Financial Management Services (FMS)

Posted: December 2, 2024

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Service Authorization Requirements

· Documentation

· Billing

Overview

Financial management services (FMS) providers help with financial tasks, billing and employer-related responsibilities for Minnesota Health Care Programs (MHCP) members who self-direct their services through:

· Consumer directed community supports (CDCS),

· Consumer Support Grant (CSG) (CFSS will replace CSG in the future), or

· Community First Services and Supports (CFSS)

· the CFSS budget model

· purchasing goods within the CFSS agency model

Eligible Providers

An FMS provider must meet all the following qualifications:

1. Successfully complete a readiness review before enrollment, conducted by a member or organization that meets the qualifications required by the state.

2. Be a financially solvent organization.

3. Have all the following:

· Current and adequate liability insurance and bonding as defined in the RFP.

· Knowledge of and compliance with Internal Revenue Service (IRS) requirements.

· An information technology security officer.

· A certified payroll professional, a certified public accountant or an individual with a bachelor’s degree in accounting.

· An electronic tracking, reporting and verification software product that can report and analyze data on people who receive services and support workers

· The ability to provide services statewide.

· The ability to meet the requirements under a collective bargaining contract.

· An established customer service system.

The Minnesota Department of Human Services (DHS) determines if FMS providers meet these qualifications through a Request for Proposal (RFP) process. FMS providers are required to go through the RFP process periodically as determined by DHS. To view open RFPs, refer to the Grants and RFPs website. DHS contracts with all FMS providers who successfully complete the RFP process to provide FMS services.

Requirements to act as agent of the MHCP member
FMS providers (referred to as “vendor fiscal/employer agents” in state contracts) must comply with Section 3504 of the Internal Revenue Service (IRS) Code and Revenue Procedure Code 2013-39, as applicable.

The previously listed federal authority requires an FMS provider to:

· Obtain an IRS authorization from the member to act as an agent for them.

· Be able to advise the member about their obligations for workers’ compensation.

· Help the member obtain workers’ compensation, if needed, and any other required insurance.

FMS Providers Must Facilitate DHS Enrollment of Individual Support Workers
FMS organization must facilitate the enrollment of individual direct support workers

Eligible Members

Members are eligible to use FMS under the following programs:

· Consumer Directed Community Supports

· Consumer Support Grant (CSG),Community First Services and Supports:

· Members who use the CFSS budget model

· Members who purchase goods within the CFSS agency model

FMS providers must verify program eligibility for each member each month through the MHCP phone-based eligibility verification system or online via MN–ITS.

Covered Services

The following FMS services are covered:

· Billing DHS and paying vendors or the person’s individual workers for authorized goods and services.

· Ensuring expenses follow the rules of the program and lead-agency-approved plan.

· Helping the person obtain workers’ compensation.

· Educating the person on how to employ workers.

· Documenting and reporting all spending of program funds.

· Initiating background studies for workers.

· Filing federal and state payroll taxes for workers on the person’s behalf.

FMS Services must be:

· Provided to an eligible member.

· Prior authorized by a lead agency.

· Included in the member’s CDCS Community Support Plan, CFSS service delivery plan or CSG plan approved by a lead agency.

Noncovered Services

The following services are not covered:

· Services that are not specified in the member’s plan approved by the lead agency.

· Services provided without authorization from the lead agency.

Service Authorization Requirements

All CDCS, CSG and CFSS services require a lead agency to complete a service authorization. A provider will not receive payment for services without a service authorization. However, an approved service authorization is not a guarantee of payment.

Providers are responsible for ensuring the service authorization is accurate when they receive their service authorization letters in their MN–ITS mailbox.

Service authorization may not be issued to more than one FMS provider for the same member for the same dates.

Service authorization for CDCS, CSG and CFSS are modified in the following way:

· Case managers and care coordinators update service authorizations for people who receive waiver or Alternative Care (AC) and receive CDCS, CSG or CFSS services.

· DHS updates CFSS service authorizations for people not on a waiver or AC and not receiving CFSS services through a managed care organization (MCO) when a CFSS provider agency, FMS provider, consultation services provider or lead agency requests a change. Refer to PCA/CFSS service agreement technical changes and corrections in the CFSS Policy Manual.

Documentation

CFSS and CSG
FMS providers must have documentation supporting that a CFSS worker provided a CFSS service. MHCP requires CFSS provider agencies to ensure that the individual CFSS worker documents all of the minimum requirements by completing the agency’s PCA time and activity documentation process (New form DHS-6893C coming, use PCA form until the new form is available). CFSS agencies determine the documentation methods used for recording time and activity.

CDCS
For CDCS workers, FMS provider must adhere to documentation requirements outlined in Minnesota Statutes, 256B.4912.

Billing

A member cannot bill the state directly for approved services. An FMS provider is the only entity that can submit claims and receive payments from the state. These payments are used to pay workers and for approved goods and other services.

FMS providers delivering CFSS and CSG, refer to the Billing Policy Overview section of Provider Basics for general billing of CFSS and CSG claims.

FMS providers delivering CDCS, refer to Billing for Waiver and Alternative Care (AC) Program for billing CDCS claims.

CFSS Billing Codes
Refer to the Community First Services and Supports codes table for a complete list of CFSS codes and modifiers under the budget model. Some modifiers are claim only and do not require to be on an SA.

CDCS Billing Codes

CDCS Service Name	Procedure code	Mod
CDCS Personal care assistance	T2028	U1
CDCS: Treatment and training	T2028	U2
CDCS Environmental modifications and provisions	T2028	U3
CDCS: Self-direction support activities	T2028	U4
CDCS: Self-direction support activities, support planner	T2028	U8
CDCS: Financial management services, unbundled	T2028	U5
CDCS Community integration and support, unbundled	T2028	U6
CDCS: Environmental modifications - vehicle modifications, unbundled	T2028	UA
CDCS: Environmental modifications - home modifications, unbundled	T2028	UB
CDCS: Support planner, unbundled	T2028	UC
CDCS: Individual directed goods and services, unbundled	T2028	U9

CSG Billing Codes

CSG Service Name	Procedure code
CSG: All claims	T2025