Building Building Relationships with Relationships with

Fiscal IntermediariesFiscal Intermediaries

Annette DowneyAnnette DowneyExecutive DirectorExecutive Director

Community Living Services of Oakland County

Ellen Sugrue HymanConsultant, Michigan Department of Community

Health

Principles of Principles of Self-DeterminationSelf-Determination

FreedomFreedom

AuthorityAuthority

Support Support

ResponsibilityResponsibility

ConfirmationConfirmation

IntroductionIntroduction

Arrangements that support self-Arrangements that support self-determination mean exercising authority to determination mean exercising authority to responsibly responsibly managemanage the use of needed the use of needed services and supports by services and supports by controlling an controlling an individual budgetindividual budget and and choosing choosing and controlling workers and and controlling workers and providers.providers.

What do we Call the FI?

• FI – Fiscal Intermediary

• FE/A- Fiscal Employer/Agent

• FSE – Fiscal Support Entity

• FMS – Financial Management Service

• NOT an Investment Banker

Michigan’s SystemMichigan’s System

• Organized Health Care Delivery Organized Health Care Delivery System (OHCDS)System (OHCDS)

• Managed Care EntitiesManaged Care Entities– 21 PIHPs21 PIHPs– 48 CMHSPs48 CMHSPs

• Each responsible for own FI Each responsible for own FI arrangementsarrangements

FI Service DefinitionFI Service Definition

• Fiscal Intermediary Services is a Fiscal Intermediary Services is a

b (3)Waiver Serviceb (3)Waiver Service

FI Service DefinitionFI Service Definition

Fiscal intermediary services include, but are not limited to:

• Facilitation of the employment of service workers by the beneficiary, including federal, state and local tax withholding/payments, unemployment compensation fees, wage settlements, and fiscal accounting;

• Tracking and monitoring participant-directed budget expenditures and identifying potential over- and under-expenditures;

• Assuring adherence to federal and state laws and regulations; and

• Ensuring compliance with documentation requirements related to management of public funds.

FI Service DefinitionFI Service Definition

Fiscal Intermediary Services is defined as servicesthat assist the adult beneficiary, or arepresentative identified in the beneficiary’sIPOS, to meet the beneficiary’s goals of community participation and integration, independence or productivity while controlling his individual budget and choosing staffwho will provide the services and supports identified in the IPOS and authorized by the PIHP. as to promote independence and inclusive community living for the beneficiary.

FI Service DefinitionFI Service DefinitionThe fiscal intermediary helps the beneficiary manage

anddistribute funds contained in the individual budget. Thefiscal intermediary may also perform othersupportive functions that enable the beneficiary• to self-direct needed services and supports. These

functions may include selecting, contracting with or employing and directing providers of services, verification of provider qualifications

• (including reference and background checks), and assisting the beneficiary to understand billing and documentation requirements.

MI Guidance on Fiscal MI Guidance on Fiscal IntermediariesIntermediaries

• Self-Determination Policy and Self-Determination Policy and Practice GuidelinePractice Guideline

• Choice Voucher System Technical Choice Voucher System Technical AdvisoryAdvisory

• Readiness Review ProtocolReadiness Review Protocol

SD Policy & Practice SD Policy & Practice GuidelineGuideline• E. E. A CMHSP shall collaborate with and guide A CMHSP shall collaborate with and guide

the fiscal intermediary and each consumer the fiscal intermediary and each consumer involved in self-determinationinvolved in self-determination to assure to assure compliance with various state and federal compliance with various state and federal requirements, and to assist the consumer in meeting requirements, and to assist the consumer in meeting his/her obligations to follow applicable requirements. his/her obligations to follow applicable requirements. It is the obligation of the CMHSP to assure that It is the obligation of the CMHSP to assure that the entities selected to perform intermediary the entities selected to perform intermediary functions are capable of meeting and functions are capable of meeting and maintaining compliance with the requirements maintaining compliance with the requirements associated with their stated functions, associated with their stated functions, including those contained in relevant MDCH including those contained in relevant MDCH Technical Assistance AdvisoriesTechnical Assistance Advisories..

