Financial Management Services (FMS)
All Plan of Care (POC) Financial Management Services (FMS) provided for individuals who are aging or disabled will be provided within the scope of the Agency With Choice (AWC) model. Within the Self-Directed model, and Kansas state law (K.S.A. 39-7,100) consumers have the right to “make decisions about, direct the provisions of and control the attendant care services received by such individuals including, but not limited to selecting, training, managing, paying and dismissing of an attendant.” The individual or individual’s representative has decision making authority over certain services and takes direct responsibility to manage their services with the assistance of a system of available supports. Included in these supports is Financial Management Services. Payment to FMS for Administrative Services Rendered
The State of Kansas has established a “Per Member Per Month (PMPM)” payment methodology with a set rate to be paid for the administrative services provided. The administrative fee cannot reduce or cause any loss of authorized waiver services to self-directing individuals. The AWC FMS provider is required to bill for all provided self-direct services that are on an individual’s plan of care.
Information and Assistance (I&A)
This is a service that is incorporated into the definition and requirements of the AWC FMS provider.
I&A is a service that is available to provide information, including independent resources, and assist in the development of options to ensure that individuals understand the responsibilities involved with directing their services. Practical skills training is offered to enable self-directing individuals, their families and/or representative to independently direct and manage waiver services. Examples of skills training include providing information on recruiting and hiring personal care workers, managing workers and providing information on effective communication and problem-solving. The extent of the assistance furnished to the self-directing individual will be determined by the self-directing individual or individual’s representative.
I & A services may provide assistance to the self-directed individual or individual’s representative with:
Defining goals, needs and resources, identifying and accessing services, supports and resources as they pertain to self-directed activities;
Practical self-direction management skills training (e.g., hiring, managing and terminating workers, problem solving, conflict resolution);
Recognizing and reporting critical events (e.g. fraudulent activities; abuse and etc.); and
Other areas related to managing services and supports.
I&A services may provide information to the self-directing individual or individual’s representative about:
Individual centered planning;
The range and scope of individual choices and options;
Grievance and appeals processes;
Risks and responsibilities of self-direction;
Individual rights;
Importance of ensuring Direct Support Worker’s health and safety during the course of their duties to reduce potential injuries and worker’s compensation insurance claims. This may include participation in training as directed by the self-directing individual.
Reassessment and review schedules;
The importance of keeping the FMS provider and TCM informed as to current contact information and planned absences, and,
Such other subjects pertinent to the participant and/or family in managing and directing services and living independently and safely in the community in the most integrated setting.
Availability and Knowledge
The AWC FMS is the employer option model Kansas is making available to individuals who reside in their own private residences or the private home of a family member and have chosen to self-direct their services. The individual or their representative have the right to choose this employer option model and have the right to choose from qualified available AWC FMS providers. This information must be made available at the time of making the choice to self-direct services, and annually thereafter. The individual or their representative or Targeted Case Manager shall notify the AWC FMS provider of their desire to enroll in services and shall provide a signed and dated copy of the choice form to initiate FMS services. The AWC FMS provider shall be listed on the Plan of Care and the administrative functions of the AWC FMS provider are reimbursed as a waiver service.
Responsibilities:
Individual or Individual’s Representative Responsibilities Related to the AWC FMS:
When using AWC FMS services, an individual or individual’s representative has the right/responsibility to choose and direct the services in the individual’s approved Plan of Care (POC)/Person Centered Support Plan (PCSP)/Customer Service Worksheet (CSW)/Attendant Care Worksheet (ACW) and the Direct Support Workers who provide the services, in accordance with Kansas state law at K.S.A. 39-7,100, without excessive restrictions or barriers. Individuals or the individual’s representatives also have the right/responsibility to access and participate in the development of all plans that identify needed individual services and supports. Individuals or the individual’s representative have the right to participate in the planning, startup, delivery and administration of providers’ services.
A self-directing individual or individual’s representative must be fully informed of his or her roles and responsibilities related to the AWC FMS provider.
The Self-Directing Individual and individual’s representative are responsible for working collaboratively with their AWC FMS provider to meet shared objectives.
These objectives include:
Self-Directing Individuals receive high quality services.
Self-Directing Individuals receive needed services from qualified workers.
Tasks are provided in accordance with state law governing self-direction, Medicaid and the State of Kansas requirements, and are approved and authorized in the POC.
The Self-Directing Individual or individual’s representative has the responsibility to:
Act as the employer for Direct Support Workers, or designate a representative to manage or help manage Direct Support Workers.
Negotiate a FMS Service Agreement with the chosen AWC FMS provider that clearly identifies the roles and responsibilities of the individual and the AWC FMS provider.
Select Direct Support Worker(s).
Refer Direct Support Workers to the AWC FMS provider for completion of required human resources and payroll documentation. In cooperation with the AWC FMS provider, all employment verification and payroll forms must be completed.
Negotiate an Employment Service Agreement with the Direct Support Worker that clearly identifies the responsibilities of all parties.
Provide or arrange for appropriate orientation and training of Direct Support Worker(s).
Determine schedules of Direct Support Worker(s).
Determine tasks to be performed by Direct Support Worker(s) and where and when they are to be performed in accordance with the approved and authorized POC /PSCP/ ACW/CSW and/ or others as identified and/or are appropriate.
Manage and supervise the day-to-day HCBS activities of Direct Support Worker(s).
