Vendor Fiscal/Employer Agent Financial Management Services

Draft Bulletin Comments

May 16, 2008

Thank you for the opportunity to comment on the above mentioned draft bulletin.  It covers vital information concerning a process that assists individuals in living an Everyday Life.  The document covers a  great deal of very complicated information which is needed but the length and complexity of the document is inaccessible for many, if not most, of the waiver participants and their potential surrogates.  As the Participant directed Services workgroup is developing a ?simple? four page explanation of the options, I would suggest that that document be referenced in this bulletin and be provided to families as a requirement of this bulletin to assist in the explanation of options.  The use of this document would also make clear to participants and surrogates that the option of agency providers is also available and can be mixed with PDS services in the plan concurrently.  There must be an assurance included in this bulletin that the selection of one model or another (or a mix) will not affect the level of services needed or provided.

I would like to present some general concerns about the process as it is established by this bulletin.  There will also be some specific concerns as well. 

• How will the determination be made as to whether an individual needs a surrogate?  Will that decision affect any other decisions concerning an individual?s abilities to be a decision maker?

• Might a surrogate need to be appointed (or changed) as the training process proceeds if the participant (or original surrogate) are unable to grasp the information or skills necessary to fulfill the responsibilities?  Will others listed at top of page 6 of draft bulletin be held to same standard?

• How will the support broker responsibilities ameliorate shortcomings in skills of participant and/or surrogate?  The role of the support broker needs to be incorporated as an additional support to participants choosing VF/EA model.

• Can surrogates start prior to completion of background checks if lengthy FBI clearance is necessary?  If not, will this cause a delay in the provision of services?

• Will information gathered in criminal background checks which might preclude an individual from being a surrogate potentially affect the living arrangement of the participant if they are living together?

• Who makes the determination about the performance of surrogates according to the principles of the MR system?  What steps will be in place to assure services are not disrupted if a surrogate needs to be replaced?

• Does the VF/EA FMS have the same responsibilities to ?orient and inform? participants if they choose not to have a surrogate?  Does VF/EA maintain any responsibility if participant mishandles responsibilities?

• Reporting of service usage must be timely (within a month is recommended)  to allow participant/surrogate to track usage and plan remaining services.

• Does the employer requirement to ?orient and train? support staff preclude payment for other training opportunities which are necessary for the support staff to fulfill their responsibilities?  This has been an issue previously with the interpretation being that the employer bore the full responsibility for any necessary training (and the cost thereof).

• On page 18 bullets 5 & 6 should include sharing concerns and procedures with the participant and/or surrogate.

• There is a serious concern about the cost of benefits being an ?optional? component in the hourly wage.  While a minimum number of hours may be necessary to qualify for benefits, they must be available for direct support staff working at least ? time and certainly for full-time staff in order to be comparable to agency providers of the same services.

• This bulletin (and several others) state that services must be approved and authorized in ISP?s before they are provided.  With Promise billing this is even more critical.  What assurances are there for continuity of existing services (from previous ISP?s) during any disagreements about services or service levels needed in ?new? plans?

• We are concerned that there is a strong indication the available funds will weigh heavily on wage ranges which will be offered.  While ODP must approve AE wage ranges, it is unclear whether any changes from current policies/rates will be required during the coming fiscal year.  We hope that ODP will judge the validity and appropriateness of AE wage ranges against the work of Mercer in the area of PD rate setting.

• There does not seem to be any training planned to be provided on incident management reporting system which surrogates and/or participants will be required to use for the first time.  A question also exists regarding the adequacy of investigators at the AE or regional level to cover needed investigations.

We hope you will consider the issues/questions listed above in finalizing this important document.  Again, thank you for the opportunity to give feedback.

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