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Support Coordination

Provider Requirements and Service Limitations

From The May 2010 Florida Medicaid Provider Handbook

Information highlighted in yellow indicates a change since the July 2007 version of this handbook.

Support Coordination- Requirements To Receive

Description:

Support coordination is the service of advocating, identifying, developing, coordinating and accessing supports and services on behalf of a recipient, or assisting the recipient or family to access supports and services on their own. These services may be provided through waiver and Medicaid State Plan services, as well as needed medical, social, educational, other appropriate services, and community resources regardless of the funding source through which access is gained. The waiver support coordinator is responsible for assessing a recipient’s needs, preferences and future goals (outcomes). From that information, the waiver support coordinator assists the recipient in developing a support plan and cost plan.

Once a recipient’s support plan is developed and the cost plan is approved by the APD, the waiver support coordinator assists the recipient to meet his support plan outcomes or personal goals by linking the recipient with natural and generic supports and services available through family, friends and community resources. When natural or generic supports are unavailable or are in the process of development, the waiver support coordinator assists the recipient in locating services available through local, state or federal sources, including Medicaid, the DD waiver and APD, as authorized.

Waiver support coordinators promote the dignity and respect for each recipient with regard to the recipient’s personal privacy, sharing personal information and making decisions.

Support coordinators promote the health, safety and well-being of the recipient; assist the recipient to identify and access formal and informal support systems; assist the recipient to increase or maintain the capacity to direct formal and informal resources; promote advocacy or informed choice for the recipient; provide information regarding the Medicaid fair hearing process; increase the recipient’s involvement in the community; and assist the recipient to achieve personal goals.

Transitional Support Coordination:

Transitional support coordination consists of activities that assist the recipient in transitioning from a nursing facility (NF), Developmental Disabilities Institution (DDI), or an intermediate care facility for the developmentally disabled (ICF/DD). These activities include working with the recipient to arrange for the provision of community-based services and supports upon discharge, including those available under this waiver and other services and supports, regardless of funding source, necessary to ensure the health and welfare of the recipient.

Waiver support coordinators are responsible for working with the institutional provider and staff and coordinating their activities with the facility’s discharge planning process. The waiver support coordinator will develop an initial support plan based on current assessments including the facility’s summary of the recipient’s developmental, behavioral, social, health and nutritional status and discharge plan designed to assist the recipient in adjusting to their new living environment. The support plan will identify the community supports and services required to meet these identified needs. Waiver support coordinators can bill for up to 90 days (three months) for services rendered prior to the recipient’s discharge. These services can be billed only after the recipient is discharged.

The waiver support coordinator will maintain, at a minimum, weekly contact with the recipient for the first 30 days following discharge to ensure that community supports and services are meeting the recipient’s needs. The waiver support coordinator will update the support plan at the end of the 30-day period, identifying progress made with the transition to community-based living and changes in supports and services. At the end of each month following discharge, if the waiver support coordinator has provided all necessary services, including the weekly face-to-face visits for the first 30 days following discharge, they may bill for up to 90 days at the enhanced waiver support coordination rate.

Limited Support Coordination:

Limited support coordination services are less intensive case management services available upon request by an adult receiving services or the adult’s guardian. Adults receiving limited support coordination may request to change to full support coordination due to an increased need for assistance, but must remain in full support coordination for the remainder of the cost plan year.

Children under the age of 18 who live in the family home shall use only limited support coordination. Limited support coordination for children living in their family home may be approved at the full support coordination level by the APD Area Office for a time limit not to exceed 60 days per cost plan year should a family emergency warrant increased support from this service. The Area Office will maintain documentation of the approval and the nature of the emergency on file. The emergency approval and explanation of the need should be clearly documented in the case notes for the recipient by the waiver support coordinator.

Limited support coordination services are billed at a reduced rate and have reduced contact requirements. The limited support coordinator must conduct two (2) face-toface visits per year (including at least one home visit) and one (1) other billable activity a month as outlined in the Documentation Requirements section of the handbook for this service.

