WaiverWatch Forum Index WaiverWatch
an eye on the Indiana Medicaid Waiver program
 FAQFAQ   SearchSearch   MemberlistMemberlist   UsergroupsUsergroups   RegisterRegister 
 ProfileProfile   Log in to check your private messagesLog in to check your private messages   Log inLog in 

How does the money get used?

Post new topic   Reply to topic    WaiverWatch Forum Index -> Questions
View previous topic :: View next topic  
Author Message

Joined: 22 Oct 2005
Posts: 45

PostPosted: Wed Oct 26, 2005 5:56 pm    Post subject: How does the money get used? Reply with quote

I have heard people say that families will have more freedom to use the res hab money in their budget as they see fit.

What is the mechanism for this? Is the provider suppposed to have a meeting with the family? Does the provider have to agree to any way the family wants to spend their money? Do they sign some kind of agreement?
Back to top
View user's profile Send private message

Joined: 21 Oct 2005
Posts: 35

PostPosted: Fri Oct 28, 2005 1:14 am    Post subject: Reply with quote

Thanks for your excellent questions, noplacelikehome--you are not alone in wondering how the flexibility we're being promised in the new system will actually work.

I'm not sure that any of the parents, providers, or case managers who are participating in this board will have an answer for us, though. Perhaps one of the folks from FSSA who is reading this could chime in with details? If so, we would certainly welcome you to the discussion. Thanks in advance.

Back to top
View user's profile Send private message
Nancy Swaim

Joined: 26 Oct 2005
Posts: 17

PostPosted: Fri Oct 28, 2005 5:55 am    Post subject: spending the money Reply with quote

We were told at a meeting this week that the provider, case manager and consumer will continue to work together, as a team, to identify the needs of the person and how those needs were to be met. This is why there continues to be an "annual" case management process.

The annual fee is to cover all of the processes that go into submitting the annual Plan of Care/Cost Comparison Budget. The team (consumer, provider, case manager, family and others the consumer may wish to participate) work together to review and update the Person Centered Plan, review and update the Individual Support Plan, complete a Service Planner to identify the way in which waiver and other services will be used to meet the consumer's needs. From these processes, the case manager will complete the annual Plan of Care/Cost Comparison Budget. The State will review the Individual Support Plan, Service Planner and the Plan of Care and revise the annual rate as they see appropriate.

This is my understanding based on the materials released by FSSA and based on the information provided at the state-wide case management and provider meetings. My understanding could be wrong.

One thing that was made very clear, however, is that providers must work with case managers in this process, as well as in reviewing progress throughout the year. If your provider is saying otherwise then please have them contact FSSA for clarification.
Back to top
View user's profile Send private message
Jenifer Asher

Joined: 28 Oct 2005
Posts: 4
Location: Indianapolis, IN

PostPosted: Fri Oct 28, 2005 7:50 pm    Post subject: Individual Support Plans and Service Changes Reply with quote

Many of you have had questions about service changes to the waiver and how it could potentially impact you or your family member. Service providers received the following clarifying information via email from DDRS this evening which may be helpful to your understanding:

Per David Gootee, DDRS Assistant Director
The Annual Plan is designed to encourage and promote maximum flexibility and choice in the provision of services, given the limited financial resources available. Individual Support Teams have both the challenge and the opportunity to design plans of care that meet the needs of individuals without having to confine activities to the structured requirements of the old service definitions. The Individual Support Plan (ISP) is the guiding document for all issues related to an individual’s service. In addition to meeting the health and welfare needs of the individual, services must be delivered in a manner that assures an individual’s progress toward the outcomes described in the ISP.

The most common things we are hearing are “my provider (or case manager) said my hours have been cut” or “my travel is gone.” The new billing system designates an amount of money to provide for the needs of an individual over the course of a year. There are many ways to fulfill those needs. Using the old model with its constraints, restrictions and frustrations (i.e. tying a dollar amount to a quarter-hour unit of staff time) as a basis is not only inappropriate, it is wrong. It is overly simplistic to say that “your services are cut” when, in fact, services are changing and may be provided in a different manner. With the increased flexibility being provided, all parties should be prepared to explore the need to share staff, utilize sleep shift personnel or technological supports where appropriate. There are also opportunities for increased use of volunteer services and for family support. The increased flexibility of a daily rate will allow families to be more involved in a loved ones life, with no fiscal impact on the provider.

