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Case Management Refresher Training. January 31, 2012. Presented by: West Central Florida Area Agency on Aging (WCFAAA). Agenda. Introductions Program Updates Enrollment Management Medicaid Benefit Counselor Role in your community Adult Protective Service Referrals

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Case management refresher training

Case ManagementRefresher Training

January 31, 2012

Presented by:

West Central Florida Area Agency on Aging (WCFAAA)


  • Introductions

  • Program Updates

  • Enrollment Management

  • Medicaid Benefit Counselor Role in your community

  • Adult Protective Service Referrals

  • SGR Case Narratives

  • Medicaid Waiver Concerns and Great CM Documentation

  • Performance Outcome Measure Overview

  • Client Satisfaction

  • Q & A

  • Kudos

ARC Enrollment Management

  • Martha Caron is the ARC Enrollment Manager

This is her office -


Arc enrollment management
ARC Enrollment Management

  • Martha’s responsibilities :

    • Evaluates the availability of State funds

    • Determines how many clients to serve

    • Releases highest priority clients for service

    • Tracks start date of service delivery

    • Reviews Care Plans submitted for approval

Sgr care plan review procedures
SGR Care Plan Review Procedures

  • Case Managers can start services for released clients up to Risk Level/Cost Threshold.

  • Does NOT apply to MedWaiver clients; advance approval is still required.

Risk level cost thresholds
Risk Level / Cost Thresholds

Risk Score Range --- Annual Est. Care Plan Cost:

> 0 to 7 = Risk Level 1 --- $3,493.92

>8 to 15 = Risk Level 2 --- $5,646.30

>16 to 26 = Risk Level 3 --- $7,246.17

>27 to 52 = Risk Level 4 --- $9,673.18

>53 to 100 = Risk Level 5 --- $14,270.86

Sgr care plan review procedures1
SGR Care Plan Review Procedures

  • Services implemented must be offered in the program for which the client is released.


    1. Client is waitlisted for: CCE & HCE

    2. AAA releases client for CCE only

    3. CCE services can be started but not HCE subsidy

    4. HCE can only be started when released by AAA

Sgr care plan review procedures cont
SGR Care Plan Review Procedurescont …

  • Once a level of care planned services has been approved by WCFAAA, further approvals are not required unless the units of service are to be increased.

The case manager s role in the arc enrollment process
The Case Manager’s role in the ARC enrollment process

  • Complete the 701B Assessment

  • If the 701B Priority Score is 1 or 2:

    • return to ARC

    • terminate APPL line in CIRTS

    • restore APCL status

  • If the client is not to be served for any other reason, terminate APPL and notify ARC.

The case manager s role in the arc enrollment process cont
The Case Manager’s role in the ARC enrollment process – cont …

  • If priority score is 5, 4 or 3, submit Care Plan for services needed by the authorized program(s).

  • Make client ACTV in CIRTS upon approval of care plan services.

  • If client is on waiting list for multiple programs and their needs are already being met, close out the other program lines.

Common problems with care plan reviews
Common Problems with Care Plan Reviews

  • Risk and/or Priority Score not provided

  • Program that services are requested under not indicated

  • Services requested that are not available under the authorized program

  • Inadequate justification provided for services requested

  • Justification states declining condition but no indication of updated assessment

  • Incorrect/Illegible completion of form

Nursing home transition case management procedures cont
Nursing Home Transition Case Management Procedures cont …

  • Transition Case Manager will conduct face to face visit within 10 business days of receiving referral from the ARC

  • TCM will update CARES 701B and complete nursing home transition plan

  • TCM will notify CARES via the NHT plan of client’s estimated discharge date and submit updated 701B with request for LOC via the DOEA-CARES form 603

Nursing home transition case management procedures cont1
Nursing Home Transition Case Management Procedures cont …

  • NHT plan must be signed by TCM and client or designated representative when determination has been made that client is able to safely return to community

  • Once Notice of Case Action is obtained from DCF, TCM must submit NOA to the ARC

  • Upon receipt of the LOC, the TCM must submit Form 2515 to DCF and request ex parte

  • Within 14 days of the waiver start date, the TCM must follow up with face to face visit

