Cost Detail Form and Operational Days Calculator User GuideJuly 2018

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Verson 2, July 24, 2018

CONTENTSA. Why a Revised Cost Detail Form?.................................................................................................................................................................................................3B. When to use the Revised Cost Detail Budget Form - Timeframe?................................................................................................................................................3C. When to use the Revised Cost Detail Budget Form - Situation?....................................................................................................................................................4D. General Information and Instructions on How to Use the Form....................................................................................................................................................6

Budget Tab...................................................................................................................................................................................................................................7Budget Tab – Demographic Table...............................................................................................................................................................................................8Budget Tab – Matrix and Staffing Ratio Table............................................................................................................................................................................9Budget Tab – Meaningful Day Table.........................................................................................................................................................................................10Budget Tab – Support Services Table........................................................................................................................................................................................11Budget Tab – Residential Services Table..................................................................................................................................................................................13Personal Supports (PS) & Add on Tool Tab..............................................................................................................................................................................14PS & Add on Tool Tab– Personal Supports Table.....................................................................................................................................................................14PS & Add on Tool Tab– Add-On Table....................................................................................................................................................................................15PS & Add on Tool Tab– Meaningful Day Transportation Table...............................................................................................................................................16PS & Add on Tool Tab– Residential Direct Support Add-On Table.........................................................................................................................................17

Appendix A: Operational Calculator.................................................................................................................................................................................................19Appendix B: New Service Implementation Rate..............................................................................................................................................................................21

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A. WHY A REVISED COST DETAIL FORM?

Revisions to the cost detail forms are needed to accommodate the Community Pathways Waiver renewal service changes and the two new Waivers (Family Supports and Community Supports). The current service specific Part 5 Cost Detail spreadsheets do not cover these new waiver services, and calculations in these spreadsheets were made manually. The revised Cost Detail form is necessary to bridge the interim year of FY 2019 until FY 2020 when all services will be authorized and billed through Long Term Services and Supports (LTSS) beginning July 1, 2019.

To reduce calculations errors, the revised cost detail form has the new services and rate structures for the Community Supports, Family Supports, and Community Pathways Waivers imbedded, so that providers can create an accurate budget for people who require services and reduce errors. The cost detail form includes all services and rates for these programs to allow for easy calculations.

B. WHEN TO USE THE REVISED COST DETAIL BUDGET FORM - TIMEFRAME?

The revised cost detail form should be used during the interim year (FY 2019 - July 2018 to June 2019) until authorized services are billed and claims processed through LTSS beginning July 1, 2019. While the cost detail is being used (July 2018 to June 2019), persons will have their Person-Centered Plans (PCPs) entered into LTSS by the Coorinators of Community Services (CCS) and authorizations will continue through the Provider Consumer Information System (PCIS2). Planning for services after June 30, 2019 in LTSS will begin January 2019. The timeline chart on the next page outlines the transition of services authorization from the revised cost detail form to LTSS authorization.

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Person-Centered Plan Done in LTSS

PCP, Service Auth, and Billing in LTSS

July 2018

January 2019

July 2019

Cost Detail Tool Used – Services Authorized in PCIS2

Service Authorization Begins in LTSS for 7/1/2019

Budget Tool and LTSS Timelines

C. WHEN TO USE THE REVISED COST DETAIL BUDGET FORM - SITUATION?

The revised cost detail form will be filled out by providers in the following situations:

1. A new person entering service with a Service Funding Plan (SFP) for the following DDA programs:

Family Supports Community Supports Community Pathways State-only

2. An existing person adding new or changing services with a Modified Service Funding Plan Request (MSFPR) for the following DDA programs:

Family Supports Community Supports

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Community Pathways State-only

3. An existing person that is unbundling services in the Community Pathways Waiver (ex. unbundling transportation services from Personal Supports) in FY 2019.

Note: A PCP must be completed annually and entered in LTSS by the CCS.

Process

1. Providers will fill out the cost detail form with services that they are providing or seeking authorization to provide and submit the Excel file to the CCS for submission to the regional office with appropriate documentation (MSFPR, SFP, PCP, etc.).

