From= MW To: Sheryl; Wiley, Jg?m; Mullins, 1am: Subject: RE: Documentation to Support Targeted Group Eligibility for Contracts.docx Date: Friday, October 23, 2015 10:47:48 AM Attachments: i i Hi Sheryl, i made a few edits with track changes for your review in the attached. One thing i am not clear on is Maine?s definition of targeted group eligibility for Maine I am really asking where could we officially define it to give credence to your argument? Would the State Plan be the logical place for it to If so, that could take a while. Is there anything we could do more immediate? I feel like this definition, as you are arguing, could be very broad if defined in a policy document. If so, that policy would be the supporting document to the attached document. Would be even better if the Feds are aware of our definition that I think would be a powerful statement in an audit. Additionally, I think 808 will ask for the actual contract language that restricts the use of funds to the FPL restriction and the target group. Would be happy to review that with my team when it becomes available. Warmest Regards, David Whitt Department of Administrative and Financial Services Deputy Director Financial Services Center 221 State Street Augusta, ME 04333 Cell: 207-248-7150 From: Peavey, Sheryl Sent: Friday, October 23, 2015 8:42 AM To: Wiley, Jeffrey; Whitt, David; Mullins, Janre Subject: Documentation to Support Targeted Group Eligibility for Contracts.docx Importance: High I don?t want to state specifically that the draft language IS exactly what we?ll end up putting in, but this feels like we?ve named most of the issues. However, I welcome your edits and suggestions. TANF Transfer Authority Maine DHHS has the authority to transfer 10% of its Temporary Assistance to Needy Families (TANF) funding to the Social Services Block Grant (SSBG). It can do so under the following conditions: 1. Under federal law, the transferred funds are subject to the rules of the program to which they are transferred; in this case, TANF transfer dollars become subject to the rules of SSBG expenditure. 2. The services funded with the transferred dollars are within the allowable categories of expenditure in SSBG. 3. Welfare reform established an income limit of 200% of poverty for recipients of services funded speci?cally fromby TANF allotments that are transferred to the SSBG and bene?t children or their families through targeted group eligibility. DHHS is using the TANF transfer for allowable categories of expenditure and using allowable categories of eligibility, speci?cally, targeted group eligibility. However, while we are con?dent that the proportion of TANF funds transferred to SSBG covers the proportion of eligible clients in those contracts, Department is moving to tighten contract language to ensure compliance with the income limits and bene?ciaries noted in condition That proposed contract language is included in this document and is presently being reviewed by the Division of Purchased Services attorney. Allowable Expenditures Under SSBG law, states can furnish social services best suited to the needs of the individuals residing in the State. Federal block grant funds may be used to provide services directed toward one of the following ?ve goals speci?ed in the law: (1) To prevent, reduce, or eliminate dependency; (2) to achieve or maintain self-suf?ciency; (3) to prevent neglect, abuse, or exploitation of children and adults; (4) to prevent or reduce inappropriate institutional care; and (5) to secure admission or referral for institutional care when other forms of care are not appropriate. The services procured by the Department using the transfer dollars to SSBG fall within those categories of eligibility. Documentation to Support Targeted Group Eligibility for Contracts 1. The Department has authority to encourage greater coordination of resources, advise regarding funding, and develop rules for this population as stated in Title 22, ?5106 The department shall establish, in accordance with the purposes and intent of this Part, the overall planning, policy, objectives and priorities for all functions and activities conducted or supported in the State that relate to Maine's aging population and incapacitated and dependent adults. In order to carry out the above, the department has the power and duty to: [2011, c. 657, Pt. BB, ?9 1. Encourage and assist development. Encourage and assist development of more coordinated use of existing and new resources and services relating to Maine's aging population and incapacitated and dependent adults; 8. Funds. Seek and receive funds from the Federal Government and private sources to further its activities. Included in this function is authority to solicit, accept, administer, disburse and coordinate for the State in accordance with the intent, objectives and purposes of this Part; and within any limitation that may apply from the sources of such funds, the efforts to obtain and the use of any funds from any source to bene?t Maine's aging population and incapacitated and dependent adults. Any gift of money or property made by will or otherwise, and any grant or other ?inds appropriated, services or property available from the Federal Government, the State or any political subdivision thereof and from all other sources, public or private, may be accepted and administered. The department may do all things necessary to cooperate with the Federal Government or any of its agencies in making application for any funds. Included in this duty is authority to advise regarding the disbursement of all state funds, or funds administered through agencies of State