The face-to-face contacts conducted in the support plan development period may count as one face-to-face contact. The second face-to-face contact shall occur toward the middle of the support plan year. The support coordinator shall:

  1. Perform required assessments and develop the annual support and cost plan. The cost plan shall be submitted for prior service authorization.
  2. Document in case notes and other records all activities completed on behalf of the recipient.
  3. Arrange initial providers and complete service authorizations as needed.
  4. Continue to ensure that Medicaid eligibility is maintained by providing all assistance necessary to maintain Medicaid benefits.
  5. Enter into an agreement specifying the activities the recipient expects the support coordinator to conduct as part of the limited support coordination on his or her behalf and those that the recipients and family will assume.

Limited Support Coordinators will not:

  1. 1. Be responsible for ongoing monthly face-to-face contact and other required monthly contacts, except as identified above.
  2. 2. Oversee the delivery of supports and services.

Limitations:

The provider must accept all recipients who select the provider for waiver support coordination services and not reject any recipient referred to them or who selects them from within the geographic boundaries previously approved by the APD Area. The APD may grant exceptions to this requirement in writing.

The caseload for waiver support coordination is established by the Legislature. Effective January 1, 2008 the caseload for this service is 43 full time recipients. Each waiver support coordinator shall maintain a caseload of no more than 43 full time recipients, or as specified in statute, even when that total includes recipients who are not participants in the waiver or are not recipients of the Developmental Disabilities Program. Support coordination services are rendered in a ratio that does not exceed one certified full-time equivalent (FTE) waiver support coordinator position to every 43 full time recipients. "Full Time Equivalent" means a person who is providing support coordination services for 43 full time recipients. A recipient who receives limited support coordination is considered a half-time recipient on a caseload. Waiver support coordinators who provide limited support coordination may have a caseload of more than 43 individuals, not to exceed 43 full time recipients. Supervisors of waiver support coordinators within group providers shall limit their caseloads to less than 43 full time recipients and must ensure that adequate supervision is also provided for support coordination employees. When a provider is planning to expand services, providers may temporarily exceed the above ratios for a period not to exceed 60 consecutive days.

The support coordination provider must notify the APD Area Office in writing of any vacancies or leave of absences granted with a list of recipients affected by this vacancy, within five days of each occurrence. Vacancies due to the termination or resignation of a waiver support coordinator that result in caseloads temporarily exceeding the maximum of 43 full time recipients may be for a period of no more than 60 consecutive days, per vacancy. The 60 consecutive days begin with the date the vacancy actually occurs. Failure of the provider to notify the APD Area Office of the vacancy within the required timeframe will result in recoupment of funds received by the provider.

Vacancies due to a waiver support coordinator submitting a written request to the APD Area Office for leave based on the intent of the Family and Medical Leave Act that result in caseloads temporarily exceeding the maximum of 43 full time recipients are allowed for a period of no more than 60 working days, per vacancy.

If the support coordination provider cannot fill a reported vacant position within the time allotted, the APD Area Office must be notified prior to the 60th consecutive or 60th working day, whichever is applicable to the situation. Upon receipt of this notification, the APD Area Office will provide 14 calendar days notice to the affected recipients and agency of the need to select a different waiver support coordination provider. This notification will enable the APD Area Office to inform the affected recipients of the impending change in their support coordination provider. This notification will allow sufficient time for the recipient to choose an available provider from within or outside the current agency and the provider to complete needed paperwork and take any other necessary actions. It will also allow the recipient time to adjust to the anticipated changes. Vacancies resulting in caseloads exceeding the maximum of 43 full time recipients for more than the above stated number of days may subject the provider to recoupment of funds and the recipients served to transition to another enrolled support coordination provider, chosen by the recipient. All caseload transfers will be accomplished by the APD Area Office working with the provider to identify those recipients affected by the vacancy and who will cause the temporary support coordinator to exceed the maximum caseload of 43 full time recipients.

Expansion of services includes increasing the number of recipients served by a solo practitioner or an agency, as well as a solo practitioner changing or expanding their status from solo practitioner to an agency. A provider must have no alerts or documentation cites indicating recoupment and have attained a satisfactory overall score on the last quality assurance monitoring conducted by the APD, AHCA or their authorized representative, and be approved by the APD Area Office in order to expand services.

