2010 fee for service agreement for dhhs networks l.
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2010 Fee-For-Service Agreement for DHHS Networks
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  1. 2010 Fee-For-Service Agreementfor DHHS Networks PRESENTED BY: Michelle Naples – Delinquency and Court Services 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)


  3. Each Milwaukee County Operated Program Will Send Out Their Own Copy of the Agreement2010 Fee for Service Agreements Each County Program will: Identify any requirements that need to be met in order to renew the agreement with that Program Establish timeframe 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 11/3/09 3

  4. General Updates Following Items Updated • State Administrative Code and Statues • Web Site References – Updated to Current URL

  5. New Definitions • Alternate Care Site • Case Notes • Emergency Management Plan (Disaster Plan) • Fraud

  6. SECTION TWOGeneral Obligations of the Provider • Item A - Move within document • Item C • Provider accountable for accuracy and completeness of all Direct Service Provider documentation • Must have written documentation of • how oversight is provided to Direct Service Providers • procedure for communication of Purchaser Policies and Procedures to Direct Service Providers • Plan related to Supervision of Direct Service Providers including process for review and approval of Service Documentation

  7. SECTION TWOGeneral Obligations of the ProviderContinued • Item K – References Case Note by Definition • Item L – Case Notes Requirements • Must be completed within 30 days of the date of services • Must be completed prior to billing for service • Item Q – Emergency Preparedness • NEW ELEMENTS – COMPLETE REVIEW OF THIS SECTION OFFERED LATER IN THIS SESSION • pandemic influenza ” added to description of an emergency to agency requirement for a written Emergency Management Plan (EMP) to address the identified emergencies

  8. SECTION THREEBackground Checks • Statement requiring Federal Background Checks for all employees that lived outside Wisconsin in past 3 years • Removed from Agreement • County Programs retain the right to require Federal Check in Program Policy • Item A - Provider MUST submit ALL employee background checks with findings other than “no record found” on DOJ form

  9. SECTION EIGHTAssignment and Subcontract Limits Last Sentence –New • Provider may NOT subcontract this agreement in part or in whole without prior written consent of purchaser • Clinical providers will need to provide written notification of contracts with individual contract staff not employed by the agency

  10. SECTION FOURTEENPurchaser Site and Service Documentation Review • Item E Added:Purchaser has authority to adjust pending billings and payments due to Providers due to • Overpayment • Recovery resulting from: • Site Review • CPA Audit • Other Reviews

  11. SECTION FIFTEENBilling Provider is: • Responsible for accuracy of billing • Agreeing to Policies/Procedures related to Service Documentation Requirements • Billing no later than 60 days following month in which service was provided

  12. SECTION FIFTEENBilling Continued Program Specific Changes • Disabilities Services Billing Procedure Added WIser Choice Billing Procedure Updated • “Once a Week” Reporting Requirement – Deleted • Replacement Language – Billing as Outlined in Policy and Procedure • Wraparound Milwaukee • Unless otherwise allowed by Policy and Procedure added • Agencies that document directly in Synthesis to invoice at different intervals

  13. SECTION SIXTEENAudit Requirements • References to Providers reporting on a fiscal year have been removed • References to “subrecipients” changed to “subcontractors” • Item (1)(j) – Reference to Reporting each program or service under County contract as a separate line has been removed

  14. SECTION SEVENTEENConditional Status & Suspension Item B.#2. Provider Subject to Conditional Status • # d. AddedFindings resulting for a Site Review/audit … that document quality and/or fiscal concerns related to Purchaser Policies and Procedures Item C. Suspension • Last ParagraphProvider will not be allowed to provide services or sign a new agreement with Milwaukee County if an outstanding payment/repayment is due to Milwaukee County

  15. SECTION TWENTY-ONENotices Section Rewritten • Notices may be sent by “mail” (U.S. or courier) • Notices may be sent by Email

  16. SECTION TWENTY-TWOAgreement Content Last Two Statements Added • If provision of the Agreement is waived by Purchaser, remainder of document remains in effect • If a provision of the Agreement is held to be invalid, the remainder of the document is not affected

  17. APPLIES TO WRAPAROUND ONLY ATTACHMENT D Applies to Payment for: • Day Treatment • Group Home • Residential Care Progress Entries in Synthesis Required ATTACHMENT E Applies to Payment for: • Crisis Stabilization Progress Entries in Synthesis Required WRAPAROUNDSPECIFIC WRAPAROUNDSPECIFIC