Government, appropriated or made available to bene?t Maine's aging population and incapacitated and dependent adults; 10. Rules. Prepare, adopt, amend, rescind and administer, subject to the direction of the commissioner, policies, priorities, procedures and rules to govern its affairs and the development and operation of facilities, programs and services. The department may adopt rules to carry out the powers and duties pursuant to this Part and in accordance with the purpose and objectives of this Part. It shall especially adopt such rules as may be necessary to de?ne contractual terms, conditions of agreements and all other rules as are necessary for the proper administration of this Part. Such adoption, amendment and rescission must be made as provided under the Maine Administrative Procedure Act; 2011, c. 657, Pt. BB, ?9 (AMD) 2. Target Group Category for Eligibility per Title 22. ?7317. 1. Intake and eligibility assessment. The department shall develop for the program a single system for intake and eligibility determination for all consumers, regardless of diagnosis, type of disability or age or other demographic factors, using the multidisciplinary teams designated by the commissioner pursuant to section 7323. The intake process, application and forms must be standardized despite differences in the criteria for eligibility for services under different provisions of the MaineCare program state plan or federally approved waiver under Medicaid or under state-funded services.[ 2011, c. 422, ?1 (NEW) And 8. Implementation. In implementing the program the department shall: B. Create structures for service delivery that apply to all types of payors; [2011, c. 422, ?1 3. Other states use target group eligibility Arizona?s State Plan for SSBG submitted and approved by the federal government clearly shows their intention to spend nearly double their SSBG allocation (thru TAN Transfer to SSBG) on populations that are not "family designated" by virtue of "group" eligibility. Target Group Eligibility is differentiated from Status Eligibility, which is the ?nancial category of eligibility quali?cation. Similarly, New Jersey included in its SSBG report to the federal DHHS that TANF transfer to SSBG is used for Case Management, Day Care-Adults, Home Based Services, Home- Delivered Meals, Protective Services ?Adult. These fall under the target group eligibility. Texas outlines use of TANF Transfer for Adult Mental Health Services, particularly case management, and education or training to improve knowledge or daily living skills. 4. Federal Guidelines offer alternate interpretation guidepdf 3.Transfers A State may transfer a total of up to 30% of its TANF funds for a ?scal year to the Child Care Development Fund (CCDF) and the Social Services Block Grant program (SSBG). However, it may transfer no more than 10% (4.25% beginning in ?scal year 2001) of the grant amount for a ?scal year to the SSBG. If a State transferred 10% of its annual TANF grant to SSBG, then it could transfer up to 20% of the annual grant to CCDF. Once a State transfers funds to either program, it must use the funds in accordance with the rules of the receiving program. ?Any Federal TAN funds that a State transfers to the SSBG and/or CCDF programs, as documented by appropriate ?nancial reports, take on the rules and regulations of the receiving program corresponding to the Federal ?scal year the funds were originally awarded to the State and transferred to SSBG and/or CCDF. The State may only transfer current year TANF funds.? 5. Related Rules referenced in Contract 0 10 144 Department of Health and Human Services, Chapter 11, Section 2 Eligibility I 10 149 Of?ce of Aging and Disability Services, Chapter 5, Sections 69.02 Eligibility and 69.06A Eligibility Determination 6. Excerpts from Current and Previous Year Contracts Outlining Eligibility Requirements Current Year: The purpose of this Agreement is to provide service coordination and other administration components for Maine?s State?funded In-Home and Community Support Services for Elderly and Other Adults (Home Based Care CMR 149, Ch. 5, Sec. 63) and Consumer Directed Personal Assistance Services (Consumer Directed Home Based Care C.M.R., ch. 11). These services are required and authorized by 34-B M.R.S.A. 5438, 22 M.R.S.A. 7301-7306 and 7321-7323, and are a core function of the Long Term Care (LTC) delivery system. The Provider shall provide service coordination and other administration services related to the delivery of HBC and CD-HBC to consumers referred to the Provider who meet ?nancial and medical eligibility criteria established in 10?149 C.M.R. ch. 5, 63. Previous Year: I. AGREEMENT FUNDING SUMMARY This Agreement funds services under the Home Based Care Program, Section 63 of the Of?ce of Aging and Disability Services (OADS) Policy Manual and includes reimbursement to the Provider for its services as well as reimbursement for payments made by the Provider to direct service providers that have a sub-contract to provide services pursuant to this Agreement. SERVICE SPECIFICATIONS AND PERFORMANCE GUIDELINES A. Description of Services Listed below are the de?nitions of the services to be provided through this Agreement, either directly or through a sub agreement. HOME CARE COORDINATION: Home Care Coordination is a care coordination service for members under the Home Based Care program, Section 63 of the OADS Policy Manual (10-149). The Provider shall act as the Home Care Coordination Agency for the provision of these services in accordance with the regulations. This includes the implementation of the plan of care as authorized by the long term