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Pennsylvania Office of Developmental ProgramsQuality Assessment & Improvement (QA&I) Questions Tool for AWC/FMS Organizations

Overview of the Quality Assessment & Improvement Process

The mission of the Office of Developmental Programs (ODP) is to support Pennsylvanians with developmental disabilities to achieve greater independence, choice and opportunity in their lives.

The mission at ODP is to continuously improve an effective system of accessible services and supports that are flexible, innovative and person-centered.

The Quality Assessment & Improvement Processes have been implemented to evaluate our current system and identify ways to improve it for all participants.

General Instructions

1. In preparation for completing the QA&I Tool, Administrative Entities (AEs), Supports Coordination, Organizations (SCOs), Providers and AWC/FMS organizations should review all relevant materials regarding the QA&I Process that is posted on the MyODP Training & Resource Center at https://www.myodp.org.

2. Please contact the ODP AWC Mailbox at [email protected] and copy the ODP Regional PDS Lead if there are questions or concerns about this tool or the AWC/FMS QA&I Process.

3. If an incident is discovered during the QA&I process that has not been reported, the incident must be immediately reported in the Enterprise Incident Management (EIM) system and Incident Management procedures should be followed. The AE, SCO and Provider shall ensure the health and welfare of participants. If any entity determines there is an imminent threat to the health and welfare of the individual, immediate steps should be taken to ensure the health and welfare of the participants. The appropriate regional ODP office should be contacted. Based on the circumstances, the entity shall proceed according to the policy established in ODP Bulletin #6000-04-01, Incident Management and as determined appropriate by the regional ODP office.

*KEY – Agency With Choice Financial Management Services (AWC/FMS); Managing Employer (ME) is either the Participant or Surrogate, On-site Review (O); Participant Directed Goods and Services (PDGS); Remediation (R); and Support Service Professional (SSP)

1Last updated: 6/21/18

mailto:[email protected]

https://www.myodp.org/


Tool Completion Instructions

The following guidelines are intended to help a user to complete this tool successfully.

1. Use the AWC / FMS MCI review spreadsheet to answer all questions related to the record review and staff training questions. The total number reviewed, and the total number verified are the final answers that should be entered into the web database.

2. All questions applicable to the entity must be answered before the tool can be submitted.3. The time frame for each question is 12 months from the date of the review unless otherwise specified. When looking back 12 months, always go to

the 1st day of the month, i.e. the review begins on July 15, 2018, look back to July 1, 2017.4. It is strongly recommended that the guidance associated with each question is reviewed before answering the question, as the guidance will assist

you in your responses5. When responding to questions, the entity MUST retain all related documentation, including policy & procedure documentation, training curriculum,

records and other training documentation as well as documentation associated with service/supports delivery. This documentary evidence along with this tool must be retained and made available to ODP or the AE upon request.

6. Questions that are labeled as exploratory are intended to inform the entity of new changes and requirements which may begin July 1, 2018. 7. When there are instances in which an entity has not met the standard of a QA&I AWC question, ODP expects that remediation will occur within 30

days of discovery unless there are concerns for health and safety where remediation must occur immediately.




# Question Type Guidance Source DocumentsDEMOGRAPHIC INFORMATION

AWC/FMS Name Non-Scored

Enter your organization’s name using in HCSIS during the enrollment process.

Master AWC/FMS Index (MPI) NumberNon-Scored

Enter your nine-digit Master AWC/FMS Index (MPI) number. This number is located in HCSIS and is the first nine digits of your Promise ID.

AWC/FMS Organization’s Assigned Administrative Entity (AE) Non-Scored

The Assigned Administrative Entity (AE) is the AE in which the most waiver participants you serve are registered or, for AWC/FMS organizations with no current authorizations, the AE within which your organization intends to serve the most waiver participants. This is the AE that processed your qualification application.

Select your Assigned AE from the drop-down list.

Region Assigned AE is located.Non-Scored

Select the appropriate region for your Assigned AE from the drop-down list.

Contact information for the person completing QA&I Tool:Non-Scored

Enter the contact information for the primary contact person for the organization who is responsible for the Quality Assessment & Improvement process in your organization.

This should be the person who received the link to the on-line version of the tool via email and the one who it into QuestionPro.

SELF-ASSESSMENT – The AWC/FMS completes an annual QA&I self-assessment.1. The AWC/FMS completed its annual

self-assessment using the ODP specified tool.

O The reviewer determines if the AWC/FMS submitted their self-assessment using the ODP specified tool. Mark YES if the AWC/FMS submitted their self-

assessment into QuestionPro. Mark NO if the AWC/FMS did not submit their self-

assessment into QuestionPro.

55 Pa Code Chapter 51 Section 51.24 (c) (d)

1a. The AWC/FMS completes their annual self-assessment.

R The reviewer should check the ODP specified tool for evidence that the AWC/FMS has completed their current annual self-assessment.





# Question Type Guidance Source Documents Mark YES if the AWC/FMS has completed their annual

self-assessment for the current fiscal year. Mark NA if no remediation actions were required or

another remediation action was selected.

1b. Other remediation action R The AE can accept documentation of “other” remediation actions taken by the AWC/FMS to comply with the requirements.

The AE will record in the comment field the REMEDIATION ACTION taken by the AWC/FMS to remediate. Mark YES if the AWC/FMS submitted remediation

documentation. Mark NA if no remediation action is required or



1c. If Yes: R The AE must calculate the number of days between the notification date to the AWC/FMS and the remediation action date.

The AE enters the appropriate timeframe (0-30 days, 31-60 days, 61-90 days, over 90 days) in the comments box. Mark NA if no remediation action was necessary, or if

no remediation action was taken by the AWC/FMS


1d. Remediation action outstanding. R Mark YES if referred for appropriate follow-up because of no remediation action within 90 days of notification of the review of the findings. Utilize the comment field to record follow-up action.





# Question Type Guidance Source Documents Mark NA if the issue was remediated or if no

remediation was required.QUALITY MANAGEMENT – There are systematic efforts to continuously improve quality.The AWC/FMS demonstrates continuous quality improvement.2. The AWC/FMS has a process to ensure

the ME has a mechanism to inform the AWC/FMS of their satisfaction or concerns regarding the administrative services received.

O The reviewer validates the AWC/FMS has a process to ensure the ME has a mechanism to inform the AWC/FMS of their satisfaction or concerns regarding the administrative services received. This process should include: a) The ME completing the annual satisfaction survey

distributed by the AWC/FMS annually (compliance is indicated if the survey has been mailed to the ME);

b) Evidence the ME indicated satisfaction or concerns with the AWC/FMS regarding the administrative services they are receiving; and

c) Evidence the AWC/FMS has provided the ME with the contact information of the staff(s) who will serve as their primary contact.

Mark YES if there is evidence that a process has been developed.

Mark NO if there is no evidence that a process has been developed.

55 Pa Code Chapter 51 Section 51.23 a (6)

55 Pa Code Chapter 51 Section 51.30 g

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section A. Individual or Surrogate Responsibilities Related to the AWC/ FMS Option #12 and 21

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 9, 15 (n), and 17

2a. Documentation was located. R The AWC/FMS has located the documentation that validates the process. Mark YES if the documentation was located. Mark NA if no remediation action is required or





ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 9, 15 (n),




# Question Type Guidance Source Documentsand 17

2b. The AWC/FMS develops and implements or amends its process to ensure the ME has a mechanism to inform them of their satisfaction or concerns regarding the administrative services received.

