Fee-For-Service Agreement for DHHS Networks

2009 Fee-For-Service Agreement

& More!Presented by:

Dennis Buesing – DHHS Contract Administrator

Pamela Erdman – Wraparound QA/QI Director

Diane Krager – DHHS QA Coordinator

Jeannine Maher – Wraparound Provider Network Coordinator

Rochelle Landingham – Contract Service Coordinator (BHD)

10/15/082

Overview 2009 Fee-for-Service

Agreement and Summary of Changes

10/15/083

Summary of ChangesPAGE 2 & 4

DEFINITION EXPANDED:“Covered Services” - services identified in this Agreement that are rendered by the Provider and are subject to the terms and conditions of this Agreement, for which the provider may request payment.

10/15/084

NEW DEFINITION:

“Site Review” – Visual inspection of Provider’s premise, employee records, service documentation, interview of appropriate persons or individuals including but not limited to: employees, participants, service recipients, parent/guardians, individuals with knowledge of the services recipient’s receipt of the Covered Service. The above may be conducted by Purchaser representatives, the Milwaukee County Department of Audit and representatives of appropriate federal, state or local agencies.

10/15/085

PAGES 4-6 SECTION TWOGENERAL OBLIGATIONS OF THE PROVIDER

Item E, H & I – New

E. Purchaser agrees not to use Direct Service Providers in the provision of Covered Services who are suspended, debarred, or under investigation by Purchaser or other Federal, State, or Local entities.

H. Provider agrees to provide Covered Services on a one on one, face-to-face basis unless otherwise specified by Purchaser Policy or Procedure

I. Provider agrees to maintain Service Documentation as required by this Agreement and Policies and Procedures including a consent for services signed and dated by the Service Recipient or parent/guardian.

10/15/086

PAGES 4-6 Continued SECTION TWO

(Section Thirteen of 2008 Combined with Section Two)

GENERAL OBLIGATIONS OF THE PROVIDER

Items J & K – Moved here from “Service Documentation” (Section Thirteen in 2008)

• Provider agrees to maintain and retain service documentation records as required by all applicable Policies and Procedures including the following minimum elements: the date, time, duration, location, intervention, summary of the activity engaged in, Participant’s response to the Covered Service, Direct Service Provider signature and signature date….

For Children’s Court Services Network and WIser Choice…

For Wraparound Milwaukee and SAIL…

K. In the case of an adult, records shall be retained for a minimum of seven (7) years after Covered Services have completed.

10/15/087

PAGES 4-6 ContinuedSECTION TWOGENERAL OBLIGATIONS OF THE PROVIDER

Item M – New

M. Provider agrees to notify purchaser in writing within 5 business days of any of the following changes or conditions:1. Agency name;2. Agency ownership; Agency director/CEO; 3. Agency business or billing address(es);4. Telephone or fax number; E-mail address; 5. Federal Employers Tax ID (FEIN) number; 6. Change of insurance carrier or insurance

coverage;7. Change in or restriction of license(s);8. Discontinuation of agreed upon service(s).

10/15/088

PAGES 4-6 ContinuedSECTION TWOGENERAL OBLIGATIONS OF THE PROVIDER

O. Emergency Preparedness:

“pandemic flu” added

to agency requirement for a written plan to address the identified emergencies

10/15/089

PAGES 9SECTION ELEVENCOMPENSATION

Item A – Sentence added in the “middle”.

Purchaser will only compensate Provider for pre-authorized Covered Services as defined in this agreement and Purchaser Policies and Procedures.

Item B – Sentences added at the “end”.

Provider may not bill Participants for Covered Services unless allowed as identified in a Purchaser Policy and Procedure or other addendum to this Agreement. This condition to remain in effect in the event the Purchaser is unable to provide compensation for Covered Service.

10/15/0810

PAGES 11-12SECTION TWELVEINDEMNITY AND INSURANCE

Item D – New

Provider hereby certifies that Provider's Direct Service Providers who use personal vehicles for any purpose related to the provision of Covered Services have in effect insurance policies in companies licensed to do business in the State of Wisconsin providing protection against all liability, including public liability and property damage, arising out of the use of their automobiles during the course of their employment. Provider further certifies that said Direct Service Providers have a Driver's License valid in the state of Wisconsin.

