County Position on Private Pay

County Governments–Issues to Address
* Values Issues

1. Would the county find constraints on capacity if private pay consumers are using supported employment agencies with which the county has contracts?

It would be the Counties expectation that if providers began accepting private pay that they would continue to be willing to accept referrals of students leaving high school and the occasional new referral of people in crisis.

Counties would have to decide whether they would need to mandate that space be saved for a certain number of people, or whether to encourage the supported employment agencies to expand to meet the number of people needing their services.

2. If a person is on the county’s waiting list for supported employment services and s/he begins receiving private pay supported employment services, does that person’s status on the waiting list change?

No. It neither increases nor decreases the availability of County funding or status on the waiting list. It should be pointed out that, if the availability of private pay ceases, it will be the responsibility of the provider agency and the individual to determining a course of action beyond the availability of funds.

3. Will the county treat private pay funds as an “offset” in a person’s Individual Service Plan (i.e., reduce the county spending accordingly), or treat it as an add-on to county services?

For those individuals already receiving supports, the private pay may only be use to enhance the person’s plan. It cannot be use to off-set County funding. It would be a violation of Medicaid rules.

4. Will the county make a commitment for future funding to someone currently on private pay?

No. The County, at this point in time, has two policies that pertain to providing funding for supported employment:

It will provide funding for individual leaving high school at age 21 who are engaged in supported paid employment, and then only at the support level the school has developed prior to transition; and;

For individuals in a crisis situation (see attached policy).

5. Is the county encouraging, discouraging or neutral on private pay for the following groups:

– People not eligible for government-funded services – Neutral

– People on the waiting list – encourage, as long as there is a plan for if and when the private pay ceases.

– People receiving services who want to add supplemental or enrichment services – encourage, as long as there is a plan for if and when the private pay ceases.
* Operational Issues

1. How could this work for people who are working with case managers/brokers* to direct their own services?

For people on the waiting list, the purchaser could purchase both support brokering and supported employment privately. As long as they purchased support from County sanctioned developmental disability providers, they could be assured that the provider had sufficient liability insurance, bonding, staff expertise, etc. that the County requires of providers. If they went outside the current developmental disability system, they would need to ascertain those requirements on their own.

For individuals currently in the service system for whom the purchaser wishes to enhance the individual plan, the purchaser could pay the provider directly, or negotiate with Fiscal Assistance of Dane County to be the recipient of funds for distribution.

2. How will the county insure that the transition from private pay to county funding goes smoothly?

If the individual is on the waiting list and there status changes that would meet the policies mentioned above, and the individual was receiving support from existing providers, the County would establish an individual support rate; make those funds available to Fiscal Assistance of Dane County and the purchaser would cease making payments.

If the individual was using providers, either support brokering or supported employment, outside of the current provider system and wanted to continue to uses these providers, and the provider was willing to continue to provide the same supports for the newly established individual rate, the provider would need to apply to the County to become a certified Medicaid provider, before funding could be distributed.

3. How does the private pay supported employment option relate to a county’s current use of family choice options?

Question applies to Family Care Counties only.

*A support broker works with the consumer and his or her team to develop a person-centered plan. It is reviewed at least annually. The broker is charged with informing the consumer and/or guardian which vocational and residential choices are available in the area. Support brokers negotiate rates with support providers, and may advocate with the county on the consumer’s behalf. They are required to have regular contact with the consumer and his or her team.

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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