The provider and all its employees who supervise staff, train staff or conduct support coordination activities shall remain free from influences that interfere with the recipient’s choice of supports and services. This includes, but is not limited to, the following:

Support and Service Planning Requirements:

The provider must be available to meet the recipient’s needs and to perform the responsibilities for support coordination. The provider shall have an on-call system in place that allows recipients to access support coordination services 24-hours per day, 7 days per week. The APD Area Office must approve this on-call system. Any time a back-up support coordinator is used during the provider’s absence, the backup support coordinator shall be a certified and an enrolled waiver support coordinator.

The name and contact information for the back-up waiver support coordinator shall be clearly communicated to the recipient and to the APD Area Office. Access to the provider or back-up provider shall be available, without toll charges to the recipient.

Waiver support coordinators should assist ADT recipients with information or referral to rehabilitation, vocational habilitation, and other employment services and employment opportunities available in their community. On an annual basis, waiver support coordinators shall provide service counseling for recipients currently in sheltered workshops or segregated work environments to apprise them of the options available to them for meaningful work activities and training. The support coordinator shall provide information to recipients on residential options available to them including owning or renting their own home with supports. This shall occur at a minimum of once a year during support planning but should also occur when anticipating a change in the residential situation.

The waiver support coordinator will complete activities that assist the recipient in determining their own future. At least once annually the provider will assist the recipient, primary caregiver, or legal guardian to:

When a recipient is newly enrolled to receive waiver services the support coordinator must complete the support plan and cost plan within 60 days of the recipient’s selection of the support coordinator.

In accordance with section 393.0651, F.S., the provider shall complete an annual report of progress.

The waiver support coordinator shall provide a copy of the notice of privacy practices required by HIPAA regulations to the recipient or legal guardian upon initial contact with the recipient, and at any time there is a significant change that necessitates the protection of a recipient’s personal health information.

The waiver support coordinator will submit to the APD Area Office, no later than twenty calendar days prior to the support plan effective date, a new annual support plan and cost plan with supporting documentation. The APD Area Office will in turn respond no later than ten working days of its receipt of the cost plan, with a statement of approval or denial. Copies of the support plan and complete approved cost plan will be provided to the recipient or his guardian at any time they are requested, but at a minimum, within ten calendar days of the effective date of the support and cost plan. If changes to the support plan’s effective date must be made by the support coordinator for purposes of case load management, the support coordinator shall notify providers 60 days in advance of the change.

For emergency support and cost plan requests, the waiver support coordinator will notify the APD Area Office of the crisis situation and provide the updated support plan, cost plan and supporting documentation, within three working days of becoming aware of the crisis.

The cost plan (plan of care) is updated annually by the support coordinator. An amendment to the plan to change services or to increase service intensity or frequency may only be submitted during the year if there is a documented significant change in the recipient’s condition or circumstance that impacts on health, safety, or welfare, or when a change in the plan is required to avoid institutionalization. A comprehensive description of these changes, including updated assessment information and sufficient information concerning the change in service needs should be thoroughly documented in an update to the support plan and the waiver support coordinator’s progress notes. Updates to the cost plan shall be initiated when the waiver support coordinator becomes aware of the need for change. The updated support and cost plans are submitted to the APD, for review and approval within five working days of the date the waiver support coordinator becomes aware of the need for change. The APD may request copies of the waiver support coordinator’s progress notes, which support and describe the need for an updated cost plan. The APD Area Office will in turn respond within ten days of their receipt of the updated cost plan, with a statement of approval or denial. Within five working days of receiving the APD Area Office response, the waiver support coordinator will notify the service provider through submission of a new service authorization of the updated changes to the cost plan and the change in the needs of the recipient.

The provider shall assist the recipient in using family, neighborhood and community supports and services funded by private, city and county sources prior to seeking services funded by federal and state sources. The provider shall assist the recipient in using Medicaid State Plan services prior to seeking services funded by the DD waiver. When services must be purchased by a source other than the DD waiver, the provider must work cooperatively with the APD Area Office in locating service vendors who meet the needs of the recipient in the most cost-beneficial manner possible.

A copy of support plan information, pertinent to the provider, and an approved service authorization will also be provided to other providers of services to authorize and initiate service delivery by the effective date of the approved support and cost plans. Through conversations with the recipient, those who know the recipient well, and through review of the service vendor's documentation, the waiver support coordinator monitors the recipient’s involvement in purchased services to determine if the activities meet the recipient’s expectations. The waiver support coordinator will determine that these services are age and culturally appropriate; address the need for which they are intended; and provide appropriate challenges, motivation and experiences to meet the recipient’s identified goals.

