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IV.C Community-Based Care (CBC) provider payment system

1/1/2016

1. Overview

The Community Based Care (CBC) provider payment system is a computer-based information system for the issuance of 512s and payments to Adult Foster Care providers, Residential Care Facilities (RCF), Assisted Living Facilities (ALF), and Adult and Child Developmental Disabilities (DD) providers. Access to the system, or certain screens within the system, is limited to authorized individuals in each local office.

2. Frequently used mainframe screens

A. Customer screens

·        SMRQ,prime# <enter>: Shows the last fourteen (14) 512s by customer; view 512s through this screen.

1.    Screens inside the 512:

·        SERF – Demographic information on the customer;

·        SNRS – Financial information;

·        RATZ – Service rate information;

·        SADD – Names and addresses of contacts for the customer. 512s are sent to these people if selected;

·        SBEG – Allows the customer’s service contribution to be adjusted for the first month of service for a specific 512; automatically opens when entering a new 512;

·        DISB – Payment information including service amount, customer contribution, room and board, needs total, State pay total, and customer pay total;

·        SCFD – Summary of information from the 512 including payment status and paid through date;

·        SMSG –Shows a suspend message if the payment is suspended.

2.    WEBM – customer case information

·        WEBM,FIND,prime#;

·        WEBM,FIND,lastname,firstname;

    • Displays customer information including name, Social Security number (SSN), prime number, date of birth (DOB), and date of death (DOD).

·        WLGR access:

    • Tab down to Prime and enter the customer’s prime number;
    • Enter a character on dot, hold Shift and F1 together;
    • F3 to return to WEBM.

·        UCMS access:

    • Tab down to Type Case. The line with a Prime ID and Medl Elig File listed is the active line;
    • Tab to the dot at the left of this line, enter a character, hold Shift and tap F;
    • F3 to return to WEBM.

3.    WLGR – customer eligibility information

Shows case eligibility information by date lines. Includes case descriptors, program codes, branch, and dates of eligibility

·        WLGR,prime# <enter>; or access from WEBM,FIND,prime#;

    • Tab down to Prime and enter the customer’s prime number;
    • Enter a character on dot, hold Shift and F1 together;
    • F3 to return to WEBM.

·        Coding on WLGR will include case descriptors and program codes designating through which program the customer is paid. Customers must have both APD and CBF case descriptors to be eligible for a CBC 512 payment.

4.    UCMS – customer case information

·        Access from WEBM; or

·        Access with UCMS,case# <enter>;

·        Displays the customer name, address, effective date, and information pulled from the customer information (CI) file;

·        Case effective date: 512s must start on or after the UCMS effective date. Any 512s necessary prior to the UCMS effective date must be entered at Central Office via an APD 0287F, SPD CBC Late Payment Request form;

    • Example: Existing 512 set up from 10/1 and continuing. If the Eff Date in UCMS is changed to 10/15, the 512 will go into suspense. Touch the 10/1 512 with a 10/15 start date and an action code 1 to begin a new 512 on the start date entered. Both 512s should be in Normal status after touching;
    • COMPUTE or SUPPLE the UCMS date back to the beginning of the month or previous month and enter a 512;
    • If unable to COMPUTE or SUPPLE the UCMS date back far enough to pay necessary dates, set up a 512 beginning the date of the UCMS effective date and submit an APD 0287F, SPD CBC Late Payment Request to pay dates prior to the UCMS effective date.

5.    SELG - CAPS information

·        The customer must have current and correct CAPS for a 512 payment to issue.

B. Provider screens

1.    SPVF – Provider search

·        SPVF <enter>;

·        Fill in the search field by last and first name, SSN/TIN, or business name and press <enter> to search;

·        View a line by typing a character to the left of the line and press <enter> to open PRV8;

·        F12 to return to SPVF.

2.    PRV8 – Provider information

·        PRV8,provider# <enter>;

·        Shows all provider information including name, address, phone, DOB, and provider type;

·        Active providers will show an ongoing end date of 12/31/9999 under Program;

·        Inactive providers will have an end date when their license expires rather than an ongoing date.

    • Note: Active will show next to the dates of licensing, even if a provider is no longer active.

·        Shows if the provider is licensed for serving customers in their primary residence under Facility.

    • Designation Y under Res: customer does live in the provider’s primary residence; or
    • Designation N under Res: customer does not live in the provider’s primary residence);
    • The designation affects the provider’s tax liability, per IRS Publication 525.

