CSS Plan/Budget Training New York State Office of Mental Retardation and Developmental Disabilities – 02/27/2009.

CSS Plan/Budget Training

New York State Office of Mental Retardation and Developmental Disabilities – 02/27/2009

Key Points:

CSS plans and budgets are individualized to meet a specific person’s needs and require attention to detail.

If a service is not approved in the budget, the cost is not reimbursable.

Plans and budgets are portable, i.e., follow the person, no guaranteed backfills.

CSS is a fiscal Partnership between the individual and OMRDD.

OMRDD is the funder of last resort, applicants must apply for all other benefits they are eligible for or entitled to first.

Plan/Budget Review Schedule:

CSS plan/budget reviews should coincide with annual/semi annual ISP reviews.

Amendments for health/life safety situations or to correct calculation errors can be done as necessary.

Plan/Budget Forms:

Overview.

Unit of Service:

CSS has a monthly unit of service. To be eligible to receive payment for the

monthly unit of service, four face to face visits are required.

Each face to face visit must be documented.

Plan/Budget Components:

Plan. Plan Worksheets. Individual Budget. Fiscal Resources. Expense Allocation. Price Sheet. Reconciliation Worksheet.

Staffing:

Reported in the Staff Supports section of the Plan Worksheets.

Must identify the Position Title, Activities Performed, Hourly Wage, Hours Worked Per Week, Weeks Per Year, Annual Earnings, Fringe Benefit Percentage and Total Cost Per Position.

Staffing Continued:

If an increase in salary (raise) is expected between plan review periods, the increase must be reflected in the Staff Supports section of the Plan Worksheets.

Increases in salary (raises) are reflected by identifying the new wage and the number of weeks at the new salary level.

Staffing Continued:

Avoid using position titles with Vocational or Educational in them.

Staffing Continued:

If one staff person is performing more than one service such as Community Integration and Residential Habilitation, the hours for each service must be identified.

Example: – Staff 1 – Community Integration 20 hours per

week.– Staff 1 – Residential Habilitation 20 hours per

week.

Staffing Continued:

Part 2 of the Plan Worksheets is a weekly schedule, and must be completed as part of the application submission.

The weekly schedule must reflect the staffing requested in the Staff Supports section.

Staffing Continued:

Self Hired Staff Vs. Staff Purchased from an agency.– Self Hired staff are identified in the Staff Supports section of

the Plan Worksheets as discussed above.– If staff are purchased from an agency they are identified at

the bottom of Part 1 of the Plan Worksheets and before the weekly schedule.

– Staff purchased from an agency must include the staff and service purchased, name of the agency, the number of units per year, the rate per unit and the total cost.

Consultants:

No Fringe Benefits are paid to consultants, their total fee is calculated within the hourly price.

Any position with a salary exceeding pricing parameters needs documented justification and needs to have three written bids from possible contractors to establish the fair market value.

Live-In Caregiver:

A companion who lives in the home of a person receiving services, who provides a service to the person with a disability, but is not related by blood or marriage.

Medicaid will pay a proportional share of rent, food and utilities. In circumstances where there is a mortgage, the proportional share of monthly interest is reimbursable.

NYS has determined the proportional amount is the total for rent, food and utilities divided by the number of people in the home.

Live-In Care Giver Continued:

Example of proportional amount:#1: 2 living in home/one is the care giver. So, total

of rent, food and utilities divided by 2 or 50% of the total.

#2: 3 Living in the home/one is the care giver. So, total of the rent, food and utilities divided by 3 or 1/3 of the total.

Live-In Care Giver Continued:

FEA Pays the consumer directly (not the care giver).

The consumer pays the bills. The live-in care giver can be paid a salary in

addition to housing but is dependent on the hours worked. The cost of the care giver is funded by the FEA.

Clinical Services:

CSS cannot fund ongoing clinical services. Funding is allowed for consultations, training and oversight.

Transportation:

Transportation is provided as a subsidy and for service related expenses as identified in the CSS Plan.

The transportation subsidy will cover the cost of service related mileage and public transportation expenses.

Transportation costs are funded by the PRA.

Transportation Continued:

CSS is no longer providing verbal or written guarantees of funding for the purchase of leased vehicles.

However, families can enter into a lease agreement for a vehicle at their own risk and the service related expenses can be purchased through the PRA.

Respite:

Purchase of Respite services from a state operated program are discouraged if there is additional Respite services being requested from CSS.

