STATE OF WASHINGTON



348615022860000STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services DivisionPO Box 45600, Olympia, WA 98504-560094996016065500H19-032 – Policy & ProcedureJune 26, 2019 TO: Area Agency on Aging (AAA) DirectorsFROM: Bea Rector, Director, Home and Community Services DivisionChanh Ly, Director, Management Services DivisionSUBJECT: 2019-2021 Aging and Long-Term Support Administration (ALTSA) Program and Fiscal MonitoringPurpose:Inform AAAs of programs, schedule, and monitoring tools for 2019-2021.Background:ALTSA is charged with monitoring AAA programs, which includes ensuring contract compliance with program and fiscal requirements. Programs are selected for monitoring based upon the results of a program, contract, and contractor risk assessment processes.What’s new, changed, orClarified:ALTSA Monitoring Plan Summary:State Unit on Aging and Management Services Division completed an internal planning process to develop the 2019-2021 monitoring plan using lean principles. We used Federal, State and DSHS Administrative Policy (AP) 19.50.30 Subrecipient Monitoring and AP 13.11 Monitoring Contractors Performance to update our monitoring plan.During analysis of the prior three year plan and considering stakeholder feedback, ALTSA recognizes the value of the long history that Area Agencies on Aging have in administering Older American’s Act and Medicaid Services in the role of contractor and subrecipient and the importance of the partnership between AAA’s and the State Unit on Aging. This aging network partnership is vital to local models of service and ALTSA’s monitoring goal is to support our service partners with risk management, mitigation, quality improvement and technical assistance.This goal requires ALTSA to strategically assess risk for contractors, contracts, and programs. Each AAA in WA is a subrecipient, contractor, and program/service provider. Each AAA has multiple contracts, funding streams, and unique service models. Due to the uniqueness and complexity of local services models, ALTSA has shifted the monitoring focus to a cluster-based model that will provide an overarching look at select clusters of programs, and allow ALTSA and the AAA to focus on areas that are unique within each AAA during the monitoring visit to provide technical assistance. The clusters ALTSA considered were Administration, Planning, Coordination, Legal Assistance, Access Services, In-Home Services, Nutrition Services, Social & Health Services, and Other Activities, consistent with the clusters identified in the AAA Area Plan Budget. We have selected the following cluster areas to monitor for the 2019-2021 monitoring cycle. In 2019-2021 ALTSA will monitor: Contract ManagementCoordinationLegal AssistanceNutrition Services Access ServicesFiscal Operations focused on the programs listed aboveCorrective Action Plan Review of 2016-2018 Monitoring CycleIf the AAA would like to request technical assistance in a cluster area that has not been selected for this cycle, they may do so when they submit their self-evaluation described below. Monitoring Process:Each AAA must submit the Required Material (described below) 30 days prior to their scheduled monitoring. Monitoring will use the attached monitoring tools, which are based upon current contracts, manuals, management bulletins, regulations and program standards. These tools should be used for AAA self-evaluation prior to the ALTSA site visit to improve and/or reduce interview time and allow for greater AAA support and technical assistance opportunities on-site. AAAs may begin working on the self-assessment 90 days prior to the scheduled visit, or before if they wish. AAAs have two options for how to use these forms:The AAA may opt to submit written responses to any or all of the tools for ALTSA to review at least 30 days prior to the on-site visit.The AAA may opt to provide their responses on-site at the time of their monitoring visit.If the AAA identifies areas for technical assistance that are not a part of the selected clusters, they may request specific assistance from ALTSA and ALTSA will do our best to provide a staff person during the monitoring visit to address the request. The tools list questions with “N/A” in the column asking “Meets Program Standards.” These questions are meant to be program development conversations to help ALTSA understand where each AAA is in the program development process.Tools may need to be revised during the three-year monitoring cycle. If tools are revised, they will be provided 90-days prior to the visit and be appropriate to current contracts and policy. Monitors will consider appropriate lookback on recent policy changes.On-site monitoring will be conducted per the attached schedule and will include file review and staff interviews. Programmatic interviews will be tailored to the risk identified in the self-assessment by ALTSA and the AAA. The monitoring schedule is based on the results of an annual risk assessment and is subject to change based on the results of future annual risk assessments. The monitoring visit begins with an entrance conference and concludes with an exit conference. Monitoring reports will be written and provided to the AAA in a draft format and the final report will be sent within 90 days of the exit conference. A corrective action plan will be tailored to the risk of the required action and will be due from the AAA within 45 days after the final report. ACTION:Review the attached schedule. Reserve workspace for 4 to 6 ALTSA staff during the on-site monitoring visit and a meeting space for the entrance and exit conferences. ALTSA staff will need access to the internet and AAA internal networks (when providing electronic files via an internal folder). ALTSA will send a monitoring reminder notice 60 days prior to the on-site visit. 