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New Mexico’s Program

Providing and Coordinating Supportive and Fiscal/Employer Agent Services

Presented at

US DHHS/OASPE-Sponsored Government and Vendor Fiscal/Employer Agent Workshop

November 2, 2007

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Focus of Today’s Presentation

• Program Design Using Separate Vendors

• Challenges and Advantages of Separate Vendors

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How are participants supported in ?

Participants are not alone…Help is available…

Consultant Contract Agency (CCA)Consumer Direct Personal Care – Consultants hired by CCA to assists participants in understanding Mi Via and developing and implementing the Service and Support Plan (SSP) and budget.

Third-Party Assessor (TPA) Lovelace Community Health Plan – Determines medical eligibility and approves participants’ SSPs and budgets.

Fiscal Management Agent (FMA) Public Partnerships Limited - Handles employer/employee-related

matters; pays for goods & services approved on SSP and budget per participant authorization.

Participant’s choice of family, friends, advocates, representatives.

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What are the core CCA/consultant services in ?

Assists with understanding Mi Via

Assists with developing a Service and Support Plan (SSP) and budget

Helps with understanding and completing the paperwork

Serves as a key resource during implementation of the SSP and budget

Is a resource when problem-solving

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What are the core TPA services in ?

Determines initial medical eligibility for new waiver participants

Determines medical eligibility for all participants during recertification

Reviews for approval all Service and Support Plans and budgets

Makes expenditures that follow the approved budget

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What are the core FMA services in ?

The FMS performs as a Vendor F/EA in accordance with IRS requirements. It:

Sets up an account for each participant;

Makes expenditures that follow the approved budget;

Handles all payroll functions;

Provides participants with a monthly expenditures report; and

Provides the State with a monthly expenditures report.

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Develops a Service and Support Plan (SSP) and budget

Directs and implements the approved SSP and budget

Arranges for purchase of services and goods, and hires and manages workers

Authorizes expenditures

Assists with monitoring SSP and budget

What are the participant’s overall responsibilities in ?

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How are CCA, TPA and FMA services coordinated in ?

Consultant works with participant in development of participant’s SSP and budget.

Consultant forwards SSP and budget to TPA for approval.

TPA reviews SSP and budget; if approved, notifies the participant and consultant, and consultant forwards approved budget to FMA. If not approved, CCA and TPA work with participant to address outstanding issues.

FMA establishes an individual account for each participant and handles employer functions, including processing payroll and paying other authorized expenditures.

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Why did the State choose separate CCA and FMA vendors? State chose to contract for CCA and FMA services as did not have the

infrastructure to perform these functions in-house.

State was looking for vendors with expertise in each area and believed that separate Requests for Proposals (RFPs) would open up the widest interest in the market; however, bidders were not precluded from responding to both RFPs.

State wanted to create the opportunity for State businesses to participate and believed separate RFPs would better accomplish this objective.

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Why did the State choose separate FMA and CCA vendors cont’? State believed checks and balances more possible with separate

vendors.

Mi Via’s CCA model recognizes the participant’s right to choose his/her own local consultant, who knows the participant. The consultant is hired and trained by the CCA while facilitating participant choice and personal attention, and expanding employment opportunities in local communities.

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Challenges of the separate FMA and CCA services model Participants must communicate and work with two support vendors.

Each vendor, with unique internal business practices, must work with the other to build a new set of practices that are complementary in support of the participant. This requires flexibility, close collaboration and commitment.

Transfer of data is required, necessitating the need for multiple secure sites.

FMA and CCA quality assurance activities are linked, e.g., each vendor is dependent upon the performance of other for a successful outcome.

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Challenges of the separate FMA and CCA services model cont.’

Streamlining practices is more challenging – especially in the beginning when processes are being developed and implemented, resulting in fewer economies of scale.

CCA and FMA services costs are claimed at the administrative match as opposed to the Federal match for services.

State has two vendor contracts to monitor.

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Advantages of the CCA and FMA model

CCA staff are from local communities, expanding the workforce, and have experience in working across the populations.

FMA has extensive experience in F/EA services, including in other states, and is bringing that expertise to Mi Via and New Mexico.

Mi Via participants are being supported by vendors that bring different strengths and unique expertise – extremely valuable at this point in Mi Via’s evolution.

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How are participants doing with the support of the two vendors?

Processes are becoming more established.

There has been more interest in Mi Via than the contractors have been able to handle.

Participants report that they are happy to be in Mi Via.

155 individuals are enrolled, receiving and using their budgets for services and goods, per the approved budget.

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Thank You!

For more information, contactMarise McFadden, Director

Elderly and Disabilities Services DivisionNew Mexico Aging and Long Term Services Department

Marise.McFadden@state.nm.us(505) 476-4706