decrease a DCW s rate of pay should submit a change on the Qualified DCW Rate Sheet Approval of the change will depend upon it being no greater than the regional maximum wage rate17 Qualified Direct Care Worker Rate Sheet18 Public Partnerships4/15 POLICIES19 Enrollment Transitioning Participants and DCWs PPL provided all transitioning participants and DCWs with the necessary paperwork to transfer services The paperwork requirements were limited because we got much of the paperwork from prior FEAs. Existing DCW s have background check status grandfathered as PASSED. Some CLEs and DCWs did NOT submit this paperwork. PPL has been contacting them to obtain this paperwork20 Public Partnerships4/15 Transitioning Participants and DCWsRequired documents for transitioning participants:qgpp IRS Form 2678 Employer Payer Appointment of Agent IRS Form 8821 Tax Information Authorization IRS Form 8822-BChange of Address - Business21 Enrollment Transitioning Participants and DCWsRequired documents for transitioning DCWs:qg Direct Care Worker Agreement Application for Tax Exemptions (if applicable)22 Public Partnerships4/15 New Participants After receiving a referral, PPL will send the CLE an enrollment packet CLE must sign and date the forms and send them back to PPL Some CLEs have not submitted this paperwork.

6 PPL has been contacting them to obtain this paperwork23 Enrollment New ParticipantsRequired documents for new participants:qpp Authorized Representative Designation Form Common Law Employer Agreement CLE Information Form IRS Form SS-4 Application for Employer Identification Number IRS Form 2678 Employer Payer Appointment of Agent24of Agent IRS Form 8821 Tax Information Authorization IRS Form 8822-BChange of Address -BusinessPublic Partnerships4/15 New DCWsApplies both to transitioning CLEs with new DCWs and to ppgnew CLEs with new DCWs: DCW enrollment packets are available on PPL s website DCWs may NOT start to work until accurate enrollment paperwork has been received by PPL and all criminal background checks have been processed and we have notified the DCW to start in writing. ALL DCWs must have a state background check If someone lives in the home where services are provided is under the age of 18, 25pg,then the DCW must also have a child abuse history check DCWs living in the state of PA for less than 2 years are also required to have an FBI criminal history check.

7 DCWs may not work while their criminal background check is in an In Process status. Enrollment New DCWsApplies both to transitioning CLEs with new DCWs and to ppgnew CLEs with new DCWs: PPL will notify the DCW that they are good to start providing services by mailing them a letter. The mailing will also include: DCW ID number Paper timesheets Paper and e-timesheet instructions Instructions for accessing PPL s web portal26 The DCW is not qualified to work before receiving this and will not be paid for any work prior to the date they are approved. Approval is based on the singular DCW/ Participant relationship. Approval to provide services to one Participant is not approval to provide services to any other Partnerships4/15 New DCWsRequired documents for new DCWs:q USCIS Form I-9 IRS Form W-4 PA Residency Certification Form Application for Tax Exemption DCW Application DCW Agreement27 DCW Qualification Form Qualified DCW Rate SheetEnrollment New DCWsCommon errors: DCWs start working BEFORE their background checks are back and BEFORE we notify them in writing that they are approved to work.

8 DCWs complete paperwork for background checks that they do not need Participants schedule DCWs prior to the 1stauthorized start date DCWs do not complete the I-9 correctly Needs to be signed by both the DCW and the CLE28 Needs to be signed by both the DCW and the CLE Section 2, which lists documentation showing that the worker is legal to work in the US, needs to be completed accuratelyPublic Partnerships4/15 I-929 Enrollment Packet Training ResourcesThe following resources are available to help CLEs and DCWs lt thikcomplete their paperwork: Customer Service Video Recorded Trainings Call Q&A SessionsoInformational PacketsPPL Web site: PPL Web site: (PADPWOLTL) and Password (PPLDPW56) are required30 Public Partnerships4/15 Policies PPL cannot pay timesheets for services worked if we do not have an authorization for those services. Whether a Participant submits a paper or electronic timesheet, it must be approved by the CLE before PPL may process it.

9 The approval of a paper timesheet is the CLE s signature The approval of an electronic timesheet is an electronic CLE signature. If the CLE does not have internet access, the DCW can print out the e-timesheet for signature and then submit by mail or fax. Currently, participants are not consistently signing paper or electronic31 Currently, participants are not consistently signing paper or electronic timesheets PPL has been contacting them to have them sign those timesheetsHow to approve and submit e-timesheets Login to the PPL Web Portal. It defaults to the Timesheet List page. Partnerships4/15 to approve and submit e-timesheetsOn the Timesheet List page, participants can search for submitted tihttimesheets The submitted timesheets will come up and then you should select the 33 Approve/Reject to approve and submit e-timesheetsAfter selecting the Approve/Reject button, the screen below will appear.. 34To approve the timesheet select the Approve button.

10 Public Partnerships4/15 of changes PPL will no longer be permitted to pay for services that do not have authorizations. PPL will no longer be permitted to pay DCWs who do have not have a wage rate. PPL will no longer be permitted to pay DCWs who do not have complete paperwork or whose CLE does not have complete paperwork. PPL will no longer be permitted to pay DCWs whose timesheets are not / Comments36 Public Partnerships4/15