2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Long-Term Careneeded to assist the member. Our aim is to ensurethat members are effectively encouraged to choosethe services, supports, and goods they believe bestmeet their community living needs.Members who participate in the SDCB chooseeither to serve as the employer of record (EOR) oftheir providers or to designate an EOR orauthorized agent to serve as the EOR on his or herbehalf. Development of the budget begins after themember’s completion of the self-assessmentrequired for the SDCB, identification of an EOR orauthorized agent if applicable, and completion ofthe CNA by Presbyterian’s care coordinator. Thesupport broker and member (and EOR orauthorized agent, when applicable) reviews theresults of the CNA. Based on the results of theCNA, the support broker provides the level ofassistance the member requires, ranging from noassistance to in-depth discussions to identify eachneed and determine how each need can best bemet. The member is also encouraged to identify hisor her short-term and long-term goals, includingneeds related to life goals and any anticipated lifechanges, such as living situation, caregiveravailability, and/or community participation. Thesupport broker obtains the member’s annual budgetallocation amount from the care coordinator and, ifappropriate, calculate the average monthly andweekly amounts for the member’s use.The support broker then guides the memberthrough the budget development process. Thesupport broker helps the member address thefollowing key decisions necessary to develop thewritten budget plan and provide background andadditional information as needed:What services, supports, and goods do youneed each month? Are there any services,supports, and goods you need once duringthe year or just a few times, and, if so, whatare they?Are there any no-cost resources availablefrom other programs, organizations, familymembers, or friends that can be used insteadof a covered service? Do you need helpcontacting these other resources?Are the remaining needed services, supports,and goods covered? Are any prohibited bystate or federal requirements?What types of workers do you need to hire toprovide the identified services, supports, andgoods?How often do you need the services, supports,and goods (daily for how many hours, weekly,other)?What is your budget to purchase services,supports, and goods? How much can youoffer to pay providers for the services,supports, and goods based on the rate rangesprovided by HSD?What is your backup or emergency plan?The Fiscal Management Agency (FMA) is the entitycontracting with the state to provide the fiscaladministration functions for members receiving theSDCB. The FMA must be an entity operating underSection 3504 of the Internal Revenue Service code,Revenue Procedure 70-6, and Notice 2003-70, as10-52014 Practitioner and Provider Manual - Ver. 3