BLUE PLUS - CONSUMER DIRECTED COMMUNITY ......Consumer Directed Community Supports (CDCS): A service...

Confidential and proprietary. Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.Confidential and proprietary.

BLUE PLUS -CONSUMER DIRECTED COMMUNITY SUPPORTS (CDCS) 101 SecureBlue MSHO & BlueAdvantage MSC+BCBS of MN – Partner Relations TeamDate recorded: December 31st, 2019

Confidential and proprietary.

Participants will:• be knowledgeable of the CDCS program

• understand program requirements

• learn how to authorize/deny CDCS services for Blue Plus

• be able to access resources for CDCS

*Disclaimer: this training is not meant to replace DHS’ CDCS trainings, CDCS Lead Agency Operations Manual or the Community Based Service Manual. Some information is directed towards fee-for-service only.

LEARNING OBJECTIVES

2


CDCS OVERVIEW

3


Consumer Directed Community Supports (CDCS):

A service option under home and community-based services (HCBS) waivers. CDCS provides more flexibility in service planning and responsibility for self-directing services. The CDCS community support plan (CSP) may include traditional goods, services and self designed services that support the individual’s assessed needs.

CDCS

4

Source: CDCS Manual


CDCS is not an option for: • MN restricted recipients (MRRP)

• members receiving services through licensed or registered setting (i.e.

hospital, nursing home, intermediate care facility for people with

developmental disabilities, foster care, or other licensed settings)

• members currently participating in CDCS and exits the waiver more than once

during the service plan

LIMITATIONS

5

Source: DHS CDCS Manual Eligibility for CDCS overview


CDCS budget is set at 70 percent of the average cost of services. Members accessing CDCS service option under a waiver have a lower monthly amount (flexible use through waiver span) and cannot exceed the annual maximum CDCS service budget amount.

*Refer to DHS-3945 LTSS Rate Limits

CDCS BUDGET

6

Source: Consumer directed community supports budget


Enhanced rate or budget is available, but not limited to the following programs: CDCS and PCA (Traditional or Choice)*

Enhanced rate applies to work that is both: • Provided by a worker that completed qualifying trainings; and• Provided to a member that is eligible for 12 or more hours per day of state plan

PCA and/or has a home care rating of EN

*Note: If member meets eligibility criteria, member would qualify for enhanced CDCS budget. CC completes DHS 6633B- CDCS Enhanced Budget Request and Community Support Plan Addendum follow the process for Request to Exceed Case Mix Cap

CDCS AND ENHANCED RATE/BUDGET

7

Source: CDCS Enhanced Budget Process and DHS Enhanced budget eligibility review


BEFORE SELECTING CDCS

8

Source: CDCS Manual Process and Procedure and CDCS online learning module

Care Coordinator provides information to the member to make an informed choice about their services. Information should include:

• explanation of self-direction and its roles and responsibilities• services that could meet the member’s needs (including CDCS)• budget information for CDCS• services, supports and goods the member can purchase within a CDCS

budget• DHS 4124- CDCS Brochure - Consumer Directed Community Supports • CDCS online learning module


Resource for Care Coordinator:• DHS 4270- CDCS Lead Agency Operations Manual

Resource(s) for member:• DHS 4124- CDCS Brochure - Consumer Directed Community Supports • DHS 4317- CDCS Consumer Handbook• CDCS online learning module for individuals

DHS CDCS RESOURCES

9


CDCS SERVICE CATEGORIES

10


CDCS provides the member the flexibility to design an individualized set of supports to meet assessed needs:

• Environmental Modification and Provisions• Personal Assistance• Self-Direction Support Activities• Treatment and Training

CDCS- SERVICE CATEGORIES

11

Source: CBSM Manual Service Categories


Service category provides supports, services or goods that help the member live and participate in their community and is required to support the member’s health and safety (must fit within the assessed waiver span budget).

ENVIRONMENTAL MODIFICATION AND PROVISIONS

12

Examples include:

• Home modification • Vehicle modification

• Assistive technology • Monitoring technology

• Transportation • Environmental supports

• Supplies and equipment • Special diets*

• Adaptive clothing • Home-delivered meals

Source: CBSM Waiver Programs Environmental accessibility adaptations

* Note: Waiver funds do not pay for food items themselves, coverage is limited to the extra cost of additional or specialized foods


This service category includes:• ADLs• IADLs• Caregiver relief• Companionship• Mobility and transfer support• Skill building

*Note: To pay a spouse for personal assistance services, the member must be assessed as having a dependency in at least one ADL.

PERSONAL ASSISTANCE

13

Source: CDCS Manual: Service Categories personal assistance


A member may choose to have PCA services through a formal PCA provider. If this occurs a PCA assessment is required. CC would follow the process for requesting MA state plan services.