Nursing home transition case management procedures cont2
Nursing Home Transition Case Management Procedures cont …

In order to bill, the following requirements must be met per the waiver handbooks:

  • Client resided in nursing home 60 consecutive days by the time they discharged

  • No more than 20 hrs of TCM can be billed within 6 months of waiver start date

  • Client has completed and signed NHT plan

  • Upon nursing home discharge, client is enrolled into ADA or ALW waiver

Nursing home transition case management procedures cont3
Nursing Home Transition Case Management Procedures cont …

  • If client is unable to transition after TCM services, the TCM will finalize the NHT plan and forward it to CARES for due process notification. Both the TCM and client or designated representative must sign the NHT plan.

  • In the case that a client cannot transition out of the nursing home and into ADA or ALE waiver, transition case management cannot be billed.

Medicaid benefits counselors

Medicaid Benefits Counselors

Working Together

with Case Managers

Introduction medicaid benefits counselors
IntroductionMedicaid Benefits Counselors

  • Kristen ‘Dani’ Gray - serves Hillsborough and Manatee Counties

  • Carol Keen – serves Polk, Highlands and Hardee Counties

How does using the mbc help you
How does using the MBC help you?

  • The MBC takes care of the Medicaid eligibility portion and can save you time.

  • The MBC expedites these applications-process time after submitting the application is 3-7 days (depending on county) as opposed to 45 days.

  • MBC’s follow up with DCF for Notices of Case Action (NOCA’s)

  • MBC’s are able to research clients in DCF’s FLORIDA system as well as FLMMIS

Ex parte in 6a
Ex parte in 6A

  • What is an ex parte?

    An ex parte is a switch from one Medicaid

    type to another.

  • Who can ex parte?

    Anyone with a “full Medicaid” (Waiver, ICP,

    Hospice, MMS).

  • What forms are needed for ex parte?

    ARC Referral Form, LOC, both pages

    of the 2515 and sometimes bank


Ex parte in 6b
Ex parte in 6B

  • Who can ex parte?

    Anyone that has Share of Cost, MMS, ICP,

    Hospice (Community or ICP) or any type

    of Waiver.

  • What forms are needed for ex parte?

    ARC Referral Form, LOC, both pages

    of the 2515, and sometimes bank


Documents needed for rfa
Documents Needed for RFA:

  • NewARC Referral Form-faxed to I&S Fax (see form in appendix)

  • Please complete all sections on this form, including the date 3008 was received.

  • The MBC Documentation List can be given directly to the client or care giver (This form is in appendix).

Documentation needed cont
Documentation Needed cont…:

  • Level of Care (LOC) and 2515 indicating Case Manager start date and include the Room and Board rate;

  • Send any income and asset based information that is available;

    • Any monthly income that is direct deposited can be excluded from the balance of their bank account for the application month.

    • Subtract income to get the value of the bank account.

    • Assets can be excluded as burial contract up to $2,500 (see form in appendix).

Qualified income trust accounts
Qualified Income Trust Accounts

  • What is a QIT?

    An account that helps you become eligible

    when you are over the income limit ($2,094).

  • How do I set up a QIT?

    Please see Irrevocable Income Cap Trust

    form in appendix. An elder law attorney

    can also assist.

  • How does it work?

    Basically, any amount over the gross income limit gets

    deposited into this account each month.

Mbc referral process
MBC Referral Process

  • Receive referral from ARC fax line

    • #888-401-4606

  • Research client on DCF Florida, CIRTS and FLMMIS databases;

  • Call client/caregiver, or facility to discuss income, assets and expenses;

  • Mail out checklist of verification needed to submit application

    • checklist includes contact info & instructions to call MBC once all verification is together.

Mbc referral process cont
MBC Referral Process cont…

  • Client can mail or fax verification if they are able and have a current DCF Medicaid case in process.

    • If not, MBC will conduct a home visit to gather all verification.

  • Application is submitted and all verification is faxed to DCF.

Commonly asked questions
Commonly Asked Questions:

  • Direct enroll clients-SSI is active, need LOC and verification that the client receives SSI. DCF does not process these clients and you WILL NOT get a NOCA.

  • Income must be verified from the source. Bank statements may not be used.

  • When whole life policies have face values that exceed $2500, the cash value must be verified from the source.


