cdde vendor services manual 20180531€¦ · case manager – a healthcare professional that...

Vendor Services Manual for Service Recipients/Representatives in the

Lifespan Waiver May, 2018

This manual is property of the Consumer Direct Care Network (CDCN) and may not be duplicated in any form without express permission from CDCN.

VENDOR SERVICES MANUAL

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Table of Contents Contact Information .................................................................................................................................................. 1

Welcome! .................................................................................................................................................................. 2

CDCN’s Role and Responsibilities .............................................................................................................................. 4

Service Provisions .................................................................................................................................................. 4

Notice of Privacy Practices (HIPAA) Statement ..................................................................................................... 4

Reporting of Abuse, Neglect and Exploitation ...................................................................................................... 4

Corporate Compliance Policy Statement .............................................................................................................. 4

Complaints and Grievances ................................................................................................................................... 4

Filing a Complaint or Grievance ............................................................................................................................ 4

Service Recipient/Representative Role and Responsibilities .................................................................................... 6

Enrolling for CDCN Services ................................................................................................................................... 6

Monitoring Spending ............................................................................................................................................. 6

Vendor Forms ........................................................................................................................................................ 6

Medicaid Fraud ...................................................................................................................................................... 6

Appendix .................................................................................................................................................................... 8

Notice of Privacy Practices .................................................................................................................................... 8

CDCN Portal Registration Instructions ................................................................................................................... 8

Spending Summary Explanation Sheet .................................................................................................................. 8

Zsecure (secure email) ........................................................................................................................................... 8

Feedback Form ...................................................................................................................................................... 8


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Contact Information

Consumer Direct Care Network (CDCN) Customer Service Representatives can be reached Monday‐

Friday 8 am to 5 pm, excluding holidays. Office hours may vary depending on staffing. Messages can

be left outside of business hours and will be returned the next business day. Contact information is

presented below:

Office Location

CDCN

744 Ryan Drive, Suite 201

Hudson, WI 54016‐7984

Important Phone Numbers

CDCN Main Line .......................................................................................................... 855‐450‐2709

CDCN Fax Line ............................................................................................................. 877‐785‐9992

CDCN Fraud Hotline .................................................................................................... 877‐532‐8530

CDCN Injury Hotline .................................................................................................... 888‐541‐1701

Adult Protective Services ............................................................................................ 800‐223‐9074

Email

[email protected]

Web (forms and information)

http://www.ConsumerDirectDE.com

Web (online spending summary)

https://CDCNPortal.com/


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Welcome!

Welcome to self‐directed services! We are the Consumer Direct Care Network. CDCN encourages

people to have more control and choice over the services they receive. We want you to live the life

that you want. People who self‐direct their services report being happier with the services they

receive. They also like the freedom they have as a result.

CDCN provides services and supports that help older adults and people with disabilities remain safe,

healthy, and independent in their own homes. We specialize in self‐directed care. We provide a

variety of options for those who self‐direct their care and services. We have extensive experience with

Medicaid, Medicare, private insurance, and supporting people who manage their own care. We believe

deeply in the philosophy of self‐determination, a process that enables a person to remain in control of

their own life. We value the strength and ability of each person. We believe that by helping you stay

involved in the direction of your own care, we contribute to your health and help build healthier,

happier communities.

Mission

To provide care and support for people in their homes and communities.

Vision

To help people live the life they want.

Values

Respect. Integrity. Service. Excellence.

Handbook

The purpose of this Handbook is to help Service Recipients and their Representative understand their

responsibilities in a self‐directed program. Please read this Handbook carefully. We suggest you keep

it as a reference for the future.

Definitions

Service Recipient – The individual receiving Medicaid Lifespan Waiver services. Also known as

the Participant.

Representative – a guardian, Power of Attorney or responsible adult selected by the Service

Recipient who manages the Service Recipients self‐directed services under the Medicaid

Lifespan Waiver.

Vendor – a business or independent contractor who provides the Service Recipient with goods

or services that have been pre‐approved on a Care Plan.