  18. APPLIES TO WIser CHOICE ONLY • Quality Assurance Policy and Procedures • Civil Rights Compliance Plan • Complete Caregiver Background Check


  20. General Obligations of the Provider ITEM Q – EMERGENCY PREPAREDNESS In order for Provider and Service Recipients that Provider serves to be prepared for a natural or man-made disaster, or any other internal or external hazard that threatens Service Recipients, staff, and/or visitor life and safety, Provider shall: • have a written Emergency Management Plan (EMP); • to be retained by the Provider and made available to DHHS upon request; • orient all employees to the proposed plan and trained to perform assigned tasks; • identify the steps Provider has taken or will be taking to prepare for an emergency and address, minimum required elements;

  21. General Obligations of the Provider Item Q Emergency PreparednessContinued • # 1 Provider’s order of succession and emergency communications plan • # 2 Develop a continuity of operations business plan • # 3 Provider to identify “essential” services to remain in operation during an emergency, and services deemed to be essential by DHHS • # 8 Residential facilities, identify the location of an Alternate Care Site for Residents/Service Recipients • # 9 Identify a means, other than public transportation, of transporting residents to the Alternate Care location • # 10 Identify the role(s) of staff during an emergency, including critical personnel, key functions and staffing schedules

  22. General Obligations of the Provider Item Q Emergency PreparednessContinued • # 11 Identify how meals will be provided to Residents/Service Recipients at an Alternate Care Site • # 12 – Expanded – Help Service Recipient prepare for an emergency and obtain essential services during emergency Identify how Providers who offer case management or personal care shall assist Service Recipients to individually prepare for an emergency and obtain essential services, including developing a Care Plan that includes an emergency plan on an individual level. • # 13 Ensure that current assessment and treatment plan for each Service Recipient with specific information about the characteristics and needs of the individual is available in an emergency and accompanies the Service Recipient to the Alternate Care Site

  23. General Obligations of the Provider Item Q Emergency PreparednessContinued • # 14 Identify staff responsible for ensuring availability of prescriptions/medical equipment and Service Recipient information at Alternate Care Site; • # 15 Communicate and Collaborate with local emergency management agencies to ensure the development of an effective emergency plan (typically the fire chief, or his/her designee); and • # 16 Collaborate with Suppliers and Personal Services Providers.

  24. General Obligations of the Provider Item Q Emergency PreparednessContinued • Providers shall have agreements or MOUs with other agencies or operators of Alternate Care Sites and Transportation Providers and assess the availability of volunteer staff for such emergencies. • See Sample Mutual Aid Transfer Agreement at: http://dhs.wi.gov/rl_dsl/NHs/MutualAidTransferAgmt.htm • If Provider organization serves persons with special needs receiving in-home care, or care in a supportive apartment, it should have the Service Recipient, the caregiver or someone upon whom the Service Recipient relies for personal assistance or safety complete the below referenced “DISASTER PREPAREDNESS CHECKLIST FOR INDIVIDUALS WITH SPECIAL NEEDS”. • http://dhs.wisconsin.gov/preparedness/pdf_files/IndPrepChecklist.pdf

  25. General Obligations of the Provider Item Q Emergency PreparednessContinued • Providers can find resources for EMPs including sample plans, templates and EMP Checklist at the following websites: • http://dhs.wi.gov/rl_dsl/Providers/SamplEmergPlans.htm • http://dhfs.wisconsin.gov/rl_DSL/Providers/EvacSheltTemplate.pdf • http://dhs.wisconsin.gov/preparedness/emergencyplans.htm • http://dhs.wisconsin.gov/rl_DSL/EmergencyPreparedness/EmPrepIndex.htm • http://www.cms.hhs.gov/SurveyCertEmergPrep/03_HealthCareProviderGuidance.asp#TopOfPage

  26. General Obligations of the Provider Item Q Emergency PreparednessContinued • WIser Choice providers must submit a copy of their written plan to Rochelle Landingham,Contract Services Coordinator • EMP for other DHHS FFS Networks must be made available upon request


  28. WRAPAROUND MILWAUKEENew Procedures/Requirements • Secondary Identifier • Required for All Direct Service Providers • Date of Birth • Email Address • Required for All Clinicians/Practitioners • Used to inform Clinician of Updates/Changes to Service Specific Policies and Procedures • Wraparound Staff will Contact Agency if New Provider • Works for Multiple Agencies in Wraparound Network • Agency Responsible for Monitoring Provider Service Delivery and Billing – Date and Times may NOT Overlap with Another Agency

