FMS: The Ultimate Self-Direction Program – Podcast

David Hancox, Podcast Host and Accra Chief Administrative Officer: Well, good afternoon listeners. This is the second edition of the Accra podcast. And we are going to be talking today later on with the FMS director. And we will be talking and exploring the FMS services here at Accra. But before we get to Val, we just wanted to take a quick moment to remind everybody that the purpose of these podcasts is to provide additional information about Accra, and its services, how to access those services, and the value that those services can provide to you as a client, yourself or a family member. And we just want to explore all of those different services that are available here at Accra, and again, how you can successfully access those services.

Jason Dorow, Podcast Co-host and Producer: Yeah, and hopefully, even if you don't wind up with Accra, but you're searching for home care services, you can benefit from this, right? Just finding out about the different services that are available. Whether you're caring for yourself, you're caring for a loved one or family member, maybe you're a case manager, and you're learning more about these services. So yes, we definitely want to introduce you to Accra, and inform everyone about the services available here. But we think there's something for everyone to learn, right. Anyone that's involved in home care.

David: Absolutely. And just as a reminder, listeners, our first episode, which I believe went on air a couple of weeks ago, was a focus on 245D services. So if you haven't listened to that yet, please go back. Listen to that. It's available on our website.

Jason: Yeah, and we learned a lot from Tyler Langenfeld, the 245D program director at Accra, about respite, homemaker services, night supervision, caregiver living expenses. There's just a smorgasbord of different offerings available under 245D. And so if you haven't listened to the episode, go back, whether it's on Spotify, Google podcasts, Apple podcasts, you can find us there now, and the episodes will keep trickling in from here.

David: Tyler was very thorough in his description and explanation. I'm sure that listeners who listen to the podcast will find it incredibly, incredibly helpful. But let's get started with today's guest. We have her in the waiting room, in the green room as we call it in the theater world. Val Patino is the director of FMS services here at Accra. Welcome, Val.

What is FMS (Financial Management Services)?

Valerie Patino, Accra's Director of Financial Management Services: Hi, David. Hello, Jason. Happy to be here talking all things FMS.

David: Absolutely. What a wonderful way to start the week on a Monday with the conversation with Val and with Jason. So we've already kind of told listeners what you're going to be covering today, Val. So why don't we go ahead and get started with you just providing for our listeners a brief description of what is FMS services? What do we mean by FMS?

Valerie: Sure. So FMS stands for financial management services. And it serves clients who are on the consumer directed community support services underneath a waiver. So all of our clients who are on CDCS are on a waiver. There are five different waiver types in the state of Minnesota and CDCS is an option for each one of those. And also we serve clients who are on the consumer support grant (CSG) as we like to call it, we're very acronym heavy in FMS. But I always like to spell out the names of the program because that will help viewers who aren't familiar with the program acronyms to find more information if they'd like to. Those on the consumer support grant have opted out of PCA services hours and opted into a state-run program where they're given a budget instead of those PCA hours. So it's a lot more flexible. There's a lot more options for them than simply using hours. But they're running a budget. Financial Management Services is the ultimate self-directing program. Participants have full budget authority, which means they're given their budget amount either monthly if you're on CSG, and yearly if you're on CDCS. And you're the employer. Accra comes alongside you and helps you along with those employer activities. We're here to walk alongside you. But you get to hire your employees, train them, and decide their rate of pay. The county does need to approve the plan and that rate of pay. However, it's ultimately decided by the family what they'd like to their caregiver.

David: Now let me interrupt you, if I might here just for a quick second to ask a question. You mentioned how the client or the family is given a budget, correct? Once they are given that budget, does it just become their carefree spending of those dollars? Or does Accra take a role in helping to support how they use those dollars and budget them and manage the line items within that budget? Or what is the role of Accra once that budget is approved?

Valerie: Sure. So no, families can't decide to spend their budget on anything or everything that they'd like. It's mainly geared towards personal supports, so helping families or the client with those daily activities. Also, treatment and training for those habilitative services that help get clients out into the community, and also environmental modifications. Is a family needing a bathroom modified so that the wheelchair can fit in? Are they needing grab bars installed? Are they needing a ramp or a fence installed? This is all dependent on the client's assessed needs. In the county, and there's all your support planners. A support planner is an individual professional who will help you write your plan. So families cannot just choose to spend whatever they want their budget on, but rather within those guidelines and according to the assessed needs that the client has.