Case Manager – A healthcare professional that assesses, plans, facilitates, coordinates care, and

evaluates the Service Recipient to ensure that the Service Recipient receives the appropriate

level of care. Also called a Community Navigator.


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CDCN Website – Consumer Direct Care Network’s website where the Service

Recipient/Representative can access and download forms and information related to the

services CDCN provides under the Medicaid Lifespan Waiver. http://www.ConsumerDirectDE.com

CDCN Portal – A secure website that provides online payroll and budget management tools to

the Service Recipient/Representative. Spending summaries can be accessed here.

If you have questions, you can get more information by:

Looking up the information in this Handbook

Calling CDCN

Welcome to CDCN! We hope your experience with CDCN is enjoyable and rewarding.


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CDCN’s Role and Responsibilities

CDCN follows all applicable Federal, State, and local laws. We also follow Federal and State Medicaid

regulations, policies, and procedures.

Service Provisions CDCN and the Service Recipient/Representative sign a service agreement at the start of service which

outlines the responsibilities of each party for the fiscal management services CDCN provides. CDCN’s

role will be to pay the Vendors you use for delivered goods and services approved on the Service

Recipient’s care plan.

Notice of Privacy Practices (HIPAA) Statement We are required by law to maintain the privacy of the Service Recipient’s health information. CDCN’s

Notice of Privacy Practices explains our legal duties and privacy practices with respect to your health

information. This can be found in the Appendix.

Reporting of Abuse, Neglect and Exploitation CDCN staff are mandatory reporters of suspected abuse, neglect and exploitation. This means if you

tell us of an incident of abuse, we must report it. You must report any suspected abuse, neglect, or

exploitation to Adult Protective Services (APS); please see the Contact Information page for the APS

phone number.

Corporate Compliance Policy Statement A policy is in place to assure compliance with all governmental laws, rules, and regulations. CDCN

maintains and promotes integrity and ethical behavior. CDCN supports:

Ethical standards.

Standards of conduct.

Has zero tolerance for fraud and abuse.

CDCN’s Corporate Compliance Policy is available upon request.

Complaints and Grievances Your feedback is very important to us. If you have a complaint or grievance regarding the services you

receive from CDCN, please let us know. CDCN will respond to all complaints and grievances in a

reasonable and prompt manner. We will work with you to attempt to reach a resolution.

Filing a Complaint or Grievance

A complaint should be filed if you have an issue with something within CDCN’s reasonable control. For

example, issues with our enrollment procedures, handling of payment issues, or web portal concerns.

Complaints may be made verbally or in writing. Written complaints may be submitted using our

Feedback Form and sent via email, USPS mail, or fax. The Feedback Form may be found in the

Appendix or on the CDCN website.


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If you feel your rights have been violated or you disagree with a CDCN Policy, you may file a grievance.

Grievances must be submitted in writing for our review.

Once you file a complaint or grievance, CDCN staff will work with you to address your concerns. If you

are not satisfied with the initial recommendations, then the issue will be escalated to the next

supervisory level until your issue is resolved. All complaints and grievances will be responded to within

CDCN policy timelines. Our Complaint and Grievance Policy is available upon request.


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Service Recipient/Representative Role and Responsibilities

Enrolling for CDCN Services Upon CDCN receiving a referral from the state of Delaware, we will provide the Service Recipient/

Representative with an enrollment packet containing necessary forms to participate in this program.

The Service Recipient/Representative is responsible to complete all required forms in a timely manner.

Monitoring Spending CDCN provides the Service Recipients/Representative with access to online spending summaries so

they can monitor how much money they have spent and how much remains of their budgeted

allocation.

Please see the included Web Portal Registration Instructions and Spending Summary Explanation Sheet

for additional information.

Vendor Forms The Service Recipient/Representative may need to acquire a completed W9 from the Vendor in certain

situations. The Service Recipient/Representative may also need to complete a Vendor Payment

Reimbursement form. CDCN will notify and send copies of the W9 and Vendor Payment

Reimbursement form to the Service Recipient/Representative if these forms are required.

