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GT Financial

Overview of Fiscal Intermediary Overview of Fiscal Intermediary Services

John Carmichael, Director of Business Development

What is Self-Determination?

• The American Revolution was fought for the right of Self-Determination.

• It’s a right for people with or without disabilities.disabilities.

• It’s not a program

Consumer-Directed Care5 Main Principles

• 1 - Freedom

– To Determine A Meaningful Life

– To Identify The Amount, Frequency, &– To Identify The Amount, Frequency, &Duration Of Services

• When The Services Are Needed

• How The Services Are Needed

• By Whom The Services Will Be Provided


• 2 - Authority

– To Control A Budget … With Assistance

– To Purchase Supports– To Purchase Supports

– To Choose (Hire) Personal Assistants WhoWill Provide Care

– To Train, Supervise, & Evaluate The PersonalAssistant (Worker)


• 3 - Support

– The Right To Obtain Formal & InformalResources To Meet Needs & Achieve LifeGoals

• To Select Individual Providers & Direct Reimbursement For Several Waiver Services

• To Release The Worker Should This Become Necessary


• 4 - Responsibility

• For The Wise Use Of Public Funds

– Ability To Negotiate The Rate Of Pay & Other Benefits

– Ability To Engage In A Cooperative Working Arrangement– Ability To Engage In A Cooperative Working ArrangementWith A Financial Manager Who Will:

• Pay The Client’s Worker

• Handle Federal/State taxes and other payroll orbenefits related to the employment of the worker

• Reimburse Other Service Providers Under TheDirection Of The Participant


• 5 - Confirmation

• Consumer-Directed Care Confirms TheImportance Of The Leadership Role Of TheIndividual & The Family

What does it Mean to Us?

1.Honoring Choice

2.Making People Responsible for Their own Supportsfor Their own Supports

3.Telling People About the Money

How does a Fiscal Intermediary help People Lead Self-Determined Lives?

•Provides a mechanism for honoring choice and authority through the employer/employee relationship.

•Choice = Who

•Authority = How, When

GT Financial215 BroadusSturgis, MI 49091(877) 659-4500

•Provides a mechanism, through monthly reports for confirmation.

•Allows for more creative ways to get services

Satisfaction

72

93

69

82

Visiting paid caregiver always came as scheduled (%)Visiting paid caregiver always came as scheduled (%)

Ages 18Ages 18--6464 Age 65+Age 65+

*** ***TT

CC

TT

CC

37

64

62

91

47

68

87

66

Very satisfied with paid help with household activities (%)Very satisfied with paid help with household activities (%)

***Significantly different from control group at .01 level.***Significantly different from control group at .01 level.

*** ***TT

CC

TT

CC

*** ***

Paid caregivers always completed tasks (%)Paid caregivers always completed tasks (%)

TT

CCTT

CC

Unmet Needs

4126

41

37

36

38

Unmet need for personal care (%)Unmet need for personal care (%)

Unmet need for household help (%)Unmet need for household help (%)


***

***

TT

CCTT

CC

***TT

32

47

56

27

27

41

32

37

47

29

29

38

Unmet need for transportation (%)Unmet need for transportation (%)


***

***

***TT

CC

TT

CC

TT

CC

TT

CC

Unmet need for routine health care (%)Unmet need for routine health care (%)

***TT

CC

TT

CC

Adverse Events and Health Problems

29

281919

Fell (%)Fell (%)

Saw doctor for a cut, burn, or scald (%)Saw doctor for a cut, burn, or scald (%)


TT

CC

TT

CC

4.0

136

1.31.9

1.4

78

Saw doctor for a cut, burn, or scald (%)Saw doctor for a cut, burn, or scald (%)

**,,**Significantly different from control group at .10 (*) or .05 (**) level.**Significantly different from control group at .10 (*) or .05 (**) level.

*

TT

CC

TT

CC

**

Bed sores developed or worsened (%)Bed sores developed or worsened (%)

TT

CC

TT

CC

Satisfaction with Overall Care and Life

42

71

54

68

Very satisfied with overall care arrangements (%)Very satisfied with overall care arrangements (%)


***TT

CC

***TT

CC

23

43

37

56

****,,***Significantly different from control group at .05 (**) or .01 (***) level.***Significantly different from control group at .05 (**) or .01 (***) level.