R The AWC/FMS develops and implements or amends their process to ensure the ME has a mechanism to inform the AWC/FMS of their satisfaction or concerns to include: a) The ME completing the annual satisfaction survey

distributed by the AWC/FMS annually (compliance is indicated if the survey has been mailed to the ME);

b) Evidence the ME indicated satisfaction or concerns with the AWC/FMS regarding the administrative services they are receiving; and

c) Evidence the AWC/FMS has provided the ME with information on how to contact the staff person(s) who will serve as their primary contact.

Mark YES if the AWC/FMS has developed and implemented or amended their process.

Mark NA if no remediation action is required or another remediation action was selected.





2c. Other remediation action R The AE can accept documentation of “other” remediation actions taken by the AWC/FMS to comply with the requirements.



another remediation action was selected








# Question Type Guidance Source Documents

2d. If YES, when: R The AE must calculate the number of days between the notification date to the Provider and the remediation action date.







2e. Remediation action outstanding R Mark YES if referred to AE for appropriate follow-up as a result of no remediation action within 90 days of notification of the review findings. Utilize the comment field to record follow-up action.

Mark NA if the issue was remediated or no remediation action was required.





3. The AWC/FMS has evaluated and O The reviewer validates that the AWC/FMS has evaluated ODP Bulletin 00-08-08, Agency With *KEY – Agency With Choice Financial Management Services (AWC/FMS); Managing Employer (ME) is either the Participant or Surrogate, On-site Review (O); Participant Directed Goods and Services (PDGS); Remediation (R); and Support Service Professional (SSP)



# Question Type Guidance Source Documentsmonitored the ME’s performance. and monitored the ME’s performance of the selected

sample by: a) Tracking performance per the ODP managing

employer agreement; b) Implementing training plans; andc) Notifying the AE or County Program of

recommendations for corrective actions and termination.

Any ME’s whose performance has not been evaluated and monitored will be completed.

Mark YES if evidence exists that the ME’s performance was evaluated or monitored.

Mark NO if the ME’s performance was not evaluated or monitored.

Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities #-14

3a. Documentation was located. R The AWC/FMS has located the documentation that the ME’s performance was evaluated and monitored. Mark YES if the documentation was located. Mark NA if no remediation action is required or


ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities #14

3b. The AWC/FMS develops or amends their process to ensure they have monitored and evaluated the ME’s performance.

R The AWC/FMS develops and implements or amends their current process to ensure the performance of the ME is tracked and monitored. This includes:a) Tracking performance as per the ODP managing

employer agreements;b) Implementing training plans; and c) Notifying the AE or County Program of recommendations

for corrective actions and termination. Mark YES if the process was developed or amended and

the ME’s performance was evaluated. Mark NA if no remediation action is required or another

remediation action was selected.








# Question Type Guidance Source Documentsdocumentation.



The AE enters the appropriate timeframe (0-30 days, 31-60 days, 61-90 days, over 90 days) in the comments box. Mark NA if no remediation action was necessary, or if no

remediation action was taken by the AWC/FMS.





4. The AWC/FMS provides the ME with an orientation and skills training on how to manage services and how to perform as an ME of their SSPs.

O The reviewer determines if the AWC/FMS has developed and implemented an orientation and skills training on managing employer’s responsibilities. The orientation and skills training must include at a minimum how to:

a) Recruit, screen, interview, select, and refer qualified support service workers to the AWC FMS for hire, to include encouraging equal opportunities to all prospective workers, regardless of race, creed, color, national origin, sex, disability, marital status, or sexual orientation.

b) Determine the wage for the SSP.c) Train or participate in the training of the SSP.d) Develop the schedules of qualified support service

professionals.e) Supervise day-to-day activities of qualified SSPs f) Verify time worked by SSPs and approve and sign

timesheets. g) Process, submit or verify the submission of timesheets and

invoices in accordance with the payment cycle established by the AWC FMS.

h) Prepare and submit progress notes.i) Report work-related injuries incurred by SSPs to the

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 11,12, &15 a-o




# Question Type Guidance Source DocumentsAWC/FMS

j) Evaluate the performance of the SSP. k) Contact and inform the AWC FMS provider that the

individual or surrogate no longer wishes to utilize a qualified SSP.

l) Develop and implement an emergency back-up qualified support service worker plan. The Emergency Back-Up Support Service Worker Designation form is located in the PA Guide to PDS.

m) Identify changes in individual or surrogate contact information and health status (that is, hospitalization) and qualified support service worker contact information, hours, and employment status and report them to the AWC/ FMS.

n) Identify satisfaction or concern with the receipt of support services and report them to the AWC/FMS.

o) Track utilization of services and budgets in accordance with approved and authorized ISP.

Mark YES if the AWC/FMS has implemented an orientation and skills training for the ME, which meets the minimum requirements, listed above.

Mark No if the AWC/FMS has not developed or implemented an orientation and skills training for the ME, which meets the minimum requirements, listed above.

4a. Documentation was located The AWC/FMS has located the documentation. Mark YES if the documentation was located. Mark NA if no remediation action is required or



4b. The AWC/FMS develops and implements or amends a process to ensure the ME is provided with training on how to manage their services and how to perform as an ME.

R The AWC/FMS develops and implements or amends its current process for ensuring a ME is provided with an orientation and skills training which includes at a minimum how to: a) Recruit, screen, interview, select, and refer qualified

support service workers to the AWC FMS for hire, to include encouraging equal opportunities to all





# Question Type Guidance Source Documentsprospective workers, regardless of race, creed, color, national origin, sex, disability, marital status, or sexual orientation.

b) Determine the wage for the SSP.c) Train or participate in the training of the SSP. d) Develop the schedules of qualified support service

workers. e) Supervise day-to-day activities of qualified SSPs f) Verify time worked by SSPs and approve and sign

timesheets. g) Process, submit or verify the submission of timesheets

and invoices in accordance with the payment cycle established by the AWC FMS.

h) Prepare and submit progress notes.i) Report work-related injuries incurred by SSPs to the

AWC/FMS.j) Evaluate the performance of the SSP. k) Contact and inform the AWC FMS provider that the

individual or surrogate no longer wishes to utilize a qualified SSP.

l) Develop and implement an emergency back-up qualified support service worker plan. The Emergency Back-Up Support Service Worker Designation form is located in the PA Guide to PDS.

m) Identify changes in individual or surrogate contact information and health status (that is, hospitalization) and qualified support service worker contact information, hours, and employment status and report them to the AWC/ FMS.

n) Identify satisfaction or concern with the receipt of support services and report them to the AWC/FMS.

o) Track utilization of services and budgets in accordance with approved and authorized ISP.

Mark YES if the evidence exists that a process has been developed and implemented or amended.

Mark N/A if no remediation action is required or if another remediation action was selected.




# Question Type Guidance Source Documents4c. Other remediation action R The AE can accept documentation of “other” remediation

actions taken by the AWC/FMS to comply with the requirements.







no remediation action was taken by the AWC/FMS.




ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 11 and 12

5. The AWC/ FMS distributes a customer satisfaction survey to the ME’s and collects and analyzes the survey

O The AWC/FMS has developed a process to collect and analyze the results of the customer satisfaction survey.

The AWC /FMS acts on the results of the survey to

55 Pa Code Chapter 51 Section 51.30




# Question Type Guidance Source Documentsresponses, and acts to improve services.Exploratory

improve services through their Quality Management Plan. Mark YES if the AWC/FMS has developed a process to

distribute the customer survey, collect and analyze the results and acts to improve services.

Mark NO if the AWC/FMS has not developed a process to distribute the customer survey, collect and analyze the results and acts to improve services.