10/15/0811

PAGE 14SECTION FIFTEENSITE AND SERVICE DOCUMENTATION

REVIEW

Item B – Sentences added at the “end”.

Purchaser may require submission of requested documentation prior to payment for Covered Services.

10/15/0812

PAGE 21SECTION SEVENTEENCONDITIONAL STATUS AND SUSPENSION

Item C – Suspension

Sub-Item 1 - New

Failure to maintain in good standing required licenses, permits, certifications and/or insurance required by this Agreement.

Sub-Item 7 – Language Added

Findings resulting from a Site Review/audit by Purchaser representatives, the Milwaukee County Department of Audit and/or representatives of appropriate federal, state or local agencies that document quality concerns related to all applicable Policies and Procedures.

10/15/0813

PAGE 23SECTION TWENTYREVISION & TERMINIATION OF AGREEMENT

Item B – New Language Added

Failure to maintain in good standing required licenses, permits, certifications and/or insurance as required by this Agreement, may, at the option of Purchaser, result in immediate termination of this Agreement

10/15/0814

APPLIES TO WRAPAROUND ONLY(Not in Sample Agreement)

ATTACHMENT DWRAPAROUND SPECIFIC REQUIEMENTS

Payment For Day Treatment, Group Home And Residential Care – Requires Progress Entries in Synthesis

10/15/0815

Service Description Details

Agency administrative staff and direct service providers – familiar with current service description for service being provided

Agree to provide service per this description and all relevant policies and procedures

10/15/0816

2009 Fee for Service Agreements

Each Milwaukee County operated program will Each Milwaukee County operated program will send out their own copy of the agreement.send out their own copy of the agreement.

Individual Programs will: Identify any requirements that need to be met in order to

renew the agreement with that Program

Establish time frame for when the signed agreement must be returned

Work with Contract Administration regarding agencies that will be unable to renew their Agreement because of pending Audit issues

10/15/0817

DHHS Provider Networks/Contract Administration Interface

Engage in Centralized QA Committee

Discuss/approve audit/review indicators

Assist with site audits/reviews

Dialogue regarding audit/review agency reports

Collaborate regarding FFS Agreement yearly revisions

10/15/0818

Insurance Requirements

Audit and Accounting Requirements

Maintaining Financial Records

General Information on Allowable Costs

Audit Requirements and Waiver Procedures

10/15/0819

Insurance RequirementAuto Liability: required for all agency vehicles (owned, non-owned, and/or hired). Coverage: 1 million per accident Employees of Providers using personal vehicles to transport participants, or for any other reason related to the provision of Covered Services shall have Automobile Insurance providing the same liability limits as required of the Network ProviderCommercial General and/or Business Owner’s Liability: Required of ALL Providers and must include premises and off premises liability coverage (may include Umbrella policy)

10/15/0820

Insurance (Professional Liability)

Professional Liability: If the services provided constitute professional services, Provider shall maintain Professional Liability coverage (i.e. if a license or certification is required to perform the service). Includes Certified/Licensed Mental Health & AODA Clinics and Providers and

: 1MM/3MM

10/15/0821

Insurance (Professional Liability)

Hospital, Licensed Physician or any other qualified healthcare provider under Sect 655 : 1MM/3MM

Changed last year: Other Licensed Professionals, CPAs,

Engineers, Attorneys, etc., $1,000,000 per Occurrence

$2,000,000 Annual aggregate or

Statutory limits whichever is higher

10/15/0822

Insurance (cont’d)Additional Insured: Milwaukee County shall be named as, and receive copies of, an “additional insured” endorsement, for general liability, automobile insurance (except for hired or non-owned vehicles), and Umbrella/excess insurance Exceptions of compliance with “additional insured” endorsement are:

1. Transport companies insured through the State “Assigned Risk Business” (ARB).

2. Professional Liability where additional insured is not allowed.

10/15/0823

Insurance (cont’d)Upon Renewal, Provider shall furnish County annually on or before the date of renewal, evidence of a Certificate indicating the required coverage (with the Milwaukee County Department of Health and Human Services named as the “Certificate Holder ”)

CERTIFICATE HOLDER Milwaukee County Department of

Health and Human Services Contract Administrator

1220 W. Vliet Street, Suite 109 Milwaukee, WI 53205

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Insurance (cont’d)

Binders are not acceptable except during preliminary application period

Failure to comply with insurance requirements may result in suspension or non-renewal of contract

10/15/0825

Who Must Have an Audit?Audits are required by State Statute if the care & service

purchased with State funding exceeds $25,000 per year

Statutes allow the Dept. to waive audits. Audits may not be waived if the audit is a condition of state licensure, or is needed to claim federal funding (e.g. Group Foster Care or CCIs)

Standards for audits are found in DHFS/DWD/DOC Provider Agency Audit Guide, 1999 Revision (on line at www.dhfs.state.wi.us/grants)

Non-profit providers that receive $500,000 or more in federal awards must also have audit performed in accordance with OMB Circular A-133 Audit of State, Local Governments, and Non-Profit Organizations.

10/15/0826

What Must the Audit Contain?

Items Frequently OmittedSummary of Auditor’s Results and Schedule of Findings and Questioned CostsCopy of Management Letter, if anyCorrective action plan for all current-year audit findings related to County funded programs & Management’s response to each audit comment and item identified in the Management Letter.Schedule of Federal and State Awards

10/15/0827

What Other Schedules are Required?

Per contract, Schedule of Program Revenue & Allowable Cost by Contract (program), or program/facility within a contract. If program receives revenue from more than 1 funding source, all funding sources must be listed separately.If applicable, Incorporated Group Home/Child Caring Institution Supplemental ScheduleNonprofit providers paid on a unit-times-unit-price contract, Reserve Supplemental ScheduleFor-profit providers, Schedule of Allowable Profits

10/15/0828

Allowable Costs & Allowable Profits or Reserves

Per State Statute, ultimately, all agreements with Milwaukee County DHHS for care & services paid with dept. funding are cost reimbursement contractsFor-profit providers may retain up to 10% in profit per contract; 7½% of allowable costs, plus 15% of net equity (Allowable Cost Policy Manual, Section III.16) Nonprofit providers paid on a unit-times-unit-price contract may add up to 5% of contract amount in excess revenues to reserves each yr., up to a cumulative maximum of 10%.

10/15/0829

Allowable Costs & Allowable Profits or Reserves

The County does not have to allow either a profit or reserves to providers who do not include a Schedule of Allowable Profits, or Reserve Supplemental Schedule with their audit

10/15/0830

Other Allowable Cost Issues

Generally interest expense, except for purchase-money mortgages to purchase real estate, or equipment is not an allowable cost. Interest paid under Working Capital Loans, a line of credit or refinancing to pull money out of a property is not an allowable cost.Generally, advertising expense, except for costs associated with hiring and recruiting, is not an allowable costAlcohol, Entertainment, Contributions & Donations and repayment of audit recoveries and other debt, are never an allowable cost

10/15/0831

Special Allowable Cost Rules for S Corporations

Distributions to Shareholders are not an allowable cost, and will be treated as a distribution of profits or dividends, not as wages.Per 48 CFR part 31, for costs to be allowable, the cost must be deductible on the entity's federal income tax return per IRS regs.To be allowable, salaries accrued for 2% or more shareholders must be paid in the current contract year

10/15/0832

Allowable Cost & Related Party Issues

Allowable Cost Rules under rental agreements with Related Parties contain additional restrictionsAllowable rent expense under related party leases may not exceed the actual costs to the related party that owns the property. (Generally, mortgage interest, RE taxes, insurance, maint./utilities & depreciation)Per contract, the auditor must disclose related party rental arrangements, rent paid to the related party, the related party’s actual expenses on the property, & the amount of unallowable rent on each property charged to any contract with Milwaukee County

10/15/0833

Maintaining Financial RecordsBoth Federal and State contracting guidelines require provider agencies to maintain proper books and adequate financial recordsProviders should maintain an accurate and up-to-date general ledger and timely financial statements for management & board membersFinancial Statements must be prepared in conformity with generally accepted accounting principles (GAAP) and on the accrual basis of accounting. Contractor must request, and receive written consent of County to use other basis of accounting in lieu of accrual basis of accounting.