*** ***

Very satisfied with way spending life (%)Very satisfied with way spending life (%)

TT

CC

TT

CC

Informal Caregiver Characteristics

• 86% Female

• 93% Related to consumer

• 62% Lived with consumer• 62% Lived with consumer

• 56% of treatment group caregivers became paid worker

Caregivers Provide Fewer Hours, but

Are More Satisfied

153

140

Hours of Care Provided During Past 2 WeeksHours of Care Provided During Past 2 Weeks

**TreatmentTreatment

ControlControl

**Significantly different from control group at .05 level.**Significantly different from control group at .05 level.

43

61

Very Satisfied with Care Arrangements (%)Very Satisfied with Care Arrangements (%)


***TreatmentTreatment

ControlControl

Caregiver Well-Being

36

22

Report caregiving causes great financial strain (%)Report caregiving causes great financial strain (%)

Report caregiving causes great emotional strain (%)Report caregiving causes great emotional strain (%)


ControlControl

32

34

23

27

Report caregiving causes great emotional strain (%)Report caregiving causes great emotional strain (%)

Report caregiving causes great physical strain (%)Report caregiving causes great physical strain (%)



ControlControl

TreatmentTreatment

ControlControl

***

Caregiver Health and Life Satisfaction

47

36

Current Health is Fair or Poor Relative to PeersCurrent Health is Fair or Poor Relative to Peers

**TreatmentTreatment

ControlControl

**Significantly different from control group at .05 level.**Significantly different from control group at .05 level.

39

51

Very Satisfied with Life (%)Very Satisfied with Life (%)



ControlControl

Policy Concerns for Hired Workers

Without agency support

Will workers be under-compensated or mistreated?

Will workers receive adequate training?Will workers receive adequate training?

Will workers feel emotionally and physically strained?

What pattern of care will workers provide?

Findings for Hired Workers

Hired workers

• Were mostly relatives (78%) and friends (16%)

• Received pay similar to that of agency • Received pay similar to that of agency workers: $6 per hour for about 12 hours a week

• Provided an average of 26 hours of unpaid care per week

• Helped with wide range of tasks

Most Concerns about Workers Didn’t Materialize

• Many lacked formal training, but:

– Most felt well-prepared

– No greater physical problems for workers or consumers

• Had low compensation and fringes, but:

– Most were very satisfied with pay and conditions

• Felt more emotional strain and wanted more respect but:

– Difference confined to hired relatives

Some Things You Should Know About GT

• We’ve been providing fiscal intermediary services in Michigan since 2005

• Our mission is to facilitate Self-Determined lives for everyone, especially people who need mental health and long term care services.

•We believe in personalized service, rapid response, accountability, collaboration, professionalism, and application of technology.


collaboration, professionalism, and application of technology.

•We provide services in Michigan, Wisconsin and North Carolina and we are the largest FI in Michigan.

Tim and Dave…


Areas of Service

•Field Services

•Customer Service

•Payroll/Disbursement

•Claims/Reimbursement

•Reporting


•Reporting

•Eligibility Monitoring

Field Services

•Field Service Representative

•Works with agency clinical staff to coordinate enrollments.

•Conducts face-to-face kickoff meetings

•Helps calculate budgets

•Heads off potential problems and works to solve problems.

•Liaison between agency clinical staff and GT administration.


•Liaison between agency clinical staff and GT administration.

Field Services Cont’d

•The Kickoff Process

•Requires an employer – Referral Form

•Requires an employee – Job Application and Background Check Authorization

•Requires an authorization/budget – info is contained on the referral form

•Field Service Representative creates budget and enrollment documents


•Field Service Representative conducts face to face meeting with family to explain documents, agreements and requirements for the program.

•Field Service Representative enrolls employees and explains payroll process.

Field Services Cont’d

•Other Services:•Work through special situations (special disbursements, family dynamics, etc.)•Provide knowledge on self-direction issues•Provide information at case management meetings


Customer Service

Customer Service Associates

•Available by toll free phone M-F 8-5

•Help employers/employees understand documentation requirements.

•Assist employers with hiring/firing of employees.

•Answer questions related to individual reports

•Maintain up to date authorization information in GT’s system.


Payroll/Disbursement

•Ensure that timesheets/invoices comply with agency standards for documentation.

•Verify that services are authorized before issuing payment

•Verify that employers have not exceeded their budget before disbursing payment.

•Issue Paychecks according to a pre-defined payroll schedule that is published and distributed to employees.


that is published and distributed to employees.

•Conduct withholding, payroll tax filing and other tax compliance activities.

•Direct deposit, garnishments, employment verifications

Claims/Reimbursement•Processed at the State level

•Referral form is my authorization

•Budget will contain information for setup in AQUIP

•Future authorization changes will come through referral forms.


Reporting

•Issue monthly individual reports to employers.

•Reports sent to case manager, agency administrative staff, whomever is designated by the employer.

•Customer service helps people understand reports.

•Reports designed to provide different levels of feedback.


Eligibility Monitoring

•Training

•Enforce training requirements as dictated by the employer or lead agency

•Background Checks

•Conduct BG checks

•Guide employers on rules around BG checks.

•Apply Criminal Background Policy per Lead Agency

•Absence of a history of abuse, neglect, exploitation, and violent crimes


•Absence of a history of abuse, neglect, exploitation, and violent crimes

•18 years of age or older

• A relative who is not acting as the legal guardian or legal representative of the participant.

