State Announces Payment Systems Change Delay; Provider Enrollment Agreements Still Needed

Dear Providers,

Yesterday, newly-appointed ODDS Interim Director Trisha Baxter announced that Oregon is putting the brakes on its move to centralize payment to providers of brokerage services.

The new target date for the change is now July 1st, 2014.

For quite some time, there has been great concern amongst brokerages, providers, and customers regarding what has been a rather rocky implementation process. Payment to our essential provider base must be top priority for our community and system. We applaud ODDS’ move to delay for solid planning and pledge to work with the Department on development of a thoughtful and thorough approach to this transition.

That said, all providers still need to turn in their Provider Enrollment Application and Agreement. Regardless of how long this process takes, one thing is certain: you will need a provider number to do business in Oregon. It’s in your best interest and in the best interest of your customers that you take this important step now.

To recap:

  • Continue to send your timesheets and invoices to INW as you always have. We’ll continue payment to you until at least June of 2014.
  • If you haven’t sent in your Provider Enrollment Agreement, do so now. This is an essential action on your part, regardless of changing timelines. The state should then follow up with you and provide you details on how to sign up and sign in to the eXPRS payment system.
  • If you have turned in your PEAA and have received no response back from the State, contact them directly at DD-MH.OHCC@state.or.us.
  • Additionally, all providers must have a criminal history check completed every two years.

Thanks for your work and support of our community. Stay warm out there!

Best,

Larry Deal
Executive Director

11/25/2013 Update on Provider Payment Changes and Provider Enrollment into the State’s System

Dear Providers,

There continue to be hold-ups on the State’s move to take over payment to providers of brokerage services.

Representatives from the Office of Developmental Disabilities Services promise there’s continued work on a solid plan, but as of right now they have produced no clear plans or feasible timelines. What we do know is this:

  • Payment will not be coming through the State effective January 1st, 2014
  • We will continue to provide your payment until an appropriate plan is developed and agreed upon.

Given the amount of work left to do during implementation, our best guess is a transition several months into the new year at this point.

If you haven’t sent in your Provider Enrollment Agreement, do so now. This is an essential action on your part, regardless of changing timelines.

If you have turned in your PEAA and have received no response back from the State, contact them directly at DD-MH.OHCC@state.or.us. (We initially thought we would be able to send out emails for those who had provider numbers, but the information we have received from the State isn’t in a format that allows us to do so given our limited resources.) Please email the State for assistance on this matter.

Many of you have received requests for W4s, I9s, and Direct Deposit forms. (Oddly, this request also went to Independent Contractors, a designation of providers who do not utilize W4s or I9s in their business practice.) Stranger still, we understand that you’re being told to submit items to brokerages. We have already processed these forms during your initial qualification and we cannot process them a second time. Please send your W9s, I9s, Direct Deposit forms directly to the State at:

            Email:            info.exprs@state.or.us
Mail:               DHS – ITBSU
ATTN: eXPRS User Enrollment
500 Summer Street NE E-12
Salem, OR  97301

Finally, provider organizations who need a provider number should be hearing from the State shortly. We are aware of a transmittal being developed and have heard it should be out within the next week or so.

Unfortunately, the State has not provided a phone number to field your questions. If that changes, we will update you and share the resource. We will continue to update you as we have more clear information. Thank you for your continued patience during this process. Rest assured that your payment will continue to come through us in the interim while these bureaucratic and procedural tangles are dealt with.

 

Join INW in December for a Community Forum on the Big Changes Happening in Brokerage Services

bigchangessmalldecember2013

Independence Northwest continues its community outreach on big changes to brokerage and I/DD services in Oregon. Since August, we’ve held many highly successful community forums presenting to over 300 community members – and we’ve got two more scheduled for the month of December!

Join us if you’d like to learn more about the K Plan, the upcoming needs assessment requirement, new options for case management, plans for a new universal ISP, changes to provider payment and rates and much more.

Remember to RSVP by calling our front desk 503.546.2950. You may also email us at larry.deal@independencenw.org. Space is limited, so reserve your space at one of our evening or day sessions today!