10/15/0834

Maintaining Financial RecordsAmounts recorded in the books should be supported by invoices, receipts or other documentationProviders should maintain a separate cost center for each contract, or program/facility within a contractWhenever possible, costs should be charged directly to a contract, all other costs should be allocated using a reasonable and consistent allocation method and supported by an Indirect Cost Allocation PlanProviders must not commingle personal and business funds. A separate checking account should be established & providers should not use personal credit cards for agency businessAll Provider agencies should maintain and adhere to a board approved, up-to-date Accounting Policy & Procedures Manual and bonus policy

10/15/0835

Audit WaiverStatutes allow the Dept. to waive audits. Audits may not be waived if the audit is a condition of state licensure, or is needed to claim federal funding (e.g. Group Foster Care or CCI).

Waiver request can only be entertained if agency does not need to have an audit according to Federal Audit requirement.

Waivers need to be approved on case by case basis by regional office based on a risk assessment ( Funding <$75,000 is considered low risk)

Waiver Request S/B submitted DHHS Contract Administration prior to audit due date

10/15/0836

Audit Waivers

DHHS has been approving Audit Waivers for Fee for Service contracts mainly on basis of economic hardship

In case of small residential care providers ( Family group home and AFH) county has the authority to grant a waiver.

Waiver Form is available at: http://www.milwaukeecounty.org/contractmgt15483.htm

2007 Audit Waiver Form

10/15/0837

Common Errors or Omissions

Nonprofits - Failure to provide Supplemental Reserve Schedule for all programs or contractsFailure to submit audit in a timely manner (results in Admin. Probation & inability to renew contract)Failure to submit written Extension requestsFailure to submit written Waiver requestsFailure to submit evidence of Insurance renewal in a timely mannerAudits are sent to wrong addressAudit confirmation are sent to wrong address

10/15/0838

Names & Address for Submissions

Submit Audits to:Dennis BuesingDHHS Contract Administration1220 W. Vliet St., Suite 109Milwaukee, WI 53205 Ph:414-289-5853

Wraparound Confirmation Requests to:Janet FriedmanWraparound Milwaukee Finance9201 W. Watertown Plank Rd., Room 255Milwaukee, WI 53226 Ph:414-257-7597

10/15/0839

Submissions (cont’d)

Wiser Choice Confirmation Requests to:Paul NeymeyrBehavioral Health Division9201 W. Watertown Plank Rd., Room 607Milwaukee, WI 53226 Ph:414-257-7912

All Other Confirms (Purchase of Service, Children’s Court Services Network & DSD)

Stanley DyettDHHS Accounting1220 W. Vliet St., Suite 109Milwaukee, WI 53205 Ph:414-289-6866

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BREAK

10/15/0841

Quality Assurance Policies and Procedures

Client Chart Maintenance

Audit/Review Indicators

10/15/0842

Quality Assurance – Policies and Procedures

Refer to the applicable Division’s policies and procedures as they may differ.

Agency is responsible for inservicing all Direct Service Providers on all relevant policies and procedures, i.e. – Mentors should be inserviced on the Mentor Policy and Procedure.

10/15/0843

Noncompliance with Policies and Procedures

Will be reflected in agency review report

Can result in:Fiscal recoupmentsSuspensionTermination from NetworkRestriction of future contracts with

Milwaukee County

Corrective Plan of Action required

10/15/0844

Client Chart Maintenance

1 chart per client/familyIf sibling or caregiver of identified enrollee, must be clearly indicatedSeparate file into sections, i.e. Referral, Consents, Plans of Care/Service Plans/Treatment Plans, Notes, Correspondence, etc.Most recent correspondence and notes on top in each sectionSee Provider Bulletin #1-09 (Wraparound only)

10/15/0845

Client Chart Maintenance (cont.)