  • Provider Log: CM’s can use this tool to check the current status of referrals made to MBC’s.

  • APPL Report: A tool used to track clients that have been released for waiver, but have not yet had eligibility established.

Mbc contact information 6a
MBC Contact Information 6A

Kristen ‘Dani’ Gray

813-676-5601 or

1-866-827-6095 Option 1

Referral Fax


Fax verification to:


Mbc contact information 6b
MBC Contact Information 6B

Carol Keen

863-413-3473 or

1-866-827-6095 Option 2

Referral Fax


Fax verification to


Aps referral process training tutorial
APS Referral ProcessTraining Tutorial

  • Required of all Case Managers

  • Online on the ARTT System

  • If you are a new Case Manager and have not taken this training module, please arrange to do so with your supervisor.

The ARTT Web site is

pictured to the left.

The ARTT website address is:

In 2011
In 2011 -

  • Services routinely provided within 72 hours !

  • Improved Documentation with better detail

  • No findings by DOEA monitors on APS files!

Opportunities for more improvement
Opportunities for More Improvement

  • Care Plan ALL services for 31 days, then revise for remaining 11 months if CM & API agree to continue services.

  • Problem continues: Many instances of only CM care planned for 1 month and all other services care planned for 12 months!

Remember to
Remember to . . .

  • Update ARTT within 72 hours and include actual dates of services.

  • Include Assessment Summary page with all assessments and updates.

  • Call API within 24 hours if client refused or delayed services.

  • Call API if all recommended services were not ordered.

Aps file notes should contain
APS File Notes Should Contain:

  • Specific dates individual was contacted by CM during the 31 days following referral.

  • Specific dates the individual was assessed

  • Individual’s abilities, needs and deficiencies observed during all assessments

Aps file notes should contain1
APS File Notes Should Contain:

  • specific services and service dates for services provided during 72 hours following referral (include NDP– non-DOEA)

  • services provided and frequency at which they were provided during 31 days following referral

  • all contact and discussions with APS staff

Aps file notes should contain2
APS File Notes Should Contain:

  • If services could not be provided for reasons beyond control of provider, document all actions taken in an attempt to provide services and/or contact the

    referred individual

  • If services were delayed, document why, when services began, and which services

    were provided.

  • CM must staff service delay issues with API immediately.

  • If the API and CM disagree on need for services requested by API, the CM Sup and API Sup jointly review and resolve.

Aps file notes should contain3
APS File Notes Should Contain:

  • all contacts and discussions with Nursing Home Diversion providers (if applicable)

  • when follow-ups are performed


      • before 14 calendar days to ensure services started ( call to client)

      • By 31st day to determine if services are still needed (call to API)

Aps referrals for existing clients
APS Referrals for Existing Clients

  • Update the current 701B by making hand-written changes on the actual 701B hard copy.

  • Update Assessment Date (#4d) to current date. (this does not change the initial referral date)

  • Update Assessment Type (#4f) to ‘U’ for update.

  • Update Referral Source (#11) to ‘A’ for APS

  • Update CIRTS with changes noted during re-assessment.

  • Print out new turnaround report and put into file.

14 days call to client
14 Days Call to Client

  • Made sometime before 14th day

    to ensure that services have started.

  • If CM has already received confirmation of service delivery prior to day 14, no need to make additional call on the 14th day.

  • Calls should be documented and include date that services started.

Aps decision point 31 days
APS Decision Point: 31 Days

  • Continue or terminate services?



    “Abuse, Neglect, Exploitation”

    ? ? ? ?

31 day call with api
31 Day Call with API

  • Before or on 31st day, CM must speak to API to determine service continuance. Remember to document call attempts and messages left.

  • If the call is delayed after the 31st day, an explanation as to why must be included in the notes.

Items to consider when determining continuation of services for an aps client
Items to consider when determining continuation of services for an APS client

  • Is the client likely to be a victim of Abuse, Neglect or Exploitation if services ended ?

  • Risk score –likelihood of nursing home placement without services

  • Caregiver in the home?

  • Income/assets – could they privately pay for services?

Termination of aps client services
Termination of APS Client Services for an APS client

  • Termination letters doNOTneed to be sent to client if it is determined that services should not continue after the 31 day period.