FI Entities in MichiganFI Entities in Michigan

Examples of entities that might serve Examples of entities that might serve in the role of a fiscal intermediary in the role of a fiscal intermediary include: bookkeeping or accounting include: bookkeeping or accounting firms; local ARC or other advocacy firms; local ARC or other advocacy organizations; a subsidiary of a service organizations; a subsidiary of a service provider entity if no conflict of interest provider entity if no conflict of interest exists.exists.

The Choice Voucher The Choice Voucher SystemSystem

The Choice Voucher System is not The Choice Voucher System is not “self- determination.” It is a “self- determination.” It is a concrete set of methods to concrete set of methods to successfully implement successfully implement arrangements that support self-arrangements that support self-determination.determination.

Fiscal Intermediary/CVS TAFiscal Intermediary/CVS TA

• Fiscal Intermediary Roles & Responsibilities Fiscal Intermediary Roles & Responsibilities .12.12

• Key Elements of the Relationship Between Key Elements of the Relationship Between the PIHP/CMHSP and the Fiscal the PIHP/CMHSP and the Fiscal IntermediaryIntermediary………….13.13

• The Value of Using an Independent Agency The Value of Using an Independent Agency 1515

• Putting it all Putting it all Together................................16Together................................16

Fiscal Intermediary/CVS TAFiscal Intermediary/CVS TAFiscal Intermediary Roles & Fiscal Intermediary Roles &

Responsibilities .......12Responsibilities .......12

• APPENDIX A: LIST OF FISCAL APPENDIX A: LIST OF FISCAL INTERMEDIARY FUNCTIONSINTERMEDIARY FUNCTIONS

• Fiscal Intermediary QualificationsFiscal Intermediary Qualifications

• Administrative FunctionsAdministrative Functions

• Employer Agent FunctionsEmployer Agent Functions

• Employee Verification FunctionsEmployee Verification Functions

• Information and Guidance FunctionsInformation and Guidance Functions

Fiscal IntermediaryFiscal Intermediary CVS/TACVS/TA

Key Elements of the Relationship Between the Key Elements of the Relationship Between the PIHP/CMHSP and the Fiscal IntermediaryPIHP/CMHSP and the Fiscal Intermediary………………1313

•FI has a fiduciary relationship with the FI has a fiduciary relationship with the PIHP/CMHSP for accountability of public fundsPIHP/CMHSP for accountability of public funds

•Service Provider to Participant b(3) ServiceService Provider to Participant b(3) Service

•Fiscal Intermediary Agreement is CriticalFiscal Intermediary Agreement is Critical

•Draft Draft AgreementAgreement……………………………………………………………………………………2323

Fiscal Intermediary CVS/TAFiscal Intermediary CVS/TAThe Value of Using an Independent The Value of Using an Independent

Agency .....15Agency .....15

• Handles and monitors Individual BudgetsHandles and monitors Individual Budgets

• Handles payments quickly and efficientlyHandles payments quickly and efficiently

• Can insulate the PIHP/CMHSP from Can insulate the PIHP/CMHSP from LiabilityLiability

• Handles Employer Agent FunctionsHandles Employer Agent Functions

PIHP/CMHSP FunctionsPIHP/CMHSP Functions1. Develop a FI Agreement that outlines the 1. Develop a FI Agreement that outlines the

minimum functions of both the PIHP/minimum functions of both the PIHP/ CMHSP and the fiscal intermediary;CMHSP and the fiscal intermediary;

2. Develop and provide a written set of 2. Develop and provide a written set of procedures for the FI including clearprocedures for the FI including clearguidance on the minimum requirements guidance on the minimum requirements for accounting;for accounting;