Big thanks to all the families, customers, providers and community members who have joined us in the past few weeks. Your questions, comments, concern and input continue to make a difference in the restructure of the I/DD system!

Update for Providers Regarding Provider Numbers and Forthcoming Payment Changes

numbersDear Providers for Customers of Independence Northwest,

I’m writing to give you a general update regarding upcoming changes to provider payments. There’s been a flurry of activity around this topic in recent weeks and here’s the latest as we know it.

As you know, the State of Oregon Office of Developmental Disabilities Services plans to take over payments to brokerage providers in the near future. The deadline has changed multiple times and their current public target is January 1st, 2014.

In preparation for this change, all providers must obtain a Provider Number. In order to receive a Provider Number, you must turn in a Provider Enrollment Application and Agreement (Word or PDF). The Provider Number will allow you to go into the State’s payment system and make your claims. Without this number, you won’t be paid.

Many of you have contacted us via phone, email, on Facebook and in-person concerned because you submitted the required paperwork, yet you’ve heard nothing from the State. Communication and direction has been spotty, for sure.

Here’s how INW can help.

A day ago, the thirteen support services brokerages received a spreadsheet from the Oregon Home Care Commission. This spreadsheet contains the names and contact information for about 3,400 providers statewide. It includes assigned Provider Numbers. We are currently in the process of sorting through the list to determine which providers are attached to Independence Northwest.

  • If your name is on the list, we will email you your Provider Number early next week. (Some providers are getting email notifications with their Provider Number from the Home Care Commission and some aren’t, so you may receive this info twice.)

 

  • If your name is not on the list, we will email you early next week and tell you that the State has not assigned you a Provider Number yet. This may be because you didn’t submit a PEAA or perhaps the State hasn’t processed your PEAA yet. We have no way of knowing which is the case (or if there are other variables), so concerned providers will need to follow up with the State at that point by emailing DD-MH.OHCC@state.or.us. At this time, the State has not provided a direct contact person or phone number. If that changes, we will update you.

We expect to receive updated Provider Number lists from the State from time to time, but don’t yet know what the frequency will be. As we receive those lists, we will update you where applicable.

If you haven’t submitted your Provider Enrollment Application and Agreement, please don’t delay – do it today.  As of right now, less than half of the Personal Support Workers in the State have been assigned Provider Numbers. It’s essential everyone is assigned a number on or before Monday, December 2nd, 2013. We can’t let a bureaucratic change affect payment for essential services to adults with I/DD.

Brokerages will continue payment (at the very least) through the end of 2013. As deadlines shift, we’ll keep you informed. You will continue to send your invoices and time sheets directly to your customer’s Personal Agent, as before.

To Recap:

  •  If you haven’t sent in your Provider Enrollment Agreement, do it now.
  •  If you have turned it in and we send you a notice saying the State hasn’t included you on its list, contact them via email at DD-MH.OHCC@state.or.us.
  • Continue to send your timesheets and invoices directly to us at Independence Northwest. We will notify you when the State is formally taking over payment. Even after the State takes over payment, you’ll still send proof of services to us for review.
  • The State will take over payment to you sometime in the new year. They are planning trainings and support for providers to get acclimated to the eXPRS system. Hold tight, information forthcoming.

We promise to communicate changes with you quickly to ensure as smooth a transition as possible. We are continuing our series of customer and community forums and welcome you to join us. It’s a great place to discuss the changes with other community members and get the latest details. I also encourage you to Like us on Facebook and subscribe to the Independence Northwest Blog to get updates as we have them.

Thank you for the essential work you do for our customers, their families and the community at large.

Best,

Larry Deal
Executive Director

PS – Provider organizations with current eXPRS log in information need not be concerned with this notice. As I currently understand it, provider organizations who are awaiting a Provider Number and eXPRS log-in will be contacted in the next week or so by the State.

ATTN: Providers – Updated Information on Payments and Provider Enrollment Agreement Timelines

calendar changeProviders, Customer Employers, and Community Members,

As you have likely heard by now, the State of Oregon Department of Human Services (DHS) has been moving toward changing the way providers of brokerage services are paid.