The AWC/FMS assumes the responsibilities of the employer of record and provide the following administrative services.6. The AWC/FMS securely maintains the

required documents related to the ME and SSP documents.

O The reviewer determines through a record review of the selected sample that:

a) A file exists for each participant and surrogate and is maintained in a safe and secure manner; and

b) The following forms are signed and located in the file:o Authorized Surrogate Designation Form (if the

participant is the ME, this form does not need to be completed);

o Managing Employer/Surrogate Agreement Formo Documentation of the Support Service Worker

Qualification Form and documentation of SSP qualifications; and

o Emergency Back-Up Support Service Worker Designation form.

o Any record not securely maintained will be securely maintained and missing documentation will be obtained Mark YES if there is evidence that all the above

items exist. Mark NO if there is evidence that the files are any

of the above items are not found in the file.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 10 (q) and 13

ODP Bulletin # 00-17-02 -Claim and Service Documentation Requirements for Providers of Consolidated and Person/Family Directed Support Waiver Services and Targeted Services Management

6a. Documentation was located. The AWC/FMS has located documentation that: a) A file exists for each participant and surrogate and is

maintained in a safe and secure manner; andb) The following forms are signed and located in the file:o Authorized Surrogate Designation Form (if the

participant is the ME, this form does not need to be





# Question Type Guidance Source Documentscompleted);


Qualification Form and documentation of SSP qualifications; and

o Emergency Back-Up Support Service Worker Designation form. Mark YES if the documentation has been located. Mark NA if no remediation action is required or



6b. The AWC/FMS develops and implements or amends the process to securely maintain the required documents related to the ME and SSP documents..

R The AWC/FMS develops and implements or amends their current process to include:

a) A file for each participant and surrogate that is maintained in a safe and secure manner;

b) The following forms are signed and located in the file:o Authorized Surrogate Designation Form (if the

participant is the ME, this form does not need to be completed);


Qualification Form and documentation of the SSP qualifications; and

o Emergency Back-Up Support Service Worker Designation form. Mark YES if evidence exists that a process has

been developed and implemented or amended. Mark NA if no remediation action is required or






documentation.


ODP Bulletin # 00-17-02 -Claim and *KEY – Agency With Choice Financial Management Services (AWC/FMS); Managing Employer (ME) is either the Participant or Surrogate, On-site Review (O); Participant Directed Goods and Services (PDGS); Remediation (R); and Support Service Professional (SSP)



# Question Type Guidance Source Documents Mark NA if no remediation action is required or

another remediation action was selected. Service Documentation Requirements for Providers of Consolidated and Person/Family Directed Support Waiver Services and Targeted Services Management

6d. If Yes: R The AE must calculate the number of days between the notification date to the Provider and the remediation action date.









7. ODP requirements for a ME are met. O The reviewer verifies that the ME’s file for the selected sample contains documentation that they meet the ODP requirements to be an ME. The requirements are:

a) At least 18 years old;b) Attestation regarding lack of criminal history.c) Agreement to participate in the required training

sponsored by the ODP and AWC/FMS;d) Agreement to sign all agreements with the ODP

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 10 (c),




# Question Type Guidance Source Documentsand the AWC/FMS related to the AWC/FMS option;

e) Agreement to perform all the tasks outlined in Section A of ODP Bulletin #00-08-08, Agency with Choice Financial Management Services; d

f) Agreement to work with the SC to develop and revise the ISP as needed; and

g) Agreement to participate in the required ISP monitoring.

Mark YES if evidence exists that all the above criteria have been met for the selected sample.

Mark NO if there is evidence that any of the above criteria have not been met for the selected sample

7a. Documentation was located. R The AWC/FMS has located documentation, evidence, which indicates a process that meets all criteria, exists, and the AWC/FMS AWCFMS providers implementing said process. Mark YES if the documentation was located. Mark NA if no remediation action is required or

another remediation action was taken.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 10 (c), (q) and 13

7b. The AWC/FMS develops or amends the process to ensure all MEs meets ODP requirements for being a ME.

R The AWC/FMS has developed and implemented or amended its current process to ensure all MEs meet the requirements required prior to them becoming one. Below are the requirements of a ME: a. Be at least 18 years old;b. Participate in the required training sponsored by ODP

and the AWC/FMS;c. Agree to participate in the required training

sponsored by ODP and the AWC/FMS; d. Agree to sign all agreements with the ODP and the

AWC/FMS related to the AWC/FMS optione. Agree to perform all the tasks outlined in Section A of

the ODP Bulletin #00-08-08 Agency with Choice Financial Management Services; and

f. Agree to work with the SC to develop and revise the ISP as needed; and

g. Participate in the required ISP monitoring.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 10 (c),




# Question Type Guidance Source Documents The AWC/FMS will train persons responsible for the

implementation of the new or amended process. Mark YES if evidence exists that a policy, procedure,

or process has been developed and implemented or amended.

Mark NA if no remediation action is required or if another remediation action was selected





ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 10 (c)

7d. If Yes: R The AE must calculate the number of days between the notification date to the AWC/FMS AWC/FMS and the remediation action date.

The AE must then choose the appropriate time frame from the drop-down list. Mark NA if no remediation action was necessary or if






8. The AWC/FMS ensures the SSP has required criminal clearances and citizenship/legal alien verification.

O The reviewers will validate the SSP record contains: a. Authorizations to conduct criminal background

checks, child abuse clearances, and FBI criminal history clearances; and

b. Verification of the SSP’s citizenship and legal alien status.

Mark YES if the record contains required

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 10 (d)




# Question Type Guidance Source Documentsdocuments.

Mark NO if the record does not contain required documents.

8a. Documentation was located. R The AWC/FMS has located the required documentation. Mark YES if the documentation was located. Mark NA if no remediation action is required or



8b. The AWC/FMS develops or amends the process to ensure the SSP has required criminal clearances and citizenship/legal alien verification.

R The AWC/FMS develops or amends the process to ensure the SSP has the required criminal clearance and citizenship/legal alien verification.

The AWC/FMS obtains any missing criminal clearances or citizenship/legal verification for SSP’s.

The AWC/FMS trains staff on the new or amended process.

Mark YES if the AWC/FMS developed or amended their process to ensure the SSP has required criminal clearances and citizenship/legal alien verification.

Mark N/A if no remediation action is required or if another remediation action was selected

.







8d. If YES. R The AE must calculate the number of days between the notification date to the Provider and the remediation action date.

The AE enters the appropriate timeframe (0-30 days, 31-





# Question Type Guidance Source Documents60 days, 61-90 days, over 90 days) in the comments box. Mark NA if no remediation action was necessary, or if





9. The AWC/FMS performs all payroll functions.

O The reviewers will validate the AWC/FMS has developed and implemented payroll processes to ensure they perform the following payroll functions:

a. Collect and process all required federal, state, and local human resources forms required for employment and the production of payroll (That is, tax, labor and citizenship);

b. Assist the ME with the establishment of the SSPs wage;

c. Collect and processes timesheets of SSPs;d. Computes, withholds, files, and deposits federal,

state, and local employment taxes for SSPs; e. Computes and pays Workers Compensation as per the

Pa. Workers Compensation Act of 1915, P.L. 736, No. 338, as amended (Title 77 of Purdon’s Statutes);

f. Approves and pays wages to SSPs in compliance with federal and state labor laws;

g. Performs all end-of-year federal, state, and local wage and tax filing requirements, as applicable (that is, IRS Forms W-2 and W-3, state income tax reconciliation form.

