SSPS Reconciliation Expectations

H13-016 – Procedure March 12, 2013

TO: Area Agency on Aging (AAA) Directors Home and Community Services Division (HCS) Regional Administrators

FROM: Bea Rector, Interim Director, Home and Community Services Division

SUBJECT: SSPS Reconciliation Expectations

PURPOSE: To establish an internal control process designed to provide reasonable assurance to monitor and safeguard the SSPS payment process.

BACKGROUND: HCS must have a standardized internal control policy for consistency in review and correction of SSPS authorization data.

Prior to March 2012, SSPS mailed turnaround paperwork to field offices to use in SSPS reconciliation and other internal control activities. To save cost, the mailing of this report was discontinued but remains available as an SSPS Web Based Report.

The SSPS mismatch report has been available to all field offices. This report identifies clients whose assessed hours (Current Care Hours) or residential rates (Assessed Rate) do not match their Total Authorized Hours or Total Authorized Rate. To produce this report, ADSA obtains information from CARE. Several enhancements have been made to the report since it was first released.

WHAT’S NEW, Staff will use the SSPS mismatch report to investigate instances where the CHANGED, OR authorizations do not match the client’s assessed hours or rates and will CLARIFIED make any needed corrections to SSPS authorizations. Please note: Corrections would not be necessary in instances where a client chooses to have less hours than CARE would generate.

The report is available as a standard report through the ADSA reporting site at http://adsaweb.dshs.wa.gov/CA/reports.htm.

HCS developed the process below as a primary internal control to effectively safeguard financial assets paid through SSPS.

ACTION: Effective immediately, the mismatch report must be run and reviewed at least once each month, for all authorizing workers. The Report 0809 covers personal care authorizations and report 0810 covers residential rate authorizations. The report should be run and reconciliation should occur in advance of each regular SSPS run deadline. The following reconciliation process will be used by all field offices: 1. Designated staff will run and review the report to determine which case managers are responsible for the clients on the report. The report must be run and reviewed by someone other than the authorizing worker. 2. The report will be forwarded to the assigned case managers who will review each discrepancy and determine what caused the mismatch in hours or rate. The SER and ETR screens may need to be checked to determine the cause of the discrepancy. 3. The assigned case manager will correct the discrepancy or provide an explanation of why the authorization should remain unchanged. 4. Region/AAA staff will process overpayments or take other appropriate action and document the action(s) taken in an SER.

Note: Effective immediately, the Centralized Bed Hold Unit will no longer send SSPS authorizations to HCS Field offices for reconciliation.

Procedure for Running the Mismatch Report: 1. Click here: http://adsaweb.dshs.wa.gov/CA/reports.htm ; 2. Click on ADSA Reporting Login; 3. Type in your username and CARE password; 4. From the Worker Reports dropdown menu, select Report 0809 for personal care authorizations or 0810 for residential authorizations; 5. Click on Division; select LTC; 6. Select your Region/PSA; 7. Select the Reporting Unit; 8. No need to click on Primary Case Manager (the default selects all); 9. No need to click on SSPS Total (default selects all totals not equal to CARE); 10. No need to click on Plan Effective Dates (default selects Current Only); 11. No need to click Auth. Effective Dates (default selects Current Only); 12. Click on View Report - the report will be seen; 13. Click on Select a format and choose Excel from the dropdown list; 14. Click Export; 15. Save the document in Excel; 16. Sort by any column(s), if desired; 17. Then follow steps 1-4 in the Action section, above.

RELATED None REFERENCES:

ATTACHMENT(S): None

CONTACT(S): Dustin Quinn Campbell, SSPS Program Manager (360) 725-2535 [email protected]

Nancy Brubaker, QA Policy Manager (360) 725-2393 [email protected]