  • CM should speak with Supervisor, then API, then advise client of termination.

    • Document case notes regarding decisions and all discussions

    • Update assessment

    • Re-write care plan

  • Put client on APCL list if they would like future services.

Sgr documentation
SGR Documentation for an APS client

  • Similar to MW requirements.

  • DOEA is closely examining files for:

    • Client eligibility

    • Use of current forms

    • Excessive billing

    • Repetitive or duplicative documentation

    • Billable vs. non-billable actions

    • Reasons for Face to face contact

Case narratives
Case Narratives for an APS client


  • Case narratives must contain the case manager’s observations of the client:

    • What did you see in and around the home?

    • What did the client or caregiver say?

    • How did the client appear?

Case narratives1
Case Narratives for an APS client

Note review:

At the end of your note, ask yourself the following:

Does the note justify the time billed?

  • If not, why not?

  • What should be included or left out?

  • Did you record the appropriate time spent and units of services?

Case narratives2
Case Narratives for an APS client

Tips to keep in mind…

  • Case notes should not be repetitive or contradict previously stated documentation. They should provide a fresh picture of the client’s current condition.

  • Keep in mind that what your write down can potentially be seen by the client, caregiver or other providers.

  • Case Narratives must justify units billed

Case narratives3
Case Narratives for an APS client


  • One line case narratives are not sufficient to justify units claimed.

    Example 1:

  • “Received Client’s new LOC.”

    Example 2:

    “The client received no PECA service as there was no worker available to provide service”

    Problems with service providers must be addressed in the narrative with a planed course of action noted.

Assisted living waiver

The purpose of the Assisted Living Waiver program is to promote, maintain, and restore the health of eligible recipients, and to minimize the effects of illness and disability in order to

delay or prevent institutionalization.

Overall objectives

  • At the conclusion of this training, case managers should know the following:

    • When to contact ALW recipients

    • What documents to maintain in case records

    • How to maintain case narratives

Specific topics to be covered








Required alw contacts


ALW Monthly Face-to-Face Assess Client Status ALW

ALW Quarterly Face-to-Face Care Plan Review ALW

ALW Annual Face-to-Face Assessment/Reassessment ALW

Case manager concerns

  • Which tool(s) are now used to monitor your work?

Doea monitoring

  • Eligibility: Gaps in Level of Care

  • Gaps in Assessments

  • Care Plan not documented timely

  • Narrative:

    • No documentation of client’s condition at face-to-face visits

    • No documentation of service receipt

Doea suggestions for improvement

  • Ensure refresher training sessions for case managers include:

    • billable or non-billable activities and documentation

    • proper documentation of monthly client contact

    • case narratives requirements

Case management billable activities

  • MW cannot bill after date of death or after nursing home/hospital entry.

Mw monthly note
MW MONTHLY NOTE for an APS client

  • Monitor client changes

  • Monitor receipt of, and satisfaction with, services

Note review
NOTE REVIEW for an APS client

  • At the end of your note, ask the following: Does the note justify the time billed?

    • If not, why not?

    • What should be included or left out?

    • Did you record the actual times spent and units of service in the case note?

      Note:Travel time and time spent documenting the case note are included in the note entry.

Tips to keep in mind
TIPS TO KEEP IN MIND for an APS client

  • Case notes should not be repetitive or contradict previously stated documentation. They should provide a fresh picture of the client’s current condition.

  • Keep in mind that what you write down can potentially be seen by a client, caregiver or other provider.

Wcfaaa monitoring

  • Case Records:

    • Eligibility: LOC’s and Medicaid printouts

    • Administrative: Fair Hearing, POA/Legal Guardianship documentation missing

    • Assessments: Missing assessments or pages, untimely assessments, assessments not updated or completed correctly

    • Care Plan: missing original care plans, not legible and maintained in detail, not properly signed, quarterly reviews not initialed or dated

Wcfaaa monitoring1

  • Case Narratives:

    • Client’s Condition at Face-to-Face Visits:

      • Client and/or staff observations and reports

      • ASK: In light of services received, are there discrepancies?

