Q: Are the employers responsible to get the documentation to the case manager?
A: The team can decide how to accomplish this task, with the employer understanding that they have a role in getting it to the case manager if that is what is decided. Self-directed services and teams get some flexibility on how they want to set these processes up, based upon how it can work to be successful for the participant. Methods may include sending documentation electronically, receiving it during home visits, sending it in the mail, etc.
Q: What if they don’t (the employers)? Do we send them a non-compliance for not receiving the paperwork (and how does that work for a relationship with your participant?)
A: Yes, if they are not complying then you can send them a non-compliance form and communicate that non-compliance can impact their ability to continue self-directing services. If the self-directed services are not carried out in compliance with the waiver requirements, the Division can involuntarily terminate the participant from self-directing. But we want the team to regroup and try to overcome any issues in a few ways before we get to the step of not allowing a person to self-direct.
Q: If services provided are not meeting their needs, then shouldn’t they just tell the support broker? Then go through the process of letting the employee know what needs to change or fire them?
A: Yes, the support broker should coach the employer through this process of either retraining the employee or firing the employee. This is difficult for new employers to do sometimes, which is why the support broker role is crucial to self-directing that first year and assisting the participant/family through learning these processes.
Q: How does goods and services work?
A: In order for a good or service to be approved, the items must meet the criteria in the service definition for Goods and Services and be within $2000. When a participant wants to purchase an item under Goods and Services, they follow these simple steps:
1. Discuss the idea with their support broker and case manager.
2. The case manager works with the person to submit a “Goods and Service” form to the Division to prior authorize the purchase of the Good or Service.
3. If approved, the case manager allocates money for the item in the PPL Web Portal.
4. The employer submits the invoice to PPL.
5. PPL will make sure the item was approved by the Division and cut a check during the next pay cycle to the vendor for the good or service.
6. The check is sent to the employer of record, who will decide when to pay the vendor for the good or service.
It is fairly easy and if you have questions, the Division can help walk you or your team through the process. In order to take advantage of the opportunities under this service, the participant must be self-directing at least one other direct care service through PPL.
Q: Do the parents keep the receipts and are they responsible for the equipment ordered?
A: Yes, they should keep the receipt, but the case manager should either have a copy or know where it is filed in case of an audit. It would be best if the case manager always had a copy of the receipt in their file.
Q: Do they have to provide things to the case manager?
A: They need to work with the case manager on how to provide a copy. They may scan the receipt and email it to the case manager or make other arrangements.
Q: I thought self-direction was to make the employer responsible for their own business. They should keep the records and oversee payment. Medicaid should check with the Employer for proof of services not the employee. I am not required to keep documentation of my hours, my employer is.
A: In many ways, the participant/family are an employer like a traditional business. Employees shall have a system to log time in and out for services in some way and document what they did during the shift. (Similar to provider agencies and staff do now on schedules). The case manager role in reviewing documentation of services provided, satisfaction and verification of service delivery and monitoring the implementation of the plan is still similar to the Division’s expectation under traditional service delivery.
However, we also know that many of the employers through self-direction need extra support and coaching in order to do this successfully. That is the reason the Support Broker, Case manager, and the Circle of Support is critical to the participant who is self-directing. Some “employers” will need more support than others. The more upfront coaching and training that occurs usually results in less work and concerns down the road.
Q: What is the role of the support broker in developing the plan of care and identifying team members for the plan meeting? Is there a deadline in which the support broker should do their part by in order for the case manager to have the right people invited to the team meeting?
A: This is how it is stated in the Support Broker Handbook:
“To build Circles of Support, Support Brokers will first help the participant identify the people who are supportive and involved in the lives of their participants. The Support Broker should assure that communication among the Circle members is effective and includes everyone. It is the Support Broker’s ongoing role to find ways to provide support to the Circle so that they are an active decision-making unit, and in the event that conflicts arise, identify strategies that will keep the Circle focused on the dreams of the participant.”
The support broker should do these things before the IPC meeting and work with the case manager on the timeline for identifying the necessary people who should be invited to the meeting. The timeline for every team may be a little different, but a month’s notice has been the Division’s request in the past.