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Service Authorization

New to Services

July 2018(Interim Process)

July 2019

Service Funding Plan(with new cost detail sheet)

LTSSPCP

Currently in Services

July 2018(Interim Process)

July 2019

MSFPR for changed, new or unbundling of services

(with new cost detail sheet)

LTSSPCP

Depending on the type of MSFPR, the excel file may be sent directly to the regional office. Note: This must be submitted securely via e-mail to to guard protected health information (PHI).

2. If the service is existing and unchanged, it should be entered into the cost detail form as it currently is authorized in PCIS23. The regional office then reviews the form and inputs services into PCIS2, if approved. 4. The cost detail form will not be needed for services after June 30, 2019 as the service authorization and budget process will

move to LTSS. 5. Currently, the cost detail form is not being used for persons using self-directed services. The Self-Direction tab in the form

should not be used. This tab was published in previous versions. DDA has provided separate guidance to Financial Management Services (FMS) and persons self-directing their services.

D. GENERAL INFORMATION AND INSTRUCTIONS ON HOW TO USE THE FORM

The revised cost detail form includes conditional formatting throughout the workbook to help the user navigate the form and avoid input errors. Cells will highlight in grey can be filled in by the user but it is not mandatory that all grey boxes are filled out. Typically, these are driven by the services and plan period selected by the user in the Budget tab. Cells will highlight red if an error has been identified. Here are several examples that would cause the workbook to highlight red and identify an error:

User requests more days of service than are available in the plan period chosen in the Budget tab input table User requests services under a fiscal year not included in the plan period User requests services in the Add-On Tool section outside the plan effective and end date inputted in the Budget tab User requested more services than are available within an Upper Pay Limit User selected a service that is not included under a specific Waiver program (this could occur if a user selects a service under

one program and then switched to another without deleting a service that is not available in the newly selected waiver)

Be aware that the cost detail form uses conditional formatting to help the user, but the errors presented in the form are not comprehensive.

All calculations in the cost detail form (rates, service add-ons, etc.) have been designed to match PCIS2.

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All the tabs are protected, meaning that only the cells without formulas can be edited. Please do not attempt to unprotect the sheet and edit cells with formulas as it will affect the integrity of the model.

Always fill out the Budget tab before moving onto the PS & Add-On Tool tab. The PS & Add-On Tool tab relies on information from the Budget tab to populate. Please be aware that the personal supports table in the Budget tab will populate based on information requested in the Personal Supports Tool located in the PS & Add-On Tool tab.

Finally, users should be aware that all service requests should fall under the federally approved service definitions for the associated program (Community Pathways, Family Supports, Community Supports, State-Funded - SF). Several services and professional add-ons have been unbundled in the new waivers and Community Pathways renewal.

For the new Waivers (Family Supports and Community Supports), service such as nursing and transportation are not available under professional add-ons or personal supports, but are now included as standalone support services

Under the Community Pathways renewal, some services will transition to new services such as Career Exploration, Behavioral Supports, and Nursing Services during the annual PCP process

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If there are service requests that fall outside of the waiver service definitions, users can request them under state-only service optionsNote: This will be demonstrated later in the manual.

BUDGET TAB

The following instructions demonstrate how to fill out the cost detail form tab by tab, starting with the Budget tab:

BUDGET TAB – DEMOGRAPHIC TABLE

1. The user should always start on the Budget tab when filling out the cost detail form. The first information that needs to be filled out is the input table beginning with Person Name. All these cells that are highlighted in grey should be filled out in the top left corner of the tab. An example of the input table filled out correctly is shown below:

Person Name John DoeSocial Security Number 123-45-6789Provider Best CommunitiesPCIS2 Provider ID doejPCP Meeting Date (ex. 2/15/2018) 6/5/2018Plan Effective Date (ex. 3/15/2018) 7/5/2018Plan End Date (must be last day in plan period, ex. 3/14/2019) 6/30/2019Next Annual PCP or IP Date (ex. 3/15/2019) 7/5/2019Plan Type TraditionalWaiver/Program Type Community Pathways WaiverParticipant County Baltimore CityFY2019 COLA 3.5%*Note: Service days need to factor in the number of operational days you have each year.