Medicaid Fraud The money for services in the program comes from state and federal governments. Fraud or abuse of

this Medicaid program is against the law. Suspected cases of Medicaid fraud or abuse must be

reported to the State by CDCN.

Examples of Service Recipient/Representative or Employee fraud and abuse of Medicaid funds are:

Writing down more time than was actually worked on a time sheet.

“Padding” time sheets. Examples are:

o Showing up late or leaving early and writing down more time than actually worked.

o Taking a break and not subtracting break time when the time is recorded.

Forging an Employee’s or Service Recipient/Employer’s signature.

Turning in a false claim for good or services that were not provided or not necessary.

Suggesting or helping a Service Recipient get services or supplies that are not required for the

person’s disability.

Not providing the quality of services for a Service Recipient that is expected.

Falsifying employment documentation.

All cases of possible Medicaid fraud and abuse must be reported immediately. Please report cases to

CDCN by calling the Fraud Hotline at 1‐877‐532‐8530. You may also report to your state’s fraud hotline


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or the Office of Inspector General. Their respective phone numbers can be found on the Contact

Information page at the beginning of this Handbook.

For additional training, please see our fraud prevention video on the CDCN website.


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Appendix

Notice of Privacy Practices

CDCN Portal Registration Instructions

Spending Summary Explanation Sheet

Zsecure (secure email)

Feedback Form

NOTICE OF PRIVACY PRACTICES

Notice of Privacy Practices 01/11/2018 Page 1 of 2

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS

NOTICE CAREFULLY. We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan and to enable us to meet our professional and legal obligations to operate this Company properly. We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. This Notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our Privacy Officer listed below.

Privacy Officer: Daryl Holzer

(877) 532‐8530

Effective Date: April 1, 2003; Revised March 26, 2013; Updated February 25, 2015

1. Below is a description, including at least one (1) example, of the types of uses and disclosures that this Company is permitted to make for each of the following purposes: treatment, payment and health care operations.

Disclosures to other health care providers, including, for example, to patients' attending physicians. Submission of claims and supporting documentation including, for example, to organizations responsible to pay for services provided by this Company. Disclosures to conduct the operations of this Company, including, for example, sharing information to supervisors of those who provide care to patients.

2. Below is a description of each of the other purposes for which this Company is permitted or

required to use or disclose protected health information without an individual's written consent or authorization.

To patients, incident to another permitted use or disclosure, by agreement, to the Secretary of the U.S. Department of Health and Human Services, as required by law, for public health activities, information about victims of abuse, neglect or domestic violence, health oversight activities, for judicial and administrative proceedings, for law enforcement proceedings, about decedents, for cadaveric organ, eye or tissue donation, for research purposes, to avert

NOTICE OF PRIVACY PRACTICES

Notice of Privacy Practices 01/11/2018 Page 2 of 2

a serious threat to health or safety, for specific government functions, to business associates of this Company, to personal representatives, de‐identified information, to workforce members who are victims of crimes, to workers' compensation programs, for involvement in the individual's care and for notification purposes, with the individual present, for limited uses and disclosures when the individual is not present, and for disaster relief purposes.

3. Other uses and disclosures, such as disclosure of psychotherapy notes, use of protected

health information for marketing activities and the sale of protected health information, will be made only with the individual's written authorization and the individual may revoke such authorization.

4. The Company may contact the individual to schedule visits and for other coordination of

care activities.

5. The individual has the right to request further restrictions on certain uses and disclosures of protected health information, but this Company is not required to agree to any requested restriction(s), except disclosures must be restricted to health plans if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law and the protected health information pertains solely to a health care item or service for which the individual or person other than the health plan, on behalf of the individual, has paid this Company in full.

6. The individual has the right to receive confidential communications of protected health

information, the right to inspect and copy protected health information, the right to amend protected health information, the right to receive an accounting of disclosures of protected health information and the right to obtain a paper copy of this Notice from the Company upon request.