C. Payment screens

1.    SCFS – Payment status screen

·        SCFS,P,provider# <enter> shows all current and open 512s and customers for the provider number specified;

·        SCFS,R,prime# <enter> shows all current and open 512s for the customer specified;

·        Shows suspended payments: S = suspended, N = normal.

    • Shows if 512s are in Normal or Suspended status. This is a good place to start troubleshooting missing payments, if the missing payment does not appear on a full suspend list or report.

2.    PESM – Payments to provider

·        PESM,p,provider# <enter>;

·        Shows payments issued to the specified provider number;

·        Tab down to a line of payment, type an S next to the payment, and press <enter> to view;

·        Press F7 to go to SCLM to view customers and amounts paid on the selected payment;

·        Payments issued via direct deposit will show under EFT Nmbr and EFT Date;

·        Payments issued via check will show under Chk Nmbrand Chk Date;

·        Provider year-to-date (YTD) earnings show on the right of the screen under Prov YTD.

3.    SCLM – Payment history by customer

·        SCLM,R,prime# <enter>;

·        Shows payments made for a customer, dates of payment, issued amount, provider name, and provider number which was issued the payments;

·        Key F1 to page through payments, or F4 to go to the bottom for the most recent payments.

D. Other screens

1.    RCIQ – Check records

·        RCIQ <enter>;

·        1 <check number> to view a check;

·        2 <provider number> to view checks issued to a provider;

·        View check information to see if they are paid (PD) or outstanding (OS) or if there is a payment alert and have been replaced.

2.    PUTL - Utilities

·        Putl <enter>;

·        Main menu for 512 utilities;

    • MRAT – option 1, calculates prorated room and board rates for customers who enter care mid-month;
    • DPRT – option 2, shows all 512s by branch waiting to be printed. Delete a 512 from printing and mailing out by placing a D next to the line to delete; press <enter>, and confirm delete with Y <enter>;
    • URAT – view current rate schedules for different types of CBC.

3.    HZIP – zip code check

·        HZIP, <enter>;

·        Enter an address to find the correct Zip Plus-4 code;

·        Note: All addresses entered into mainframe should have a Plus-4 code to reduce postage costs.

E. Rate exception screens:

·        SRXQ,prime# or provider# - View only the list of rate exception records for the customer or provider number;

·        SRXI – viewable from inside SRXQ, displays detailed information on adjustment selected.

3. Entering a new 512

·        On a clear mainframe screen, type SMRQ,prime# <enter>;

    • Displays the most recent 512s for the customer entered;
    • If touching an ongoing 512, type any character next to that line and press <enter> to continue to SMFR;
    • If beginning a new 512, type F10 to continue to SMRF.

·        In SMRF, fill in all blanks on the form, if entering a new 512:

    • Prime ID;
    • Provider number;
    • 2nd provider, Y or N; used when a customer is staying with a new provider for a trial visit. A second provider can only be entered for seven (7) days and the system will automatically truncate to seven (7) days if entered for longer;
    • Effective Begin Date - date to start the 512;
    • Effective End Date - cannot be entered. Leave this as ongoing;
    • Operator ID - load code;
    • Action Type – Change to a 1 to open a new 512 (see below for action type descriptions);

·        Page through the 512 using F7 to navigate through the 512;

·        Verify all information is correct on all the pages;

·        On the DISB screen, specify how many prints to make and to whom they will be sent, select Y at the cursor, and F7 to complete the entry.

4. 512 action types

·        1 = New, Financial, or Assessment changes; “touching the 512”

    • Pulls new information and changes over to the 512 system.

·        4 = Viewing a 512

    • Read/print only to view or print copies of the 512.

·        5 = Closing a 512

    • Permanently close a 512 and stop paying the provider as of the close date.

·        6 = Deleting a 512

    • Use to delete an unpaid 512 and permanently remove the 512 and all narratives from the system.

5. Error messages

A. Error messages when entering a 512

1.    Dates are within a SCF time period for same prime

·        The customer has already been paid through these dates or there is already a 512 setup for these dates;

    • Go to SMRQ,prime# to view 512s for the specified customer. Adjust the new 512 dates to those dates which have not already been setup for payment.

2.    Provider not active during 512 period. Provider is not currently licensed through this time period

·        Verify the correct provider number;

·        If the provider number is correct, go to PRV8,provider# to verify when the license began or ended and adjust 512 dates accordingly;

·        If the provider is supposed to be licensed through the time period entered, contact licensing.