David: And just to be clear, let's say the one scenario that you identified was perhaps doing a home modification. If that is a line item in that client's budget, it's not necessarily Accra that's going to be doing that home modification. The client is free to choose the vendor of their choice, but we just help them manage the budget that then pays for that modification.

Valerie: Absolutely. Yes, the family has full budget authority. So they're choosing who that vendor is and Accra helps with the payment to that vendor. Exactly.

Jason: So Val, what else does Accra do in helping people employ their caregivers? And what else does Accra do for the clients in FMS?

Valerie: Sure. So we're really helping with payroll, we're helping getting your employees paid, we're helping with the tax portion of it as well, figuring out what taxes are owed, those employer taxes with FICA, Social Security, FUTA and SUTA (federal and state unemployment). So we're really helping you manage and walk through those employer related taxes. And with IRS codes, we're helping out with getting your employees W4s filled out, we're sending you those W2s at the end of the year, we're sending those 1099s to your vendors. We're helping your vendors get set up as independent contractors. We have a lot of families who will include snow removal or lawn care services on their budget. So we're helping those folks get into our system and then issuing those correct tax forms to them at the end of the year.

How to Get Started with FMS

David: And Val who qualifies for FMS services, and how do they go about getting qualified?

Valerie: So for CDCS services, consumer directed community supports, all those folks are on a waiver. There are five different waiver types in the state of Minnesota. Also, those who qualify for PCA services can utilize the consumer support grant in lieu of PCA services. And they're given that state portion of those funds to turn into a budget that they that they can fully run. So those two things.

Jason: So once they're working with CDCS or are working with the consumer support grant, how do they decide FMS is for me? And then do they call Accra? What did they do to start unlocking these services?

Valerie: Sure. So if you're on CDCS or CSG, it's required that you utilize an FMS to bill for those hours directly to the state. There are 13 different FMS is in the state of Minnesota right now, and Accra is one of them. And so it is required that they would utilize an FMS and they can go to our website, and we do have an intake team that would be so happy to walk you through getting started with our services. It's a fast process. It's as fast or as slow as you want it to be. We tailor it to you. We set up an intake meeting where we're going through the different services, the employer handbook, the policies and procedures and then how to get timesheets and how to hire your employees, etc. In each participant is matched with an intake coordinator to really walk them through the process. Because in the beginning, you know, there are a lot of questions that come up and we want to make sure folks have access to someone, one person in particular, for them to ask any and all questions that they may have.

David: Val, is there a significant difference between CDCS and CSG?

Valerie: There is a significant difference. Yes. So those who are on waiver have been SMRT’d. SMRT. So they've been certified disabled, through the state of Minnesota. through DHS. The state reports that usually within 60 days, from starting the process, you will have an answer. And then that's when the waiver is opened up to you. Those who are in the consumer support grant simply need to just qualify for PCA services and do not have to go through the SMRT process. But your county of residence should be able to walk you through that, that process and provide more information on that.

David: Before we actually started recording the podcast, we were talking about private pay, which we agreed would probably be a total podcast on its own. But just real briefly, if someone is using FMS services, can they also do that with private pay?

Valerie: Yes, we have had people who have, you know, had a budget cap, and they're wanting to privately pay out of their own pocket, not through medical assistance dollars, additional employee hours, we've had that happen. Obviously, that's not included in their budget spreadsheet, and it's not needed to be included in any of that. But Accra can run those two programs simultaneously.

Jason: Now, earlier you were talking about the different ways that FMS clients can use their budget. And I'm thinking about some of the different clients we've spoken to. One of the clients was a child with autism who tends to elope and so I believe they use their budget for some security things such as a fence in the backyard. They might have got a ring doorbell too. And because he needs breaks from stimuli, they have a crash pad. Are those typically things that people might be able to do through FMS?