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2. When selecting the dates in the Input table, use the following definitions:

PCP Meeting Date – This date marks when the PCP meeting occured. The cost detail form will highlight red if it occurs after the Plan Effective Date. Be advised that this is the PCP meeting date that occurs and not a meeting for a MSFPR. Typically, this meeting happens between 20 and 40 days prior to the Plan Effective Date

Plan Effective Date – This date marks the start date of services for the plan period. The cost detail form will highlight red if it occurs before FY 2018, July 1, 2017, which is outside the interim year. This plan effective date should not change in the event of a Modified Service Funding Plan Request (MSFPR). There are other locations to document MSFPR service start and end dates in the cost detail form

o Plan End Date – This date marks the last day of the service plan period (ex. If a year-long plan begins July 5, 2018, the end date should be June 30, 2019). This date will highlight red in the cost detail form if it occurs before the Plan Effective Date or on the same day or after the Annual PCP Date

o The cost detail form will also highlight red if it occurs a year or more after the Plan Effective Dateo Finally, the cost detail form will highlight red if this date occurs after June 30, 2019. Again, the form is not to be used

after this date o If a plan period crosses into FY 2020, the user should mark the end date as June 30, 2019 (as shown in the example

above). Service authorizations for the rest of the plan period would be inputted into LTSS by the CCS Next Annual PCP Date – This is a person’s fixed recurring PCP date which marks the beginning of another service plan

periodo The cost detail form will highlight red if it occurs more than 365 days after the Plan Effective Dateo The cost detail form will also highlight red if it occurs before or on the same date as the Plan End Dateo If a plan period crosses into FY 2020, the user can put an Annual PCP Date on July 1, 2019 or after for record-keeping

purposes (as shown in the example above) o Services should not be requested for FY 2020 in this cost detail form as they will be entered into LTSS beginning

January 2019

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BUDGET TAB – MATRIX AND STAFFING RATIO TABLE

After the user fills out the input table in the top left corner of the Budget tab, they should fill out the Matrix Score table (screenshot shown below).

Enter the scores for the relevant matrix-related services being requested (ex. Residential, Day, and/or Employment services) into the appropriate drop-down categories. These rates will not populate until this criterion is completed. We’ve outlined below which services are effected by each matrix category:

o Residential Matrix Category – Community Livingo Day Services Matrix Category – Day Habilitation Services and Community Development Services o Employment Matrix Category – Career Exploration, Employment Discovery and Customization, and Supported

Employment Additionally, the user should be able to document a staffing ratio for each of the service types when applicable

Note: The staffing ratio will not affect the calculations in the workbook but should be used for documentation purposes.

For reference, these are the number of 1:1 staff hours that are included in each matrix level for Day and Residential Services:

Hours per WeekDay Services Residential

1 5 6.672 6.67 13.333 10 244 13.33 405 20 58

Supervision Matrix Level

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BUDGET TAB – MEANINGFUL DAY TABLE

After both input tables are filled out at the top of the Budget tab, the user can begin requesting services in the tables below. Starting at the Meaningful Day Service table, the user should select the drop-down of the requested service. All services provided by a provider should be entered into the cost detail form. Additional fields that should be filled out are highlighted in grey:

Funding Adjustment – This field tracks whether a service is a new request, an unbundled new service, the same as a previous request, or a reduction or addition from a prior request. This is important when tracking MSFPRs. An example of moving to a new service would be transitioning from Supported Employment to Employment Discovery and Customization. Examples of unbundled new services would be unbundling nursing and BSS services from Personal Supports or Day Services.

Service Start Date and Service End Date – These inputs track the specific periods for which the services are being requestedNote: These fields are for documentation purposes only and do not highlight red if there is an error.

Site Number – These are the PCIS2 site numbers. This input field mirrors the documentation required in PCIS2. Each Day and Residential Service must have a site number and the user should fill out this cell as necessary.

Site-Based County – Since the county where a person lives isn’t necessarily the same county where they receive services, the user is required to input the county of the site where the person will be receiving service. The rate will not populate if this is not completed. Again, this functionality mirrors PCIS2.