care Assessing Services Agency, as de?ned in Section 63. Activities include arranging for services; assuring consumer choice and that the consumers? identi?ed needs are addressed; acting as a resource for the consumer and family members; and answering questions and resolving problems. Care coordination of services helps to identify the medical, social, educational, and other needs of eligible consumers, as well as the services needed to meet those needs. Contact with consumers helps to determine if the care plans are effectively meeting the consumers? needs and whether any modifications to the plan of care are needed. Care coordination activities provided by the HCCA are documented in consumers? records. Other administrative activities of the Provider include maintaining consumers? records; processing invoices for payment from subcontractors providing services to clients; maintaining a direct service provider network and paying direct service providers; conducting utilization/quality/ compliance review activities to assure that direct service providers in the network operate within applicable laws and rules; managing the Family Provider Service Option establishing and managing a waiting list as needed; managing consumer co-payments; and issuing reports pursuant to Rider A and Rider of this Agreement SERVICE PROVIDER BILLING AND COMPLIANCE AUDITS: The HCCA and the Department will maintain a process for conducting an independent review of direct service provider billings and supporting provider documentation in order to ensure that: direct service providers are properly licensed, quali?ed personnel are performing services, direct service providers maintain adequate case files to document client status and services provided, proper rates are charged for the services billed, the types of services and number of units billed appear reasonable under the circumstances and agree with case documentation, verify the eligibility of the consumer; and the direct service provider is not on the federal debarred parties list. RECOUPING OVERPAYMENTS FROM PROVIDERS: Pursuant to the program regulations, the HCCA bills direct service providers acting as subcontractors immediately when it discovers over-payments (whether due to error or misrepresentation) and must return the funds to the Department whether or not it recoups the funds from the subcontractors. 7. Proposed changes to Contract Language regarding Eligibility As noted in the Congressional Research Service document on SSBG prepared for Congress in 2012, there are no federal eligibility criteria for SSBG participants. The exception is that welfare reform established an income limit of 200% of poverty for recipients of services funded by TANF allotments that are transferred to the SSBG. To that end, Maine DHHS proposes the following language addition to contracts by contract amendment. This language may be modi?ed pending general counsel review. Draft Contract Amendment Language Block Grant Funding - It is contemplated that the Department will utilize Federal Block Grant funding for this contract. The Provider will agree to comply with the requirements applicable to the federal TANF program, including the audit requirements of OMB Circular A-l33 (the circular is available online at This agreement shall be extended to and communicated in writing to subcontractors and sub? recipients implementing the programs. Contractor compliance with and noti?cation to Subcontractors and subrecipients in writing shall include the following: a. that use of Federal awards shall be monitored through reporting, site visits, regular contact, or other means to provide reasonable assurance that the subrecipient administers Federal awards in compliance with laws, regulations, and the provisions of contracts or grant agreements and that performance goals are achieved. that programs funded under this agreement comply with State and federal TANF requirements subject to all terms and conditions as applicable pursuant to 45 CFR Parts 260 et al. that programs funded under this agreement shall comply with requirements relating to use of federal funds and awareness that funds may be provided by Temporary Assistance for Needy Families Block Grant (TANF) - Catalog of Federal Domestic Assistance (CFDA) TANF - 93.558 and programs funded under this agreement are aware that they are receiving federal funds and the CFDA title and number of the funds, award name, amount of the award of the use of these funds, and the name of federal agency: the US Department of Health and Human Services, Administration for Children and Families. that TANF program expenditures reported to the Department will be claimed as TANF, must meet the federal requirements for TANF, and must be considered federal funds for audit purposes, whether the funds were from federal, commingled, segregated or separate state sources. The Department will notify the Provider if the amount claimed as TANF is signi?cantly lower than the estimated or ?nal amount reported as TANF-eligible by the Provider. that all acknowledge and agree not to use funds provided by this agreement as a match to any federal grant, nor may they federally claim any of the dollars utilized as they are being claimed by the Department; and in accordance with 45 CPR 263.2 the funds or in?kind contributions used to meet the non-federal share of the program costs shall be considered to be Temporary Assistance for Needy Families (TAN F) State Maintenance of Effort funds and will be treated and reported as such to the federal government. that all maintain any necessary data and documentation required for auditing of any of the grant funds.