7. This Company is required by law to maintain the privacy of protected health information and

to provide individuals with notice of its legal duties and privacy practices with respect to protected health information and to notify affected individuals following a breach of unsecured protected health information.

8. This Company is required to abide by the terms of this Notice currently in effect.

9. This Company reserves the right to change the terms of its Notice and to make the new

notice provisions effective for all protected health information that it maintains. Individuals may obtain a revised copy of this Notice upon request.

10. Individuals may complain to this Company and to the Secretary of the U.S. Department of

Health and Human Services if they believe their privacy rights have been violated. Complaints should be directed to Daryl Holzer, Privacy Officer, at this Company at the following telephone number (877) 532‐8530. Individuals will not be retaliated against for filing a complaint.

WEB PORTAL REGISTRATION INSTRUCTIONS

Rev. 05/31/2018 Page 1 of 3

Introduction

The Consumer Direct Care Network (CDCN) Portal, or CDCN Portal (https://CDCNPortal.com/) is a secure website that provides online payroll and budget management tools to individuals who receive services through a CDCN company.

Figure 1. CDCN Portal home page with Sign in and Register buttons

Note on terminology: People enrolled in a Medicaid program and who receive CDCN payroll services are called a “Participant” in the CDCN Portal. Workers who provide services to the Medicaid recipient are called a “Care Giver” in the CDCN Portal.

Registration Steps

1. Go to the CDCN Portal. On a computer with internet access, open a browser and enter https://CDCNPortal.com/ in the address bar. This will take you to the opening page of the CDCN Portal as shown in Figure 1 above.

2. Click on the Register button (Figure 2) to open the registration page.

3. Enter your email address and click the Send Verification Code button. An email address is required to register. Enter your email address in the top‐most field and click the “Send verification code” button (Figure 3).

Figure 2. Register Button


Rev. 05/31/2018 Page 2 of 3

4. Retrieve and confirm your verification code. Upon clicking the “Send verification code” button, a code will be sent to your email address you provided in the box above the button. Check your email for the code. The code will be a numeric code. Copy and paste the code, or type the code into the box that appears below the email address labeled “verification code” (Figure 4). If you did not receive the code in your email, you can click on “Send new code” to have another code sent. If you still don’t see an email, please look in your junk email, for it may have been marked as spam.

5. Enter a password in the New Password

field. Your password must be between 8 and 16 characters. It must contain a combination of lowercase, uppercase and special characters and digits as explained in the accompanying red text next to the field (Figure 5).

6. Retype the same Password in the Confirm New Password field. The password must be typed exactly as the New Password field.

7. Enter your name in the First Name and Last Name fields.

8. Select your Role. Click in the field labeled “Role” to receive a listing of roles in the system (Figure 6). Workers providing care to program participants will select “Care Giver”. Program participants will select “Participant”. An authorized or designated representative of a participant who provides employer functions will choose “Designated Representative”.

Email Address

Figure 3. Registration Page Fields

Figure 4. Verify Code

Figure 4. Verify Code

Figure 5. Enter Password

Figure 6. Select your Role


Rev. 05/31/2018 Page 3 of 3

9. Chose the state where service is provided. Click in the field labeled “State” to receive a listing of states where CDCN operates (Figure 7). Select the state where the Participant resides and service is delivered.

10. Enter your primary phone number in the bottom most field labeled “Phone”. A CDCN representative will contact you at this number to confirm your registration. This is a security step to prevent someone from impersonating you. Please enter only numbers in this field. Do not enter any parentheses “( )” or dashes/hyphens “ ‐ ”.

11. Click the Create button to finish the registration process. Once you have completed all the necessary information, click the “Create” button to finish your registration process at CDCNPortal.com.

Note on Activation of All Features: All enrollment paperwork for both the Care Giver (if applicable) and Participant must be submitted and approved prior to complete activation of all CDCN Portal functions. Once all paperwork has been approved and we have contacted you to verify registration, you may begin to enter time online or access spending summaries.

Figure 7. Select your state

SPENDING SUMMARY EXPLANATION SHEET

The Spending Summary Example below shows how you can easily track information in the Consumer Direct accounting System. The Summary shows the amount of money spent and remaining for authorized services.