Actual Days – This is the actual number of days of service the person needs for each fiscal year. It will highlight red if the number of days requested is greater than the number of days in each fiscal year according to the plan period selected in the Budget tab input table. The provider should use their unique operational calendar to make sure the number of requested days does not exceed the number of days discussed during the PCP meeting and approved by DDA Note: See appendix for Operational Day Calculator.

Each of these input fields is highlighted below:

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BUDGET TAB – SUPPORT SERVICES TABLE

1. Continuing in the Budget tab, the user would now input services in the Support Services table. Choose from the Support Services drop down and select a service name. When service names are selected, the user will be prompted to input values for the funding adjustment (addition, reduction, or new service), service start date, service end date units, and Upper Pay Limit (UPL)/Total Entry. The users should refer to the federally-approved waiver services associated with the program (Community Pathways, Family Supports, Community Supports) or SF the person is enrolled. Please see below for specific notes on support service examples:

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A. Nursing services are now included in the Community Supports Waiver and the Community Pathways Waiver but not the Family Supports Waiver. There are also skilled Nursing (State-Only) services available in the Community Pathways Waiver. These services are no longer included as professional support add-ons. They have been unbundled and will need to be individually selected as stand-alone services during the annual PCP process or when initially entering as a new service. All bundled services such as transportation and nursing should be unbundled during a person’s annual PCP meeting.

B. Transportation, not associated with Meaningful Day or Community Living – Group Home services, is a stand-alone dropdown service item as well. It cannot be requested as an add-on for Personal Supports. The services here do not pro-rate by fiscal year automatically. The user will have to input specific amounts that they are requesting for the funding period.

C. If Other (State-Only Funded) is chosen, filling out a description of the support service will be required. This field will highlight grey. Providers may select Other (State-Only Funded) for services that do not specifically fall under the waiver definitions if the person is in the Community Pathways Waiver or State-funded services. Regions and CCS Coordinators would review each request and consider the description inputted into the cost detail form.

2. The Support Services table will also display unique unit types for each selected service. The user will be required to input either the units or UPL/Total Entry based on the service’s defined units. The Additional Supports subtotals for all combined services will be displayed at the bottom.

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BUDGET TAB – RESIDENTIAL SERVICES TABLE

1. The last table on the Budget tab allows the user to request residential services. To fill out the Residential Services table, select the service name from the drop-down. From there, depending on the selection, categories to the right will populate in grey requiring them to be filled out. The user will be prompted to enter information into the funding adjustment, site number, and service start and end date columns. Just like the site-based services in the Meaningful Day Services table before, the user should also enter a site-based county when prompted (highlighted grey).

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Residential ServicesService Name Funding Adjustment Service Start Date Service End Date Site Number Site-Based County

Community Living - Group Home No Change 7/1/2018 6/30/2019 1111 Baltimore CityShared Living Addition 7/1/2018 6/30/2019 2222

2. After selecting Residential Services, Funding Adjustment, Service Start Date, Service End Date, Site Number, and Site Base County (if applicable), enter the requested units or the UPL values for the plan period. Please be advised that the units here will always be the number of days that the user is requesting Residential Services when Community Living – Group Home is selected. An example is shown below:

PS & ADD ON TOOL TAB

After the user fills out the Budget tab, they will need to click on the PS & Add-On Tool tab to request Personal Supports and add-on services. We do not advise to fill out this tab first, as some information completed here will flow back to the Budget tab.

PS & ADD ON TOOL TAB– PERSONAL SUPPORTS TABLE

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1. If Personal Supports are needed, the provider should update the Personal Supports Tool table. First, input the county where the participant is receiving services and then the number of persons in the home (1, 2, or 3). Then populate either the number of hours per month or the hours per week that the person needs for each month in the plan year in the table.Note: the relevant months will automatically update for the user based on the plan period selected in the input table in the Budget tab. The cost detail tool is built so that the number of Personal Support Services hours can vary throughout the year depending on the need of the person. However, for FY 2019, Personal Supports will be authorized for the entire year.

The cost detail form will highlight red if both hours per week and hours per month are selected for the same month. The examples on the next page show how the Personal Supports table can be filled out both ways. These two mechanisms can also be blended from month to month.

See example on the next page.