Mark YES if evidence indicates that the AWC/FMS has

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 15 (f-g) and (j-m)

ODP Communication #064-17 Reissue Consolidated and P/FDS Agency With Choice Wage Ranges, Benefit Allowance and Corresponding Department Established Fees for Specific Participant Directed Services Effective July 1, 2017




# Question Type Guidance Source Documentsdeveloped and implemented processes to ensure they perform all payroll functions.

Mark NO if there is evidence that the AWC/FMS has not developed and implemented any of the processes to ensure they perform all payroll functions.

9a. Documentation was located. R The AWC/FMS has located documentation. Mark YES if the documentation was located. Mark NA if no remediation action is required or




9b. The AWC/FMS develops or amends a process to ensure they meet all payroll functions.

R The AWC/FMS develops or amends its current a process to complete the following payroll functions: a) Collects and process all required federal, state, and

local human resources forms required for employment and the production of payroll (that is, tax, labor and citizenship)

b) Assists the ME with the establishment of the SSPs wage;

c) Collects and processes timesheets of SSPs;d) Computes, withholds, files, and deposits federal,

state, and local employment taxes for SSPs; e) Computes and pays Workers Compensation as per the

Pa. Workers Compensation Act of 1915, P.L. 736, No. 338, as amended (Title 77 of Purdon’s Statutes);

f) Approves and pays wages to SSPs in compliance with federal and state labor laws;

g) Performs all end-of-year federal, state, and local wage and tax filing requirements, as applicable (that is, IRS






# Question Type Guidance Source DocumentsForms W-2 and W-3, state income tax reconciliation form

The AWC/FMS provides training to staff on the new or amended process. Mark YES if the evidence exists that a process has

been developed or amended and staff has been trained.

Mark N/A if no remediation action is required or if another remediation action was selected.







9d. IF YES: R The AE must calculate the number of days between the notification date to the Provider and the remediation action date.



ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 15 (f-g) and (j-m)ODP Communication #064-17 Reissue Consolidated and P/FDS Agency With Choice Wage Ranges, Benefit Allowance and Corresponding Department Established Fees for Specific Participant Directed Services Effective July 1, 2017




# Question Type Guidance Source Documents9e. Remediation action outstanding R Mark YES if referred to AE for appropriate follow-up

as a result of no remediation action within 90 days of notification of the review findings. Utilize the comment field to record follow-up action.




10. The AWC/FMS administers payments for one-time and ongoing services rendered by qualified vendors within the pay cycle established by the AWC /FMS.

O The reviewer will validate the vendor records for the selected sample and determine if the AWC/FMS administered payments for one-time and ongoing services rendered by qualified vendors within the pay cycle established by the AWC/FMS. Mark YES if evidence exists that payments were made

within the pay cycle. Mark NO if any payment was not made within the pay

cycle.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 10 (n)

10a. Documentation was located. R The AWC/FMS has located documentation to determine the AWC /FMS administers payments for one-time and ongoing services rendered by qualified vendors within the pay cycle established by the AWC/FMS.

Mark YES if the documentation was located. Mark NA if no remediation action is required or



10b. The AWC/FMS developed or amended the process for ensuring they administer payments for one-time and ongoing services rendered by qualified vendors.

The AWC/FMS has developed or amended its current process to administer payments for one-time and ongoing services rendered by qualified vendors.

Any outstanding vendor payments are made. The AWC/FMS will provide staff on the new or amended

process. Mark YES if evidence exists that a process has been





# Question Type Guidance Source Documentsdeveloped or amended and the AWC/FMS administered any outstanding payments.







10d. IF YES: R The AE must calculate the number of days between the notification date to the Provider and the remediation action date.





Mark NA if the issue was remitted or no remediation action was required


11. The AWC/FMS has implemented a process to determine under what circumstances they will dismiss a participant’s SSP from AWC/FMS employment for just cause without the consent of the ME.

O The reviewer will validate the AWC/FMS’s process to determine under what circumstances they will dismiss a participant’s SSP from AWC/FMS employment for just cause without the consent of their ME.

This process must include the following: a) Prior to dismissing the SSP the AWC/FMS must

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 16




# Question Type Guidance Source Documentscontact the AE or County Program to inform and provide information on just cause for dismissal; and

b) The AWC/FMS must notify the ME of the dismissal. Mark YES if evidence exists that all the above criteria

have been met. Mark NO if evidence exists that any of the above

criteria have not been met.11a. Documentation was located. R The AWC/FMS has located documentation to determine

under what circumstances they will dismiss a participant’s SSP from AWC/FMS employment for just cause without the consent of their ME Mark YES if the documentation was located. Mark NA if no remediation action is required or



11b. The AWC/FMS develops or amends its process to address the dismissal of an SSP for just cause.

R The AWC/FMS develops or amends their process to ensure that if they dismiss an SSP for just cause without the consent of the ME, the following has occurred: a) The AWC/FMS must contact the AE or County

Program to inform and provide information on just cause for dismissal prior to dismissal; and

b) The AWC/FMS must also notify the ME of the dismissal.

The AWC/FMS provides training to the ME on the new or amended process. Mark YES if the process was developed or amended

and the AWC/FMS has trained the ME. Mark NA if no remediation action is required or

















Mark NA if the issue was remitted or no remediation action was required.


12. The AWC/FMS provides training to the ME in recruiting, screening, interviewing, selecting, and referring SSPs to the AWC /FMS for hire, to include encouraging equal opportunities to all prospective workers, regardless of race, creed, color, national origin, sex, disability, marital status, or sexual orientation.

O The reviewer reviews the ME’s training records to ensure they have received training in recruiting, screening, interviewing, selecting, and referring SSPs to the AWC /FMS for hire. At a minimum, this must include encouraging equal opportunities to all prospective workers, regardless of race, creed, color, national origin, sex, disability, marital status, or sexual orientation.

Any MEs not trained in any of the above have been trained. Mark YES if evidence exists that ME was trained in the

above. Mark NO if evidence exists the training did not occur,

or it did not include the above.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities #15 (a)

12a. Documentation has been located. R The AWC/FMS has located documentation and evidence indicating the AWC/FMS Mark YES if the documentation was located.



12b. The AWC/FMS develops and implements a process to ensure the

R The AWC/FMS develops or amends their process to ensure they have trained the ME in recruiting,

ODP Bulletin 00-08-08, Agency With Choice Financial Management




# Question Type Guidance Source DocumentsME is trained in recruiting, screening, interviewing, selecting, and referring SSPs to the AWC /FMS for hire, to include encouraging equal opportunities to all prospective workers, regardless of race, creed, color, national origin, sex, disability, marital status, or sexual orientation.

screening, interviewing, selecting, and referring SSPs to the AWC /FMS for hire. At a minimum, this must include encouraging equal opportunities to all prospective workers, regardless of race, creed, color, national origin, sex, disability, marital status, or sexual orientation.

MEs are trained on the process. Mark YES if AWC/FMS developed and implemented a

process. Mark NA if no remediation action is required or


Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities #15 (a)






12d. If YES: R The AE must calculate the number of days between the notification date to the Provider and the remediation action date.











MANAGING EMPLOYER RESPONSIBILITIES: The ME fulfills the responsibilities listed on the Management Agreement Form.13. The ME recruits, screens, interviews,

selects, and refers qualified SSPs for hire.

O The reviewer will validate the AWC/FMS’s process to ensure that all MEs are able to recruit, screen, interview, select, and refer qualified SSPs for hire.

Additionally, it must include what mechanism the AWC/FMS has in place to efficiently process SSP referrals that MEs have made and not discourage participants or surrogates from choosing to recruit and refer their own SSPs. Mark YES if evidence that a process exists. Mark NO if evidence exists that a process does not

exist or any of the above items are missing,

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section A Individual or Surrogate Responsibilities Related to the AWC/FMS Option #2

13a. Documentation has been located. R The AWC/FMS has located documentation and evidence, which indicates a process that meets all criteria, exists and the AWC/FMS is implementing said process.