Your Spending Summary can be accessed by logging into the Consumer Direct Portal (CDCNPortal). Click on the link at www.ConsumerDirectDE.com. It will be helpful to regularly check your Spending Summary.

Spending Summary Example and Explanation

Participant Contact Information.

Participant Number Program Coordinator Current SUTA Rate

0000000 NAME #.##%

Phone External CM

(555) 555‐5555 NAME

Authorization Period. The dates you are approved for services

Name of Payer and Program You are Enrolled With

Start End % Time Elapsed

Auth Period Date Date 15.96%

Overview of Budget by Service Code. Money spent and remaining in each service category.

Service Budget Used YTD Processing to be Paid

Dollars Remaining

ServiceCode 1

$500.00 $0.00 $0.00 $500.00

ServiceCode 2

$5,000.00 $450.00 $0.00 $4,550.00

Overview of Total Budget. Total money spent and remaining.

Totals $5,500.00 $450.00 $0.00 $5,050.00

These amounts include taxes and, in some cases, fees.

Explanation of Columns

Service. The service

codes available to you

Budget. Total money available

in each category.

Used YTD. Money spent in each

category. (YTD= “Year to Date”)

Processing to be Paid.

Money for pending payments.

Remaining. Money left in

each category.

Graphs. The graphs on your Spending Summary provide a visual of the following:

Percentage of budget time remaining

Percentage of amount spent vs. amount remaining

The goal is to have the percentage of elapsed time and the percentage of money spent to be close. If there is a large difference between the two percentages, your spending will need to be adjusted accordingly.

** Please call our office with questions. Thank you! **

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SECURE EMAIL

Rev. 02/23/2018 Page 1 of 4

Accessing Secure Email Sent by Consumer Direct Care Network AllCare uses a secure messaging system to send protected health information.

Below is an example of a secure message. This is not spam so do not delete.

Step 1: To view the message, click the “open message” button.

Step 2: You will need to register the first time you view a secure email. This is different than your web portal login. Create a password. Passwords must meet the password rules. Enter your password and click the register button.

SECURE EMAIL

Rev. 02/23/2018 Page 2 of 4

Step 2 Continued: If you’ve already created a password, you will get the login screen below. Enter your password and click the sign in button.

Step 3: After signing in you will be able to read and respond to your message(s). Messages do expire so print or save the email if you wish to keep it. Remember to check your spam/junk folder often.

SECURE EMAIL

Rev. 02/23/2018 Page 3 of 4

Changing Your Secure Email Password

Step 1: From the login screen, click the reset button under the “forgot your password” section.

Step 2: Enter your e‐mail address and new password. Click the reset button.

SECURE EMAIL

Rev. 02/23/2018 Page 4 of 4

Step 3: You will receive an e‐mail with the links below. Click the activate link to accept your new password.

Step 4: You will receive the message below after you click the activation link. Click the continue button to proceed to the login screen.

FEEDBACK FORM

Rev. 04/26/2018

For Consumer Direct Office Use

Date Received: / / Signature: ________________________

Action Taken: □ Resolved □ Not Resolved □ Submitted to Program Manager

Plan: (Please use back of form)

Name: _____________________________________ Date: _____________ (Please Print)

You are a (Please check): Participant Employee Agency Other _________________

Address: ________________________________________________________________

City: _______________________________ State: ____________ Zip: ____________

Telephone: _________________________ Email: _____________________________

Would you like us to contact you? Yes No If yes, how: Phone Email Mail

Please send to: Consumer Direct Care Network Delaware 744 Ryan Drive, Suite 201 Hudson, WI 54016 Toll Free Fax: 1‐877‐785‐9992 Email: [email protected]

Directions: Please complete all the sections except the gray one at the bottom of the page. Mail, email or fax the form to Consumer Direct Care Network Delaware.

Please check the box that applies: Compliment Suggestion Complaint

Please describe the compliment, suggestion or complaint:

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