Chart should be orderly, neat, accessible

Keep files in alphabetical order

Separate current files from disenrolled files.

Maintain file until youth turns age 19 or until 7 years after service is completed, whichever is longer

10/15/0846

QUALITY ASSURANCEWhat we look for during a Site

Review

1. Network Provider cooperation.

2. Compliance with Requirements: Fee-For-Service Agreement Policies and Procedures Provider Bulletins (Wraparound only) HFS 12: Wis. Adm. Code State of Wis. Caregiver

Program Other applicable Federal, State, and County

regulations

10/15/0847

Basic Review Indicators

Agency Indicators Required Licenses: i.e. Current Outpatient Clinic

Mental Health State Certification, AODA Clinic License, etc.

Required Insurance Coverage's: i.e. Gen. Commercial Liability ($1MM min. w/ MC named as addit. insured), Professional Liability, Wisc. Workers’ Compensation, etc.

Required Training Manuals (service specific-Wraparound only)

10/15/0848

Basic Review Indicators(cont’d)

Provider Indicators Current Professional Licenses or Certifications Evidence that Counselors meet Minimum

Credential Requirements Evidence of Minimum Training Prior to Provision

of Service (service specific) Compliance with 3 components of Background

Check and Wisc. Caregiver Law and Milwaukee County Resolution

Valid Driver’s Licenses, Auto Insurance, Driving Abstracts on File

10/15/0849

Criminal Background Checks

Your agency is required to complete a State-wide criminal background check through the Department of Justice Crime Information Bureau (CIB) on all prospective direct service providers

When hiring direct service providers/employees that lived outside the state of WI within the prior 3 years: Obtain out of state background check within state employee resided and a Federal criminal background check

Three parts to Caregiver Background Checks: 1. Background Information Disclosure (BID) Form2. Response from Dept of Justice3. Letter from Dept of Health and Family Services (DHFS)

10/15/0850

Criminal Background Checks (continued)

Repeat every 4 years for ongoing Providers (or at any time within that period when an agency has reason to believe a new background check should be obtained).

10/15/0851

Reporting of Criminal Background Checks

Before requesting to add a new Provider to the Network, agency must follow-up on any charges without dispositions

Contact:

Milwaukee County Clerk of Courts

Milwaukee County Courthouse

901 North Ninth StreetReport convictions to Network (submit criminal

background check with Add Sheet for new providers – Wraparound only)

Must be completed before service provider is authorized to provide services.

If a current/authorized Provider is arrested and/or has been charged with or convicted of any crime specified in the Caregiver Law/ County Resolution, the Provider must notify the Network within two (2) business days.

10/15/0852

Basic Audit/Review Indicators(cont’d)

Client Indicators Provider Referral Form/Service Plan on File

Prior to Provision of Services, clearly identifying each Service being requested.

Consents (Consent for Service/Treatment &/or Transportation Consent) Signed/Dated by Legal Guardian/Client Prior to Provision of Services.

10/15/0853

Basic Review Indicators(cont’d)

Client Indicators Plan(s) of Care (POC) &/or Treatment Plan(s) in

File for Duration of Service. Monthly Logs/Reports/Sign-In Logs and/or

Progress Notes in File for each month billed. Logs and/or Progress Notes Contain all Required

Elements.

Discharge Summary in File, if applicable.

10/15/0854

Documentation

Agency is responsible to ensure adequate and accurate documentation is maintained in the client file.

Client files/records must be kept in secure, fireproof cabinet or room.

Documentation reflective of service provision must be in file before a service is billed.

10/15/0855

Documentation (cont’d)

Unless indicated by specific policy, Bulletin, statute, etc., documentation must include minimum elements: Client/Recipient Name Date of Service: i.e. 6/11/06 Times and Duration: i.e. 2:00-4:00 p.m., 2 Hrs. Location of Service: i.e. Office Summary of activity/interaction/intervention,

including client’s response to activity. Signature of provider.