*Note: CC must include the cost of the service(s) for the waiver year in the MA State Plan field services in Bridgeview. This counts towards the waiver span and must be within the CDCS case mix budget/annual waiver span.

PERSONAL CARE ASSISTANCE- PCA

14


Service category that includes services and supports and expenses incurred for administering or helping the member administer CDCS. They must be chosen by the member, included in the CDCS CSP and purchased under agreements as negotiated.

SELF-DIRECTION SUPPORT ACTIVITIES

15

Examples include: FMS (required) Worker recruitment

Support planning services (optional)

Support planner (optional)

Source: CDCS Manual Service Categories Self-direction support activities

Note: annual fees or subscription costs for worker recruitment such as advertising or matching services is not covered. This must be per job posting/per ad or an expense on a monthly basis.


Service category that has a range of services that increases a member’s ability to live and take part in the community.

Source: CDCS Manual Service Categories

TREATMENT AND TRAINING

16

Examples include: • Day services and day programs • Extended therapy treatment• Family counseling • Habilitative services• Independent Living Services • Supported employment• Therapies, special diets and

behavioral supports not available through MA

• Training and education to increase a member’s ability to manage CDCS

• Training and education to paid or unpaid caregivers


CDCS EXPENDITURE LIMITS

17

Source: CDCS Manual Allowable/unallowable goods and services

Unallowable CDCS Expenditures

• Services and goods covered by MA, Medicare, or other liable third parties

• Travel, lodging, or meal expenses related to training for: MemberRepresentativepaid or unpaid caregivers

• Services and goods provided to or directly benefiting individuals other than the member using CDCS

• Services and goods that are diversionary or recreational• Services and goods for comfort or convenience• Items or support normally provided by the member/family or spouse without

a disability or condition


UNALLOWABLE EXPENSES

18

Included are examples of unallowable CDCS expenditures:

Source: CDCS online learning module

Note: this is not an all-inclusive list


BLUE PLUS REQUIREMENTS

19


• Health Risk Assessment; LTCC (or MnCHOICES and THRA if no significant changes)

• Collaborative Care Plan (or Coordinated Services and Support Plan-CSSP)

• Community Support Plan (DHS 6532 template or equivalent) review and determination

• OBRA Level I (must be completed)• Bridgeview: HRA/LTCC Case Mix span, MA state plan field and service

agreement(s) in Bridgeview*• SD in MMIS indicating “Y” CDCS and open to elderly waiver

*Note: Refer to Bridgeview requirements for additional documentation requirements

REQUIRED DOCUMENTATION

20


Additional forms

• DHS 6633A- CDCS Community Support Plan Addendum with 20YY Budget Increase (required)

• DHS 6633B- CDCS Enhanced Budget Request and Community Support Plan Addendum (if eligible)

• DHS 3956A- Elderly Waiver CDCS Conversion Rate Request (if eligible)

*Note: BluePlus members- DO NOT fax/mail DHS e-docs to DHS

DHS RELATED E-DOCUMENTS

21


AFTER SELECTING CDCS

22

Care Coordinator authorizes MA state plan home care services while member develops CDCS CSP.

Care Coordinator provides: • list of certified support planners (if applicable)• list of DHS-certified financial management services (FMS) providers• DHS 4317- CDCS Consumer Handbook• DHS 6532- CDCS Community Support Plan• options for person-centered planning • summary of assessment information to help guide their plan development

Source: CDCS Manual Process and Procedure


Note: FMS Provider cannot formally provide both Support Planner services and FMS services for an individual

FINANCIAL MANAGEMENT SERVICES (FMS) PROVIDER (REQUIRED)

23

Source: CDCS Manual Process and procedure

FMS provides one employment model: payroll model• Initiating background studies• submit claims to Blue Plus (Bridgeview)• receive and process invoices for approved expenditures• review and process support workers’ timesheets • help member hire and pay their worker(s)• file member employer taxes• pay workers compensation on the members behalf if necessary• provide monthly spending summaries to the member• provide quarterly spending summaries to the Care Coordinator• provide monthly reports to the Care Coordinator when over/under-spending

occurs


If a member would like more assistance. They have the option to use funds from their CDCS budget to hire a CDCS support planner assist with planning and implementing services:

SUPPORT PLANNER (OPTIONAL)

24

Support Planners can assist with: • Providing information on CDCS

and provider options• Developing CDCS CSP

• Monitoring support plan • Purchasing goods and receive services and supports

• Recruit, screen, hire, train, schedule and monitor support workers

• Problem solving



After the member develops a CDCS CSP (at least 30 days before the plan starts), the Care Coordinator must:

• Review CDCS plan (DHS 6532 CSP or equivalent)• Ensure services or items identified in CDCS CSP meet waiver criteria• Approve, recommend changes, approves part or denies the plan

ADDITIONAL RESPONSIBILITIES

25

Source: CBSM Waiver programs CDCS- Process and procedures and CDCS Manual Process and Procedure and CDCS online learning module


If members choose not to use the DHS 6632 CSP plan. At a minimum, the following elements must be included in their CSP:

REQUIRED CDCS CSP ELEMENTS

26



The CC can request a report from the FMS provider. At a minimum during the first year of members accessing CDCS, CC must review the member’s budget and spending before:

• Third month,• sixth month, and • twelfth month

Thereafter, the budget and spending should be reviewed semiannually and prior to adding new services.

MONITORING REQUIREMENTS

27

Source: CBSM Waiver programs CDCS Required case management


When there is a legislative rate increase, Care Coordinators must:

• notify member via DHS 6633A (mail DHS 6633A with rate increase) • upon receipt of the signed addendum, review and make determination within

60 days • notify FMS and member with approved CDCS CSP addendum, as applicable• end current service agreement in Bridgeview• add new service agreement in Bridgeview (must add an attestation in service

agreement description CSP was reviewed and addendum approved)• send email [email protected] to request combination of

service agreements into one service agreement

Note: since CDCS monthly budget may be used flexibly throughout the waiver span; Bridgeview must be notified to combine the service agreements

LEGISLATIVE RATE INCREASE REQUIREMENTS

28


If member is accessing CDCS through CADI waiver;

• do not enter any SA’s into Bridgeview, other waiver CM will complete this following their established process

• enter 3428H assessment into Bridgeview• document on 3428H in the Notes section of your assessment as applicable• for MSHO members open to CADI accessing MSHO supplemental benefits,

enter LTCC Case Mix span following instructions for U-supplemental benefits • for MA state plan services wavier CM will need to notify BP CC to authorize

services (complete CC Request for Service Auth form)• complete 6.17 Care Plan-ICFDD and HCBS Waivers

ACCESSING CDCS THROUGH OTHER WAIVER

29


When a member changes program service options or starts a program mid-month, for the Bridgeview LTCC Case Mix History entry:

• Care Coordinator may use the first day of that month that the member becomes eligible for services under the higher case mix budget as the LTCC start date instead of the actual assessment date, or

• Care Coordinator may start the higher LTCC and Case Mix entry effective the date of the assessment.

If the case mix decreases, keep the higher LTCC & Case Mix entry in effect for the rest of the month, then start the lower LTCC & Case Mix the first day of the following month.

MID-MONTH

30


Care Coordinator must use BluePlus form from the Care Coordination Website, anytime Care Coordinator/member/authorized representative/provider is denying, terminating or reducing services.

Care Coordinator must:• complete Care Coordinator Request for DTR within 24 hours of determination

and submit to AGP UM:notify member and provider (as applicable) within 24 hours of determinationlist out each service/item denied/terminated or reduced individually on one form (do

not use T2028 as you are not denying CDCS) include comments -no service agreements for service/items being denied/terminated

or reduced• provide alternative supports/services to meet assessed needs

DENIAL, TERMINATE OR REDUCTION (DTR)

31


Reasons AGP UM will reach out to Care Coordinator: • seek clarification • obtain additional information• notification of DTR effective date

DTR’S

32


Involuntary exits: there is a process in place that must be followed to discharge a member involuntarily from CDCS. Member may be exited from CDCS and offered waivered services or MA state plan home care services upon:

• Immediate health and safety concerns• Maltreatment of the member• Purchases or practices not allowed in CDCS• Suspected fraud or misuse of funds by the member/authorized representative

or service provider

INVOLUNTARY EXITS

33

Source: CBSM Waiver Program CDCS Involuntary exit


CDCS & BRIDGEVIEW REQUIREMENTS

34


CDCS- BRIDGEVIEW REQUIREMENTS

35

Document appropriate dates, case mix, diagnosis, “Y” to CDCS and select appropriate waiver type.

In the MA state plan services field do notinclude:• CC fees• CDCS CM fees (T2041)• CDCS service plan

(T2028)• Background checks

(T2040)

If no formal MA state plan services, enter .01. Field cannot be blank.


MA state plan home care services must be authorized separately using the CC Request for Service Authorization form. These services will be billed directly by the home care agency to Blue Plus.Services include:

• HCN (formerly known as PDN)• HHA• PCA• PCA supervision• SNV

*Note: CC must include the cost of these service(s) for the waiver year in the MA State Plan field services in Bridgeview. These count towards the annual CDCS case mix budget. .