3. Require FI to maintain liability insurance 3. Require FI to maintain liability insurance and indemnify PIHP/CMHSP forand indemnify PIHP/CMHSP for performance of FI functions;performance of FI functions;

FI QualificationsFI Qualifications

• Cannot be a provider of direct mental Cannot be a provider of direct mental health serviceshealth services

• Cannot be a guardian or trust holder of Cannot be a guardian or trust holder of any participant or have any other any participant or have any other compensated fiduciary relationship with a compensated fiduciary relationship with a participant except rep. payeeparticipant except rep. payee

• Must be able to fulfill the functions Must be able to fulfill the functions required by CMHSP as identified in the FI required by CMHSP as identified in the FI AgreementAgreement

ProcurementProcurement

• Networking at Conferences/EventsNetworking at Conferences/Events

• Request for Proposal ProcessRequest for Proposal Process

• Readiness Review ProcessReadiness Review Process

SD Policy & Practice SD Policy & Practice GuidelineGuideline

• A CMHSP shall select and make A CMHSP shall select and make available qualified third-party available qualified third-party entities that may function as fiscal entities that may function as fiscal intermediariesintermediaries to perform employer to perform employer agent functions and/or provide other agent functions and/or provide other support management functions, in support management functions, in order to assist the consumer in order to assist the consumer in selecting, directing and controlling selecting, directing and controlling providers of specialty services and providers of specialty services and supports.supports.

Readiness Review ProtocolReadiness Review Protocol Procurement/Readiness Review ProtocolProcurement/Readiness Review Protocol

• I. Status Of Physical Plant Equipment, Information I. Status Of Physical Plant Equipment, Information Systems Technology, And Customer Service SystemSystems Technology, And Customer Service System

• II. Coordination And Communication With II. Coordination And Communication With PIHP/CMHSP Support CoordinatorsPIHP/CMHSP Support Coordinators

• III. Administration III. Administration –– FI Policies And Procedures FI Policies And Procedures Manual, Quality Management Plan, And Staying Up-to-Manual, Quality Management Plan, And Staying Up-to-date With Federal And State Rules And Regulations date With Federal And State Rules And Regulations Pertaining To Vendor FiscalPertaining To Vendor Fiscal

Readiness Review ProtocolReadiness Review Protocol

• IV. Administration IV. Administration –– Record Management Process Record Management Process• V. Administration V. Administration –– Processing Payroll And Invoices Processing Payroll And Invoices

Preparing And Submitting Required Reports To StatePreparing And Submitting Required Reports To State• Government And Program Government And Program

Participants/representativesParticipants/representatives• VI. Enrollment Of Participants And WorkersVI. Enrollment Of Participants And Workers• Vii. FEIN ProcessVii. FEIN Process

Request for Proposal Request for Proposal ProcessProcess

• FI QualificationsFI Qualifications

• FI ServicesFI Services

• Other RequirementsOther Requirements

• Service Cost/PaymentService Cost/Payment

Agreement/ServicesAgreement/Services

• Agreement defines Agreement defines functions/responsibility of each party.functions/responsibility of each party.

• Required Functions/Other FunctionsRequired Functions/Other Functions

• Payment ArrangementsPayment Arrangements

• Should be IndividualizedShould be Individualized

Developing the FI Relationship• Involve Clinical and Finance People.

• The Relationship requires input from both sides.• Create Empathy for a common goal. (you’re on the same team!)

• Involve the FI• The FI is a financial arm of arrangements Self-Determination.• The FI can be a great resource for documentation and backup.