3.    CMS effective date is later than 512 effective date

·        The CMS effective date is in the middle or before the 512 requested time frame;

    • Verify the CMS effective date in UCMS;
    • SUPPLE or COMPUTE back to the date needed to begin the 512 and enter the new 512 with that date;
    • If unable to SUPPLE or COMPUTE back to the necessary date, enter the new 512 beginning as of the CMS effective date and submit a APD 0287F, SPD CBC Late Payment Request, for dates of payment necessary prior to the UCMS effective date.

4.    A pending 512 exists for this time. Cancel or complete it to continue

·        Go into SMRQ to view 512s. The pending 512 will be marked on the right side with a P for Pending;

·        Complete, close, or delete the pending 512 before continuing with the new 512.

B. Error messages closing a 512

1.    Act type not possible. Paid thru > eff date

·        This means the customer has already been paid through the dates requested to close. A 512 cannot be closed on or before a date already paid;

·        Close the 512 as of the last paid date shown on SCLM,R,Prime#).If this resulted in an overpayment to the provider, submit an SDS 0287D, SPD CBC Adjustment Request Overpayment form to Payment Support.

2.    Cannot close 512 past existing end date

·        The 512 has an ending date before the date of closure;

·        Close the 512 before, or as of, the existing end date.

C. 512 suspend messages

·        Click here for a list of common 512 suspend messages

6. Adjusting payments

A. Late payment requests

When a provider has not been paid for a specific time period for which they are owed and the staff member is unable to enter a new 512, an APD 0287F SPD Late Payment Request must be submitted to Apd-dd cbcpayments on Outlook, or apd.dd-cbcpayments@state.or.us for Central Office to enter the payment.

Complete all contact information, customer, and provider information at the top of the form.

1.    Late pay begin date:

·        Enter the date the late payment is to begin: month, day, year;

·        This is the first day the provider should have been paid.

2.    Late pay end date:

  • Enter the date the late payment is to end: month, day, year;
  • This is the last day the provider should have been paid.

3.    Customer service contribution amount:

  • This is the amount the customer is mandated to pay towards their cost of care for the specified dates only. This does not include room and board or other needs; it is only a service contribution.
    • The amount is found in the 512 on the DISB screen near the bottom right across from SVC CNTRB. Do NOT use the CLNT PAY as this includes the room and board amount;
    • Enter what the customer should have paid for their service contribution. If the service contribution in DISB is incorrect, enter the correct amount of what the customer owes for the dates requested on the late payment request;
  • If the customer does not have a service contribution, or does not owe a service contribution for the dates requested, enter 0 (zero).

4.    Service amount:

  • This is the full monthly service rate/amount the State is authorized to pay for the customer, per month;
  • Include the full monthly amount on your payment requests - Do NOT prorate this amount for a partial month of service;
  • The amount is found in the 512 on the DISB screen across from SERV AMT;
    • Do NOT use TOT DUE as this includes the room and board;
    • If the service amount is not correct on the 512, enter the correct amount that should have been used for payment.

5.    Reason for late payment:

  • Describe why the payment was late;

B. Overpayment requests

When a provider has been paid for services, but an incorrect amount was paid, an APD 0287D, SPD CBC Adjustment Request Overpayment form must be submitted.

Complete all contact, customer, and provider information at the top of the form.

1.    Overpayment begin date:

  • Enter the date the overpayment began: month/day/year;
  • This is the first date for which the customer was paid, but is incorrect;
    • Example: If January paid from the 1st – 31st, but the customer moved out on the 25th, the begin date would be January 1st as the whole payment needs to be adjusted.

2.    Overpayment end date:

  • Enter the date the overpayment ended: month, day year;
  • This is the last date for which the incorrect payment occurred;
    • Example: If January paid from the 1st – 31st, but the customer moved out on the 25th, the end date would be January 31st as the whole payment needs to be adjusted.

3.    Customer service contribution amount

  • This is the amount the customer is mandated to pay towards their cost of care for the specified dates only. This does not include room and board or other needs; it is only a service contribution;
    • The amount is found in the 512 on the DISB screen near the bottom right across from SVC CNTRB. Do NOT use the CLNT PAY as this includes the room and board amount;
    • Enter what the customer should have paid for their service contribution. If the service contribution in DISB is incorrect, enter the correct amount the customer owes for the dates requested on the late payment request;
  • If the customer does not have a service contribution, or does not owe a service contribution for the dates requested, enter 0 (zero).

