fiscal intermediary budget review process 2019 · fiscal intermediary budget review checklist ....

Fiscal Intermediary Budget Review Checklist

Edited: 9/5/2019

Fiscal Intermediaries are responsible for reviewing all Self-Direction Budgets for completeness, accuracy and validity prior to submitting the Budgets to the Regional Office Self-Direction Liaisons for approval.

This document contains separate review checklists for:

-3: Start-up Budgets (SUBs)

Pages 4-16: Initial Budgets and Amended Budgets

• The most current Budget Template must be used. If a Budget is submitted on the wrong template it should be returned to the Broker for correction.

• A clean (new) Budget Template must be used for each budget. • Fiscal Intermediaries are required to review SD Budgets/Amendments prior to the

budgets being submitted to the SD Liaison. The FI review will include looking at the budget template, staff action/habilitation plans, Life plan/ISP, budget template and any other supporting documentation.

• Once FI reviews and is satisfied with all the documentation received, the budget is sent to the SD Liaison.

• Fiscal Intermediaries will use the most current SD guidance when reviewing the template.

Start-up Budgets (SUBs) Preliminary

� The Budget is on the current Budget Template

Demographics Tab

Individuals Information

� There is a value entered in every yellow cell. Only acceptable exceptions are Street Address (Line 2) and E-mail

� Medicaid enrollment is complete and verified in Choices/EmedNY � Waiver enrollment is verified in Choices. � Last Name and First Name fields are accurate as verified in Choices � Address information is accurate as verified in Choices � County is accurate as verified in Choices � Phone Number is accurate as verified in Choices � Medicaid ID Number is Accurate as verified in Choices


Edited: 9/5/2019

� TABS ID Number is Accurate as verified in Choices � Date of Birth is Accurate as verified in Choices � Marital Status is accurate and verified in TABS/Choices. � “Yes” is selected for “Requesting Start-up Broker Services?” � Broker Authorization Number (labeled as Broker Certification Number) is accurate as

verified in the support broker list

Brokerage Tab

� Annual Staff Hours and Hourly Fee match figures from the Support Broker Agreement � Total is more than zero and does not exceed $2,400


Edited: 9/5/2019

Verification of Clean SUB Template � No information has been entered into any field below line 10 on the Demographics page

of the budget template, (Requesting Start-up Broker Services) o Before submitting the start-up Budget to the SD Liaison, ensure that no other

extraneous info has been entered for Broker services. Turn the Requesting Start-up Broker Services “YES” to a “NO” and review the Demo page, each individual page, and the budget summary page to make sure that no other data has been typed in, or remains on the budget template from a prior budget because a new template was not used. Info typed in that is not applicable to a Start-Up broker Budget is considered corrupt and will be rejected by the Regional SD Liaison.

� After the above verifications are complete, “Requesting Start-up Broker Services?” is changed back to “Yes”

Final

� Budget Template is saved with correct naming convention: S_LASTNAME,FIRSTNAME-SDSUB-17.xlsx

� Budget is submitted to Regional Office Self-Direction Liaison and indicated that the Fiscal Intermediary has reviewed and approved the Budget, and agreed to act as the Fiscal Intermediary for the Self-Direction Participant.

Other General Guidelines o If an error appears when opening the budget, and/or the message is indicating

the budget is linked to information somewhere outside of the spreadsheet, then the budget is considered corrupt. This indicates that either a clean budget was not used or that cells outside of the budget were copied into the budget. A clean budget template must be used.

Follow up: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Edited: 9/5/2019

Initial and Amended Budgets

Preliminary

� The Budget is on the current Budget Template � Life plan/ ISP, Staff Action Habilitation Plans and any other supporting documents are

submitted for review

Demographics Tab

Individual Information

� There is a value entered in every yellow cell. Only acceptable exceptions are Street Address (Line 2) and E-mail

� Medicaid enrollment is complete and is verified in Choices/EmedNY � Waiver enrollment is verified in Choices � Last Name and First Name fields are accurate as verified in Choices � Address information is accurate as verified in Choices � County is accurate as verified in Choices � Phone Number is accurate as verified in Choices � Medicaid ID Number is accurate as verified in Choices � TABS ID Number is accurate as verified in Choices � Date of Birth is accurate as verified in Choices � Marital Status is accurate and verified in TABS/Choices. � Broker Authorization Number (labeled as Broker Certification Number) is accurate as

verified in the support broker list

Start up Broker Services � “No” is selected for “Requesting Start-up Broker Services?”