• Electronic Claims Processing• The FI should understand and interface with the claims system.• Develop relationships with third party vendors• Shortcut process steps for more efficient data transfer• Reimbursement cycle shortens

Variety in the FI Role

• Traditional service includes:– Payroll Agent– Individual Reporting– Customer/Field Services– Claims Processing/Invoicing

• More limited version:– Payroll Agent– Basic Claims

MonitoringMonitoring

• Service Monitoring by PIHP/CMHSPService Monitoring by PIHP/CMHSP

• Monthly ReportsMonthly Reports

• Ongoing CommunicationOngoing Communication

• Mechanisms for Q&A from Mechanisms for Q&A from PIHP/CMHSPPIHP/CMHSP

Assessment CriteriaAssessment Criteria

• Develop and implement plan for assessing Develop and implement plan for assessing and monitoring FI performance that involves and monitoring FI performance that involves participants, families and advocatesparticipants, families and advocates– Fulfillment of FI Agreement RequirementsFulfillment of FI Agreement Requirements– Evaluation of participant feedback and Evaluation of participant feedback and

satisfaction datasatisfaction data– Involvement of participants and family Involvement of participants and family

members in the development and members in the development and implementation of the FI arrangementimplementation of the FI arrangement

– Perform audit of a sample of the budgetsPerform audit of a sample of the budgets

Monthly Budget Report• Monthly Budget Reports to Supports Coordinator (at PIHP/CMHSP) and Participant

• Things to Look Out for

• No/Reduced budget activity

• High employee turnover

• Over use of budget

• Participant Follow-up is key

Community Living Community Living Services Services

of Oakland Countyof Oakland CountyFunded by the Oakland County Community Funded by the Oakland County Community

Mental Health AuthorityMental Health Authority

CLS/OC was developed in October, 2004 after CLS/OC was developed in October, 2004 after a response to a RFP issued by OCCMHAa response to a RFP issued by OCCMHA

OCCMHA was looking to contract with an OCCMHA was looking to contract with an agency exclusively designed to advance Self-agency exclusively designed to advance Self-Determination, and to add choice of provider Determination, and to add choice of provider agencies for people with developmental agencies for people with developmental disabilities in Oakland County.disabilities in Oakland County.

Community Living Community Living Services Services

of Oakland Countyof Oakland County

Actively supporting 450 people, each self-Actively supporting 450 people, each self-directs their services via an individual directs their services via an individual budget and use of a Fiscal Intermediary budget and use of a Fiscal Intermediary (FI).(FI).

Our enrollment numbers increase each Our enrollment numbers increase each month by approximately 15 people per month by approximately 15 people per month, some are transferring from the month, some are transferring from the other service provider, and some are new other service provider, and some are new to the system.to the system.

Community Living Community Living Services Services

of Oakland Countyof Oakland CountyEveryone who chooses CLS/OC is choosing Everyone who chooses CLS/OC is choosing

Self-Determination, as it is our only model of Self-Determination, as it is our only model of support.support.

GT Financial Services is the Fiscal GT Financial Services is the Fiscal Intermediary for everyone served by CLS/OC.Intermediary for everyone served by CLS/OC.

Our agency is designed exclusively around Our agency is designed exclusively around the principles of Self-Determination and the principles of Self-Determination and having people being served self-direct ALL of having people being served self-direct ALL of their authorized services through a Fiscal their authorized services through a Fiscal Intermediary.Intermediary.

More than just an individual More than just an individual budget:budget:

Planning for Meaningful Planning for Meaningful LivesLives

• Dreaming- A Person’s Vision Of Dreaming- A Person’s Vision Of His/Her Desired FutureHis/Her Desired Future

• Planning- Taking the Steps to Get Planning- Taking the Steps to Get ThereThere

• Attaining the Desired OutcomesAttaining the Desired Outcomes– Someone to Love, Something to Do, Someone to Love, Something to Do,

Something to Look Forward toSomething to Look Forward to– Having Friends, Relationships, Income, Having Friends, Relationships, Income,

and a Role in the Communityand a Role in the Community– Choosing Where and With Whom You LiveChoosing Where and With Whom You Live– Being Healthy And SafeBeing Healthy And Safe

Funding people, not Funding people, not programsprograms

Everyone supported by CLS/OC has a self-Everyone supported by CLS/OC has a self-directed budget they use to implement their directed budget they use to implement their Person-Centered Plan. Person-Centered Plan.