When services must be purchased by the DD waiver, the provider shall locate potential service vendors who are qualified to meet the needs of the recipient in the most cost beneficial manner possible. The provider may recruit qualified vendors who are acceptable to the recipient and assist them with waiver enrollment procedures. The waiver support coordinator must assure that purchased supports and services do not exceed the annual limits of the current approved cost plan(s) for recipients served. The waiver support coordinator shall use the ABC system to regularly monitor service utilization and expenditures. If the support coordinator becomes aware that supports and services are in excess of the annual limits of the approved cost plan, he will notify the APD Area Office and provider as soon as the excess is known to them.

If paid services are used, the provider shall review with service vendors the goals to be achieved for the recipient and note these discussions in the recipient’s progress notes. The agreed upon goal(s) shall be reflected on the service authorization form for that provider.

The provider shall maintain each recipient’s central record in accordance with APD procedures. The central records remain the property of the APD. The APD retains the right to review, retrieve, or take possession of a recipient’s central record at any time. The provider shall assist the recipient in maintaining their Medicaid eligibility. The provider shall also notify other waiver service providers and the APD when it is determined that a recipient receiving services is ineligible for Medicaid. The waiver support coordinator will work with providers and the APD to plan for alternative funding sources.

The provider is responsible for the cost of the electronic access to the APD’s intranet site as well as entering, updating and assuring the accuracy of demographic information pertinent to the recipient in the ABC system. Failure of the waiver support coordinator to enter, update and assure the accuracy of this information could result in recoupment of funds paid to the waiver support coordinator.

The provider shall comply with all written procedures established by the APD regarding the transition of recipients from developmental disabilities support coordinators or other waiver support coordinators to the provider.

For recipients residing in supported living arrangements or licensed residential facilities and who are taking any psychiatric or anti-epileptic medications, the support coordinator will document in the progress notes attempts and efforts to assure:

The recipient receives follow-up reviews by the psychiatrist, neurologist or ARNP at a frequency established by these practitioners. If the frequency of review established by the psychiatrist, neurologist or ARNP is less frequent than every ninety days, documentation for their rationale will be provided. This documentation will be maintained in the recipient’s central record.

If while serving a recipient, the recipient chooses another support coordination provider, the current provider shall render quality services for the recipient until the end of the month, when the transfer to the new support coordination provider takes place, unless otherwise instructed by the APD. Additionally, the current provider shall assist the recipient in making a smooth transition to the new support coordination provider.

When a new support coordination provider is selected by the recipient; the support coordination services agency is downsized; or the support coordination services are terminated, either voluntarily or involuntarily, the waiver support coordinator shall assure that all appropriate central record information is transferred to the new provider or to the APD Area Office, as directed, within two weeks of the effective date of the action.

Note: Refer to the medication review service section for additional information.

Documentation Requirements:

For reimbursement* purposes, the provider must meet certain basic billing requirements. These include support coordination notes, which adequately document the support coordination services rendered and which are individualized. Exceptions granted by the APD to any requirements set forth in the assurances or policy must also be documented. All documentation must be filed in the recipient’s central record prior to billing. For full support coordination, the provider must have, at a minimum, two contacts with or activities on behalf of recipients each month in order to bill to Medicaid. For limited support coordination, the provider must have a minimum of one contact with or activity on behalf of recipient each month in order to bill Medicaid. Prior to submitting a claim for payment of support coordination services for a recipient, the provider shall complete the following:

  1. *Have on file in the recipient’s central record, the recipient’s current support planning information to include the individually determined goal information, the APD-approved assessment, a current waiver eligibility worksheet, a current support plan and current approved cost plan; and
  2. Full support coordination: *Have at least one face-to-face contact monthly with recipients living in a licensed residential facility or supported living situation. Have at least one face-to-face contact every three months for recipients living in their family home, and two of those contacts per year will be held in the recipient’s residence at six-month intervals.
  3. Limited support coordination: Have at least two face-to-face contacts per year, with a minimum of one of the contacts being in the recipient’s home. One faceto- face contact should occur at the time of support planning and the second face-to-face contact should occur at approximately a six month interval.
  4. Face-to-face contacts shall relate to or accomplish one or more of the following:

(a) Assist the recipient to reach outcomes on the support plan, including gathering information to identify outcomes;
(b) Monitor the health and well-being of the recipient;
(c) Obtain, develop and maintain resources needed or requested by the recipient to include natural supports, generic community supports and other types of resources;
(d) Increase the recipient’s involvement in the community;
(e) Promote advocacy or informed choice for the recipient; or
(f) Follow-up on unresolved concerns of conflicts.