4.    Service amount:

  • This is the full monthly service rate/amount the State is authorized to pay for the customer, per month;
  • Include the full monthly amount on the payment requests - Do NOT prorate this amount for a partial month of service;
  • The amount is found in the 512 on the DISB screen across from SERV AMT;
    • Do NOT use TOT DUE as this includes the room and board;
    • If the service amount is not correct on the 512, enter the correct amount that should have been used for payment.

5.    Incorrect payment:

  • This is the amount the provider was paid incorrectly for the dates specified;
  • Payments by the customer can be found on SCLM,R,prime#. Press F1 to page through to the month to be corrected, or F4 to go to the last page for the most recent payments;
  • Enter the total amount the State paid for the dates of the requested adjustment;
    • Example: If submitting an adjustment for January 1st – 31st, fill in the payment for January 1st - 31st that issued, but is incorrect.

6.    Correct payment:

  • This is the amount the provider should have been paid for the dates requested;
  • Full month of service:
    • If the customer does NOT have a service contribution, the correct payment is the full service amount;
    • If the customer does have a service contribution, subtract the customer’s service contribution from the service amount;
  • Partial month of service:

7.    Date client left facility (MM/DD/YY):

  • Enter the date the customer left the facility, if applicable.

8.    Date client returned to the facility (MM/DD/YY):

  • Enter the date the customer returned to the facility, if applicable.

9.    Reason for Adjustment:

  • Briefly describe why the adjustment is requested;

C. Underpayment requests

Instructions: Complete all contact, customer, or provider information at the top of the form.

1.    Underpayment begin date:

  • Enter the date the underpayment began: month day year;
  • This is the first date for which the customer was paid, but is incorrect;
    • Example: If January paid from the 1st – 31st, but the customer has an exception as of the 25th, the begin date would be January 1st as the whole payment needs to be adjusted.

2.    Underpayment end date:

  • Enter the date the underpayment ended: month/day/year;
  • This is the last date for which the incorrect payment occurred;
    • Example: If January paid from the 1st – 31st, but the customer has an exception as of the 25th, the end date would be January 31st as the whole payment needs to be adjusted.

3.    Customer service contribution amount:

  • This is the amount the customer is mandated to pay towards their cost of care for the specified dates only. This does not include room and board or other needs; it is only a service contribution.
    • The amount is found in the 512 on the DISB screen near the bottom right across from SVC CNTRB. Do NOT use the CLNT PAY as this includes the room and board amount;
    • Enter what the customer should have paid for their service contribution. If the service contribution on DISB is incorrect, enter the correct amount of what the customer owes for the dates requested on the late payment request;
  • If the customer does not have a service contribution, or does not owe a service contribution for the dates requested, enter 0 (zero).

4.    Service amount:

  • This is the full monthly service rate/amount the State is authorized to pay for the customer, per month;
  • Include the full monthly amount on the payment requests - Do NOT prorate this amount for a partial month of service;
  • The amount is found in the 512 on the DISB screen. It is across from SERV AMT;
    • Do NOT use TOT DUE as this includes the room and board;
    • If the service amount is not correct on the 512, enter the correct amount that should have been used for payment.

5.    Incorrect payment:

  • This is the amount the provider was paid incorrectly for the dates specified;
    • Payments by customers can be found in SCLM,R,prime#. Press F1 to page through to the month to be corrected, or press F4 to go to the last page for the most recent payments;
  • Enter the total amount the State paid for the dates of the requested adjustment;
    • Example: If submitting an adjustment for January 1st – 31st, fill in the payment for January 1st - 31st issued, but is incorrect.

6.    Correct payment:

  • This is the amount the provider should have been paid for the dates requested;
    • Full month of service: If the customer does NOT have a service contribution, the correct payment is the full service amount;
    • If the customer does have a service contribution, subtract the customer’s service contribution from the Service amount.
  • Partial month of service:

7.    Reason for adjustment:

  • Briefly describe why the adjustment is being made;
    • Example: Customer income level changed beginning January 1st.

o   Click here for example

D. Adjustment calculation tips

The CBC Service Payment Calculation form is available on the APD Case Management Tools website.

Things to remember:

  • The State does not pay for the day of move out for any reason;
  • The customer service contribution is never pro-rated to pay throughout the month. It is the “first dollar” paid to the provider and is owed to the provider in its entirety at the beginning of the month. The state picks up the balance to the provider AFTER the service contribution has been paid;
  • Complete the calculations based on the days the customer is IN the home, rather than days the customer was away from the home;
  • Payments issue on the night of the first of each month and Wednesday nights thereafter; checks mail the next business day.
  • Direct Deposit payments are sent to the Department of Treasury and out to individual banks for processing the next business day as well. Banks have up to three (3) banking days to deposit funds into provider accounts; banking days do not include weekends or holidays. This is a federal mandate and not something which DHS has ability to alter.

