The Challenge:
The West Virginia Medicaid Aged & Disabled Waiver Program provides home and community based services to over 4,500 seniors and adults with disabilities who qualify for nursing facility level of care. In 2002, West Virginia received a Cash & Counseling Expansion grant from the Robert Wood Johnson Foundation to implement a self-directed service model within the AD Waiver program. West Virginia was selected to pilot the Consumer Direction Module (CDM), a Web-based application designed to support self-direction. The Bureau was looking for a single statewide contractor with a physical presence in West Virginia to provide bundled financial management and resource consulting services utilizing a Government Fiscal/Employer Agent model. In 2006, WVDHHR amended its existing contract with PCG (PPL’s parent company), to engage PPL’s services.

The PPL Approach:
PPL provides statewide billing agent services (including payroll, accounts payable, and co-pay collection) for one Medicaid-funded program and two state-funded programs in New Jersey serving over 4,500 participants. In 2007, NJDHSS received a Nursing Home Diversion Modernization Grant from the Administration on Aging (AOA). The eighteen-month demonstration will be conducted in Camden County. The goals of the project are to:

• Transform the way the aging services network allocates existing OAA funds and other State funded home and community-based services from community agency-based contracts to flexible service dollars that are directed and controlled by consumers through a Cash & Counseling option; and
• Redesign the aging network service delivery system to be consumer directed and controlled for individuals who are not eligible for Medicaid yet at risk for nursing home placement and spend-down to Medicaid.

Building on the Aging and Disability Resource Center (ADRC) model, the project will offer flexible service dollars (budget authority), allowing consumers to purchase services to meet their care needs consistent with the Cash & Counseling approach. The project design will also introduce participant costsharing (co-pay) requirements based on a sliding scale similar to the state-funded JACC Program. NJDHSS has projected enrollment of 30 participants.

The Solution:

NJDHSS-DACS will amend its current contract with PPL to serve as the billing agent for the demonstration grant. PPL will collaborate with NJDHSS and its state partners to:

• Adapt financial management systems and business processes, including adding new service codes and expanding service definitions;
• Adapt and apply program-specific co-pay requirements;
• Enhance reporting capabilities to track participant use of grant funds to purchase an expanded array of goods and services;
• Provide customer services to additional participants and state partners; and
• Participate in external project evaluation activities.

Specific deliverables include:

• Confirm functional requirements for systems enhancements;
• Design, test and install systems enhancements based on functional requirements; and
• Support authorized users to enter service authorizations and co-pay requirements in the enhanced system and validate integrity of the data.