Valerie: Absolutely. Again, it goes back to the assessed need. So as your county is approving the plan that you've written up, they will go back to that main choices assessment that the client has gone through, and base those needs off of those results. But yes, we've seen so many creative things. Crash pads, trampolines. Some kids, especially with an autism diagnosis, just love that, the bouncing. I've had families tell me before we got the fence, my daughter was found on our county highway, ready to try to cross the street because we didn't have a fence in place. And she had skipped out of the house, and we didn't even notice she was so quiet. I have been at a lot of home visits where all of a sudden, you hear a little ding ding ding. And we're like, oh, someone just came in the door. We have a door alarm and an alarm for anything that's opened including windows, just for the safety of the clients. We've seen adapted bikes, just some amazing stories that give you goosebumps of seeing a little one who can now participate in the neighborhood tricycling or bicycling because they have an adapted bicycle or tricycle and can ride around with their neighborhood friends. That brings tears to your eyes, just to see that inclusion. We’ve seen so many things that are really neat on these plans, again, tailored to the person so not one budget is ever the same.

Jason: Yeah, we recently spoke to another client who is another child who has hypotonia or reduced muscle tone. And so she can't spend long times on her feet going around walking and running. And the family wants to go to state parks, they want to go to the Renaissance Festival, things like that. And so they got a wagon eventually. That helps her spend long days with the family out and about doing things that otherwise simply aren't possible. David, looks like you had something for Val.

FMS Tips and Tricks

David: I just wonder as someone is considering possibly using this CDCS or CSG grant to access FMS, are there any little insider secrets? You know tips or tricks that you would want to remind people of as they're beginning the process of exploring the possibility of FMS services?

Valerie: Yeah, I would say that there are many. We didn't even touch on the fact that parents who have minor children, and of adult children, can be paid caregivers for the client. Offers for some wonderful tax savingssince you're not having to pay into those employer taxes. And sometimes there are some personal income tax savings with those too and your FMS, such as Accra, will help you lay all of that out and map that out. Another thing really cool thing with staffing is that we hire as young as 14 and 15 year olds, so we'll see a lot of siblings that will be working for their older or younger sibling, and that offers for some great tax savings as well. You had mentioned 245D services in the beginning of the podcast, and a lot of those services mentioned can be included on a CDCS budget. The caregiver living expense is one of my favorite ones but we don't see it come through very often. But it's a wonderful service for those clients who are ready to live independently. But with some additional help to make sure that they're living as safely as possible. So yeah, those are some of my favorite tips and tricks. Oh, and also Accra, for those items that we mentioned before, will facilitate purchasing those items. So if you're having a hard time paying for something out of pocket, Accra will order those items for you. And if it's from amazon.com, we get a lot from Walmart, from specialty stores for sensory items. Not all FMS providers do that. So as you're exploring your options for FMS, that might be a really important question to ask is, you know, will you help me with purchasing? It's not coming directly out of my pocket. Accra will purchase the item after you specify exactly what you're looking for. And then we'll just build the budget directly and you won't have to submit any receipts or pay for that out of pocket. So that's a really great service that we provide.

David: Well, Val, if the listener wanted to contact Accra specifically to talk about FMS services and perhaps apply for FMS services, who do they call at Accra?

Valerie: Yeah, so as you're calling 952-935-3515, you can ask your Accra connect representative to be transferred to the FMS intake department. Also, you can email FMSintake@Accracare.org. And somebody will get back to you as soon as possible.

David: Fantastic. Well, Val , thank you so much for being here with us today and sharing with the listeners about FMS services and how to apply for them and the incredible variety of services that FMS provides to individuals and the fact that it really is, as you said, the ultimate in self-direction that people really do get to manage their own lives. And isn't that a wonderful opportunity for people? So, again, thank you for being here with us today. And I really appreciate you taking the time and sharing all this wonderful information.

Jason: Yeah, thank you, Val. We appreciate it. Any final words before we let you go?

Valerie: No, just that it is one of the fastest growing programs at Accra because of the self-directed option. And we'd love to speak with you more about it. And I look forward to future podcasts.

News and Views

David: Well, Jason, I'm sure you would agree with me that it was really wonderful to have Val join us today to talk about all the different qualities of the FMS program and the variety of different services that it provides to our clients who use that program. One of the items that she mentioned was the ability for parents and spouses to provide PCA services for their family member. And we just wanted to mention under news and views that one of the outcomes from the most recent Minnesota legislative session was a pending federal approval, because CMS has to approve these things, but a pending approval for single parents, parents and spouses and unpaid guardians of individuals with disabilities to continue to be paid to provide PCA services until the implementation of CFSS. Once CFSS begins, parents, spouses and guardians ability to provide PCA services will already be included in that program. So we're covering that interim period. But the important thing is that it allows single parents to provide up to 60 hours a week of PCA services, which is an increase from 40 hours previously, and that parenting couples can provide up to 40 hours each per week of PCA services. So that's a really nice feature that allows families an additional means of addressing that workforce crisis. We know that there's about 7500 open PCA and DSP positions available across the state of Minnesota right now. So for families to continue to have the ability to pay for PCA services, or provide those PCA services, takes a huge weight off the shoulders, I think, you know, when facing this workforce crisis, because it's very difficult to go out and find PCA workers right now. So I'm glad that Val pointed that out. And we have the opportunity here to reinforce that as well.

