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The Health Care Authority’s mission is: We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
Mi Via Service Planning & Budgets
Service Planning and budget development start with person-centered thinking, planning and practice. The Service Support Plan (SSP) is the document that results from the planning process. The SSP/budget, once approved by the participant will be submitted by the consultant to the Third-Party Assessor (TPA) for review.
Person-Centered
The following person-centered thinking, processes, and practices are central to the development process.
Thinking
Person-Centered thinking values and supports individuals with intellectual and developmental disabilities to make informed choices and exercise the same basic, civil and human rights as other citizens, including dignity of risk.
Planning
Person-Centered Planning (PCP) is an ongoing process that identifies what is important to and what is important for a person. The individual with Intellectual and/or Developmental Disability (IDD) is at the center of the process and is encourage to direct the process as much as possible. No matter what the nature or severity of a person’s disability, there are many ways to identify a person’s strengths, abilities, preferences, needs, and goals. PCP supports people with IDD to exercise the same basic legal, civil and human rights as other citizens.
Practice
Person-centered practice is aligning service and resources to support individuals to achieve individual goals and outcomes that are important to and for them.
Service and Support Plan
The Service and Support Plan (SSP) development process starts with person-centered planning. This process obtains information about the participant’s strengths, capacities, preferences desired outcomes and risk factors. In person-centered planning, the SSP must revolve around the individual participant and reflect his or her chosen lifestyle, culture, functional, and social needs for successful community living. The consultant will use information obtained from the TPA (in-home assessment and CIA) to incorporate into the discussion and planning process. The goal of the planning process is for the participant to achieve a meaningful life in the community, as defined by the participant. The participant is the leader in the development of the SSP. The participant will take the lead or be encouraged and supported to take the lead to the best of their abilities to direct development of the SSP. The participant may involve, if he/she so desires, family members or other individuals, including service workers or providers, in the planning process.
Legally Responsible Individuals (LRI’s), relatives, and legal guardians are permitted to provide all Mi Via services except Consultant services, Individual Directed Goods and Services, and Customized Community Supports Group. Details are included in resources below.
Components
The Mi Via SSP template is organized by the four (4) categories of services, and includes questions in each section that help identify the participant’s strengths, goals, natural and informal supports, concerns and challenges, and how the participant will know whether the plan he/she has developed is working well.
Each section of the SSP must be completed by the participant, even if he/she does not plan to request services or goods from that section. This is because the SSP is a comprehensive planning tool and all areas need to be considered carefully.
Forms
- Appendix B: Service and Support Plan
- 1915c Waivers Individual Transition Plan Checklist
- Client Rights Grievance Process and ANE Reporting Form and Reporting Abuse Neglect and Exploitation (Brochure)
- Requirements for Payment to Legally Responsible Individuals (LRIs), Relatives and Legal Guardians and Q & A
- Legally Responsible Individual (LRI) Information Form
Legally Responsible Individual (LRI) Process Flowchart
24-Hour Emergency Back-up Plan
This section lists who the participant will contact in an emergency or if regularly scheduled employees or service providers are unable to report to work. The Emergency Back-Up Plan is mandatory and must be completed in the SSP.
Consultant/Support Guide Services
The last section of the SSP addresses how much help the participant or his/her employer of record may need from their Consultant/Support Guide or others to be successful with self-direction and with being a successful employer.
Completing and Submitting
The SSP can be written out by hand, or the consultant can use the Mi Via Self-Directed Waiver Service Standards – Appendix B: Service and Support Plan form to fill it out electronically. However, in order for the SSP to be submitted to the TPA, all sections completed with detailed descriptive information must be entered into the Mi Via on-line system SSP by the consultant.
Developing a Budget
Once the SSP has been completed and the participant has identified the supports he/she would like to obtain through the Mi Via program, the consultant and participant work together to develop the SSP/budget request. The budget is developed one (1) goal at a time. Each goal includes a clear and complete explanation of the requested services(s) or good(s), how they are related to the participant’s qualifying condition and why they are appropriate for the participant. Each goal includes full details about each of the requested services(s) or good(s), including: amount, frequency and duration, type of provider, cost or estimated cost, rate of pay etc.
Individual Budgetary Allotment
The Individual Budgetary Allotment (IBA) is the maximum amount of funding for each participant that is determined by the individual’s assessed Level of Care (LOC) and age. There are three established limits based on ages 0-17, ages 18-21, and ages 21 and over . This amount of funding will allow the participant to develop a plan to meet functional, medical and habilitative assessed need(s) to enable the participant to remain in his or her community.
Authorized Annual Budget
The Authorized Annual Budget (AAB) is the amount of the annual budget approved for a participant by the TPA. Participants work with their consultant to develop an annual budget request which is submitted to the TPA for review and approval. The total amount approved by the TPA is the AAB.
Participants Budget Authority
There are three (3) elements to participant’s budget-related authority.
Budget-Spending Authority
Participants have authority to expend waiver funds for services through an AAB that shall be expended monthly over the course of the budget year and per the participant’s approved SSP/budget.
Employer Authority
The Employer of Record (EOR) is the employer of service providers. The FMA serves as the participant’s agent in conducting payroll and other employer-related responsibilities that are required by Federal and State law.
Decision-Making Authority
Participants can determine the amount paid for services within the State’s limit. Please see Mi Via Self-Directed Waiver Service Standards.
Participants have the authority to identify service providers and complete the applicable paperwork. All employees and/or vendor agencies must have a signed agreement packet with the participant to provide services.
Budget Submission
Once the budget request is complete and approved by the participant, the consultant will submit it to the TPA for consideration using the Mi Via Plan of Care Online system.
Resources
The Financial Management Agency
The Financial Management Agency (FMA) helps implement the approved budget by paying the participant’s employees and vendors and tracking expenditures.
1720-A Randolph Road SE, PO Box 27460
Albuquerque, NM 87125-7460
505-924-2010 Phone
866-916-0310 Toll-Free
866-302-6787 Fax
Third Party Assessor
The Third-Party Assessor (TPA) performs utilization management duties such as reviewing, approving, or denying participant’s Service Support Plans/budgets (SSP). Participants work with their consultants to develop an SSP/budget, which is submitted through the Mi Via Plan of Care Online-system for TPA review and approval. The TPA also provides services related to medical eligibility (Level of Care) determination and re-determinations.
Comagine Health
ATTN: Mi Via
P.O. Box 20910
Albuquerque, NM 87154-0190
866-962-2180 Toll-Free
https://comagine.org/program/new-mexico-medicaid
Mi Via Plan of Care Online System
The Mi Via Plan of Care online system (FOCoSonline) is used by the Mi Via FMA for receiving and processing payments. The Mi Via plan of care on-line system is also used by participants to view the plan, monitor their budgets, review and approve their employee timesheet. Working with the participant, consultants use the Mi Via Plan of Care online system to submit developed SSP/budget requests.