30 days prior to monitoring, share or send the following to ALTSA: A list of all current contracts (Medicaid and non-Medicaid) and any contracts that were active since the last ALTSA monitoring visit or the date the AAA’s Contract Management Corrective Action Plan was approved. Include the following: Provider name and business type (NGO vs. gov)Service(s) providedTarget population (all OAA, any OAA target population subset where applicable (for example, 60+ limited English proficiency), Medicaid LTSS, MAC/TSOA) Funding sources Effective datesAnnual contract budget (or amount billed each year through Provider One)A copy of the AAA’s contract monitoring risk assessment including fiscal, if it is a separate risk assessment.Provider monitoring schedules since the last ALTSA monitoring visit or the date the AAA’s Contract Management Corrective Action Plan was approved. In lieu of a provider monitoring schedule, the AAA may send the annual risk assessment results. A list of partner organizations that the AAA engages with formally (if not already included in the contracts list) to develop a comprehensive, coordinated community-based system. Include the name of the organization and the focus of the partnership. Indicate if the partnership is used to provide outreach or services to a particular target population and which target group. A list of services/contracts procured and the dates of procurement since the last ALTSA monitoring visit or the date the AAA’s Contract Management Corrective Action Plan was approved. Indicate any sole-source contracts and any procurements that resulted in a provider grievance. Medicaid provider application tracking since the last ALTSA monitoring visit or the date the AAA’s Contract Management Corrective Action Plan was approved. Any reports sent to the ALTSA AAA Specialist prior do not need to be resent. Indicate any applicants that resulted in a provider grievance. Nutrition provider and meal site listing for the PSA, including days of operation and site addressesChart of accounts (fiscal)Current organizational chartThe names and titles of all AAA staff that direct charge time to the cluster areas being monitored.Material that can be sent in advance or covered on-site:ALTSA will accept any portion of the following items 30 days prior to the visit. Anything not received 30 days prior will be reviewed on-site. ALTSA monitoring tools with self-evaluation narrative or reference to where items can be found AAA internal policies and procedures for:Contract management and procurement Nutrition services as applicable One or more contracts, memoranda of understanding, recent monitoring reports, and corrective action plans (when applicable) for providers of: Legal services Access services (including transportation, case management, information and assistance as applicable) Nutrition services (including congregate meals, home delivered meals, and senior farmer’s market nutrition program)The following items must be available on-site during the ALTSA visit:For fiscal operations: Chart of accounts Accounting manual and/or policies/procedures manualCopies of the contract and invoice signature authority listList of all staff and position titles that direct charge to all programs. The staff lists shall include personnel who participate in admin claiming. Include Title XIX contract management activities to ensure CS/CM and non-TXIX items are provided.Management letters and any corrective action plans related to the last single audit (if applicable)General ledgers Accounting records, time sheets, payroll records and all pertinent back-up for the review of the selected month’s billings, including the related BARS forms. (ALTSA will notify the AAA prior to the visit of which month has been selected for review)Time study results (if applicable)For all files selected by ALTSA as a representative sample: Contracts, monitoring reports, corrective action plans, requested source documentation (when applicable) and follow-up Procurement files, including the list of applicants and grievances (when applicable) Medicaid provider application files, including grievances (when applicable)For nutrition services:Records documenting Senior Farmers Market Nutrition Program participant eligibility and check distribution systemsRecords indicating process for monitoring that Health inspection reports are current for meal sites Evidence that corrective actions from the 2016-2018 ALTSA monitoring cycle have been implemented ATTACHMENT(S): 2019-2021 Monitoring Schedule \sMonitoring Tools: Coordination & Contracting \sLegal Service \sNutrition Services \sAccess Services \sFiscal Operations \sCONTACT(S): Program Monitoring:Andrea Meewes-Sanchez, AAA Unit Manager(360) 725-2554SanchAC@dshs. Caroline R. Wood, AAA Specialist/Monitoring Program Manager(360) 725-3466WoodCR@dshs. Fiscal Monitoring:Valerie Bahl, Federal Compliance Manager(360) 725-2390BahlVA@dshs. ................
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