  29. WRAPAROUND MILWAUKEEServices with Training Curriculum Requirement Submit with Agreement Renewal • Daily Living Skills – Individual and Group • Life Skills Training – Individual and Group • Supported Work/Job Coach Client record documentation should reference the topics addressed during each client contact Summarize or “Outline” • how and where the training is conducted • identification of standardized assessment tools (if any) used • topics/subject addressed as part of the training • reference materials used as part of training Provider Network staff will contact the agency if additional information is required when the summary material is reviewed  

  30. WRAPAROUND MILWAUKEEServices with Specific Staff Training Requirements Submit with Agreement Renewal • Crisis Stabilization/Supervision • Mentoring • Tutoring • Parent Assistance Summarize/Outline of Topics Covered and Materials Used • Training Topics Covered • Documents • Videos • Courses • Publications

  31. WRAPAROUND MILWAUKEEStaff Training RequirementsContinued Identify • The total time per module for each training component • The training method used (ie: lecture, video, reading material, etc) • The name and credentials of the trainer (for lecture, videos, course work) • Other informationthat validates the service provider benefit Provider Network staff will contact the agency if additional information is required when the summary material is reviewed  

  32. WRAPAROUND MILWAUKEEPolicy Changes • Vendor Responsibilities and Guidelines • Client Record Requirement Incorporated • Mentor/Parent Assistance/Tutor • 15 Hour Training Verification Certificate • Job Description reviewed/signed off by Employee Must accompany the “Provider ADD Sheet” • Recreation Policy • Staffing / Presence of Crisis Stabilizers • Outings – Requirement if Not all Clients Can Attend

  33. WRAPAROUND MILWAUKEEPolicy ChangesContinued • Transportation FINANCE DIRECTOR AUTHORIZATION REQUIRED • Authorization Obtained by Care Coordinator • More then 20 Miles from the pick-up location to the destination • Pick-up location is more than 20 miles from City

  34. Civil Rights Compliance PlanRequirements Presented by: Dennis Buesing, DHHS Contract Administrator 11/3/09 34

  35. 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 County Equal Employment Opportunity certificate is a separate requirement and does not qualify as a CRC document. 11/3/09 35

  36. 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 11/3/09 36

  37. Other Required Forms & Appendixes to be Attached to the CRC LOA Submitted to DHHS Required Items Appendix A: Contact Info & Signature page Appendix B: Funding Relationship to DCF, DHS or DWD Appendix C Funded Program Checklist Appendix D EO in Employment & Service Delivery Policy Appendix E LEP Policy Statement Profit & Nonprofit Entities Required by DHHS Not Required by DHHS Not Required by DHHS Required by DHHS Required by DHHS 11/3/09 37

  38. CRC (Cont’d)…….. New CRC plan requirements for years 2010-13 have been posted at DHFS web sites. LOA and CRC Plan Requirements, Instructions & Templates including links for Training webcasts are available at: http://dhfs.wisconsin.gov/civilrights/Index.HTM 11/3/09 38

  39. Wisconsin Civil Rights Compliance Officer Questions may also be directed to: David Duran, CRC Officer PO Box 7850 One West Wilson Street, Room 561 Madison, WI 53707-7850 durand@dhfs.state.wi.us Phone: (608) 266-9372 Fax: (608) 267-2147 11/3/09 39

  40. BREAK 11/3/09 40

  41. 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

  42. Insurance & Audit Requirements Insurance RequirementsAudit and Accounting RequirementsMaintaining Financial RecordsGeneral Information on Allowable CostsAudit Requirements and Waiver Procedures

  43. Insurance Requirement • Auto 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 Provider • Commercial General and/or Business Owner’s Liability: Required of ALL Providers and must include premises and off premises liability coverage (may include Umbrella policy)

  44. 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

  45. 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

  46. 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: • Transport companies insured through the State “Assigned Risk Business” (ARB). • Professional Liability where additional insured is not allowed.

  47. 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 Dept. of Health & Human Services Contract Administrator 1220 W. Vliet Street, Suite 109 Milwaukee, WI 53205

  48. 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

  49. 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.

  50. What Must the Audit Contain? • Items Frequently Omitted Summary of Auditor’s Results and Schedule of Findings and Questioned Costs Copy of Management Letter, if any Corrective 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