Mark YES if the documentation was located. Mark NA if no remediation action is required or other

remediation actions were selected.


13b. The AWC/FMS develops or amends the process, which ensures the ME can recruit, screen, and interview, select, and refer qualified SSPs for hire.

R The AWC/ develops or amends its current process to ensure all MEs can screen, interview, select, and refer qualified SSPs for hire.

Additionally, it must include what mechanisms the AWC/FMS has in place to efficiently process the SSP referrals that MEs have made and not discourage participants or surrogates from choosing to recruit and refer their own SSPs.

The AWC/ FMS trains the ME on the amended or new process. Mark YES if evidence exists that a policy, procedure,

or process has been developed or amended and MEs have been trained.



13c. Other remediation action R The AE can accept documentation of “other” remediation ODP Bulletin 00-08-08, Agency With *KEY – Agency With Choice Financial Management Services (AWC/FMS); Managing Employer (ME) is either the Participant or Surrogate, On-site Review (O); Participant Directed Goods and Services (PDGS); Remediation (R); and Support Service Professional (SSP)



# Question Type Guidance Source Documentsactions taken by the AWC/FMS to comply with the requirements.




Choice Financial Management Services (AWC/FMS) Section A Individual or Surrogate Responsibilities Related to the AWC/FMS Option # 2

13d, If YES: R The AE must calculate the number of days between the notification date to the Provider and the remediation action date.







14. The ME is trained to determine the wage of the SSP within the established ODP‘s approved wage and benefit allowance.

O The reviewer will validate the training records of the selected sample, including the course description, sign-in sheets, transcripts, or certificates of completion from the training and determines if the ME was trained in determining the wage of the SSP within the established ODP‘s approved wage and benefit allowance. Mark YES if evidence exists and has all the above

criteria. Mark NO if evidence exists that the ME is not able to

determine the wage of the SSP.


ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 10 (g &l) and 15 (b)




# Question Type Guidance Source Documents ODP Communication #064-17

Reissue Consolidated and P/FDS Agency With Choice Wage Ranges, Benefit Allowance and Corresponding Department Established Fees for Specific Participant Directed Services Effective July 1, 2017

14a. Documentation has been located. R The AWC/FMS has located documentation that the ME has been trained to determine the wage of the SSP within the established ODP‘s approved wage and benefit allowance. Mark YES if the documentation was located. Mark NA if no remediation action is required or





14b. The AWC/FMS develops or amends the process to ensure MEs can determine the SSPs’ wages within the ODP’s

R The AWC/FMS develops or amends its process that ensures all MEs determine the SSPs’ wages within ODP’s

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section A




# Question Type Guidance Source Documentsapproved wage. approved wage range.

The ME is trained on the new or amended process. Mark YES if evidence exists that a process has been

developed or amended and the ME has been trained. Mark N/A if no remediation action is required or


Individual or Surrogate Responsibilities Related to the AWC/FMS Option #6













# Question Type Guidance Source Documents14d. If YES: R The AE must calculate the number of days between the

notification date to the Provider and the remediation action date.










ODP Communication #064-17 Reissue Consolidated and P/FDS Agency With Choice Wage Ranges, Benefit Allowance and Corresponding Department




# Question Type Guidance Source DocumentsEstablished Fees for Specific Participant Directed Services Effective July 1, 2017

15. The ME is trained to perform employer related tasks.

O The reviewer will validate the AWC/FMS’s process and training records for the selected sample to ensure the ME is trained to perform the following employer related tasks:

a) Providing or participating in the provision of SSP orientation and training;

b) Determining schedules of SSPs;c) Determining tasks to be performed by SSPs and

where and when they are to be performed in accordance with the approved and authorized ISP;

d) Managing the day-to-day activities of SSPs;e) Verifying time worked by SSPs and approve and

sign timesheets; f) Evaluating whether SSPs can perform necessary

job functions as described in the participant’s approved and authorized ISP;

g) Training or participating in the training of qualified SSP;

h) Evaluating the performance of the SSP; and i) Supervising the day-to-day activities of the SSP.

Mark YES if evidence exists that all the above criteria have been met.

Mark NO if evidence exists that any of the above criteria have not been met.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section A Individual or Surrogate Responsibilities Related to the AWC/FMS Option # 5, 6.7, 8,9 &16

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 15 (c-f) & (j)

15a. Documentation has been located. R The AWC/FMS has located documentation and evidence that indicates the ME has been trained to perform the above listed employer related tasks. Mark YES if the documentation was located. Mark NA if no remediation action is required or



ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’




# Question Type Guidance Source DocumentsRoles and Responsibilities # 15 (c-f) & (j)

15b. The AWC/FMS develops or amends their process to ensure the ME preforms employer related tasks.

R The AWC/FMS develops or amends its current process to ensure the ME preforms the following employer related tasks:a) Providing or participating in the provision of SSP

orientation and training; b) Determining schedules of SSPs;c) Determining tasks to be performed by SSPs and

where and when they are to be performed in accordance with the approved and authorized ISP;

d) Managing the day-to-day activities of SSPs;e) Verifying time worked by SSPs and approve and sign

timesheets; f) Evaluating whether SSPs can perform necessary job

functions as described in the person’s approved and authorized ISP;

g) Training or participating in the training of qualified SSP;

h) Evaluating the performance of the SSP; and i) Supervising the day-to-day activities of the SSP.

The ME is trained on the new or amended process. Mark YES if the AWC/FMS developed or amended its

current process and trained the ME. Mark N/A if no remediation action is required or





ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section A.




# Question Type Guidance Source Documents The AE will record in the comment field the REMEDIATION

ACTION taken by the AWC/FMS to remediate. Mark YES if the AWC/FMS submitted remediation



Individual or Surrogate Responsibilities Related to the AWC/FMS Option # 5, 6.7, 8,9 &16











16 The ME verifies the submission of time sheets and invoices in accordance with the payment cycle established by the AWC/FMS.

O The reviewer validates the AWC /FMS has a process to ensure the ME approves and signs the timesheets and submits them in accordance with the payment cycle established by the AWC/FMS.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section A Individual or Surrogate




# Question Type Guidance Source Documents Mark YES if evidence exists that the AWC/FMS has a

process. Mark NO if the AWC/FMS does not have a process.

Responsibilities Related to the AWC/FMS Option # 9 & 10

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 15 (f& g)

16a. Documentation has been located. R The AWC/FMS has located documentation that the ME has verified and submitted the time sheets in accordance with the payment cycle established by the AWC/FMS. Mark YES if the documentation was located. Mark NA if no remediation action is required or other

remediation actions taken was selected.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section A Individual or Surrogate Responsibilities Related to the AWC/FMS Option # 9 & 10


16b. The AWC/FMS develops or amends the process to ensure the ME verifies the submission of time sheets and invoices in accordance with the payment cycle established by the AWC/FMS.

R The AWC/FMS develops or amend its current process to ensure MEs verify the submission of time sheets and invoices in accordance with the payment cycle established by the AWC/FMS.

The ME is trained on the new or amended process. Mark YES if evidence exists that a policy, procedure,

or process has been developed or amended and the ME has been trained.

Mark N/A if no remediation action is required or another remediation action was selected.






# Question Type Guidance Source Documents16c. Other remediation action R The AE can accept documentation of “other” remediation

actions taken by the AWC/FMS to comply with the requirements.