A subtle, but important, issue is the point of reference used when discussing these billing changes with families. The historical reference point, used by all of us, has been the budget which indicates the maximum allowable amount of service available to any one waiver participant displayed in units and hours. Only in the rarest of cases was the actual service delivered close to the amount approved. Actual paid claims data for the DD waiver ranged from about 80% for RHS and Case Management to 60% for Behavior Management to less than 50% for Day Services.

The new annual funding allotments are based on actual spending history, which is a more realistic measure of the amount of state funding needed to provide for an individual and help them achieve their goals. Given this, it is unrealistic to speak to families and individuals in terms of a large percentage cut from a “budget” that included service amounts that have not been delivered.

Unilateral decisions about service provision restrict the creative abilities of the Individual Support Team to design a plan of care that recognizes the realities of everyday life, including the limited financial resources available from the State, to maximize the ability of the individual to achieve their outcomes. The Individual Support Team, and not any one member, must drive decisions related to change in service. However, neither should any single individual of the team unilaterally refuse to agree to changes in the plan. In those cases when the Individual Support Team cannot agree upon the types or amounts of service needed to meet the needs of the individual, the dispute resolution process, as described in 460 IAC 6-10-8, is an option available through the BDDS District Office.
Back to top
View user's profile Send private message Send e-mail Visit poster's website

Joined: 07 Nov 2005
Posts: 2

PostPosted: Mon Nov 07, 2005 2:47 pm    Post subject: Also told my daughter's "hours were cut"! Reply with quote

My 23 year old daughter is profoundly disabled- unable to talk, walk or stand, feed herself- we do everything for her including turning her at intervals 24 hours a day. Previously Sara "got" 51 hours/week RH and 10 hr/mo. Respite. Since our provider could not "locate" caretakers for our rural area I was paid for 40 of Sara's hours a week (I have a BS in Nursing and quit a good paying job to stay home with her due to inadequate day services in Wabash County). Since no other caretaker could be found to fill Sara's remaining 11 hours per week and much of her Respite the STATE said she must not need them and is taking them away. So we and Sara are punished because our agency could not find caregivers. And by the way, I receive about $60 per day to "care" for my daughter- while Indiana pays the agency about $150++/day--- WHY CAN'T INDIANA PAY SARA the $150++/day and let us get our own caregivers at a better pay rate than $8.00/hour and use the dollars when we need them?
Back to top
View user's profile Send private message Send e-mail

Joined: 16 Nov 2005
Posts: 4
Location: Winslow, IN

PostPosted: Wed Nov 16, 2005 5:00 pm    Post subject: Reply with quote


I am assuming that you are with FSSA here, so now lets be realistic. Do you honestly think that $250.00 for an Annual really covers the actual amount of time that it takes a Case Manager to do the Annual? I know that the State is wanting us CM's to take the crunch as well, but I want to put a few things into perspective: First of all, you have to hold the Annual meeting-1 to 2 hours (in some cases longer) imput that data into the system via PCP, ISP, DDP, LOC, Assessments, E-screens, etc. Total amount of time: Approximately 10 hours of work here for the CM, not counting any emergencies that may come up!! It seems to me that the State is saying that all this information is required, and our costs as CM's are going up with the providers costs too!!! If it takes longer because you take your time or INsite is screwed up, then the CM eats the cost! So we are at a catch-22 here! Do it fast, sloppy, incorrectly, and save money, or do it right and loose money!!

Most CM's have most of their annuals due at the same time (June-July). Being proactive doesn't work either because of emergencies and such! God forbid that a CM have a life other than work here!!!

Just to clarify one more thing, each service is allowed a set amount of monies via Annualized budget. Each provider of that service is required to do a set amount of paperwork and set amount of time with the client EXCEPT for the provider-who now can use the planner as a "guide". So where does the money go? Staffing, training, transportation, QMRP services, and then upper level management of those providers!! Can you do what you want to with it? Not really! If you need other services that your provider doesn't currently provide your SOL! If you need transportation and it was not allocated prior to the changes, you'll be giving up some residential time!!

Shonna Cofer,
Denise Medcalf...Visions Unlimited
Waiver Case Manager
Back to top
View user's profile Send private message Send e-mail Yahoo Messenger MSN Messenger
Display posts from previous:   
Post new topic   Reply to topic    WaiverWatch Forum Index -> Questions All times are GMT - 5 Hours
Page 1 of 1

Jump to:  
You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot vote in polls in this forum
You can attach files in this forum
You can download files in this forum

Powered by phpBB © 2001, 2005 phpBB Group