MA STATE PLAN HOME CARE

36


The cost of these services do not count towards the member’s individual CDCS budget (T2028). Follow the process for authorizing these home care services:

• OT- Occupational therapy• PT- Physical therapy• RT- Respiratory therapy• SP- Speech therapy

OTHER MA STATE PLAN HOME CARE

37


CDCS- BRIDGEVIEW REQUIREMENTS

38

After successfully entering and saving the LTCC & Case Mix History; for members choosing CDCS, the CDCS monthly budget will be visible under the “CDCS Amt”.

Reminder: services cannot exceed the sum of the monthly CDCS budget multiplied by the months in the waiver span (also known as the annual CDCS waiver span). Funds can be used flexibly throughout the span.


CDCS- BRIDGEVIEW REQUIREMENTS: T2028

39

*Note: CDCS should only have one SA for service plan during waiver span so funds can be accessed flexibly


The T2028 service agreement should include the following:

• FMS Provider fees• support planner/support services fees (optional, as applicable)• allowable services and goods per the CDCS CSP• all extended home care services

BRIDGEVIEW REMINDERS

40


The following require separate service agreement(s) in Bridgeview and does not count towards the member’s CDCS budget or waiver obligation:

• Required CDCS Case Management (T2041)• Background Studies (T2040)

*Note: contact [email protected] if increasing services/budget due to a legislative increase and supporting CSP

BRIDGEVIEW REMINDERS

41


REQUIRED CDCS CASE MANAGEMENT: T2041

42

*Note: This is an up to amount that can be used for Care Coordination Delegate billing for required CDCS CM costs


CDCS BACKGROUND CHECK: T2040

43

* If CDCS CSP requires more than one background check; indicate that in the total units authorized


RESOURCES

44


CBSM CDCS Required case management Environmental accessibility adaptations Involuntary exit Manual Service Categories Process and procedures Technical assistance and supports

RESOURCES

45


CDCS ManualAllowable/unallowable goods and servicesCDCS Enhanced Budget Process DHS Enhanced budget eligibility reviewEligibility for CDCSPersonal assistanceProcess and ProcedureSelf-direction support activitiesService Categories

CDCS BudgetCDCS online learning moduleMHCP Provider ManualPersonal Care Assistance Program Manual

RESOURCES

46


Care Coordination WebsiteBridgeview Care Coordination User GuideT2029 Guide6.27 Request to Exceed Case Mix Cap-Conversion RequestCare Coordinator Request for Service Authorization

TrainLink DHSConsumer Directed Community Supports (CDCS)Environmental Accessibility Adaptation (EAA): Home Modification

RESOURCES

47


DHS 3945 LTSS Rate LimitsDHS 4124- CDCS Brochure - Consumer Directed Community Supports DHS 4270- CDCS Lead Agency Operations ManualDHS 4317- CDCS Consumer HandbookDHS 6532- CDCS Community Support PlanDHS 6633A- CDCS Community Support Plan Addendum with 20YY Budget Increase DHS 6633B- CDCS Enhanced Budget Request and Community Support Plan Addendum DHS 3956A- Elderly Waiver CDCS Conversion Rate Request

DHS E-DOCS

48


If you have questions regarding service agreements, contact [email protected]

If you have process questions, contact your Partner Relations Consultant or send a secure email to: [email protected]

49

Confidential and proprietary. Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.Confidential and proprietary.

THANK YOU! Government Market SolutionsPartner Relations [email protected]


APPENDIX

51


• CC- Care Coordinator• CCP- Collaborative Care Plan• CDCS- Consumer Directed Community Supports• CSP- Community Support Plan • CSSP- Community Support Service Plan• DHS- Department of Human Services• DTR- Deny, Terminate or Reduction• EW- Elderly Waiver• FFS- Fee for Service

ACRONYMS

52


• FMS- Financial Management Services• HCBS- Home Community Based Services• HCN- Home Care Nursing• HHA- Home Health Aide• LTCC- Long Term Care Consultation• MCO- Managed Care Organization• MMIS- Medicaid Management Information System• MRRP- Minnesota Restricted Recipients Program• MN- Minnesota

ACRONYMS

53


• OT- Occupational Therapy• PCA- Personal Care Assistance• PDN- Private Duty Nursing• PT-Physical Therapy• SA- Service Agreement• SD- Screening Document• SP-Speech Therapy• RT- Respiratory Therapy

ACRONYMS

54

BLUE PLUS - CONSUMER DIRECTED COMMUNITY ......Consumer Directed Community Supports (CDCS): A service...

Documents

Transcript of BLUE PLUS - CONSUMER DIRECTED COMMUNITY ......Consumer Directed Community Supports (CDCS): A service...