Open choice of service providers.Open choice of service providers. Services are Services are provided by community based, independent provided by community based, independent contractors and agencies including:contractors and agencies including:Independent Supports Coordinators & BrokersIndependent Supports Coordinators & BrokersRespiteRespiteClinical ServicesClinical ServicesCommunity Living Supports (Staffing)Community Living Supports (Staffing)Skill-Building or Employment ServicesSkill-Building or Employment Services

Building Real Building Real Authority & ControlAuthority & Control

Independent people and agencies enter into Independent people and agencies enter into agreements directly with the people they support. The agreements directly with the people they support. The agreements outline roles, responsibilities, agreements outline roles, responsibilities, expectations, and agreed upon fees for services.expectations, and agreed upon fees for services.

Their invoices or timesheets are reviewed with the Their invoices or timesheets are reviewed with the person / family and then payments are issued through person / family and then payments are issued through the Fiscal Intermediary.the Fiscal Intermediary.

The person is provided with a monthly Revenue & The person is provided with a monthly Revenue & Expense Report, so they know the exact cost related Expense Report, so they know the exact cost related to the services they receive. They also know how to the services they receive. They also know how much they have spent YTD and how much is left in much they have spent YTD and how much is left in their budget.their budget.

Building Real Building Real Authority & ControlAuthority & Control

• Staff/clinicians/providers are all hired and fired Staff/clinicians/providers are all hired and fired by the individuals they support.by the individuals they support.

Focus is upon the person as the customer.Focus is upon the person as the customer.

Providers compete for person’s choice (must Providers compete for person’s choice (must satisfy the person in order to stay in business).satisfy the person in order to stay in business).

Competition drives provider quality, and Competition drives provider quality, and “raises the bar” on quality service provision.“raises the bar” on quality service provision.

Budget ProcessBudget Process

Budget Development is based on good Budget Development is based on good Person-Centered Planning.Person-Centered Planning.

Identification of Hopes & DreamsIdentification of Hopes & DreamsIdentification of Support NeedsIdentification of Support NeedsUtilization of Natural Supports/ Utilization of Natural Supports/

Community Resources/EntitlementsCommunity Resources/EntitlementsAuthorization of ServicesAuthorization of Services

Plan Authorization + Rates = Plan Authorization + Rates = BudgetBudget

Budget ImplementationBudget Implementation

Discuss Fiscal Intermediary role / schedule Discuss Fiscal Intermediary role / schedule kick off meeting with the FI.kick off meeting with the FI.

Coordinate/confirm Service Provider Coordinate/confirm Service Provider selection and understanding of selection and understanding of expectations.expectations.

Signed AgreementsSigned Agreements

Signed ConsentsSigned Consents

Service AuthorizationsService Authorizations

Adherence to Medicaid Adherence to Medicaid RegsRegs

CLS/OC maintains responsibility for CLS/OC maintains responsibility for credentialing/screening providers before credentialing/screening providers before authorizing Medicaid payments:authorizing Medicaid payments:

CLS conducts the credentialing process CLS conducts the credentialing process for independent contractors and agencies, if for independent contractors and agencies, if the individual has a person or agency in mind the individual has a person or agency in mind that they would like to hire.that they would like to hire.

If the person does not have anyone in If the person does not have anyone in mind, CLS/OC provides options/resources mind, CLS/OC provides options/resources regarding pre-credentialed providers, and regarding pre-credentialed providers, and assists the person in the interviewing and assists the person in the interviewing and selection process.selection process.