Q: Is it the employers responsibility to write the goals for appropriate services such as supported living? Does anyone need to approve these goals? Who is responsible to track progress on the goals and get the documentation to the case manager? Is it enough for me as the case manager to check the time sheets from PPL for self directed services or do I need other documentation?
A: The team, including the support broker, Case manager, Employer and Employees still should work together to identify goals. The Support Broker and the Employer should write them out, though. The team should agree to the goals being worked on through supports and services. The Employer, Support Broker, and Employee should collaborate on how the progress will be measured, tracked, and reported monthly to case managers. The “documentation” may be timesheets with summaries, a separate summary, paper schedules and task analysis sheets, electronic journaling or logging, etc. The team should be discussing how it will be given to the case manager or if the case manager will receive a copy during their monthly home visit. Checking timesheets through PPL may be enough if it is giving you the information you need to do the appropriate monitoring and tracking progress as required on a monthly and/quarterly basis.
Q: What if a case manager notices a family self-directing is hiring their own family to work for a person and now they probably won’t even be leaving their home now… What can the case manager do or say? A natural support turning into a paid support doesn’t seem to be the right answer.
A: A main part of self-directing in the beginning is role of the Support Broker to work with the participant/family to figure out what is important to and important for the person and identify the circle of supports, including both paid and non-paid supports. The circle is supposed to help the person meet their needs and goals and honor what’s important to them. If non-paid supports become paid supports because the participant prefers those people assisting him/her as opposed to outside staff, then hiring them may make the most sense. But if the people hired are not supporting the person according to the plan of care, where preferences and community integration activities are listed, then the case manager has to monitor and follow up on that situation as you would in traditional services.
Another control in place is that the IBA is not changing for the person, it still needs to be used to fill in the gaps for services not fulfilled by a person’s natural supports. If the support broker, case manager and team are meeting to discuss the support and services needed to meet the person’s needs and wants, before modifying the plan, then that process should provide some quality assurance that the waiver funds are being allocated and utilized appropriately.
If there are concerns with the person’s needs not being met with current services and supports, the case manager’s role would be to work with the support broker to address the issue with the participant & family. When the support broker is no longer involved, down the road, the case manager works directly with the family to ensure the plan of care and waiver funding is being utilized to meet the person’s assessed needs and preferences…or work with the Division so we can become involved in the situation to do some re-education as needed. If the support broker needs to have consultation on how to help in this situation, we can work with the support broker as well.
Q: Who determines what a need is? I would not go into a company and tell them how to run their business or employees.
A: It depends on if something has been determined a “need” or a “request” by the participant’s circle of support. The team should still listen to the participant and family and work collaboratively to identify needs and services desired through the waiver. If there is disagreement regarding a need or requested service, it should be evaluated by the team. If it remains unmet, it needs to be documented along with an action plan to work to address it.
Q: What is the case manager suppose to do about the situation if we are not in charge of the employees?
A: The case manager should discuss the concerns with the support broker, who should then discuss the matter with the participant/family. If the matter does not get resolved, then the case manager should address it directly with the family and explain the consequences of not self-directing in accordance with the waiver requirements, which may result in involuntary termination of self-directing some or all of their services. Many attempts to discuss the concern should be made with the support broker and participant and family before formal changes or actions are taken by the case manager.
Q: Can the Support Broker also be the Case Manager on the same plan of care?
A: No. The Support Broker can only provide Support Broker services and nothing else on an individual’s plan of care. If the provider or provider agency is currently providing case management services, or any services on the plan of care, they cannot be a Support Broker for that participant.
Q: Where can we find a Support Broker or will one be provided?
A: As individuals become certified to become Support Brokers, they will be included on the Division’s provider list. If you know of someone that is interested in becoming a Support Broker, information about this service is posted on the Division’s website at:http://www.health.wyo.gov/ddd/supportbroker.html. The interested person can complete a Support Broker “Notice of Intent” which is located at the bottom of the web page. The Division has also scheduled Support Broker Trainings throughout the state and the training locations and dates are posted on the Division’s website.
Q: If an individual is certified as a Case Manager can they become a Support Broker as well?