•Other requirements as specified by the participant

Nuts And Bolts

• Referrals

• Authorizations

• Pre-enrollment

• Enrollment

• Employee payroll

• Budget reports


Referrals

• Lead Agencies begin the process by explaining the Self Direction option.

• During the Person Centered Planning process, the Participant will identify the resources they need to achieve their goals.

• Participant indicates interest in self-direction

• Care Advisor facilitates self-direction training

• Care Advisor completes referral form.


• GT Financial field representative calculates budget and returns authorization form.

Authorizations

• Lead agency enters authorization data in AQUIP system

• Future changes to authorization are done through a new referral form

• GT will confirm AQUIP authorization


Budget Template Only Enter Data in the Yellow Cells!

Revenue Agency/Co-employment arrangement, check here:

Direct Care Hours Authorized Units D/H Rate

Total Gross

Payments Monthly Worker's Comp Rates Employee Gross Wages:

Hourly only WC Rate- Home/Pulic/etc.

Supportive Home Care 1560 H $10.92 17,037.07 1,419.76 Consumer Name: Robert Sample Gross Premium

0 H $10.92 0.00 0.00 Auth Begin: 3/1/10 Auth End: 2/28/11 Expense Constant

0 $10.92 0.00 0.00 Start Date: 3/1/10 Member ID: 999999 Total Premium

0 $10.92 0.00 0.00 EOR (if different): GT Financial Services Minimum Premium

Total Hourly/Daily 1560 17,037.07 1,419.76

Non-Hourly Revenue 0.00

Classificati

on

Full

Time

Hours

Full Time

Rate

Part

Time

Hours

Part

Time

Rate

Expense

Constant

Charge Estimated Premium

Respite (Per Diem) D 0.00 $0.00 0.00 908/913

20 or

more $476.00

less than

20 $309.00 $220.00. $0.00 0.00 8835 N/A $628.00 N/A $628.00 $0.00

Months covered by budget: 12

Total Income/Service Hours 1560 $17,037.07 $1,419.76

# FT #PT Worker Compensation Category

Workers Comp (Enter # of FT/PT Employees to the right. ) $483.13 0 0 Domestic Worker FALSE FALSE FALSE

Additional Non Hourly-Payroll Expenses: 0 0 Home/Public/Traveling Healthcare 483.13

. $0.00 Notes:

Respite (Per Diem) Employees: Supportive Home Care 1,560.00

$0.00 Personal Care 0.00

0.00

DO NOT ERA

0.00

Subtotal $16,553.94 0.00

Total Equivalent Hrs 1,560.00

Employer Payroll Taxes $1,430.13 Total Cost of Services

Summary Total Monthly

Total Available For Employee $15,123.81 Labor, including taxes, mileage $16,553.94 1,379.50 PER DIEM SERVICES

Max Daily Rate $9.50 Workmans Compensation $483.13 40.26 Enter Respite Pay Rate Per Day:

Other Non Hourly Expense $0.00 0.00 Payroll taxes and W/C:

Enter Rate to Calculate Cost: $9.50 . $0.00 . Total cost of SHC per day

Calculated Cost $17,037.07 Total $17,037.07 1,419.76

Left Over $0.00

Payroll taxes 12.05percent, W/C 3.49 perce

Payroll tax - Per Diem

Workmans Comp

Note: Total

Hourly services only TRUE 455

Per diem services (Respite, etc. must be shown in both areas.

Pre-enrollment

• The employee will complete a job application and consent for background check.

• Upon receiving a referral form, the GT Field rep will collect completed employment applications/BG check authorizations from the care advisor and conduct the background check

• Background checks are typically done within 48 hours after receipt of the consent.

• The field service representative will coordinate an enrollment with • The field service representative will coordinate an enrollment with the participant, employee and care advisor.

• The enrollment documents are prepared prior to the enrollment. Enrollments can usually be scheduled within 5 business days of receiving necessary intake forms.

GT Financial113 N. Monroe StSturgis, MI 49091(877) 659-4500

Enrollment

• The enrollment can take place at the participant’s home, or preferred public location. The field service representative will be flexible.

• The purpose of the enrollment is to complete the required agreements and tax forms and to provide instructions on the payroll process (filling and sending timesheets)

• In addition, the enrollment is an opportunity to coach participants and employees about being in the employer/employee relationship and helping them to understand Medicaid requirements. and helping them to understand Medicaid requirements.


Employee Payroll

• Employees are paid twice a month.

• Payment is made by:

– Paper check

– Direct deposit

– Debit Card

• Time reports can be mailed, scanned and emailed, or faxed via toll free number

• When time reports are received they are examined for conflicting or incomplete data. Participants/employees are contacted when data is conflicting or incomplete.


Payroll Schedule


Employee Payroll


Budget Reports

• Budget reports are issued monthly, usually mid month of the following month.

• Reports will be distributed to the Participant and the Lead Agency/Care Advisor


Thank You

Downloadable forms are located at:

http://www.gtindependence.com/cap-da

This presentation can also be downloaded at the above link.

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