17. The ME reports work-related injuries incurred by the SSPs to the AWC/FMS.

O The reviewer will validate that the AWC/FMS has a process to ensure MEs report work-related injuries that qualified SSPs incur to the AWC/FMS.

The reviewer reviews any records with work-related

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section A Individual or Surrogate




# Question Type Guidance Source Documentsinjuries and determines if the ME reported it. Mark YES if it the AWC/FMS has a process for the

ensuring the ME reports, work -related injuries and all work-related injuries were reported.

Mark NO if the AWC/FMS does not have a process for ensuring the ME reports work related injuries or a work-related injury was not reported.

Mark NA if no work-related injuries occurred.

Responsibilities Related to the AWC/FMS Option # 11

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 15 (i)

17a. Documentation has been located. R The AWC/FMS has located documentation that the ME reported work related injuries incurred by the SSP.

Mark YES if the documentation was located. Mark NA if no remediation action is required or other

remediation actions taken was selected.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section A Individual or Surrogate Responsibilities Related to the AWC/FMS Option # 11


17b. The AWC/FMS develops or amends the process to ensure the ME reports, work-related injuries to the AWC/FMS.

R The AWC/FMS develops or amends its process to ensure MEs report work-related injuries to the AWC/FMS.

The AWC/FMS trains the ME on the new or amended process. Mark YES if evidence exists that a process has been

developed or amended and the ME was trained. Mark N/A if no remediation action is required or




17c. Other remediation action R The AE can accept documentation of “other” remediation actions taken by the AWC/FMS to comply with the

ODP Bulletin 00-08-08, Agency With Choice Financial Management




# Question Type Guidance Source Documentsrequirements.




Services (AWC/FMS) Section A Individual or Surrogate Responsibilities Related to the AWC/FMS Option # 11















The AWC/FMS supports the participant’s need to receive all services approved in the ISP. 18. The AWC/FMS trains the ME to ensure

services are being provided in accordance with the service definitions contained in the approved waivers.

Exploratory

O The reviewer will validate the AWC/FMS’s training process and review the training record for the ME to ensure they were trained on the current service definitions contained in the waiver. Mark YES if evidence exists that the ME has been

trained. Mark N/A if no training occurred.

Community Living Waiver Appendix C, Consolidated Waiver Appendix C, and P/FDS Waiver Appendix C

19. The AWC/FMS has developed and implemented a process to ensure they meet the requirements outlined in ODP Communication Number: Memo 069-16 Clarifying the Provision of Home and Community Habilitation and/or Companion Services by Relatives and Legal Guardians in the Consolidated and P/FDS Waivers.

Exploratory

O The reviewer will validate the AWC/ FMS shows evidence that they understand and are following the requirements outlined in ODP Communication Number: Memo 069-16. These requirements are: a) Clarify the maximum number of hours per week of

Home and Community Habilitation and/or Companion services that relatives and legal guardians may provide to individuals who are enrolled in the Consolidated, P/FDS, or Community Living waiver;

b) Explain the exceptional circumstances that will permit relatives and legal guardians to provide Home and Community Habilitation and/or Companion beyond the maximum allowed hours per week; and

c) Establish how often exceptions are allowed and how to track exception use.

Mark Yes, if evidence exists. Mark N/A if evidence does not exist. No remediation

action is required.

ODP Communication Number: Memo 069-16 Clarifying the Provision of Home and Community Habilitation and/or Companion Services by Relatives and Legal Guardians in the Consolidated and P/FDS Waivers

PERSON-CENTERED PLANNING, SERVICE DELIVERY, AND OUTCOMES – The individual is supported in developing an ISP20. The AWC/FMS service note indicates

actions taken to address the lack of progress in achieving a desired outcome.

O The reviewer checks the service notes for the past twelve months.

The reviewer identifies any service notes that indicate lack of progress in achieving a desired outcome.

For those without progress, the note should include

ODP Bulletin # 00-17-02 -Claim and Service Documentation Requirements for Providers of Consolidated and Person/Family




# Question Type Guidance Source Documentsactions that have been taken to address the lack of progress.

Actions may include recommending a change to the service being rendered, requesting a team meeting to discuss with the ISP team, or retraining SSPs on delivery of service.

The AE should have conversations with the AWC/FMS to discuss the reasons why progress is not being achieved. Mark YES if the service note reviewed indicates action

taken to address the lack of progress. Mark NO if the service note reviewed does not

indicate any action taken to address lack of progress. Mark N/A if the service note shows progress in

achieving an outcome.

Directed Support Waiver Services and Targeted Services Management

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 15 (h)

20a. The AWC/FMS develops a process that ensures SSP’s have an understanding of documenting progress related to achieving desired outcomes.

R The AWC/FMS develops a process to ensure SSP’s have an understanding of documenting progress related to achieving outcomes. Mark YES if the process was developed. Mark NA if no remediation action is required or




20b. SSP’s are trained on how to appropriately document service notes.

R The AWC/FMS submits documentation to the AE that the SSPs were trained on how to appropriately document service notes. Mark YES if the AWC/FMS submits documentation to

the AE that training was completed by AWC/FMS. Mark N/A if no remediation action is required or



ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B.




# Question Type Guidance Source DocumentsAgency With Choice FMS Providers’ Roles and Responsibilities # 15 (h)







20d. IF YES, when: R The AE must calculate the number of days between the notification date to the AWC/FMS and the remediation action date.

The AE enters the appropriate timeframe (0-30 days, 31-60 days, 61-90 days, over 90 days) in the comments box. Mark NA if no remediation action was necessary or if







# Question Type Guidance Source Documents20e. Remediation action outstanding R Mark YES if referred to AE for appropriate follow-up

as a result of no remediation action within 90 days of notification of the review findings. Utilize the comment field to record follow-up action.




PERSON-CENTERED PLANNING, SERVICE DELIVERY, AND OUTCOMES – The ME has personal choice and control. 21. The AWC/FMS has demonstrated that

the ME is afforded the right to choose, direct, and control their services and the qualified support service workers who provide them without excessive restrictions or barriers.

O The reviewer validates the AWC/FMS’s has a written procedure and implemented procedures to ensure the ME is afforded the right to choose, direct, and control their services and the qualified support service workers who provide them without excessive restrictions or barriers. Mark YES if the AWC/FMS has a written procedure

and evidence exists that the procedure has been implemented.

Mark No if the AWC/FMS does not have written and no evidence exists that the procedure has been implemented.


21a. Documentation has been located. R The AWC/FMS has located documentation and evidence that indicates a process exists that meets all criteria and AWC/FMS is implementing said process. Mark YES if the documentation was located. Mark N/A if no remediation action is required or



21b. The AWC/FMS develops and implements a process to ensure the ME chooses or directs and determines

R The AWC/FMS will develop, implement, or amend its current process to ensure MEs can choose or direct and determine the terms and conditions of





# Question Type Guidance Source Documentsthe terms and conditions of the participant’s services and the SSPs who provide him or her services without excessive restrictions or barriers.

the participant’s services and the SSPs who provide them with services without excessive restrictions or barriers.

The AWC/FMS will train the ME on the new or amended process.

Mark YES if evidence exists that a policy, procedure, or process has been developed and implemented.


Agency With Choice FMS Providers’ Roles and Responsibilities # 5 and 7
















# Question Type Guidance Source Documents22. The AWC/FMS implements safeguards

that reflects the guiding principles of self- determination and ensures the ME has the option to train the SSP themselves or participate in the training.