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Example of Hours per Week Example of Hours per Month

2. Once the Personal Supports table has been completely filled out, the corresponding table on the Budget tab will automatically update. For record-keeping purposes, the user will be prompted to fill out the columns for the funding adjustment and service start and end date.

PS & ADD ON TOOL TAB– ADD-ON TABLE

1. To request add-on services, use the add-on tables to the right of the Personal Supports table in the PS & Add-On Tool tab. To request add-on services for meaningful day services, select a service from the drop-down plan in the Meaningful Day Add-On Tool table. After selecting this service, fill in the pre-populated grey areas to the right. The rate will not populate until the service has been selected, hours/week, and annual days. This functionality mirrors PCIS2.

2. Please note that start and end dates should be contained within the plan period entered in the Budget tab. The Actual Days selected in the Budget tab must not exceed the actual days between the start and end date from the PS & Add-On Tool tab. The Annual Days column should reflect the total operational days for the provider for the year. Be aware that days in the tables showing day services need to be filled out in accordance with a provider’s specific operational calendar.Note: See appendix for Operational Day Calculator.

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3. Also, the hours/week requested in all the add-on tables are the services that a person requires above and beyond the direct support included in the base matrix funding. For example, if a person has a 5-5 matrix score for Day Services which includes a base amount of 20 hours of service a week but actually requires 40 total hours, the user would input the additional 20 hours in the Hours/Week column in the add-on table.

PS & ADD ON TOOL TAB– MEANINGFUL DAY TRANSPORTATION TABLE

1. To use the Meaningful Day Transportation Add-On Tool, make sure that start and end dates are contained within the plan period entered into the Budget tab. The Transportation add-on can be used for any day service that is entered into the Budget Tab. After the user selects the service and inputs the total in the Wheelchair $ and actual days columns, the cost detail form will calculate the daily rate and spread the requested amount over the number of days requested. Again, this calculation reflects what is done in PCIS2. An example is shown below:

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PS & ADD ON TOOL TAB– RESIDENTIAL DIRECT SUPPORT ADD-ON TABLE

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To use the Residential Direct Support Add-on Tool and the Residential Awake/Overnight Add-on Tool, make sure that the corresponding service is first selected in the Budget tab. Just like the Meaningful Day Add-on Service table, the user cannot input more days in the add-on table then are requested in the Budget Tab. The provider will then select the service from the drop-down as shown below. From there, fill in the Funding adjustment, Start date, End date, Hours/Week, and Actual Days. These will be highlighted grey.

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APPENDIX A: OPERATIONAL CALCULATOR

A calculator has been provided to help providers determine the number of operational days they have available for a given period. This is helpful when requesting meaningful day services and an associated add-on. In PCIS2, each provider’s operational calendar is stored and the system will automatically calculate requested service amounts based on this information. In this form, a separate operational calculator has been offered since the workbook is unable to store every provider’s unique calendar.

To use the operational calculator, first delete all dates in the Calendar Date column that are not operational dates for your agency. From there, input a start and end date in the cost detail form. The number of operational days in the period will then populate based on these selected dates. Federal holidays are included as a reference but they could be operational days for the provider.

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APPENDIX B: NEW SERVICE IMPLEMENTATION RATE

Until new service rates are implemented, existing rates will be used for services currently being provided. The below table outlines when new rates will be released for each service. Only rate based services are included.

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New Service Rate Implementation FSW CSW CPW Service Not in Waiver

1 Behavioral Support Services Available Now Available Now July 2018 Available Now2 Environmental Assessment Available Now Available Now July 2018 July 20183 Respite Services Available Now Available Now July 2018 July 20194 Housing Support Services Available Now Available Now July 20185 Participant, Family and Peer Mentoring Supports Available Now Available Now July 20186 Nursing Services Available Now July 20187 Supported Living July 20198 Personal Supports July 2019 July 2019 July 20199 Career Exploration Services July 2019 July 2019

10 Community Development Services July 2019 July 201911 Day Habilitation July 2019 July 201913 Employment Services July 2019 July 201911 Community Living (Group Home & Enhanced) July 201914 Live-In Caregiver Supports July 201815 Shared Living July 2019