    • Service Provision:

      • Document changes to care plan, and why

      • Document informal supports participation

Wcfaaa monitoring2

  • Case Narratives:

    • Service Receipt:

      • Document review results

    • Medical Care Episodes:

      • Missing documentation of changes upon client’s return

Wcfaaa monitoring3

  • Case Narratives:

    • Client Satisfaction:

      • A statement from the client they are satisfied with services, or a similar statement

Wcfaaa monitoring4

  • Case Narratives:

    • A narrative is comprehensive when you:

      • Document purpose of visit

      • Document care plan reviews

      • Document eligibility activity

      • Document reason for

        untimely assessment

      • Address unmet client needs

      • Contact the facility after hospitalization

Wcfaaa monitoring5

  • Complaints/Grievances:

    • Document client complaints and how resolved

  • Case Narratives

    • Case Management Billing:

      • Sign the case narratives

      • Document billable activities

      • Include case narratives

  • Wcfaaa monitoring6
    WCFAAA MONITORING for an APS client

    • Case Management Billing

      • The Date of Service (DOS) is always the last day of the month for which reimbursement is requested.

    Wcfaaa suggestions for improvement

    • Eligibility:

      • Contact MBC’s for assistance

      • Encourage facility involvement

      • Communicate with the facility

      • Use documentation receipts

    Wcfaaa suggestions for improvement1

    • Administrative/Procedural:

      • Send 2515’s to MWS for transfers and terminations

      • Update CIRTS when client info. changes

      • Notify WCFAAA of adverse incidents

      • Maintain well-organized case files

    Wcfaaa suggestions for improvement2

    • Care Plan:

      • Thoroughly document problems or gaps

      • Review care plan service descriptions

      • Review care plans prior to signing

    • Case Narratives:

      • Use narrative templates! It helps!

    Wcfaaa suggestions for improvement3

    • Case Narratives:

      • When A Case Manager Changes:

        • Spot check case files to ensure duties were completed

        • Ensure proper training is given

        • Utilize model case files and case managers

    Case narrative best practices

    • Great case management included:

      • Eligibility:

        • Constant contact with provider facility

      • Administrative

        • Well-organized case files

      • Case Narratives:

        • Use of narrative templates

        • Great problem/complaint follow-up

    BREAK TIME for an APS client

    Aged disabled adult waiver
    Aged/Disabled Adult Waiver for an APS client

    • The purpose of the A/DA Waiver Program is to promote, maintain, and restore the health of eligible elders and adults with disabilities and to minimize the effects of illness and disabilities in order to delay or prevent institutionalization.

    Required ada mw contacts

    Required ADA MW Contacts for an APS client

    Required ADA MW Contacts


    MW Monthly Telephone Assess Client ADA

    MW Quarterly Face-to-Face Care Plan Review ADA

    MW Annual Face-to-Face Assessment or ADA


    Case record and case narrative documentation should
    Case Record and Case Narrative Documentation should … for an APS client

    • The assessment, care plan and narrative dates should be congruent;

      that means all of the dates match !

    • Narratives must describe the client’s current situation, support the need for the case management services provided and the units billed

    • Changes to care plan services must be documented and include agreement by client/representative.

    Client s condition status
    Client’s Condition/Status for an APS client

    • Document in the case narrative for all Face-to-face contacts:

    • Brief description of the Case Manager’sprofessional observations of the client’s behavior, affect, appearance, dress, grooming, and environment; NOT just a medical diagnosis

    • Include the Client’s self-reported health, functional, mental, emotional states

    • Financial or other issues of client concern

    Medical care episodes
    Medical Care Episodes for an APS client

    • Significant Changes or Medical Care Episodes requirefollow-up and documentation, to determine the following:

      • If the consumer is safe

      • If the 701B and care plan need updating

      • If additional services are needed

    • Examples of significant changes include:

      • Consumer returns from hospital, nursing home, rehab

      • Caregiver moves or has significant health change

      • An APS report has been made for an active consumer

      • The consumer moved to a new home

    Monthly mw contact
    Monthly MW Contact for an APS client

    • CM must maintain Monthly Contact to monitor client changes, receipt of and satisfaction with services;