Personal Resource Account � DDP Adaptive, Health and Behavior scores are accurate as verified in Choices � School-age question on lines 14 and 15 is answered accurately (Date of Birth and

information from Choices can be used to check this) � “Initial Budget” or “Amended Budget” is selected � “Yes” or “No” is selected for “Template Funding Approved.” If “Yes” is selected this is

verified as accurate and the correct “Type of Template Funding” is selected � Correct DDRO has been selected � DDRO Contact, Phone and E-mail are accurate. Here is the link for accurate information

https://opwdd.ny.gov/opwdd_services_supports/self-direction/self_direction_liaisons_list � “Both,” “Residential Only” or “Other Than Residential” has been selected for the type of

budget.

https://opwdd.ny.gov/opwdd_services_supports/self-direction/self_direction_liaisons_list

https://opwdd.ny.gov/opwdd_services_supports/self-direction/self_direction_liaisons_list


Edited: 9/5/2019

Determination is made whether or not the person lives in a certified setting (e.g., IRA or Family Care). If the person does live in a certified setting, “Other Than Residential” is selected for the type of Budget

� “Yes” or “No” is selected for “CSS Participant Prior to 10/01/14.” If “Yes” is selected, this is verified as accurate.

Services Requested (Select “yes” if the service is being requested and “No” if the service is not being requested) Lines 23-43

� Any service requested with a “Yes” response is reflected in the Life Plan/ ISP � “Yes” or “No” has been selected for every Service. No “Please Specify” responses for

Services are left � Any Service requested with a “Yes” response has information entered in the

corresponding Tab � If “Yes” is selected for Live-In Caregiver, the person is living independently or has a plan

to before this service begins � If “Yes” is selected for Live-In Caregiver, the Number of Line-In Caregivers and Number

of Individuals Served by the Live-In Caregiver fields are complete � If Housing Subsidy and Family Reimbursed Respite are both “Yes,” there is justification

in the Life Plan/ISP and a plan in place to ensure that both services will not be provided during the same time period

� If Housing Subsidy is “Yes” the person is at least 18 years’ old


Edited: 9/5/2019

� If Self-Hired Respite, Direct Provider Purchased Respite, Agency Supported Respite or Family Reimbursed Respite are “Yes” the person has a primary caregiver who provides daily caregiving

� If Self-Hired SEMP, Direct Provider Purchased SEMP, Agency Supported SEMP are “Yes,” the SEMP authorization process has been followed (see attached)

Lines 47-77

� Every yellow cell related to the Fiscal Intermediary (FI), Broker and Care Manager has values entered

� The Fiscal Intermediary Agency Name matches the Fiscal Intermediary that has reviewed and approved the Budget and is the same as the FI listed on the Support Broker Agreement

� The Broker Name matches the Broker Name on the Support Broker Agreement � The Care Manager matches the Name on the Support Broker Agreement � The Care Manager matches the Care manager in Choices � The Annual Budget Effective Date, Transmittal Date and Amendment Date fields are all

left blank


Edited: 9/5/2019

Self-Hired Staff Tab

� Fiscal Intermediary is selected as the employer of record � Hourly wages are at least minimum wage � Fringe Benefit is consistent with information reported by FI � Staffing, including backup plan, is consistent with habilitation plans/ Staff action/ISP/ Life

Plan. � If Self-Hired SEMP, Budgeted amount, combined with amount for Direct Provider

Purchased SEMP and/or Agency Supported SEMP matches authorization � Hourly unit costs are within the Provider’s reimbursement rate for the service � The weeks/year in column “E” cannot exceed more than 52 weeks (may have less due

to individual in camp, school, vacation, etc). � There may be a position broken up into two lines to allow for raises (I.E. $17 for 26

weeks going $17.50 for 26 weeks).


Edited: 9/5/2019

Brokerage Tab

� Annual Staff Hours and Hourly Fee match figures from the Support Broker Agreement � Justification for excessive Annual Staff Hours is provided if regional average is exceeded

IDGS Tab

o Use most IDGS current guidance for complete details on the requirements and monies allowed in each designated line

� Any Category with an Annual Cost is supported by a Valued Outcome(s)/ Staff action in the person’s ISP/ Life Plan

� No individual Category’s cap has been exceeded (Camp, Coaching, Health Club, Household-Related, Paid Neighbor, Transition Program)

� The $32,000 max for all IDGS has not been exceeded � If Coaching/Education for Parents is selected, the person is over 18 years old. � If Paid Neighbor is selected, the person is living independently � If Transition Program is selected, the person has aged out of receiving school services

or completed their education. � Self-Directed Staffing Support, the person has self-hired staff in their budget


Edited: 9/5/2019

Live-In Caregiver Tab

� A value has been provided for every yellow cell

Agency Supported Self-Directed Tab

� At least one line has been filled in for any service selected as Agency Supported on the Demographics Tab

� The correct Provider is identified, as indicated in the ISP/ Life Plan � Rates and units for services obtained in this section has been entered completely.