Since 2001, brokerages have operated as a fiscal intermediary for our customers and we have been responsible for provision of provider payment. For many years, DHS has shared its intent to update its systemic capabilities and pay providers of brokerage services directly instead. It looked like 2013 would be the year things changed.

In May of 2013, DHS sent out a missive to all Personal Support Workers, which included a copy of a Personal Support Worker Provider Enrollment Application and Agreement. The mailer stated “completion of this document is required for you to be on the State Registry” and that “by signing this agreement the state will issue a provider number which will be necessary for payment on or prior to October 1, 2013.”

However, the state’s payment change efforts have experienced continued delays and as a result of these delays payment will continue through brokerages for the time being. We are being told that January 1st, 2014 is the new target date for when you’ll be paid directly through the State.

Our office has begun receiving multiple calls from providers concerned about their payment and where it will come from as a result of the registry and the October 1st, 2013 deadline. We request two things:

1. Please continue to send your invoices and time sheets to Independence Northwest as you always have. We will follow our regular payment schedules for providers and you should experience no disruption in payment.

2. If you have not yet completed a Provider Enrollment Agreement, we implore you to do so. While we can’t be certain the new January 1st, 2014 date will be met, we know that eventually you *will* receive payment through the DHS payment system and you must be set up in order to avoid delay in payment. It’s imperative you have a provider number assigned to you before being paid. Please take a moment to take care of this important piece of business.

Thank you for your continued partnership, efforts and support of our customer base. And thank you for your patience during the current transition.

*Please note: We were told by state employees that provider organizations who are not already set up in the state’s payment system will receive a provider number via the state’s licensing unit. If you have questions about this, please contact Larry Deal at larry.deal(at)independencenw.org. Thanks.

Concern Over Talk of Reduction in Pay to Providers

By Ron Spence, Operations Director and
Larry Deal, Executive Director

Last Tuesday, August 20th, Independence Northwest hosted a community forum focusing on the big changes afoot in brokerage services and how those changes will affect providers and the provider community. We had an excellent turnout and lively conversation. A couple dozen providers (primarily Independent Contractors and a few Domestic Employees) came together to discuss upcoming systemic shifts including a change to how providers will be paid and quite possibly, how much they’re paid. As mentioned in earlier articles published by Independence Northwest, these changes are a result of the K Plan and poor audit findings. Read more about that here.

Significant Rate Reductions Potentially Ahead for Providers?

At present, SEIU (Service Employees Union International) and the State of Oregon Department of Human Services are in the process of bargaining rates for SEIU’s provider members. Thanks to House Bill 3618, all Domestic Employees and the majority of Independent Contractors serving brokerage customers are represented by SEIU. You’ll often hear these providers referred to as PSWs [Personal Support Workers] as a result).

Elvyss Argueta, an SEIU organizer who showed up to Tuesday’s forum, dropped a bombshell when he announced that there is movement by the State in current negotiations to reduce the top amount an Independent Contractor can be paid from $24 per hour to a paltry $14.00.

On Wednesday, August 21st, 2013, SEIU sent an email blast out to its members confirming Elvyss’s claims. Per SEIU: “We met with the state last Tuesday and bargained into the evening… The State is continuing to press for significant cuts to Independent Contractor rates … (and) is proposing that Independent Contractors’ current wages will only be kept whole until July 2014, at which point IC wages will drop to $14 per hour. This is unacceptable.”

We agree. Dropping rates down to such a measly rate would create a true crisis for the providers affected and the families and customers who receive services from them. There’s really no way to sugarcoat this. If SEIU’s claims become a reality, this type of service provider (with very few exceptions) will cease to exist as an option for brokerage customers.

Understanding the “Wage” of an Independent Contractor

First things first: employees and contractors are completely different animals. Decision-makers must understand this. The mere suggestion of cuts this deep points to a misunderstanding of not only the unique supports provided by these small businesses, but also of the very definition of an independent contractor.

On the surface, $14 per hour may sound like a fair and decent wage. It’s several steps above minimum wage and is considerably higher than the average direct support professional’s wage in Oregon. However, a closer look at what an Independent Contractor is and does reveals a completely different picture (please stick with us while we offer some context.) Independent Contractors get “paid” rates like $24 per hour because they assume all responsibilities for their own taxes, insurance and benefits; as a result, they take home much less than you’d think. The State was keenly aware of this important distinction as it developed a set of published rate ranges at the onset of brokerage services in the early ’00s.