Verify time worked by Direct Support Worker(s) was delivered according to the POC; and approve and sign timesheets.
Assure submission of Direct Support Worker timesheets and all other required documents to the AWC FMS provider for processing and payment in accordance with established FMS, State, and Federal requirements. The timesheet will be reflective of actual hours worked in accordance with an approved POC.
Report work-related injuries incurred by Direct Support Worker(s) to the AWC FMS.
Develop an emergency worker back-up plan in case a substitute Direct Support Worker is ever needed on short notice or as a back-up (short-term replacement worker).
Assure all appropriate service documentation is recorded as required by the State of Kansas HCBS Waiver program policies, procedures, or by Medicaid Provider Agreement.
Inform the AWC FMS provider of any changes in the status of Direct Support Worker(s), such as changes of address or telephone number, in a timely fashion.
Inform the AWC FMS provider and Targeted Case Manager of the dismissal of a Direct Support Worker within 3 working days.
Inform the AWC FMS provider and Targeted Case Manager of any changes in the status of the individual or individual’s representative, such as the individual’s address, telephone number or hospitalizations within 3 working days.
Participate in required quality assurance visits with Targeted Case Managers, and State Quality Assurance Staff, State Quality Management Specialist (QMS), or other appropriate and authorized reviewers / auditors.
Financial Management Service Definitions
Administrative fees – cost associated with the provision of “administrative” payroll and Information & Assistance services.
Direct Support Worker – (DSW): The person that is hired to provide some type of direct care service paid through Medicaid or state funds or both; commonly known as Personal Care Attendant; Attendant Care Worker; In-Home Support Worker; Personal Service Attendant-Self Direct.
Financial Management Service -(FMS): An administrative service that is provided for individuals that have chosen to self-direct their direct care services.
Per Member Per Month-(PMPM): A methodology by which an AWC FMS provider is paid to perform administrative payroll/HR and Information & Assistance services for an individual self- directing their services during a specific identified period.
Targeted Case Management
Case management includes needs assessment, locating resources, making referrals and developing a plan of care to meet your unique needs.
Traumatic Brain Injury (TBI)
We at the Home Team of Kansas understand that having a TBI does not mean that an individual’s life cannot still be lived with fulfillment and enjoyment. Not all TBI patients need to be confined to a hospital or nursing facility. Many TBI patients can live comfortably in their own homes with the assistance of others. We provide a more affordable alternative to nursing facilities and rehab hospitals.
We at the Home Team of Kansas understand that having a TBI does not mean that an individual’s life cannot still be lived with fulfillment and enjoyment. Not all TBI patients need to be confined to a hospital or nursing facility. Many TBI patients can live comfortably in their own homes with the assistance of others. We provide a more affordable alternative to nursing facilities and rehab hospitals.
We provide services through the Medicate-State of Kansas TBI Waiver. The waiver entitles the consumer the same rehabilitation that they receive in a rehab hospital, but remain in their community if they choose to do so.
Traumatic brain injury, often referred to as TBI, is most often an acute event similar to other injuries, but results in a different result. These injuries have long term effects which can affect the physical, metal as well as emotional health of the person with the TBI. Brain injuries do not heal like other injuries. Recovery is a functional recovery, based on mechanisms that remain uncertain. No two brain injuries are alike and the consequence of two similar injuries may be very different. Symptoms may appear right away or may not be present for days or weeks after the injury.
One of the consequences of brain injury is that the person often does not realize that a brain injury has occurred.
According to the Center for Disease Control (CDC) there are approximately 1.5 million people in the U.S. who suffer from a traumatic brain injury each year. 50,000 people die from TBI each year and 85,000 people suffer long term disabilities. In the U.S., more than 5.3 million people live with disabilities caused by TBI. This number is much higher than many people would suspect.
The causes of TBI’s are as diverse as the person who has suffered the injury:
open and closed head trauma
deceleration injuries i.e. car accidents, sport related injuries, domestic violence, falls, etc.
chemical/toxic substance exposure or usage
lack of oxygen (hypoxia)
tumors
infection
stroke
The list of causes goes on, but no matter what the reason is for the injury or the severity of the injury there is a need for proper initial treatment, follow up, and long term care.
To be eligible for the waiver the consumer must meet the following criteria:
Between the age of 16-65 years old;
Have traumatic, non-degenerative brain injury resulting in residual deficits and disabilities (not caused from stroke or seizure);
Eligible for an in-patient care in a Head Injury Rehabilitation Hospital;
Medicaid financial eligibility requirements apply.
We provide and assist in the coordination of the following services for those with a TBI:
targeted case management
personal services
transitional living skills
sleep cycle support
personal emergency response units
rehabilitation therapies
Money Follows the Person (MFP)
(MFP) this service is designed to help a person transition from a nursing home setting back into the community. Case management services are provided to assist and coordinate all services required to return to the community. Assist can be provided with housing, home modifications, assistive service devices or equipment needed to help regain the individual’s independence.
Work Program/Working Healthy Program
These programs are designed to assist the individual with returning to the work force by seeking and obtaining gainful employment. This program can provide coordination of attendant care services and other resources as needed.
Wellness monitoring
Sleep Cycle Support
Personal Emergency Response Units (PERS)
Veteran Assistance
Senior Care Act
This program is administered by the local dept of aging. This service provides attendant care for those persons over 60 years living in the community. The Home Team of Kansas is a contracted provider for this service with the NEK dept of aging.