7. Earnings statement vs. 1099s

Some income paid to CBC providers is “non-reported” to the IRS because it is not taxable. This is in accordance with IRS Publication 525 which states:

A. Foster care providers

Payments received from a state, political subdivision, or a qualified foster care placement agency for providing care to qualified foster individuals in the home generally are not included in income. However, income payments received for the care of more than 5 individuals age 19 or older and certain difficulty of care payments must be included.

A qualified foster individual is a person who:

  • Is living in a foster family home; and
  • Was placed there by:
    • An agency of a state or one of its political subdivisions; or
    • A qualified foster care placement agency.

B. Difficulty-of-care payments

Payments designated by the payer as compensation for providing the additional care required for physically, mentally, or emotionally handicapped qualified foster individuals. A state must determine the additional compensation is needed, and the care for which the payments are made must be provided in the home.

Certain Medicaid waiver payments are treated as difficulty of care payments when received by an individual care provider for caring for an eligible individual (whether related or unrelated) living in the provider's home.

·        See Notice 2014–7, 20144 I.R.B. 445 available at www.irs.gov/Individuals for more information.

Include income difficulty of care payments received for more than:

  • 10 qualified foster individuals under age 19; or
  • 5 qualified foster individuals age 19 or older.

Providers who have foster care customers living with them in their primary residence are paid income which is non-reported to the IRS. They do NOT receive a 1099 or W2 for this type of income Residence status can be viewed in PRV8 at the bottom right corner under Res: Y means they are licensed as living in the home with the customers.

  • For more information on non-reported income, the provider or their tax consultant may refer to IRS Publication 525.

Providers with a residing status of N are licensed as not living in the home with the customer. These providers are paid income which is reported to the IRS on a 1099. They will receive a 1099 mailed on or before January 31st of the following year with their taxable income listed for tax filing.

  • Changes to a provider’s residing status must be made through licensing; refer the provider to their licensor.

8. Print remittance advices

  • On a blank screen, type PESM,p,provider#;
  • Tab down to date range provider has requested. Write down the CHK DATE(S) needed, or print PESM screen for multiple RAs;
  • On a blank main frame page, type RD2 <enter>.

A. View Direct screen

1.    Recipient ID: HSbranch #;

2.    Password: Branch #;

3.    Report/topic/queue ID: SJD2450R <enter>.

B. Reports screen

1.    Open report with Remittance Advice on top;

2.    On the line, type an S <enter>.

C. Reports versions screen

1.    Look for the date of the first remittance advice to print. Ex: 11/17/09. The system reads YYYY/MM/DD;

2.    Type an S on the line to view the report. If the report says available under the status, it will open; if it says recall required wait for the system to recall it. Sometimes it is available immediately, but may take a few hours;

3.    Once inside the RA to print, on the command line, type F<space>provider#<enter>;

    • If the report is not viewable and there is not an error string found, the date is wrong. F3 returns to the previous screen;
    • If the 10000 lines searched error appears press F5 until the correct RA appears;

4.    To print the report, key F2<enter>.

D. Printing menu

  • To print more than one page, change the number of pages to be printed.
    • Ex: From = = > page: 000001

To = = > page: 000003

  • Number of pages to be printed: 000001 (default setting). Increase it to 000003;
  • Online Printer ID: Enter the name/location of the local printer;
  • Press <enter> <enter>. The screen will say “to print” at top);
  • Change the TO and Number of pages is if there is more than one customer being paid for the time period. If the page with the RA total and YTD totals on it did not print, to change the number of pages and reprint;
  • Press F3 to exit the program.

9. Resources

CMS questions

MMIS questions

Client Maintenance

503-378-4369

CAPS questions

Service Desk

503-945-5623

Provider questions

Provider Relations

503-947-1141

512 questions

512 policy questions

Michael Avery

503-945-6410

512 exceptions

Margaret May

503-945-3418

DD payments

Kristen Hutton

503-945-6741

APD payments

Kristen Hutton

503-945-6741

Mental health

DMAP

503-947-5031

Licensing inquiries

Adult DD

Susan Eggert

503-945-7804

Child DD

Local licensing office

 

Adult APD

Local licensing office

RCF/ALF

Becky Mapes

Debra Concidine

Warren Bird

503-373-2076-

503-373-1975

503-373-1959