      MUST be documented in the case narrative

    • Typically a phone call

    • Should not exceed 15 minutes total (1 unit) to complete and document

    • Attempt to contact recipient at least twice and document in narrative

    Keep in mind

    Keep in mind … for an APS client

    Keep in mind …

    • In all client contacts, you must make every effort to speak directly with the client, not just the caregiver

    • If the client is unable to communicate for him or herself, the reason why must be documented in the case narrative at minimum on the annual review and be supported by the 701B assessment

    Termination of services
    Termination of Services for an APS client

    • When a recipient’s participation in the A/DA waiver is terminated, the case manager must:

      • If appropriate, Notify the recipient of his right to due process, (minimum of ten daysadvance written notice of any termination, suspension, or reduction of services)

      • Notify all service providers to cancel A/DA waiver services

      • Notify the local Department of Children and Families

      • END the Care Plan and,

      • Document all final contacts in the case narrative and WHY the case is being closed or terminated

    Care plans
    Care Plans for an APS client

    • Care Plans must document

      • Formal and Informal services

      • Begin and End dates, Revisions, Duration of services, Funding sources

      • Document all current services and updates

      • Care Plan is dated and signed by the case manager and the consumer (or the consumer’s caregiver/authorized representative)

      • Quarterly Reviews are noted with date and CM initials

    Do not duplicate
    Do Not Duplicate for an APS client

    • The case note for the annual review, quarterly review and monthly contacts should not be repetitive with only a word or two changed from one to the next. It should provide a freshpicture of the client’s current condition.

    • The case note should not be an essay repeating verbatim everything covered on the 701b.

      • It should be a summary of the interview with the client and any observations of facts not captured in the assessment

    Legal corrections in the permanent case file record
    Legal Corrections in the permanent case file record for an APS client

    • Legally correct any errors in the case file

      • NO “WITE OUT,” SCRIBBLES or WRITE OVERS, and over, and over, and over……

    • What is a legal correction?

      • Cross out the error with one line

      • Correct the error

      • Date the correction

      • Initial the correction

    Best practices
    Best Practices for an APS client

    • Great case management documentation

      • Narratives justify units claimed

      • Avoid “excessive billing” issues

      • No billing logs in the case narrative documentation

      • Focus on QUALITY not Quantity; narratives should be relevant, clear and concise

    QUESTIONS ??? for an APS client

    Quieres Taco Bell?

    * for an APS client ADL score* IADL score* APS w/in 72 hrs* Imminent risk * Average time in CCE for MW probable clients * Caregiver likely to continue* Caregiver able to continue * Nutrition* Environment

    Doea focus in 2011 2012
    DOEA Focus in 2011-2012 for an APS client

    • APS

    • Imminent Risk

    • Caregiver Likely to continue providing care

    • Caregiver Ability to provide care

    Statewide Focus

    Outcome measures 2011 2012
    Outcome Measures – 2011-2012 for an APS client

    • Currently achieving 8 of 9 goals!


    • Which one is not being achieved?


    Is this environment high risk
    Is this environment high risk? for an APS client

    Negative aspects included:

    • Furniture needed repairs

    • No phone

    • Insects visible throughout the house

    • Unsanitary conditions due to odor (client incontinent)

    MAYBE- MAYBE NOT for an APS client

    • Ask yourself these questions:

    • Can the client safely stay in the house?

    • Are you imposing your standard of living on the client?

    • Can any of these issues be easily rectified by providing services?

    Documenting exceptions
    Documenting Exceptions for an APS client


    • Describe the changes from the last assessment.


      Client’s ADL score went from a 5 to a 9.

      “Client had a mild stroke and now needs bathing and dressing assistance.”

    Wcfaaa 2011 customer satisfaction survey

    WCFAAA for an APS client 2011 Customer Satisfaction Survey

    Mailed March 2011

    Survey return rate
    Survey Return Rate for an APS client


    Case Management Survey for an APS client

    It’s all about YOU!

    • 94% know how to contact YOU.

    • 90% believe YOU listen to what they say.

    • 94% believe YOU are polite and treat them with respect.

    • 94% believe YOU are knowledgeable about the available services.

    Wcfaaa web site
    WCFAAA Web site for an APS client

    Additional questions
    Additional Questions for an APS client

    ??? ? ??? ?

    The end for an APS client