Let’s start with a typical employee situation. If you are employed by a company and earn $14 per hour, that fourteen dollar figure does not represent the whole story. For starters, add 12% due to the taxes your employer must pay just to employ you and the cost jumps to $15.68 per hour or more. Then, let’s say you get health benefits – even low level benefits – from your employer. That’s probably another $300 per month (about $3,600 per year). That ends up costing your employer another $1.73 or so an hour, bringing your “wage” up to $17.41. Now, let’s throw in two weeks paid vacation and another week of sick time. That costs your employer about $1,881 for the three weeks (another 90 cents an hour) and now we’re up to $18.31 per hour. Maybe you have 401(k) or retirement benefits or if you are a government employee, maybe there’s some PERS being stashed away on your behalf. Your employer buys the supplies you need to do your job, pays for you to attend trainings, pays business insurance and liability insurance, pays for Workers Compensation insurance and mileage reimbursement and on and on… Anyway, you get the idea. $14 to you isn’t $14 to your employer.

Now let’s reverse all of that and look at it from the perspective of a contractor.

A properly classified Independent Contractor is a walking business. Unlike an employee, a contractor has no employer to offer them benefits, liability insurance, mileage/travel costs, computers, office supplies, software, training, sick or vacation time. Everything *starts* at the hourly rate which is exactly why they charge more. Your Independent Contractor might charge $24 to your Plan of Care, but his/her take-home is nowhere near that. Chances are pretty high that your Independent Contractor doesn’t drive a Lexus.

If Oregon starts paying Independent Contractors $14 per hour, these workers will very likely take home less than minimum wage for a professional service. Why would someone do all this work to make less than the guy across the street employed by a brokerage customer or provider organization? Why carry the headache of purchasing liability insurance, ensuring proper deductions, paying self-employment taxes (15.3% in 2013), worrying about your own health insurance only to make less?

If rates really are reduced to this level, we will witness hundreds of small businesses shutter and close up shop. Small businesses truly are the engine fueling Oregon’s current economic recovery.

The Need for Diversity of Provider Types to Serve a Diverse Population

We are lucky to have at our fingertips a rich community of Independent Contractors with varied backgrounds and specialties: former teachers, former case managers, people from the business community who decided they wanted to something more rewarding with their lives. Just as we value diversity in the people we serve, we value diversity in our provider base. We don’t just value that diversity for its own sake. We value it because it promotes choice and increases the quality of supports customers receive. Brokerage customers have wildly variant needs and that calls for a wildly variant set of skills in the provider community. Caregivers in the home meet certain essential needs for our customers. Skills trainers meet others. Provider agencies meet still others. It’s the diversity of choice that makes brokerage services exemplary and completely unique in the system.

A Need for Capacity and a Pledge of Support

In the Portland metro area, we work with hundreds of independent contractors. They have played an integral role in the development of brokerage services over the last twelve years and are a highly valued, essential part of this system.  As the K Plan rolls out, more services will be available for our customer base. This is a great thing. But all those extra financial resources mean nothing unless we have qualified, competent providers who can make a living doing the work. If we price them out, we all lose. Reducing capacity makes no sense.

We realize all too well that information is changing rapidly. This reduction may not even be on the table in a week. But, presently, this conversation is on the table. We feel an obligation to respond to this public information and to support the providers we, our customers, and their families rely on each day for critical health and safety supports. Independence Northwest stands in unequivocal opposition to a reduction in the rates of any provider who serves brokerage customers. 

We encourage providers to communicate with their legislators and leadership at the State to advocate for no reduction to the rates and to educate them on the services they provide. We promise to do the same.

Any reduction in rates for providers serving our customers is a step backward for all of us.

Get Involved!

Independent Contractor Patricia Lawrence is organizing Independent Contractors in the Portland metro area. Visit her new Facebook group for Independent Contractors  or send her an email directly at plawrence@tds.net to get involved.