*For recipients in supported living, residing in their own home or residing in licensed facilities, a face-to-face visit with the recipient in the recipient’s place of residence is required every three months. If the recipient lives with his family, the face-to-face contact with the recipient in the residence is required every six months for full support coordination, and once a year for limited support coordination. The recipient or family may not waive the required visit(s) in the home. The need for more frequent face-toface- visits may be determined by the recipient, family or primary caregiver. The waiver support coordinator shall document this preference in the support plan. The purpose of the face to face visit is to discuss progress/changes to the individual’s goals, status of any unresolved issues, and satisfaction with current supports received.

*For recipients receiving supported living coaching services, it is the waiver support coordinator’s responsibility to schedule a quarterly meeting with the recipient and the supported living coach. The purpose of this meeting is to:

This quarterly meeting with the recipient and the supported living coach, unless the supported living coach is excluded at the request of the recipient, may satisfy the quarterly face-to-face meeting requirement above, provided the meeting takes place in the recipient’s home.

*Conduct at least one other contact or activity per month. These contacts or activities are not merely incidental, but are planned and shall relate to or accomplish those items, previously identified in 4 (a-f). These contacts or activities may be either with the recipient or with other persons, such as family members, service vendors, community members and others, and may be conducted face-to-face or via telephone, letter writing or through e-mail transmission. Administrative activities such as typing, filing, mailing, or leaving messages shall not qualify as contacts or activities, nor do calls to schedule meetings, setting up face to face visits or scheduling meetings with the individual’s employer, family, providers, etc.

Upon receipt of a determination that terminates or reduces the level of services, the support coordinator will, within ten business days of receipt of the determination, inform the recipient of the decision and submit a revised service authorization to the service provider. If the determination affects the provider immediately, the support coordinator must contact the provider by phone call, fax or other method to inform him of the need to immediately revise the services being provided with notification that the service authorization will be sent to the provider to document the change. If the support coordinator does not follow these procedures and this results in the provider not being notified of the service change, the support coordinator may be subject to recoupment of the services that were provided when the service provider was unaware of the need to change the level of service provision. Upon receipt of a determination of approval of a new service, the support coordinator must issue a service authorization within ten business days of receipt of the determination.

For monitoring review purposes the provider must have on file, for the period being reviewed:

  1. A copy of all of the recipients’ support plans and approved cost plans in their central records;
  2. Documentation in the central records that the basic billing requirements were met for the months in which the provider was reimbursed for services;
  3. Documentation in the support coordination notes and the support plan of activities and contacts that assisted the support coordinator in meeting individually determined goals;
  4. Documentation that the support coordinator facilitated opportunities for community involvement as determined by the support plan goals. The notes clearly and adequately reflect services provided in sufficient detail;
  5. Documentation in the central records that a face-to-face visit with the recipient was conducted in their place of residence, including those recipients in supported living, quarterly meetings with the recipient and their supported living coach;
  6. Documentation that service authorizations were provided to all service providers within three consecutive calendar days of the support coordinator receiving approval of the service; and
  7. Current and correct demographic information for each recipient, including current health and medical information and emergency contacts.

In addition, the provider is expected to document in all recipient central records all other support coordination services, activities or contacts that assisted him in meeting support plan outcomes or personal goals, become more integrated into communities and address each recipient’s or family’s concerns. Support coordination notes should adequately and clearly document all support coordination services provided to a recipient.

If the provider plans to transport the recipient in his private vehicle, at the time of enrollment, the provider must be able to show proof of valid: 1) driver’s license, 2) car registration, and 3) insurance. Subsequent to enrollment, the provider is responsible for keeping this documentation up-to-date.

*Indicates reimbursement documentation.

Place of Service:

This service may be provided in the recipient’s residence or anywhere in the community.