A: If they attend the training and pass the test, they can add it to their certification. As a Support Broker, the provider or provider agency cannot provide any other services on an individual’s plan of care.
Q: What are the criteria to become a Support Broker?
A: The criteria are the same as it is for becoming a case manager. If an individual has a Bachelor’s degree, then they are required to have at least one year of experience working in the Developmental Disabilities field. If they have 48 college credit hours, they need to have two years of experience working in the Developmental Disabilities field. In order to become certified as a Support Broker, an individual must complete the Support Broker training and pass the competency-based test.
Q: Is support broker required if they self-direct?
A: Yes, at least for the first year. After the first year the participant may chose to no longer use a support broker [opt out]. Specific criteria is addressed in the Self-direction Handbook and the form is available on the Case Manager Forms page.
Q: Do I have to have a Supports Broker and a Case Manager?
A: Based on research on other states, input from stakeholders and input from consultants with expertise in this area, the Division has decided that participants self-directing their services an any of the waivers will need to choose both a Supports Broker and Case Manager. The same person or agency cannot be providing both services to a participant. Support Brokers and Case Managers will not be permitted to provide any other services to participants self-directing their services to minimize the concerns with conflicts of interest.
Q: Who is going to assist a participant with the responsibilities of self-direction and assure the participant is healthy and safe?
A: The Division has a process in place to help a participant or their representative determine if the participant is willing and able to self-direct some or all of their services. There are also services and supports available, such as Support Broker, Case Manager and the Financial Management Service, who are responsible for being an on-going resources to help a participant succeed in self-directing. However, if there are health, safety or other significant concerns identified with a participant who is self-directing, the Division will work with the participant and their Circle of Support to address the concerns. The Division has the authority to discontinue a person from self-directing their services, but will only do so if all other approaches have been attempted and failed, or if there is fraudulent activity occurring, such as a participant or their representative authorizing payments for services that they know have not been provided.
Q: Where are we going to find the Support Brokers to fulfill this role?
A: The Support Broker Service is going to be considered a waiver service; therefore, any individual meeting the provider qualifications for a Support Broker can be certified to provide this service.
Q: What is the definition for a Support Broker, and are they assigned by the DD Division?
A: A Support Broker is the individual who assists a self-directing participant in many functions of their self-direction responsibilities. For example, hiring and firing staff, helping to ensure staff meet the qualifications for the support services they will be providing, ensuring that the self-directing participant and/or representative is following labor laws, etc. Support Brokers will not be assigned by the DD Division; instead, the participant and/or legal representative selects their Support Broker.
Q: What if there are no qualified Support Brokers available for me to utilize in the area where I live?
A: Ideally, support brokerage would be provided by a person or an agency that has direct contact and knowledge of the participant and his/her needs. If a provider cannot be found in the local area of the participant, then another option would be to seek brokerage from a nearby town or county that does have more resources available. The DD Division is proposing that participants and/or their legal representative can self-direct this service and choose someone they know well who may not meet the more stringent provider qualifications for Support Brokerage to provide this service. Draft DD Division rules state that the selected person is only able to provide Support Brokerage to one participant, but this would allow people to use neighbors, friends, or family members who live in closer proximity to them to provide the service, as long as it wasn’t the parent, stepparent, spouse or guardian of the participant.
Q: How do we chose or find Support Brokers?
A: Since Support Brokerage is considered a waiver service, all providers certified to provide this service will appear on the Division’s Searchable Provider list online. Once you find a Support Broker from the list, you can contact the Support Broker and begin the hiring process.
Q: How do we document for our Support Broker Services?
A: There is a Support Broker Monthly Documentation form you can use. It is located on the Support broker page of the Division’s website. You can also have one emailed to you by contacting your provider support specialist. This form may be modified to meet your business needs.
Q: My Case Manager is under a certain case manager organization. Can someone within the organization get certified individually as a Support Broker and provide these services to me without charge if they also provide another service on my plan and there is conflict of interest?
A: No, the Support broker must be free of conflict to the participant self-directing and therefore he/she nor their organization may provide any other service to a person on that plan of care.