Case Study: participant-Directed Attendant Support Services (CDASS)
Colorado Department of Health Care Policy and Finance (HCPF)
Public Partnerships, LLC (PPL) acts as the Financial Management Services (FMS) organization for participant-directed Medicaid service delivery options throughout the state of Colorado. PPL engages in both fiscal and personnel services. The fiscal responsibilities include accurately making financial transactions and payroll on behalf of clients, including but not limited to federal, state, and local taxes and workers’ compensation. Additionally, as a personnel service, PPL is responsible for providing skills training to new and current CDASS clients to ensure that they understand the philosophy of participant direction, are able to recognize and monitor the quality of services they receive, and are able to maintain their support services within their monthly allocation.
PPL serves as an “Agency with Choice” through its subsidiary, Public Partnerships – Colorado, Inc (PPC), where the Client and/or an authorized representative is designated as the managing employer and PPC serves as the common law employer of record, allowing clients to have increased flexibility and control when they assume shared responsibility for the hiring and management of employees who provide participant-directed services to them. In addition, PPL ensures that all expenditures are in compliance with program rules and budget allocations. PPL provides extensive online capabilities via its Web portal, including the creation of monthly allocations by Case Managers, the submission of timesheets, and mechanisms to track expenditures.
As part of its fiscal responsibilities, PPL sends weekly billing files to the state of Colorado’s Medicaid billing system. These files contain the CDASS service transactions paid by PPC to employees. PPL has established an ongoing process of working with the Department of Health Care Policy and Financing to review Medicaid billing and ensure PPL’s systems and the State’s Medicaid billing systems are in concert.
PPL has opened an office in a Denver suburb to provide more local and direct supports to the clients they serve in the CDASS program. The current CDASS program serves over 1, 100 clients, who employ more than 3,000 individuals. The program is expected to grow to over 4,000 clients using over 10,000 employees during the next three years.
Neither the state of Colorado nor its disabled community was pleased with the support services that a former vendor was providing. A Request for Proposal was issued and Public Partnerships, LLC (PPL) was selected to provide Financial Management Services for participant-directed Medicaid service delivery options throughout the state.
The PPL Approach:
PPL’s Web portal is a very unique tool that allows clients to manage their budgets and submit timesheets online and case managers to monitor how well clients are managing their monthly and certification period allocations. Additionally, PPL has committed to listening to the community and continuing to improve the CDASS program. We have participated in all CDASS Advisory Committee meetings (moved from quarterly to bi-monthly) and every other week Advisory Committee Sub-Group meetings, which have largely focused on areas for desired improvement and change. Feedback from these meetings has led to changes such as modifying the paper timesheet format from three separate timesheets with one service type per timesheet to a single page format reflecting all three service types. Feedback from Web portal users has led to more user friendly navigation and the ability for clients to create timesheet templates for their employees.
Also unique to the PPL approach is our use of Peer Trainers to conduct training and support for new CDASS clients. PPL has established a network of Peer Trainers, led by a Peer Trainer Coordinator. New CDASS clients are scheduled for group training sessions, led by someone who has been a CDASS participant and can share experiences. Peer Trainers are periodically brought together to share best practices and brainstorm on ways to improve the training curriculum.
While this project, with a time frame of December 2009 – December 2012, is still in an early stage, PPL has been able to provide the state of Colorado with programmatic analyses which it has used to help draft new State CDASS program rules. The new rules, currently under review, will establish a more structured framework for the CDASS program and will ultimately help the program stay within intended spending limits.
This project’s other results to date include:
- reaching “steady state’ in operations by month four of the transition. The PPL team has also developed new support services and customized supports.
- more efficient management, integrity and accountability of public funds and resources.
- increased efficiency and accessibility of expenditure data.
- the establishment of processes and procedures to accommodate substantial program growth.