Please Note: The proposed $10 per hour reduction is specific to those providers who fall under the Personal Support Worker/Independent Contractor designation. Services such as Behavioral and Social/Sexual Supports are not included in the announced proposed reduction.

Oregon Developmental Disabilities Director: “Guardians Can Be Paid with Right Processes in Place”

Oregon Developmental Disabilities Patrice Botsford makes a big announcement on the payment to guardians issue this afternoon:

“WE HAVE GOOD NEWS!!!! Today our federal partner, the Centers for Medicare and Medicaid Services (CMS) informed Oregon that guardians can be paid to provide care to their loved ones with the right processes in place. We are working quickly with CMS to clarify those processes and to develop a new notice for beneficiaries, but we wanted to share this information with you as soon as possible. When those details are worked out, we will provide you with an update and more information about next steps.

Thank you for your patience as we have been working through this difficult issue. We know that this issue is important and that the uncertainty about how we are moving forward is stressful for families and their loved ones. We appreciate the care and concern we have heard these past weeks and we remain committed to providing you with the most up-to-date, accurate information that we have.” Patrice Botsford Director, DHS Office of Developmental Disabilities Services

Big Changes in Oregon’s I/DD Service System | Part Two: Payment to Legal Guardians

Part Two: Payment to Legal Guardians
By Larry Deal, Independence Northwest Executive Director

NOTE: The State has reversed its take on payment to Guardians. Check out the latest details from Patrice Botsford here.


As mentioned in last week’s piece, Oregon’s Department of Human Services has chosen to change its primary funding source from Title XIX Waiver services to the new Community First Choice Option/K Plan. This change increases federal revenue for Oregon and expands services for seniors, people with physical disabilities, and children and adults with intellectual and developmental disabilities. With the additional revenue comes new mandates and expectations.

Perhaps the most controversial change thus far is the mandate that legal guardians no longer be paid as care providers through brokerages. Keep in mind that legal guardianship requires a court order and is not something that automatically occurs when an individual with a developmental disability turns eighteen. Guardianship also requires annual renewal action by the guardian.

Per ODDS (Oregon Office on Developmental Disability Services), CMS (Centers for Medicare and Medicaid Services) views payment to a legal guardian as a conflict of interest (see CFR 441.505.) When the funding was coming primarily through waivers, guardianship payment was permitted, but because Oregon has chosen to change its primary funding to Community First Choice Option/K Plan, the expectation has changed. It is now consistent with the regulations for how services are implemented for seniors and people with physical disabilities.

Statewide, well over 400 guardians are paid to provide services, the majority of them supporting people served by brokerages.  At present, brokerages and CDDPs (Community Developmental Disabilities Programs) have been directed by the state (ODDS) to begin conversations with our customers and their legal representatives about how to come into compliance with the new standards. We have requested clear, written materials to be shared with families and individuals regarding this directive.

As you can imagine, there has been a lot of concern and discussion on this topic. There’s quite a bit at risk here and clear, direct communication from all parties is key right now.

In a recent mailer to its members, SEIU (Service Employees International Union) claimed “some brokerages and CDDPs have incorrectly informed parent providers that they can no longer be their child’s guardian if they want to be paid as a provider. This is not true.” We share SEIU’s concerns on this change, but their mailer is misleading. ODDS has clearly and publicly stated this is their policy and has instructed brokerages and CDDPs to share this mandate and begin the conversation on this planned change. If one follows the directive up the chain, its genesis is with the government, not brokerages and CDDPs.

Two weeks back, ODDS Director Patrice Botsford released an extensive statement explaining the state’s position. “Families must make a decision whether the guardian will remain in place and not continue as the paid service provider and a new service provider chosen, or the guardianship may be terminated or transferred… We are asking that their decision be relayed to us via their case manager no later than December 1, 2013 for January 1, 2014 implementation. Read her entire statement here.

In addition to the statement, ODDS released a two-page Frequently Asked Questions document highlighting the specifics of the change. It’s worth a read.