10/15/0856

Basic Review Indicators(cont’d)

Fiscal Indicators Documentation must be reflective of the service

provided and billed.

Documentation must include all Required Elements.

Hours (units) billed must match hours (units) documented.

10/15/0857

PLEASE NOTE: Progress Notes must be specific to client served and descriptive

of the session provided; including the client’s response to the treatment. PNs can not be simply copied and pasted from session to session.

Service Logs or Sign-In Logs (if applicable); signatures must be obtained at the time the client receives the service and match the corresponding PN (date, time/duration). Any pre-signing of Logs by provider or client is considered fraudulent and grounds for termination from Network and future contracting with DHHS.

PNs and Logs must be fully completed.

Referral Forms must clearly identify service being referred (i.e. should read “In-Home Therapy (5160)”; not “Family Therapy,” unless if Individual/Family Therapy (5100)

REVIEW FILES/RECORDS ON REGULAR BASIS FOR ACCURACY & COMPLETENESS

10/15/0858

Risk Assessment CriteriaFactors to determine which agencies are audited/reviewed:

Prior Audits identifying problems; Agencies receiving combined billings in auditable

services equal to or > $100,000 in prior 12 month period within 3 DHHS FFS Provider Networks;

Agencies with billing patterns above the average utilization for each respective service within a program will be reviewed for that program;

Agencies for which DHHS or program staff have received recent grievances, complaints, or evidence of health & safety concerns or client reports non-delivery of service;

Agencies in the network less than 2 years, with billings equal to or > $50,000.

10/15/0859

Civil Rights Compliance PlanRequirements

Presented by:

Dennis Buesing, DHHS Contract Administrator

10/15/0860

Civil Rights Compliance (CRC)

All recipients of Federal and/or State funds are required to submit either a Civil Rights Letter Of Assurance (LOA) or a Civil Rights Plan for their agency

The Equal Employment Opportunity certificate is a separate requirement and does not qualify as a CRC document.

10/15/0861

CRC (Cont’d)……..

Agencies with 25 or more employees AND awarded at least $25,000 in federal, state & county funds are required to submit a full CRC plan

Agencies with fewer than 25 employees AND/OR receive less than $25,000 in funding may opt to submit a Letter of Assurance instead, which includes AA, EO and LEP policies

Agencies who subcontract are also required to ensure the subcontractor maintains CRC requirements

10/15/0862

OTHER REQUIRED ITEMS (ATTACHMENTS) FOR SUBMITTING WITH THE CRC LOA

Required Items Attachment 1:AA EO in Employment Policy

Attachment 2:Form DOA-3607

Approval to be in Vendor Directory Form DOA-3024

Request for Exemption for Submitting AA Strategies for achieving a balanced workforce Form DOA-3023

Vendor Subcontractor List

Profit & Nonprofit Entities

Required

Not Required

Not Required

Not Required

10/15/0863

CRC (Cont’d)……..

New CRC plan requirements for years 2007-2009

have been posted at DWD and DHFS web sites.

LOA Instructions & Templates are available at: http://dwd.wisconsin.gov/dws/civil%5Frights/plans0708/loa_contents_page.htm

CRC Plan Requirements & Templates are available at: http://dwd.wisconsin.gov/dws/civil_rights/plans0708/doc/plan_07_09.doc

Plan instruction and resources are available at http://dwd.wisconsin.gov/dws/civil_rights/plans_instructions.htm

Training webcasts are available at: http://dhfs.wisconsin.gov/civilrights/Index.HTM

10/15/0864

Wisconsin Civil Rights Compliance Officer

Questions may also be directed to:

David Duran, CRC OfficerPO Box 7850One West Wilson Street, Room 561Madison, WI 53707-7850durand@dhfs.state.wi.usPhone: (608) 266-9372Fax: (608) 267-2147

10/15/0865

Thank you for your participation!

Have a Great Day!