SPECIFIC PROGRAM REQUIREMENTS
FINANCIAL SUPPORT SERVICES
SCOPE OF SERVICES
Financial Support Services (FSS) are designed to perform fiscal and related finance functions for the participant or representative who elects the participant-direction option for service delivery and supports. FSS assure that the funds to provide services and supports, outlined in the Individual Service Plan (ISP) and to be implemented through a self-directed approach, are managed and distributed as intended. Financial Support Services are provided by a Fiscal Intermediary Agency (FIA) established as a legally recognized entity in the United States, qualified and registered to do business in the state of Georgia, and approved as a Medicaid provider by the Department of Community Health (DCH.).
2202 Special Requirements of Participation
In addition to those conditions of participation in the Medical Assistance Program as outlined in Part I, Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers, Section 106 (General Conditions of Participation), and Part II, Chapter 600 Policies and Procedures for the COMP Program, Financial Support Services providers must meet the following:
1. Provider Qualifications:
a. Be a Fiscal Intermediary Agency;
Financial Support Services are mandatory and
integral to participant-direction (budget authority).
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b. Be approved by the IRS under procedure 70-6 and meet requirements and functions as established by IRS code, Section 3504;
c. Hold and execute Medicaid provider agreements and function as an Organized Health Care Delivery System (OHCDS) or as authorized under a written agreement with the Department of Community Health;
d. Understand the laws and rules that regulate the expenditure of public resources;
e. Have at least two years of basic accounting and payroll experience;
f. Have a surety bond issued by a company authorized to do business in the State of Georgia in an amount equal to or greater than the monetary value of the participants’ business accounts managed but not less than $250,000;
g. Be approved by the IRS (under IRS Revenue Procedure 70-6) and meet requirements and functions as established by the IRS code, section 3504;
h. Not be enrolled to provide any other Medicaid services in the State of Georgia.
2. Service Delivery Requirements:
a. Receive and disburse funds for the payment of participant-directed services under an agreement with the Department of Community Health, the State Medicaid agency.
b. File claims through the Medicaid Management Information System (MMIS) for participant directed goods and services.
c. Utilize accounting systems that operate effectively on a large scale and have the capacity to track individual budgets;
d. Adhere to the timelines for payment that meet the individual participant’s needs within Department of Labor standards;
e. Develop, implement and maintain an effective payroll system that adheres to all related tax obligations for both payment and reporting;
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f. Maintain separate, individual accounts for each participant’s funds to be used for participant-directed waiver services;
g. Establish procedures for conducting and paying for up to five (5) local and national criminal background checks, and for completing age verification on service support workers;
h. Establish procedures for generating service management, and statistical information and reports during each payroll cycle;
i. Develop materials for startup training and technical assistance to participants, their representatives, and others as required to include, but not limited to, timesheets and payroll forms.
j. Establish procedures for processing and maintaining all unemployment records;
k. Provide an electronic process for reporting and tracking timesheets and expense reports;
l. Establish procedures to execute and hold the Medicaid provider agreements as authorized under a written agreement with the Department of Community Health, the State Medicaid Agency.
m. Monitor expenditures of individual budgets on a regular basis to ensure that payments to not exceed the total units amount and the total dollar amount allocated for each participant in the participant’s approved budget;
n. Provide all necessary employment and budget forms to Participants (employers) to include but not limited to timesheets, W-2s and a financial orientation package;
o. Provide financial instruction and technical assistance to Participants (employers);
p. Supply a fax machine to participant or participant’s representative upon enrollment.
Provider agencies that render Financial Support Services must hold the applicable business license as required by the local, city, or county government in which the services are provided.
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2204 Special Eligibility Conditions
A. Only participants who opt for participant-direction of services are eligible to receive Financial Support Services.
B. The need for Financial Support Services must be reflected in the Individual Service Plan approved by the Intake and Evaluation Team.
C. Financial Support Services are not available to participants or representatives who choose the Co-Employer model for self-directed services and supports.
2205 Prior Approval
Financial Support Services must be authorized prior to service delivery by the applicable DBHDD Regional Office at least annually in conjunction with the Individual Service Plan development and revisions.
2206 Covered Services
Based on the assessed need of the participant and as specified in the approved ISP, the Financial Support Services Provider:
1. Conducts and pays for criminal background checks (local and national) and completes age verification on service support workers.
2. Receives and disburses funds for payment of participant-directed services, in accordance with all related tax obligations, unemployment records, and worker compensation on earned income.
3. Generates service management, statistical information, and reports during each payroll cycle.
4. Provides startup training and technical assistance to participants, their representatives, and others as required.
5. Process and maintain all unemployment records.
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2207 Non-Covered Services
1. Supplies and maintenance for fax machine.
2. The FSS provider can only provide Financial Support Services and must not be enrolled to provide any other Medicaid services in Georgia.
3. Financial Support Services are not available to participants or representatives who choose the Co-Employer model for self-directed services and supports.
4. Payment is not made for those goods and services covered by the State Medicaid Plan except where a participant’s need exceeds State Plan coverage limits and exceptions to the coverage limits are not available.
2208 Basis for Reimbursement
A. One unit per month per member.
B. Reimbursement Rate
The reimbursement rate for Financial Support Services is found in Appendix A.
2209 Participant-Direction Options
A. Financial Support Services is a mandatory and non-negotiable for participants who choose the participant-directed option for service delivery.
B. When the participant is the employer of record, the FSS provider is the Internal Revenue Service approved Fiscal Employer Agent (FEA).
C. For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.
Rev 01 2013
CHAPTER 2200 Financial Support Services