Addendum to the Homecare Workers Procedures Manual. 4. Correctly Completed Voucher (With New Voucher Implementation between 1/1/16-4/15/16)

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1 Addendum to the Homecare Workers Procedures Manual 4. Correctly Completed Voucher (With New Voucher Implementation between 1/1/16-4/15/16) A voucher must be correctly completed in order to begin processing for payment. A correctly complete voucher is one that includes: 1. The Date column filled in for each shift. 2. The first date reported and last date reported must fall within the authorized service period. 3. The Start Time column filled in for each shift, including AM or PM 4. The End Time column filled in for each shift, including AM or PM 5. If service mileage was authorized and provided it must be reported in the Mileage Provided field *The Total Hours Provided field is not required for voucher to be accepted.* 6. The voucher is signed by the individual and the HCW only after the voucher is correctly completed by the HCW. It is not considered complete if any part is filled out after it is signed by the consumer. The billable services reported must be less than or equal to the services prior authorized for the service period. 5. INCOMPLETE VOUCHERS (Missing Information) Vouchers must be returned to the HCW and corrected, including the individual initialing changes, when the voucher is: Missing a signature from the HCW; or Missing a signature from the individual/the designated representative; or Missing start/end times (on new voucher only); or Missing dates; or Missing AM/PM designations (on new voucher only).

2 In the event the individual is unable to sign the voucher, the Case Manager may review and authorize the voucher with a notation and narration that the individual was unable to sign. Vouchers may be corrected by the processing office by calling the HCW for clarification by writing and initialing the voucher, then narrating in Oregon Access the change in the following instances: Not legible; or Not perfectly clear what the reported intent is (i.e. AM or PM is not clearly marked or the optional hours that were reported does not match the actual number of hours during their shift). 6. INCORRECT VOUCHERS Vouchers that indicate information that is clearly incorrect may be handled on a case by case basis. Some examples include: Marking AM when it should have been PM; or Reporting conflicting dates or times within the same voucher or with a different voucher (which is determined when staff input the voucher); or Reporting a shift that crosses midnight, For example, a HCW that meant to indicate PM however they actually indicated AM may be corrected by staff after confirming with the HCW by writing and initialing the voucher, then narrating in Oregon Access the change. However, if a time-in/time-out entry must be corrected to resolve a conflict in reporting, it may be more appropriate to send back to the HCW to correct and have the individual initial the correction. All decisions must be narrated in Oregon Access. 7. PRIOR AUTHORIZATION OF HOURS HCWs may only work hours that are prior authorized. Any authorization of additional hours must include narration of justification and approval.

3 In the event that the HCW must work additional hours due to an emergency situation that can t be prior authorized, the HCW must report to a Case Manager within 2 business days for approval. Hours that are not prior authorized or do not meet the emergency situation criteria as described above will not be paid per APD-PT In the event a voucher is received that is reporting above the prior authorized hours, the processing office must communicate with the HCW to determine the appropriate action: If it is determined that the HCW did not report their hours accurately, the voucher must be returned to the HCW. The HCW must correct the appropriate shift(s) to reflect the actual hours prior authorized and worked, with the individual initialing any changes. If it is determined that the HCW worked unauthorized hours, the processing office may proceed with paying what is prior authorized, which includes writing and initialing the voucher and narrating in Oregon Access which shift(s) were modified in order to process the payment. It may also be appropriate for the Case Manager to review the service plan with the individual to determine if there has been a change of condition or there are unmet service related needs. This review must not be used to retroactively modify authorized hours. It may result in a new service plan with additional or reduced hours. 8. Multiple HCW s in One Service Plan If an individual has multiple HCWs, there is a possibility that HCWs may trade shifts or substitute for each other. This may cause a HCW to have worked more hours than were prior authorized for that HCW, but is within the total amount that is prior authorized in the service plan. HCWs must notify the office within two business days and then the local office may pay these claims on a case by case basis. It is important to remember that service hours are Medicaid service, HCWs are Medicaid providers and all Medicaid services must be prior authorized except in emergency situations. 9. Overpayments