Adherence to Medicaid Adherence to Medicaid RegsRegs

Fiscal Intermediary does credentialing for all Fiscal Intermediary does credentialing for all direct hire employees, including:direct hire employees, including:

Criminal Background ChecksCriminal Background Checks

Tracking and ongoing follow up related Tracking and ongoing follow up related to training requirementsto training requirements

Fiscal Intermediary RoleFiscal Intermediary Role

• IntakeIntake – includes face to face “kick off” – includes face to face “kick off” meeting with new people choosing SDS to meeting with new people choosing SDS to explain procedures and complete all formsexplain procedures and complete all forms

• DisbursementDisbursement – disburse payroll for – disburse payroll for direct hire employees and pay invoicesdirect hire employees and pay invoices

• ReportingReporting - Individual and aggregate R & - Individual and aggregate R & E ReportsE Reports

• Claims/ReimbursementClaims/Reimbursement – data – data processing, submission of claims in processing, submission of claims in electronic 837 fileelectronic 837 file

• Customer Support ServicesCustomer Support Services

Fiscal Intermediary RoleFiscal Intermediary Role

• IntakeIntake – includes face to face “kick – includes face to face “kick off” meeting with new people to off” meeting with new people to explain procedures and complete all explain procedures and complete all formsforms

A smile, friendly handshake, and A smile, friendly handshake, and discussions over a cup of coffee discussions over a cup of coffee means a lot to peoplemeans a lot to people

Fiscal Intermediary RoleFiscal Intermediary Role

The employer/employee forms and hiring The employer/employee forms and hiring process are far less intimidating for people process are far less intimidating for people with face to face Fiscal Intermediary with face to face Fiscal Intermediary guidance.guidance.

Case Managers/Support Coordinators Case Managers/Support Coordinators

don’t have to be Employer/Employee don’t have to be Employer/Employee regulation experts:regulation experts:

Let the FI do what they do best!Let the FI do what they do best!

Fiscal Intermediary RoleFiscal Intermediary Role

Let the FI do Let the FI do what they do best!what they do best!

Assist with completion of all required IRS forms.Assist with completion of all required IRS forms.

Assures all taxes are deducted/paid.Assures all taxes are deducted/paid.

Labor laws are followed.Labor laws are followed.

Fiduciary responsibility to handle, manage, Fiduciary responsibility to handle, manage, and account for the funds in the budgets.and account for the funds in the budgets.

Fiscal Intermediary RoleFiscal Intermediary Role

• DisbursementDisbursement – Disburse payroll for – Disburse payroll for direct hire employees and pay direct hire employees and pay invoicesinvoices

For the person’s entire plan, all For the person’s entire plan, all authorized services, not just payrollauthorized services, not just payroll

A combination of direct hire A combination of direct hire employees, individual contractors employees, individual contractors (Support Coordinators or Brokers), and (Support Coordinators or Brokers), and agencies can be utilizedagencies can be utilized

Fiscal Intermediary RoleFiscal Intermediary Role

• ReportingReporting – Revenue & Expense – Revenue & Expense

ReportsReports

Challenge is to provide as Challenge is to provide as much information as possible, much information as possible,

while still being user friendly.while still being user friendly.

Fiscal Intermediary RoleFiscal Intermediary Role

• ReportingReporting – Revenue & Expense – Revenue & Expense

ReportsReports

Challenge is to provide as Challenge is to provide as much information as possible, much information as possible,

while still being user friendly.while still being user friendly.

Individual R&Es are sent to Individual R&Es are sent to the person and Independent the person and Independent Support Coordinator each month.Support Coordinator each month.

CLS/OC Self-Determination Coordinator CLS/OC Self-Determination Coordinator reviews individual R&E reports each month reviews individual R&E reports each month to monitor for over/under utilization. to monitor for over/under utilization. Schedules a meeting with person/support Schedules a meeting with person/support circle if concerns are noted.circle if concerns are noted.

CLS/OC Director reviews aggregate CLS/OC Director reviews aggregate report for entire agency / total report for entire agency / total enrollment (ongoing assessment of enrollment (ongoing assessment of expenditures vs. revenue in aggregate).expenditures vs. revenue in aggregate).