Special Considerations:

Support coordination services may be rendered in any community location conducive to the contact or activity being provided, including the waiver support coordinator’s office, the recipient’s residence, a library, a park, or any other community location. In order to get to know each recipient well, waiver support coordinators are encouraged to interact with and observe each recipient in a variety of settings during different times of the day and on different days of the week.

Support coordination may be provided while a recipient is a temporary patient in a hospital or nursing facility. The waiver support coordinator may not duplicate the services of the hospital or nursing facility case manager or discharge planner and may not bill until after the recipient is discharged.

Providers of support coordination services must participate in monitoring reviews conducted by the APD, AHCA or an authorized representative of the state. Support coordinators are expected to meet the needs of the recipients receiving services; regardless of the number of contacts it takes to meet those needs. Waiver support coordinators should not assume that meeting the basic billing requirements will necessarily result in a successful monitoring review and approval to continue services.

The provider will be responsible for the cost to access any APD or AHCA required management, claim submission information or data collection systems.

Support Coordination Provider Requirements

Provider Qualifications:

Providers of support coordination services may be either solo providers or agency providers.

Training and Experience:

For applicants who have other employment at the time of application to become a waiver provider and intend to remain in the current employment, the application must include a statement addressing a plan for dual employment. The plan should address the type of employment held at the time of the application, the total number of hours involved in that employment on a weekly basis, a plan for the manner in which the applicant may be contacted by recipients receiving services during the hours employed in the other job, and how conflicting priorities, emergencies and meetings will be handled. The plan shall also address any long-range plan for reducing or terminating the other employment should a full waiver caseload be assumed. The APD Area Office shall approve the dual employment plan as a part of the waiver enrollment process. If it is determined that the applicant cannot be available to meet the needs of recipients on the applicant’s caseload, the application may be denied. In no instance may the dual employment include providing services to recipients with developmental disabilities, unless services are provided within the role of case manager or support coordination.

Pre-Service Training Requirements:

A minimum of 60 hours of pre-service training is required for solo providers and for the director or managers and the waiver support coordinator supervisor of provider agencies. This pre-service training shall consist of 34 hours of statewide pre-service training that is conducted by APD or by a trainer certified by APD and 26 hours of Area training. The Area training shall include orientation to the Area staff and responsibilities, Area resources, ABC training regarding entry and maintenance of recipient’s demographic information, and general Area operational procedures. The Area training content must be approved by the APD Central Office to ensure statewide uniformity and must be provided by the Area within 90 days of the completion of the statewide pre-service training.

Support coordinators employed by agencies are required to receive the same number of training hours and are to be trained on the same topics covered in the statewide and area training. This training may be conducted by the support coordination agency once approved by APD. Agency trainers must attend a train-the-trainer session conducted by APD and mandatory refresher courses, as required by APD.

Agency trainers and the agency training plan must be prior approved by the APD’s Central and Area Office. Support coordinators trained by their agency in the use of the APD-approved assessment must undergo certification by the Area.

Waiver support coordinators currently enrolled as DD waiver support coordination providers must become certified in the use of an APD assessment within 90 days of the effective date of the implementation of this rule. Failure to become certified in the use of the APD-approved assessment will result in termination as a DD waiver support coordination provider.

Proof of annual or required updated training shall be maintained on file for review.

The provider is responsible for all training requirements outlined in the Core Assurances.

Note: Refer to the Core Assurances in Appendix A for the provider training requirements.

Continuing Training Requirements:

All waiver support coordinators and agency supervisors, directors or managers shall attend 24 hours of job-related in-service training annually. Internal management meetings, held by agency providers, shall not apply toward the 24 hours requirement unless approved by the Area. For support coordination supervisors and employees of agency providers, 12 hours of the 24 hours in-service requirement must be provided by trainers outside of the agency.

All waiver support coordinators shall attend training in individually determined goals conducted by the APD or an APD certified trainer within 90 days of receiving a certificate of enrollment from the Area. This training shall satisfy the annually required 24 hours of job related training for that year. Support coordinators who have not completed this training must have a trained waiver support coordinator in attendance when conducting interviews, as part of the annual support planning process.

Documentation of all training will be maintained on file by the solo provider or the agency provider and be available for monitoring and review.