O The reviewer validates the AWC/FMS’s process to ensure they have written procedures, internal controls and other safeguards in place which reflects the ODP’s requirements, the guiding principles of self-determination (including the principles outlined in Bulletin 00-03-05, Principles for the Mental Retardation System), for SSPs who provide them without excessive restrictions or barriers. These procedures, internal controls and other safeguards must include, at a minimum: a) Qualified SSP worker orientation and training that

outlines and emphasizes the rights of the ME to select and control services and workers, including information on the principles for the Developmental Program system. The orientation and training must be customizable to the participant’s needs; and

b) The option for ME to train their SSPs themselves or participate in the SSP training (initial and ongoing) provided by the AWC/FMS.

Mark YES if there is evidence that the AWC/FMS has developed a process to address the above.

Mark NO if there is evidence that the AWC/FMS has not developed a process to address the above.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 5 (c& d)

22a. Documentation has been located. R The AWC/FMS has located documentation and evidence, which indicates a process that meets all criteria, exists and the AWC/FMS AWCFMS provider is implementing said process. Mark YES if the documentation was located. Mark NA if no remediation action is required or



22b. The AWC/FMS has developed and implemented systems, written procedures, internal controls, and other safeguards that reflect the guiding self- determination and ensures the ME has the option to train

R The AWC/FMS develops, implements, or amends its process to implemented systems, written procedures, internal controls, and other safeguards that reflect ODP requirements, the guiding principles of self- determination and ensure the ME, rather than the AWC/FMS, have the right to choose, direct, and control their services and the





# Question Type Guidance Source Documentsthe SSP themselves or participate in the training.

SSPs who provide them without excessive restrictions or barriers.

The policy, procedure, or process includes at a minimum: a) Qualified SSP worker orientation and training

that outlines and emphasizes the rights of the ME to select and control services and workers, including information on the principles for the Developmental Program system. The orientation and training must be customizable to the participant’s needs;

b) The option for ME to train their SSPs themselves or participate in the SSP training (initial and ongoing) provided by the AWC/FMS; and

The AWC/FMS will train the ME on the new or amended process. Mark YES if evidence exists that a process has been

developed and implemented or amended. Mark NA if no remediation action is required or

another remediation action was selected. 22c. Other remediation action R The AE can accept documentation of “other” remediation

actions taken by the Provider to comply with the requirements.

The AE will record in the comment field the REMEDIATION ACTION taken by the Provider to remediate. Mark YES if the Provider submitted remediation










# Question Type Guidance Source Documentsno remediation action was taken by the AWC/FMS




QUALIFIED PROVIDERS 23. Any newly hired SSPs receive training

to meet the needs of the participant they support as identified in the current approved Individual Support Plan (ISP) before providing services to the participant.

O The reviewer validates the hire dates for all newly hired SSPs who work directly with participants to determine whether any SSPs were hired within 12 months of the review date.

The AWC/FMS will give a list of all newly hired SSPs who work with the participants in the sample selected during the review period. This list should include the date when the SSPs began working with the participants.

The reviewer determines whether the last newly hired SSPs who work directly with the participants in the sample received training on the current approved ISP of the participant(s) they support prior to working with the participant(s).

Review training records, including a description of the course, sign-in sheets, transcripts, or certificates of completion from the training.

SSPs who work directly with the participants should be trained on the current approved ISP for the participant(s) they support.

Cross-reference the hire date with the training records to ensure the SSPs were trained prior to providing service(s).

Training should include all aspects of the ISP such as outcomes, special health care needs, behavior, accessibility, nutrition/diet, communication methods and SSP’s sign language skills (when required), and risk mitigation strategies. Mark YES if the training records indicate that SSPs

55 Pa. Code Chapter 51 Sections 51.4, 51.23 (a) (2), (b) and (c)



http://www.pacode.com/secure/data/055/chapter51/chap51toc.html#51.23.



# Question Type Guidance Source Documentsreceived training on the current approved ISP for the person they support prior to beginning work with the participant.

Mark NO if there are no training records or if the SSPs did not receive training on the current approved ISP prior to beginning work with the participant.

Mark N/A if the AWC/FMS did not hire any new SSPs during the review period.

23a. Documentation was located. R The AWC/FMS has located training records that indicate that all AWC/FMS SSP’s have completed training on the current, approved ISP for the participant(s) they support prior to service delivery. Mark YES if the documentation was located. Mark NA if no remediation action is required or



23b. SSP’s are trained as appropriate on the ISP(s) of the participants they support prior to service delivery.

R The AWC/FMS submits documentation to the AE that the SSP’s who work directly with participants were trained on the ISP(s) of the participants they support within 30 days. Mark YES if the AWC/FMS submitted documentation

that the SSP’s has been trained. Mark NA if no remediation action is required or









The AE enters the appropriate timeframe (0-30 days, 31-













# Question Type Guidance Source Documents60 days, 61-90 days, over 90 days) in the comments box. Mark NA if no remediation action was necessary, or if





24. The AWC/FMS ensures SSP’s are trained to meet the needs of the participant they support as identified in the current, approved Individual Support Plan (ISP) before providing services to the participant.

O Review the hire dates for all new hire SSP’s working directly with participants to determine if any SSP were hired within the last 12 months of the date of review.

Review training records, including a description of the course, sign-in sheets, transcripts, or certificates of completion from the training.

SSP’s who work directly with the individuals should be trained on the current, approved ISP for the participant(s) they support.

Cross-reference the hire date with the training records to ensure the SSP’s were trained prior to providing services.

Training should include all aspects of the ISP such as outcomes, special health care needs, behavior, accessibility, nutrition/diet, communication methods and staff sign language skills (when required) and risk mitigation strategies. Mark YES if the training records indicate that SSPs

received training on the current approved ISP for the person they support prior to beginning work with the individual.

Mark NO if there are no training records or if the SSPs did not receive training on the current, approved ISP prior to beginning work with the individual.

Mark NA if the AWC/FMS did not have any new hire SSPs for the review period.

55 Pa Code Chapter 51 Sections 51.4, 51.23 (a) (2), (b) and (c)







24a. Documentation was located. R The AWC/FMS has located training records that indicate that all AWC/FMS SSP’s have completed training on the current, approved ISP for the participant(s) they support prior to service delivery. Mark YES if the documentation was located. Mark NA if no remediation action is required or



24b. SSP’s are trained as appropriate on the ISP(s) of the participants they support prior to service delivery.

R The AWC/FMS submits documentation to the AE that the AWC/FMS SSP’s who work directly with participants was trained on the ISP(s) of the participants they support within 30 days. Mark YES if the AWC/FMS provided documentation to

the AE of training completed by the AWC/FMS Mark NA if no remediation action is required or













Mark NA if the issue was remediated or no







# Question Type Guidance Source Documentsremediation action was required.

PROMOTE SELF –DIRECTION CHOICE AND CONTOL- Participant Directed Goods and Services (PDGS) in the P/FDS waiver25. The participant receives Participant

Directed Goods & Services (PDGS) from the AWC/FMS. (Only answer if the participant is enrolled in the P/FDS or Community Living Waiver) (Only answer if the participant is enrolled in the P/FDS or Community Living Waiver) Exploratory

O For the sample selected, review the Services and Support section of the ISP to determine if the individual receives PDGS from the AWC/FMS. Mark YES if the participant received PDGS from the

AWC/FMS. Mark NO if the individual does not receive PDGS from

the AWC/FMS. Mark NA if the participant of the selected sample did

not utilize PDGS or is enrolled in the Consolidated Waiver.

PERSON /FAMILY DIRECTED SUPPORTS AND COMMUNITY LIVING WAIVER – APPENDIX C

26. (Only answer if the participant used PDGS) The AWC/FMS ensures prior to purchasing PDGS the participant has completed the enrollment process for enrolling the AWC model of service.