Respite Continued:

Family Reimbursed Respite must be reflected in the staffing section and not included in the Miscellaneous section.

If the same individual is providing services on a regular basis they need to appear on the FEA payroll.

All staff/individuals who provide services must be fingerprinted.

All staff hired to provide Respite services need to sign an invoice, sent to the FEA outlining the date, hourly wage and hours of service provided.

Miscellaneous CSS Services, Other OMRDD and State Agency Services:

All miscellaneous items and their cost that are requested from CSS must be identified.

– Examples include: advertising costs for staff, gym memberships, classes, activity fees.

All continuing and prior OMRDD supports and services not funded by CSS and their related costs must be identified.

– Examples include: Environmental Modifications, Adaptive Equipment or contracts.

Miscellaneous CSS Services, Other OMRDD and State Agency Services:

All services received from agencies outside of OMRDD must be identified.

Therapies such as Aqua Therapy or Hippo Therapy should not be included in the miscellaneous section of the plan worksheets.

A $3,000 cap has been established for miscellaneous items.

Day Habilitation Services:

If purchasing Day Habilitation Services from an Agency:

– Can purchase up to two full days per week.– However, CSS cannot pay the To/From transportation.– If purchasing less than a full day of service, the agency

must pro-rate their daily rate to identify an hourly amount.– Must be a written agreement between the vender agency

and the FEA that the agency will bill the FEA directly for the purchase of these services and not bill EmedNy.

Maximum Annual Amounts:

Cell Phones - $360 / Year Staff Activity Fees - $520 / Year. Clothing Allowance - $250 / Year. Support Brokers $40.00/Agency and

$35.00/Individual.

Other Amounts:

Mileage Reimbursement – See Pricing. Parameters.

Training. Advertising. Summer Camps

Fiscal Resources:

Under CSS, all resources a person has available must be identified, and used, prior to CSS funding being made available.

Other funding includes but is not limited to:– SSI– SSDI– Wages – Checking/Savings Accounts– Public Assistance– Etc.

Trust Funds:

Information needed:– What items does the trust pay for and who are the

beneficiaries?– If applying for a room and board subsidy, what is

the dollar amount paid for items identified in the trust.

– If the trust pays for housing expenses is SSI/SSDI included in the trust or separate?

Extraordinary Funding Requests:

When Justified:– Requested room and board supplement is greater

than Streamlined room and board supplement allowable amount.

– Amount requested is over PRA (screen).

Housing Subsidy:

Rent has to be within HCBS Waiver Capital Guidelines.

Food and Utilities must be reasonable. Lease must be an arm’s length transaction.

Housing Subsidy Calculation:

Congregate Care Level II SSI (Net Personal Allowance) – Net Personal Income and Benefits = R & B Subsidy.

Net Personal Income and Benefits = (Personal Employment + Other Personal Income + Other Personal Assets + Public Assistance + Social Security + Other Benefits) – (Medicaid Spend Down + Income Tax and Mandated Withholdings).

Note: If this calculation yields a negative number you are not eligible for a streamlined Room & Board subsidy.

Housing Subsidy Continued:

2 Levels of Housing Subsidy:– Streamlined Subsidy– Extraordinary Funding Request above and

beyond the streamlined level.

Housing Subsidy Continued:

If a person is living at home with family, they are not eligible for a housing subsidy or a clothing allowance.

Needs Allowance:

Maximum $250 per year. Only for persons not living in a family

members home.

Items Paid By 100% State Dollars:

Items without a direct habilitative outcome such as:– Staff Activity Fee.– Advertising Costs.– Consumer Education.– Cell Phone.– Room & Board Subsidy (Except Live- In Care

Giver.– College or Technical School.

Start Up Advances:

Start Up Advances are currently not available.

Annual Reconciliation:

FEA must review and complete the annual reconciliation form.– The reconciliation is person specific. – The reconciliation identifies funds drawn down

from EmedNy net of expenses.– Annual reconciliations are due by May 31st of the

year following the close of a fiscal period.

Key Points:

CSS plans and budgets are individualized to meet a specific person’s needs and require attention to detail.

If a service is not approved in the budget, the cost is not reimbursable.

Plans and budgets are portable, i.e., follow the person, no guaranteed backfills.

CSS is a fiscal Partnership between the individual and OMRDD.

OMRDD is the funder of last resort, applicants must apply for all other benefits they are eligible for or entitled to first.

Questions ?????