by Richard O. Stimson

This is an article published in the August Connecting Point, a Special Gathering monthly newsletter published for and by the mentally challenged community.

With all the changes by the State, there is one question I am asking.  Who is the  primary person responsible for a consumer’s Health and Safety?

The June 23, 2005 edition of the Handbook on page 2-87 includes in the description of support coordination: “Support coordinators promote the health, safety and well-being of the recipient.” Page 2-97 goes on to say, “Monitor the health and well-being of the recipient” as one of the reasons for face-to-face visits.  Also, on Page 4 of the WISCC (monitoring tool), it states: “WSC is aware of the health, safety, and well-being of the people they serve…”

It has been my position that one advantage for the State’s privatization of case management (i.e., Support Coordination) is moving responsibility for Health and Safety from the State to non-governmental persons or companies.  Then when something goes wrong, it is not the State Government in the limelight, but a Support Coordinator with the State pointing a finger at the Support Coordinator.  To me, this arrangement has worked just that way.

I have not found agreement in the past among Support Coordinators as to whether Support Coordinators were the primary professional responsible for the Health and Safety of their clients.  It has been my opinion in the past that Support Coordinators were the primary professional responsible for the Heath and Safety of their clients.  I no longer feel we can expect this of them.  This is particularly true with Limited Support Coordination.  But if not the Support Coordinator, then who?  It concerns me that this has not received more discussion.  Maybe it is because the State (and Support Coordinators) do not like the choices.

This may not seem important to you because your parents or your family helps you with your Health and Safety needs.  But that is not true for everyone. Also, it may not always be true for you.  I would identify in your Support Plan who will be the primary person or agency to help you with Health and Safety concerns.  Will it be your Supportive Living Coach? Will it be a family member? Will it be your Group Home?

            If I were you, I would start identifying in your Support Plan who is your Primary Support for Health and Safety.

Note from specialgathering:  Once again, I’ve stolen from Aaron Nangle’s newsletter for Special Gathering weblog.  I wanted to use this as an opportunity to remind you of the great work he is doing.  And to let you know that if you would like to subscribe to his newsletter you can do so by going to WaiverProvider.com

Much of what he has to say this month, applies to only providers and Support Coordinators but parents and advocates need to understand what is happening to providers through APD.

Will Providers and Support Coordinators be Working For Free?

Do You Have Your Service Authorization?

Provider and Support Coordinators, do you have your service authorization? The new fiscal year starts on July 1, 2008.

You Can Work Without a Service Authorization, But Don’t Expect To Get Paid.

Do you have your service authorizations for the new fiscal year? Many of you do not. And, even if you do- they are most likely outdated with the old provider rates. You can work without a service authorization, but don’t expect to be paid. In this time of fiscal crisis and uncertainty, APD could very well say, “Thank you for your donation.” It has happened before, we just predict this year to be much worse.

There is Very Little The Support Coordinator Can Do.

The Allocation and Budget Control System (ABC) is now controlled by the Agency For Persons With Disabilities (APD). Therefore, APD puts the cost plan budgets into ABC, which in turn, will create service authorizations for providers. Support Coordinators can only VIEW and PRINT service authorizations. They can not even make a simple provider change. So, come July 1st, if you don’t have your service authorization.

Services Are Medically Necessary

When services have been deemed as medically necessary, the provider is faced with a difficult choice. Should my company work without a service authorization, and risk not getting paid? In many cases, that is not even an option. Not providing the service is in essence, neglect.

Are You Up To Date With The Billing Changes?

ACS is No Longer The Medicaid Billing Agent.

ACS is no longer the Medicaid Billing Agent. The new agent is EDS. This went into affect on June 19, 2008. ACS is no longer accepting or processing WINASAP or 837 X12N electronic claim transactions.

During the week of June 30, 2008, providers will not receive a payment from Medicaid.

According to Medicaid, “This week for non-payment is standard operation.”