Exploratory

O The reviewers review the records of the selected sample and ensure that prior to the use of PDGS the participant has completed the enrollment process for enrolling in an AWC model of service. Mark YES if there is a completed enrollment packet. Mark NO if there is no completed enrollment packet. Mark NA if the participant of the selected sample did

not utilize PDGS or is enrolled in the Consolidated Waiver.

PERSON /FAMILY DIRECTED SUPPORTS AND COMMUNITY LIVING WAIVER – APPENDIX C

FINANCIAL ACCOUNTABILITY- The ME tracks and monitors the authorized budget. 27. The AWC/FMS trains the ME on how

to track the utilization of services in accordance with the approved and authorized ISP.

O The reviewers review the training records for the selected sample and determines if the ME was provided training on:a) How to track the utilization of services in accordance

with the approved and authorized ISP;b) The process which will be implemented if the ME

allows the SSP to render services in excess of the authorized and approved ISP; and

c) The process that will be implemented if the ME allows vendor services to be authorized in excess of the approved and authorized ISP.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities 15 (o)




# Question Type Guidance Source Documents Mark YES if there is evidence that the training

occurred. Mark NO if there are no training records or evidence

that one of the above trainings were not provided. 27a. Documentation was located. The AWC/FMS has located training records that indicate

that all AWC/FMS SSP’s have completed training on: a) How to track the utilization of services in accordance

in accordance with the approved and authorized ISP;b) The process which will be implemented if the ME

allows the SSP to render services Mark YES if the documentation was located. Mark NA if no remediation action is required or


ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 15 (o)

27b. The AWC/FMS develops, implements or amends its process to train ME’s on how to track the utilization of services in accordance with the approved and authorized ISP.

The AWC/FMS will develop, implement, or amend its current process to ensure MEs are trained on how to track the utilization of services in accordance with the approved and authorized ISP.

Any ME’s who have not received the training will be trained. Mark YES if the AWC FMS develops, implements, or

amends its process and any ME’s who were not trained are trained.

Mark NA if no remediation action is required or another remediation action was selected


27c. Other remediation actions taken: The AE can accept documentation of “other” remediation actions taken by the AWC/FMS to comply with the requirements.





27d. If YES, when. The AE must calculate the number of days between the notification date to the Provider and the remediation

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC FMS) Section B.




# Question Type Guidance Source Documentsaction date.



Agency With Choice FMS Providers’ Roles and Responsibilities 15 (o)

27e. Remediation action outstanding Mark YES if referred to AE for appropriate follow-up as a result of no remediation action within 90 days of notification of the review findings. Utilize the comment field to record follow-up action.



28. The AWC /FMS generates standardized reports which include the annual payment cycle and the monthly service utilization and budget reports and provides them to the ME and the AE.

O The reviewer reviews the AWC/FMS process for generating reports to the ME and AE, which includes the annual payment cycle and monthly service utilization and budget reports.

The reviewer verifies that the reports were sent to the M and AE. Mark YES if the AWC/FMS has a process for sending

the reports to the ME and the AE. Mark NO if the AWC/FMS has not developed a

process for sending the reports to the ME and AE.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities 10 (p)

28a. Documentation has been located. R The AWC/FMS has located evidence they have a process for generating the reports and the ME and AE has received them.

Mark YES if the documentation was located. Mark NA if no remediation action is required or another

remediation action was selected.


28b. The AWC/FMS develops and The AWC/FMS develops and implements or amended its ODP Bulletin 00-08-08, Agency With




# Question Type Guidance Source Documentsimplements or amended a process to ensure that the ME and AE receive standardized reports which include the annual payment cycle and the monthly service utilization and budget reports and provides them to the ME and the AE.

process to ensure the ME and AE receives standardized reports, which includes the annual payment cycle, and the monthly service utilization and budget reports. Mark Yes, if evidence exists that the AWC/FMS has

developed, implemented, or amended the above process.


Choice Financial Management Services (AWC FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities 10 (p)

28c. Other remediation actions: R The AE can accept documentation of “other” remediation actions taken by the AWC FMS provider to comply with the requirements.

The AE will record the remediation action taken by the AWC FMS provider to remediate in the comment field. Mark YES if the AWC FMS provider submitted

remediation documentation. Mark N/A if no remediation action is required or if



28d. If YES. R The AE can accept documentation of “other” remediation actions taken by the AWC/FMS to comply with the requirements.






Mark NA if the issue was remediated or no





# Question Type Guidance Source Documentsremediation action was required.

HEALTH & WELFARE – The individual’s health, safety and rights are protected.29. The AWC/FMS develops a process that

ensures the back-up plans for participants are implemented.

O The AWC/FMS develops a process that ensures that back-up plans for participants is implemented. Mark YES if the process was developed. Mark NO if a process does not exist.

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 14 and 15 (l)

DP 1009 - The Emergency Backup Support Service Worker Designation form is in the PA Guide to PDS on the website: http: /MY ODP topic/info/participant-directed-services/participant directed-forms-and-additional-information agency-with-choice-awc-financial management-services/

29a. Documentation was located. R Mark YES if the documentation was located that a

process exists. Mark NA if no remediation action is required or



The Emergency Backup Support Service Worker Designation form is in the PA Guide to PDS on the website: http: /MY ODP topic/info/participant-directed-services/participant directed-forms-and-additional-information agency-with-choice-awc-financial management-services/

29b. AWC/FMS trains the ME on the process for implementing the back-up plan.

R The AWC/FMS develops a process that ensures back-up plans for participants are implemented as specified in the ISP and ensures the ME has been trained on the process.





# Question Type Guidance Source Documents Mark YES if evidence exists that a process has been

developed and the ME has been trained. Mark NA if no remediation action is required or


Agency With Choice FMS Providers’ Roles and Responsibilities # 14 and 15 (l)









The AE enters the appropriate timeframe (0-30 days, 31-60 days, 61-90 days, over 90 days) in the comments box. Mark NA if no remediation action was necessary or if



The Emergency Backup Support Service Worker Designation form is




# Question Type Guidance Source Documentsin the PA Guide to PDS on the website: http: /MY ODP topic/info/participant-directed-services/participant directed-forms-and-additional-information agency-with-choice-awc-financial management-services/





30 The AWC/FMS ensures the ME has been trained to report changes in a participant’s health status (e.g., hospitalization) to the AWC/FMS.

O The reviewer will validate the ME training records to ensure the ME was trained on reporting changes in a participant’s health status.

Mark YES if evidence exists that the ME has received training

Mark NO if no evidence exists that the ME has received training

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 15 (m)

30a. Documentation was located. R Mark YES if the documentation was located that a process exists.

Mark NA if no remediation action is required or another remediation action was selected

ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and




# Question Type Guidance Source DocumentsResponsibilities # 15 (m)

30b. The AWC/FMS develops and a process to ensure the ME reports changes in a participant’s health status (e.g., hospitalization) to the AWC/FMS and retrains the ME.

R The AWC/FMS will develop a process to ensure MEs report changes in a participant’s health status (e.g., hospitalization) to the AWC/FMS and retrains the ME as appropriate. Mark YES if AWC/FMS has developed a process and

evidence exists that the ME has been retrained. Mark N/A if no remediation action is required or


ODP Bulletin 00-08-08, Agency With Choice Financial Management Services (AWC/FMS) Section B. Agency With Choice FMS Providers’ Roles and Responsibilities # 15 (m











Mark NA if the issue was remitted or no remediation action was required.