Long-time disability rights advocate Representative Sara Gelser (D-Corvallis District 16) has become involved in the discussion. She recently began requesting stories through posts on her Facebook page. Per a post on August 7th, Rep. Gelser had met with Patrice Botsford and others at ODDS. Wrote Gelser: ” I had a very good meeting today with Patrice Botsford and her Deputy (Director) from the Office of Developmental Disabilities. I am feeling hopeful that we can find a solution that will meet everyone’s needs and will cause minimal disruption. Thank you for your stories. Please keep sending them, as they are very helpful.” She went on to thank Patrice and her team for partnering for a solution. Sara Gelser is beginning to look at potential legislative action that could influence the future.

At present, ODDS is developing an exception policy that will potentially allow for some guardians to be paid under the K Plan. The exception policy is still in draft format and will be reviewed by CMS in the next week or so.

Advocates throughout the system continue to comb through federal regulations and state law to see if there are other approaches that can be taken to address the situation. In the meantime, if you would like to be involved in the discussion and share your story, you have a few options.

Later this week, we’ll send out another missive on the Designated Representative piece. The representative issue is linked to the guardianship discussion, but deserves its own attention due to its complexity. For the sake of clarity, we’ll address it separately.

Additional Resources:

08/15/2013 UPDATE:
DD Director Patrice Botsford shared the following new information on ODDS’ Facebook page: “I wanted to quickly update you on where we are on our request for exception on guardians as paid caregivers. Our request is currently in the hands of CMS and their attorneys. We have near daily communication with them, and are looking forward to the best possible outcome. We are as anxious as you are, and we will post here as soon as we have any updates. Keep up the good work, and thank you all again for your advocacy and support.”

Abuse Reporting Training – Tues September 18th, 2012

The folks at Clackamas County Developmental Disabilities Program are offering a great training opportunity for all professionals serving people with disabilities: a one hour training on Abuse Reporting led by Abuse Investigator Brian Pollard.

WHAT: Abuse Reporting Training
WHEN: Tuesday September 18th, 2012 from 11am to 12 noon
WHERE: Clackamas County Public Services Building (2051 Kaen Road Room 369B Oregon City, OR  97045)

Abuse Reporting is geared toward adults eligible for DD Services, their families, Personal Support Workers, Foster Care Providers and staff, Residential and Vocational staff. Adults eligible for DD services are a protected class and therefore those paid to support them are Mandatory Abuse Reporters. The class will address when and how to report abuse and neglect of adults eligible for DD services.

If you are a Personal Support Worker, Domestic Employee or Independent Contractor, we at Independence Northwest strongly urge you consider this training opportunity.

Please contact Robyn Hoffman at 503.557.2872 or robynhof@co.clackamas.or.us for any questions and to RSVP. Space is limited, so please register to reserve your place.

2012 Funds Distribution Dates and Payment Information for Providers

A Message for Independent Contractors and Provider Organizations Qualified with Independence Northwest:

It is the policy of Independence Northwest to pay all invoices on a net 30 basis. (This means that we will disburse funds within 30 days of receiving an invoice from a provider.) As a result of this policy we do not adhere to particular invoice due dates or pay dates. However, for independent contractors and provider agencies to be paid in the first cycle of checks each month, we recommend they have their invoices to our office by noon on the following dates in 2012.

Friday, January 6th
Tuesday, February 7th
Tuesday, March 6th
Friday, April 6th
Monday, May 7th
Wednesday, June 6th
Friday, July 6th
Tuesday, August 7th
Thursday, September 6th
Friday, October 5th
Tuesday, November 6th
Thursday, December 6th

A note about postal delivery and direct deposit: We have been offering direct deposit to the entire provider community since August of 2010 and it’s been a great success. It helps us process payments faster and ensures your money lands in your bank account sooner. But now there’s a new reason to consider direct deposit: As you may have read in the news, budgetary cuts to the US Postal Service are expected to result in a significant slowdown of domestic mail. Local mail that previously arrived in one day may soon take three to four days to arrive. In anticipation of this change Independence Northwest is strongly urging all providers to sign up for direct deposit. All providers are being mailed a copy of this letter along with a direct deposit form.

Thank you all for your service to our community. Here’s hoping for a productive and
rewarding 2012.

Ron Spence
Operations Director
rspence(at)independencenw.org