o Rate/Unit costs are the Provider’s reimbursement rate for the service. � (Can be found at

http://www.health.ny.gov/health_care/medicaid/rates/mental/hygiene/index.htm




Edited: 9/5/2019

Housing Tab

� If “Enrolled in ISS before 10/01/10” is “Yes”, this is confirmed and accurate. � “a. Residents” information is entered numerically � Live In Caregiver (B17) matches number of Live In Caregivers on Demographics Tab. � “b. Other Resident Information” matches with “a. Residents” to reflect any relevant

information � “No. bedrooms in Home field is complete with numerical value. � A selection has been made for “Type of Housing”. � A selection has been made for “Does the ISS recipient receive Section 8 or USDA Rural

Development Section 521?” � If the individual receives Section 8, they will only receive $50/month towards housing.

This is automatically calculated on line 20/J of the housing tab. � Information has been entered for “III. Countable Income” fields. If all countable income

fields are left blank, the DDRO verifies that there the person does not have any income.


Edited: 9/5/2019

� Fields on lines 57, 58 and 59 and 63 are entered as a monthly amount and reflect costs of entire residence.

� If a Subsidy Calculation Exception is requested, the local ISS Coordinator has been consulted before approving

� Template calculates the monthly housing subsidy on Line 67 � Ensure that line 68 and line 69 are left blank. � Any “DDRO Recommended Supplement” input is entered by the DDRO Liaison � “Administration” Field on line 71 is 0.00%


Edited: 9/5/2019

� If Transition Stipend information is filled out, the Participant/Broker is informed that Transition Stipends are outside of Self-Direction Budgets and is provided with instructions on how to pursue a Transition Stipend through the local DDRO ISS Office.

� Lines 93-99 are left blank.


Edited: 9/5/2019

Family Reimbursed Respite Tab

� A value has been entered for Total Annual Cost � The Total Annual Cost does not exceed $3,000 � If Housing Subsidy and Family Reimbursed Respite are both checked “Yes”, there is

justification in the ISP / Life Plan and a plan in place to ensure that both services will not be provided during the same time period.


Edited: 9/5/2019

OTPS Tab

� The Total Annual Cost does not exceed $3,000 � Any Category with an Annual Cost is supported by a Valued Outcome(s)/ staff action in

the person’s ISP/ Life plan. � No values are entered for Internet and/or Utilities categories if the participant is under

the age of 18 and has a primary caregiver. Exceptions may be granted by the Developmental Disability Regional Office (DDRO) in cases where justification for a specific need is established (e.g., the family would not otherwise have internet in the home but it is necessary to support a technology system utilized by the FI and self-hired staff).

� If Board Stipend is selected, there is verification that SNAP has been requested and denied or determined to be insufficient

� If a value is entered for either “Other Goods and Services” line, there is justification in the ISP/ Life Plan or provided by the Participant/Broker


Edited: 9/5/2019

Direct Provider Purchased Tab

� At least one line has been filled in for any service selected as Direct Provider Purchased on the Demographics Tab

� The correct Provider is identified, as indicated in the ISP/ Life Plan Rate/Unit costs are within the Provider’s reimbursement rate for the

service (Can be found at http://www.health.ny.gov/health_care/medicaid/rates/mental/hygiene/index.htm






Edited: 9/5/2019

Contracted Services Section

� Contracted Services information has been entered if selected as “Yes” on the Demographics Tab

� This is for FSS and assistive support service only. The SD Budget does not authorize someone for FSS services.

Budget Summary Tab

� Total Services on line 109 does not exceed Total PRA or Authorized Amount on line 108 � No total annual cost numbers are negative numbers.


Edited: 9/5/2019

Verification of Clean Budget Template � On the Demographics page, Lines 26-43 (Services Requested) changing a “Yes” to

“No” without deleting any entered information on the corresponding page will “corrupt” the budget template.

o To verify this, change any selection for “Services Requested” from “No” to “Yes” and examine the corresponding pages to ensure that they are blank. If any information has been entered in these cells, delete it. Then change the “Yes” back to a “No” on the Demographics page.

Final

� If an error appears when opening the budget, and/or the message is indicating the budget is linked to information somewhere outside of the spreadsheet, then the budget is considered corrupt. This indicates that either a clean budget was not used or that cells outside of the budget were copied into the budget. A clean budget template must be used.

� Budget Template is saved with correct naming convention: I_LASTNAME,FIRSTNAME-SDBUDGET-19.xlsx for Initial Budgets and A_LASTNAME,FIRSTNAME-SDBUDGET-19.xlsx

� Budget is submitted to Regional Office Self-Direction Liaison for approval and indicated that the FI has reviewed and approved the budget.


Edited: 9/5/2019

� Follow up: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

fiscal intermediary budget review process 2019 · fiscal intermediary budget review checklist ....

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