4 An overpayment is any payment made to a HCW by the Department that is more than the person is authorized to receive. HCW overpayments are reported and sent by the local office to Provider Relations. The union contract, under Article 19 Wage Overpayments, allows HCWs to file a grievance with the Home Care Commission if they disagree with the determination that an overpayment has been made. Overpayments made as the result of fraud by the HCW should also be reported to the Medicaid Fraud Unit by utilizing form SDS The Medicaid Fraud Unit investigates and prosecutes fraud by Medicaid providers. Payments that have been made and later determined to be fraudulent will be recouped at 100% from the HCWs service payment(s) until the overpayment is paid in full. 10. Payment Schedule and Processing Timelines Per the Homecare collective bargaining agreement, all HCWs will have two pay periods a month. The pay periods are the 1st-15th and the 16th through the last day of the month. Starting in January 2016, HCWs have three (3) business days after the end of each pay period to submit a correctly completed voucher for payment. Vouchers that are determined to be incomplete or inaccurate when submitted and are returned to the HCW must be resubmitted with the necessary corrections in order for it to be considered complete. Correctly completed vouchers that are submitted after the deadline will not be processed until the next available pay date. The processing office will have eight (8) business days after the submission cutoff date to process each voucher for payment. Staff may elect (but are not required) to process vouchers that were submitted after the deadline as time allows. However, all vouchers that were submitted by the deadline must be processed first. Paychecks will be issued for processed vouchers at the end of the eight business days. This means that paychecks will issue eleven (11) business days after the end of the pay period. 11. Requesting a Calendar or Record of Days Worked If the local office has a concern about the hours claimed for a particular service period, local APD/AAA staff can ask the individual for a calendar or

5 other accounting of the days worked. It would not be appropriate however, to arbitrarily ask every individual for a calendar; only if there is a specific concern being reviewed or addressed. This request may be mitigated by the new voucher that requires HCWs to document actual days and times worked. 12. Vouchers Submitted Early Vouchers turned in prior to the end of the pay period may be received by the processing office if all of the hours have been worked for that pay period. However, payment will not occur until the regularly scheduled pay date. A HCW cannot claim payment for hours that have not been worked and doing so may be considered fraudulent. 13. Vouchers Submitted Late Vouchers must be submitted within 12 months of the starting date of service. See OAR (10) (b) and OAR HCWs should be encouraged to submit vouchers within the three days after the pay period ends in order to be paid on the next pay date. When the vouchers haven t been paid, it appears on the computer system as if no services have been received, and those individuals who have a pay-in on SFMU end up receiving refunds after a period of time even though they did in fact receive the services. 14. Voucher Submission Methods HCWs may submit vouchers in person in the local APD/AAA office or send completed vouchers by mail, or fax to the APD/AAA office. 15. Fraudulent Activities Staff may determine fraudulent activities are occurring including, but not limited to: A HCW intentionally reports information that is incorrect or not authorized by the individual or representative. A HCW reports working for multiple consumers at the same time resulting in overlapping shifts.

6 A HCW makes changes to, or attempts to complete a previously signed voucher in the office. Staff should not accept any voucher when fraud is suspected and may redirect the HCW to bring the voucher to the individual or representative to initial each shift that was worked. Fraud may also be reported to the Medicaid Fraud Unit if appropriate. The Medicaid Fraud Unit investigates and prosecutes fraud by Medicaid providers. Staff may report suspected fraud by utilizing form SDS HCWs that engage in fiscal improprieties are subject to termination. Individuals that knowingly sign blank, incomplete or inaccurate vouchers (i.e. some or all of the hours claimed were not actually worked) may also be considered fraudulent. Individuals that engage in this activity, or are unable to fully manage their responsibilities as an employer may be more appropriate to receive their services through an in-home agency provider or have a designated representative that can manage the consumer employer responsibilities