MARC on Private Pay

MARC Response

Supported Employment Providers—Issues to Address


Values Issues

1. Will the supported employment 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?).

MARC will offer the same quality of services to all clients, regardless of funding. Job development is as much art as science, and matching employer needs and consumer abilities proceeds in an equal manner for all consumers. Employer needs can change unexpectedly and can suddenly create opportunity for an individual independent of funding source, length of service or any other unrelated factors. MARC record keeping is similar for all clients, with little distinction due to funding source.

2. Would the supported employment 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?

Available funding fully determines the hours per week of support every individual receives at MARC. Less funding means fewer staff hours assigned to an individual, and more money means more staff hours assigned to an individual.Costs do go up over time, and if funding is frozen or reduced, fewer staff support hours will be available over time, perhaps ultimately effecting the hours of support or service. This tends to be especially true when the effects of aging or health needs progress during periods of funding decline.

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?

MARC charges all clients the same hourly rate for each hour of staff support made available. That rate effective January 1, 2007 is $31 per hour. Staff support does not equate to attendance, as many people only need 10 to 30 minutes of one-to-one support per attendance hour (hence their “attendance rate” [a non-existent term in MARC parlance] might be quite economical). Many people can turn a staff hour into 2, 3, 4 or even more hours of attendance. It certainly depends upon the quality of the job match, the transportation plan, personal care needs, employer support, center vs. community time split, and the degree of independent function.

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?

MARC uses fundraising to assure quality services for underfunded clients, typically county clients, and to purchase equipment and supplies benefiting all clients. Inadequately funded clients, including county clients, are subject to reductions in available staff hours, increases in class size or reductions in attendance. MARC makes every effort to avoid accepting underfunded clients from all funding sources, however, when increased needs occur and remain unfunded MARC will make the effort to fundraise to cover the resulting deficit prior to cutting services.

Continued County budget cuts cause concern that the cuts will compromise MARC’s ability to maintain service levels.

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?

MARC is never comfortable terminating services, having developed relationships with clients and families over many decades. MARC may have to cut unfunded attendance if it cannot continue its subsidy. That is, a client may be attending five days but only paying for four, and we would need to reduce attendance to match available funding.
Often this is due to increasing needs due to the effects of aging or medical needs. When one person begins consuming staff hours beyond their ability to pay for them, they are actually taking staff hours away from people who did paid for them, a condition that cannot continue.

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?

Private pay agreements are simple letters of agreement, and mirror the content of an SDS agreement. An individual plan is written in the usual manner, reflecting needs and services. Individual agreements and plans can be changed at any time, with reasonable notice and foresight.

2. Will the same vocational 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?
All MARC services are the same, and cost the same, for public or privately funding clients.

All MARC clients receive the same assessments and Individual Service Plan process.

All services are billed on the basis of staff hours consumed.

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?

MARC bills for budgeted staff hours on a flat amount per month basis. All budgeted hours are billed for since those staff costs are incurred regardless of actual client attendance. Any unusual variations in attendance and staff hour consumption is best described during the evaluation process so that it can be considered in the annual cost determination. Most client attendance exceeds 90%, making the flat monthly fee appropriate.

MARC hires staff in response to available funding and needs, therefore variations may take time to implement. It is best to write an annual contract and plan, and pay on a monthly basis for services. Payments can be suspended for lengthy absences, but readmission to the program is subject to available space and staff hours.

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?

Past due is in excess of the normal ten day payment period.

MARC will communicate its collection procedures to late payers before discussing reduction or termination of services for lack of payment. MARC can clearly spell this out in the beginning of service.

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

None. MARC is prepared to bill and account for private pay.

The rates and services are the same for all clients.

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

Families are advised to consult county staff or an attorney, and not to rely upon MARC for information about public funding.

7. Is the vocational 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?

MARC services are purchased on a first-come, first-served basis. Capacity is not reserved for any population.

Few funding sources want to fund empty “slots” to reserve space should someone need it.

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

MARC needs documentation about disability, work experience, special and personal care needs, communication and transportation skills and more to help determine realistic plans and support needs for all incoming referrals, including the annual crop of H.S. graduates.

MARC has an incentive for all clients to succeed, regardless of their most recent experience.

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

Staff performance bonuses are not part of MARC private pay agreements.

MARC staff are represented by AFSCME Local 412, and all compensation is subject to collective bargaining.

All services cost the same for all participants.

Individual MARC Centers can accept unrestricted donations to use for the betterment of the program for all clients.

The MARC Foundation of Dane County does maintain an Awards Fund. Three awards are presented to deserving staff on a revolving basis. Each award includes a cash gift. Donations to the Award Fund are welcomed.

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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