Jason: Yeah, given the ongoing caregiver shortage, that's a massive, massive change so that parents, spouses and unpaid guardians, as you mentioned, don't have to go searching for as much support as they would have needed if not for this change.

David: Exactly. And also, there is a self-direction connection conference coming up this fall here in Minnesota, it's a new conference in Minnesota for people receiving or providing services under the Consumer Directed Community Supports grant and consumer support grant that Val mentioned in her comments, and it's called the self-direction connection conference.

Jason: Yeah, it seems like this is going to be a first of its kind convening, and it's something that we'll be sharing in the FMS newsletter that goes out to Accra’s FMS clients. It’s planned for Friday, October 27, from 8 am to 3 pm, at the Mankato Civic Center, and it's intended for families, for caregivers, for self-advocates, case managers and support planners. There's going to be a wide range of people convening at this conference.

David: Absolutely sounds like a wonderful event, and attendees can plan to learn about the latest trends and practices for CDCS and CSG. And there will be opportunities to meet other people using these programs. So the networking opportunities should be wonderful. The conference will also feature a keynote speaker, exhibits, learning sessions, networking opportunities, and prizes.

Jason: And there's another sort of prize involved here. Accra is offering five passes to clients or responsible parties interested in attending. So Accra clients, you can contact your service coordinator to be entered into a drawing for free passes. Or you can register for the conference at the standard registration fee of $40.

David: And the event is being hosted by the Harry Meyering Center. So you can go to their website or just search for self-direction connection conference to find more information.

Jason: And David in our first podcast episode, we talked about upcoming Medicaid enrollment renewals and the fact that Medicaid enrollees andd Minnesota Care enrollees will have to update their contact info and get their coverage renewed. And we've had a little update to share since that first episode.

David: That's right. And listeners, it's important that you hear this. Minnesota has pushed back the re-enrollment deadline date to August 1 for the first wave of enrollees. But you should not delay in updating your contact information. And find out when you need to review and complete your packet once it arrives in the mail. Don't take a pause there. Once that packet arrives, attend to it quickly because you don't want to miss that August 1 deadline.

Jason: And if you have any questions, head to Accrahomecare.org. There's a link at the top of the screen that says Medicaid enrollees will need to renew their coverage, click there and then you have a lot of info all in one place that will help you figure out exactly what you need to do to update your contact info and make sure that you don't have any disruption in your coverage.

David: Absolutely. That's so critically important. And I think there's probably a lot of listeners out there that may not be aware that this re-enrollment is even required. So if you're listening, please make sure that you attend to that because you don't want to have any lapse in your coverage. So I also wanted to let folks know about Accra Mobile. We are excited to announce that the Accra mobile application will be coming soon and that this will allow Accra caregivers and responsible parties to very easily record, submit and approve time timecards electronically from their mobile phones. So that should make that so much more accessible and easy. And I think a lot of people have been waiting a long time for this electronic availability. So this will pave the way for that.

Jason: That's a game changer, right? The paper and pencil you can put away and now do it right from your device no matter where you are, which is excellent. So, David, two podcasts in the books, two great conversations about 245D and FMS and surely a lot more great stuff to come.

David: A lot more to come. And I hope listeners that you're finding this helpful and useful and valuable information and we look forward to bringing you even more information in the future.

Jason: If you haven't already, search for the Champions of Homecare podcast on Google podcasts, Apple podcasts and Spotify, you can find us on any of those platforms. Follow us there. And we should have an episode every other week for you to tune into to not only learn about the service programs here at Accra, but other things going on in the homecare world.

David: Well, thanks, everybody for tuning in. And again, follow us on all of those different spots that Jason just mentioned. I won't list them again. But it's a pleasure. We look forward to seeing you on the Accra podcast number three coming up.