SCL Questions and Answers

Questions Related to Participant Directed Services (PDS)
Q.
Can a consumer use Skype or a similar face-to-face communication mode through the Internet and this be considered allowable through a direct waiver service, like CLS and attendant care through Michelle P? We have denied this possibility in CDO under three CLS service.
A.
A required face-to-face visit by the case manager must be conducted in person. Skype or other programs could be used for non-billable contacts.

This question also pertains to the employee-participant contact. Employees, guardians and parents have considered it possible that using this technology may serve as an aid to participants in meeting their outcomes and objectives.

After conversations with DBHDID, the Department for Medicaid Services, and the Office of Legal Services in recent years, the Department for Aging and Independent Living has stated that this is not an acceptable means of providing a service to a participant.
Q.
Who is responsible for serving as the Financial Management Agency? Please clarify.

Also, further clarification is needed we feel on what the Case Management responsibility is for PDS. It remains unclear to many how PDS and Case Management should be integrated and who has what specific responsibilities, despite recent emails.
A.
The corresponding AAA/CMHC in the area is the Financial Management Agency (FMA). A list of contacts has been sent to case manager supervisors' agencies. If you have not received this, please email Evan Charles (evan.charles@ky.gov) and you will receive a copy.
  • Once the case manager is aware that the participant wishes to choose a PDS service, the participant should have an employee set up for the employment process, ideally through recruiting and interviewing, but this could also be done through acquaintances of family members, friends, or neighbors.

    Please note that immediate family members must qualify through the MAP-532 Exemption process. The case manager may assist in this, through providing ideas about possible advertising or through team discussions about who could be available.
  • The case manager then informs the participant/team about employee requirements, such as drug screen, TB screen, CPR/First Aid, College of Direct Support (CDS), any additional training, possible educational requirements, and background check requirements (employer is responsible for payment for processing these requirements).

    Please note that the funding for these requirements is the responsibility of the employer; having these requirements paid for the first five employees by Medicaid is not an option.
  • Once an employee is qualified, the employer should direct the employee on what duties to be performed as related to the POC.
  • As timesheets are completed, the timesheets are to be reviewed by the employer to ensure accuracy. The case manager then reviews the timesheet to ensure that the plan of care is being followed in terms of outcomes and objectives, unit maximums, and regulation maximums.
Q.
How do we complete the Time Sheets for PDS?
A.
  • The employee writes in the hours, dates, and attaches supporting documentation.
  • The employee/employer is responsible for the identifying information at the top of the timesheet, but the case manager may pre fill this information in order to reduce chances of error.
  • Each party responsible for the timesheet shall provide a signature at the bottom; calculations at the bottom are optional.
  • The case manager reviews the timesheet and ensures it complies with PA limits, and POC guidelines.
  • The case manager submits the original page 1 to the FMA for payment processing, retaining a copy of page 1, and the service documentation, page 2.
Q.
Is there a difference in PDS respite service and traditional respite services?
A.
PDS respite can look a little different. PDS respite is directed by the person and the person's family. They can choose non-SCL staff to provide this service. However, there are outlined training requirements for PDS staff. You can find more information on the SCL Regulations page (see Related Links).

Participant Directed Services (PDS)

907 KAR 12:010 5(1)(a)

The following services may be participant directed and shall be provided in accordance with the specifications and requirements established in Section 4 of this administrative regulation, the Supports for Community Living Policy Manual, and the training requirements specified in paragraph (b) of this subsection:
  • 1. Community access services;
  • 2. Community guide services;
  • 3. Day training;
  • 4. Personal assistance services;
  • 5. Respite;
  • 6. Shared living; or
  • 7. Supported employment.
Q.
When will the PDS manual for case managers be available?
A.
The manual is in its final draft stages.
Q.
Who will it fall back on for recoupment of payment under PDS?
A.
This would depend on the situation and contributing factors. Some billing infractions may be FMA, CM or both. They are looked at on a case-by-case basis.
Q.
What about the consumer handbook f or PDS?
A.
The manual is in its final draft stages.
Q.
For PDS under SCL2 do we complete the MAP-2000?
A.
No, the designation for a representative is on the Rights, Risks, and Responsibilities form.
Q.
Could a Community Guide assist the consumer with an appeal regarding the waiver and/or services?
A.
It has been confirmed that this function would be considered out of the scope of the community guide service and this would be the responsibility of the participant, appointed representative or legal guardian.
Q.
What is the turnaround time for exemptions? And can family members seeking approval work until determination and/or through the appeal process?
A.
DAIL has a turnaround time of 14 days; we request that with each submission, the most recent Plan of Care and Assessment be submitted along with the request (the MAP-351 can substitute for the SIS). A requesting family member cannot be prior authorized to provide services without approval from DAIL and therefore shall be considered an invalid employee, both during the determination process and the denial process.

