CCLS on Private Pay

PROVIDER ISSUES

Residential Providers—Issues to Address


Values Issues

1. Will the Residential agency provide services differently to private pay consumers than the way it provides them to government-funded consumers? If so, what is the justification for that? Would a private pay consumer get the services of a job developer ahead of a county consumer because the private pay consumer is paying more? (or requires less paperwork and bureaucratic compliance?)

The services we provide to our private pay consumers are no different than the services provided to our government-funded consumers. All consumers when coming to CCLS have a detailed assessment completed which identifies the specific types of services needed. We do not differentiate or provide preferential treatment to our consumers based on funding source.

2. Would the Residential agency consider providing more hours per week of support to a private pay consumer than the agency would provide that same person if s/he were receiving government-funded services? If so, what is the justification?

No, the amount of support provided depends upon each consumer’s level of needed. Budgets are developed based on the information we glean from the completed assessment and the information we receive from their team and other support systems. Once all of the information has been gathered, we along with the consumer and their team determine the amount of support to provide.

3. Would the provider charge the same rates for private pay consumers as it charges government-funded consumers? If not, how would the difference be justified? If the provider is trying to achieve “rate parity” or rate consistency for all consumers, how is that defined?

The charge for services is dependant upon what we are being asked to do. How much staffing is needed? Can the consumer live in a cluster site to help keep costs down? Are there other supports needed? CCLS does not have a set cost for services. Each budget is based on the amount of support needed and agreed to by each consumers respective teams.

4. Who should benefit from agency fundraising—everyone, or only consumers which the county serves, because the county may not be paying their full share of the costs? Should fundraising be used in part to offset costs to private pay consumers and their families?

CCLS does not conduct any fundraising.

5. Will the agency be comfortable terminating service if a client’s private funds are depleted? Does terminating a client for that reason violate the agency’s mission?

We will try every option first before terminating a client based on their ability to pay, either private or government funded. We have already moved some consumers who’s rate did not match their support needs into cluster sites where the rates of other consumers could be used to help. The sharing of staff helps us keep the overall cost of support down.

We already have a number of clients who’s rate does not match the supports needed nd in some cases we are taking planned/budgeted losses. We continually monitor those programs and are always looking for new and creative ways to provide the supports needed at a reduced cost. Should a situation arise where the losses were too great and it was beginning to affect the overall financial performance of the organization, we would have no choice but to terminate services at that point. I would also like to add that none of this would come as a surprise to any member of the consumers team. We make it a point to routinely keep the team and funding source updated on what has been tried and where we are standing financially. To answer your last questions, terminating a client based on funding does not violate our mission or philosophy if it is done only after having tried everything else and there is just no other options available.

Operational Issues

1. Will the provider have an “annual contract” or “annual agreement” with each family? If so, how will the contract be developed between provider and family? Will it focus on outcomes or units of service? How much flexibility will be in the document for the consumers, families, or the provider to make adjustments during the year?

We already have and use contracts for our private pay consumers. Each contract is unique and individually developed to meet the needs for the specific funding sources.

2. Will the same assessment process be used for publicly and privately-funded consumers? Will the Individual Service Plan format be the same as it is for a provider using public funds? How will job development services be billed?

As mentioned earlier, there is no differentiation in the types of services provided.

3. Will the provider bill families a set rate for each hour of service, or a flat amount per month? What will be the provision for periods of unemployment or sick days?

We bill for the actual number of hours of support provided at the contracted hourly rate. The billing each month will vary depending on vacations, sick, days, etc. Should the consumer be faced with a long term of unemployment, we would work with the team to help reduce the overall costs in service.

4. How will providers define “past due” in relation to private pay invoices sent to families? What steps will the provider take before terminating service? Will this be clearly spelled out in the contract/agreement?

5. What adjustments must be made in the agency’s fiscal accounting procedures to handle private pay clients?

We would not need to adjust any of our accounting procedures in order to accommodate a private pay client.

6. How will providers educate or remind families that purchasing services with private funds does not guarantee that the consumer would be eligible for county funding or move them up on the waiting list?

It is important to maintain open and honest communication with the families to remind them that purchasing services with private funds has absolutely nothing to do with their eligibility for county funding. This conversation or reminder needs to occur yearly during the contract renewal conversations.

7. Is the provider setting aside a certain portion of its capacity for private pay consumers, or do they plan to do this on a more fluid basis?

Our ability to take on any new client is done on a fluid basis depending on program vacancies, the types of supports needed and the availability of adequate staffing.

8. What will agencies do to assure a smooth transition from school-supported services to private pay services?

Each transition is handled individually based on the person and their families unique needs. The transition from school into adult services works better when the school staff are included on the team and involved in the development of the transition plan. In some cases, we have hired school staff to work with the transitioning student to ease the process. They can then fade out of the plan as needed.

9. Will agencies or staff be permitted to accept a yearly bonus for a job well done?

CCLS has a conflict of interest policy, which states the following. No employee of CCLS nor any member of his or her immediate family should engage in any business transaction with a client of CCLS, which gives, or has the appearance of giving, any personal gain, or benefit to the CCLS employee or his or her family. CCLS trust responsibilities for its clients require that all dealings between clients and CCLS employees or representatives be above any suspicion. CCLS must ensure that decisions made by its staff concerning client services, and the recommendations and counseling given by staff to its clients, are not colored by the prospect of personal gain to CCLS staff.
The practice of accepting gifts or gratuities is not only unnecessary and undesirable, but also contrary to the public interest served by CCLS. Accordingly, no employee or member of his or her immediate family may accept any money, gifts of other than token value, unusual hospitality, or other preferential treatment or substantial favors which may arise or appear to be related to the employee’s position while working at CCLS. If any employee is offered a gift or gratuity, which is of more than token value, and it is not possible to decline, the employee shall advise his or her supervisor in writing, explaining the circumstances and verifying that the transaction will not embarrass or cause financial risk to CCLS.

The Arc-Dane County
6602 Grand Teton Plaza
Madison, WI 53719
833-1199 phone
833-1307 fax

www.arcdanecounty.org

March 26, 2008

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