Revenue & Expense Revenue & Expense ReportsReports

Fiscal Intermediary RoleFiscal Intermediary Role

• Claims/ReimbursementClaims/Reimbursement – data – data processing, submission of claims in processing, submission of claims in electronic 837 fileelectronic 837 file

Encounter data, with exact unit costs, Encounter data, with exact unit costs, are entered for submission to are entered for submission to county/state by the Fiscal county/state by the Fiscal Intermediary.Intermediary.

Fiscal Intermediary RoleFiscal Intermediary Role

• ReportingReporting – Revenue & Expense – Revenue & Expense

ReportsReports

Challenge is to provide as Challenge is to provide as much information as possible, much information as possible,

while still being user friendly.while still being user friendly.

Individual R&Es are sent to Individual R&Es are sent to the person and Independent the person and Independent Support Coordinator each month.Support Coordinator each month.

CLS/OC Self-Determination Coordinator CLS/OC Self-Determination Coordinator reviews individual R&E reports each month reviews individual R&E reports each month to monitor for over/under utilization. to monitor for over/under utilization. Schedules a meeting with person/support Schedules a meeting with person/support circle if concerns are noted.circle if concerns are noted.

CLS/OC Director reviews aggregate CLS/OC Director reviews aggregate report for entire agency / total report for entire agency / total enrollment (ongoing assessment of enrollment (ongoing assessment of expenditures vs. revenue in aggregate).expenditures vs. revenue in aggregate).

Revenue & Expense Revenue & Expense ReportsReports

Fiscal Intermediary RoleFiscal Intermediary Role

• Customer Support ServicesCustomer Support Services

Think about how you want to define Think about how you want to define the FIs role in Customer Service?the FIs role in Customer Service?

There are lots of options, varying from There are lots of options, varying from FIs participating in three hour FIs participating in three hour problem solving meetings in people’s problem solving meetings in people’s homes homes TO/ORTO/OR strict policy strict policy implementation (you set the policy implementation (you set the policy and they enforce it)? and they enforce it)?

Fiscal Intermediary RoleFiscal Intermediary Role

• Customer Support ServicesCustomer Support Services

Make sure you agree on agency Make sure you agree on agency philosophy, language, flexibility, etc.philosophy, language, flexibility, etc.

For example, at CLS/OC we do not For example, at CLS/OC we do not refer to those we support as “clients” refer to those we support as “clients” or “consumers”, and therefore we or “consumers”, and therefore we expect the same from our FI. expect the same from our FI.

Joint PartnershipJoint PartnershipPeople We Support, FI, CMHPeople We Support, FI, CMH

The establishment of a positive rapport and The establishment of a positive rapport and trust with people supported and their trust with people supported and their families is key to successful Self-families is key to successful Self-Determination arrangements.Determination arrangements.

Be honest and acknowledge that you are Be honest and acknowledge that you are working together to make these working together to make these arrangements work well for everyone arrangements work well for everyone involved – successful system changes take involved – successful system changes take time and solid partnerships.time and solid partnerships.

Say what you mean, mean what you Say what you mean, mean what you say.say.

Benefits of Fiscal Intermediary

• Removing Paperwork Roadblocks

• Collaborating with PIHP/CMHHS Staff

• Helping Navigate SD related Issues

Viewing Services Viewing Services DifferentlyDifferently

People need to know how much their People need to know how much their services cost in order for them to services cost in order for them to assess whether what they are assess whether what they are receiving is of good value to them.receiving is of good value to them.

Shifting control over supports helps Shifting control over supports helps people and their families be more in people and their families be more in control of their lives. It also helps control of their lives. It also helps make sure providers know who they make sure providers know who they work for.work for.

Aim HighAim High

Celebrate Self-Determination Celebrate Self-Determination success stories!success stories!

Where creativity leads, Where creativity leads,

policy and practice follows. policy and practice follows.