DAIL pointed out that case managers should not be completing the MAP-532 for the potential employee. DAIL submitted an email to the field that was a "helpful hints" that case managers can use to assist potential employees complete the questions. It was noted that not all AAAs/CMHCs received this email, so it will be resent. If you still have not received the information, please let us know.
Q.
What is the expected time frame for receiving Prior Authorizations?
A.
DAIL will consult with Carewise oversight agency HP to clarify the Prior Authorization procedure and examine any scenarios that are making approval of Prior Authorizations more complex. A couple of agencies footnote that a participant may have an LOI issued, and the agency responded accordingly, only to experience a further delay. Agencies were asked to provide participants with MAID fitting this issue.
Q.
When transitioning from SCL1 to SCL2, what is it necessary for an employee to complete?
A.
All employees will need to complete all background checks and screenings before beginning work after the transition date (Central Registry Check has a 30-day window from beginning work date). All training must be completed for transitioning employees within one year of the transition date.

DAIL added that case managers need to keep in mind that when it comes to drug-related convictions, the five-year window of exclusion ends at the date of conviction for a drug related crime, not a sentencing date, nor a charged date. Quoting from SCL2 regulation Section 3 (3)(aa)3: "Has a drug related conviction within the past five (5) years…"
Q.
Are employees responsible for paying for these background checks?
A.
This is the employer's responsibility according to federal law, the Fair Labor Standards Act.
Q.
How soon could transitioning employees complete background checks before the transition date?
A.
DAIL stated that up to 30 days before the transition date would be acceptable.
Q.
What is the purpose of the additional training form?
A.
This is provided to show documentation that, should a participant require that an employee complete additional training – such as any element of routine treatment or physical restraining courses, medication administration, etc. – an employee would have proof that this training was completed and that the participant verified its completion. Some participants may not require any additional training of their employees.

It was also confirmed that medication administration is not a standard requirement of an employee unless the participant requests so, or if the employee works for three or more participants.
Q.
What is the responsibility of the Case Manager Supervisor regarding undersigning documents?
A.
Please review Page 30 and 31 in the SCL Policy Manual. The CM Supervisor is required to sign the monthly summaries for all Case Managers. The CM Supervisor is to monitor other responsibilities.
Q.
How do PDS Day Training and/or Supported Employment look for a participant?
A.
An employee would be working specifically on objectives designed towards interests of vocation/employment, or towards activities/interests that may later develop into prevocational activities. The participant's team would need to discuss possibilities and/or opportunities that can parallel a participant's interests and/or hobbies with vocation, and what steps could be laid out to get there.
Q.
There is confusion when requesting PDS services on the MAP-530 related to the number of units requested. Please clarify.
A.
In the past, when requesting PDS (CDO) services, this was requested as hours. With the change to PDS in SCL2, you must now request the service in units of 15 minutes. If you are using the hourly rate you must divide by 4 to get the unit rate. If you are requesting 4 hours of service at $16.00 per hour, then on the MAP-350 you will need to request 16 units at $4.00 per unit.
Q.
If a client is going to be SCL (PDS) does it start like SCL2 on the day after the client's birthdate or, if the PA ends in the same month as the birthdate, on the date the PA ends? I am just not sure if it works the same. If you could help me with this I would appreciate it very much. Also, is CLS the same as the Community Access? Thank you for any input you can give me on this.
A.
Yes, the LOC and PA dates will be the same based on the birth date. All services, whether traditional or PDS, are SCL services; participant-directed services are just simply a different way to manage certain SCL services.

No, CLS is not the same service as Community Access; SCL2 does not have a service called CLS. If a person received CLS in SCL1, the person-centered team might consider utilizing Personal Assistance if the service provided meets the service definition of Personal Assistance.

Community Access is a very specific service to help people make connections with groups, clubs and organizations in the broader community. It is used to help a person in SCL become a member of an established community group. It is short-term and requires a plan for reducing services, which would be the criteria for fading the CA service and transitioning ongoing supports, if needed, to another service such as residential, ADT, natural supports, etc.

Additional information about services and supports may be found here.
Q.
On the MAP-530, what should we enter under "Provider Name" and "Provider Number" for a service listed under PDS? Is "Provider Name" the participant/employer's name, the PDS representative's name, or the Financial Management Agency? Is "Provider Number" the participant's EIN? If so, what do we enter if the SS-4 (Application for EIN) has yet to be returned?
A.
The provider for a PDS service is the Financial Management Agency and the provider number is the provider number for the Financial Management Agency.
Q.
I need instruction about listing PDS service FMA T2040 on the MAP-530. I do not see a dropdown box or how to enter this information. I believed it was incurred, but Carewise sent an LOI. Please give guidance.
A.
When requesting a PDS service, enter the Financial Management Agency/Service and its provider number as the provider of the PDS service. This automatically triggers the payment for Financial Management Services. It is not necessary to request the FMA-T2040 as a separate service. The MAP-530 has been revised for this change.