Carmel FAQ

1. If I receive residential services, can I still visit my family?
Yes, family contact is encouraged and assistance is provided as needed.
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2. What do I need to do to get a job?
Medicaid does not fund job placement; only the state Division for Vocational Rehabilitation (DVR) [link to DVR website] has funds to pay for finding a job. If you receive Comprehensive or SLS services, the Resource Coordinator at your CCB needs to send a referral for you to DVR. Progressive Job Solutions (PJS), Carmel’s vocational division, contracts with DVR to find jobs for our clients. Once you have a job and DVR has closed your case, Medicaid will pay for job coaching and follow-along services through Comp or SLS.
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3. What is PETI?
PETI stands for Post Eligibility Treatment of Income. The State of Colorado requires people in Comprehensive Services to pay a portion of their income – both earned through a job and unearned through benefits – to offset the cost of their services. If you receive Supplemental Security Income (SSI), - either alone or with other benefits - you most likely will not have to make a PETI payment. If you do not receive SSI, you will most likely have to make a PETI payment.

The amount of your payment is determined using a formula developed by the state – it is the same for every agency providing services in Colorado. Certain deductions and allowances are subtracted from your total income, and the remainder is your PETI assessment.
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4. What does Carmel do with my Social Security money?
Your Social Security money (and/or other benefits you may receive) is used to pay for the Room and Board portion of your services. Medicaid does not allow any provider agency to use Medicaid funds to pay for rent, food, utilities, etc., - all of your basic living expenses. Medicaid money can only be used for services. So, all providers of residential services charge clients for room and board.

Each January, the Federal Government sets the SSI payment amount – this is the basis for the Room and Board payment. Included in SSI is an amount for Personal Needs which is paid to you; the balance goes to room and board. For 2008, the SSI total is $637, with $61 for personal needs; that leaves $576 as the maximum an agency can charge for living expenses. If you receive other benefits instead of SSI, the room and board amount is the same.

If your monthly benefits are less than $637, you are required to make up the difference from your earned income. In a Host Home, the Provider is paid the $576 to cover all living costs. If your monthly benefits are more than $637 and you are not required to make a PETI payment, the balance of your benefits are refunded to you.

You can not be charged for any living expenses except for “non-basic” things such as long distance calls, cable TV, DSL hook-ups, etc. You are also responsible for using your Personal Needs funds for personal items like clothes and shoes, magazines, books, DVDs, recreation, vacations, cell phones, medical co-pays, some hygiene supplies, pets and their food and supplies, plants and other decorations for your room, etc. The state publishes a list of who is required to pay for what items.
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5. What is a Host Home?
In a Host Home, Carmel contracts with an individual, couple or family to take a person receiving services into their home. The Host Home provides or arranges all services needed by the person. This setting is most often used for people who need access to supports on a 24-hour basis.
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6. Can I live alone and still have Carmel support me?
Yes, Carmel uses apartment settings for individuals who have demonstrated the skills necessary to live alone. Your Individual Plan (IP) will specify the types and frequency of services Carmel will provide. Some people have staff work with them twice a day; others who are more independent see staff a few times a week. Regardless of your scheduled services, you will have access to your Case Manager, nurse and other staff during office hours, and to the on-call emergency staff 24-hours a day. Similar services are also available through Supported Living Services (SLS) and private pay [See #14 below]
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7. Can I bring my own furniture or other possessions?
Of course! Carmel will provide you with any furniture and household furnishings you need (linens, kitchenware, housekeeping supplies, etc.), but you are certainly encouraged to bring your own things so that your home will feel more like YOUR OWN home. In a Host Home, the provider usually has all or most of the house furnished, so there may not always be room for all of your things, but this can be worked out before you move in. Some rental properties and some Host Homes do not allow certain types of pets – if you have or want a pet, this can be an important consideration.
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8. What makes Carmel better than other service providers?
We provide really good services! When the State inspects our programs, [See #12 below] they agree that we do a good job. You can see our survey reports from the State on DDD’s page at www.cdhs.state.co.us. Carmel employs Quality Assurance Managers whose main focus is assuring that we are providing a high quality of services, and it shows! We also have many long-term staff and providers whose experience, guidance and expertise are invaluable.

We are strict about doing things right, but otherwise we tend to be pretty informal, which makes interacting with us easy and relaxed. We are available to you and happy to visit with you. In an emergency, you can always reach a Carmel staff person on our 24-hour emergency line. We welcome feedback; we really want to know what you want, and we work hard to make whatever that is happen. We think of our community of staff, providers and people receiving services as a family and work hard to support each other.

We are also strict about trying to do things the way you want and/or need them to be. Your desires, needs, goals and opinions, as well as those of your family, are extremely important to us in developing services that are individualized just for you. We really try not to make you fit into our mold, but to mold our services to fit you.
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9. What is the role of my Case Manager at Carmel?
Case Managers are responsible for making sure that we are providing the services and supports that you are supposed to be getting. Your Case Manager will visit you and your Host Home Provider or staff to make sure everything is going well. Your Case Manager will train your HHP or staff person and will help you choose a new HHP or staff when needed. Your Case Manager will also go to your IDT meetings. In addition, Case Managers must make sure that we are abiding by all the rules and regulations set forth by the State of Colorado. There are also Case Managers for the SLS/CES program.
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10. Who do I call if there is a problem?
It is usually best to talk to the person who works with you directly (Host Home Provider, or your Residential, Vocational, Day Program or SLS staff). If the problem is about that person, talk to the Program Manager or your Carmel Case Manager, or to the Region Manager. And, you are always free to call our Program Director, Operations Director or President at our main office in Boulder.
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11. How is Carmel structured?
Carmel’s Corporate office directs all Administrative, Financial, Human Resources, Program and Operations functions for the company. Our four Regions manage the direct services within their areas.

The Region Manager (RM) is responsible supervising all activities within his/her region. Assisting the RM is the Program Manager (PM) who directly supervises and trains the Case Managers [See #9 above] and Day/Vocational Program Managers.

Day/Vocational Program Managers oversee those services and supervise staff within their assigned program/location.

Nurse Consultants in each Region perform staff and provider training, client assessment and care, and coordinate all medical/dental services for the people in their Region. We also have an RN Manager of Nursing Services who visits each Region to assist with training and to ensure that State Regulations and Carmel policies and procedures are being followed.

We have two Quality Assurance Managers who monitor all services by visiting homes and program sites, and by reviewing paperwork. They also provide training in CPR/First Aid and Mandt, a behavior management system.

Hiring, payroll, benefits and other personnel issues are handled by Human Resource Coordinators in each region.

Consumer Finance Coordinators assist people receiving services, their providers and families to manage personal funds and to ensure compliance with federal and state regulations.
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12. How do I get funding for services?
The majority of the people with whom we work are funded by Medicaid, which is a combination of state and federal money. The state decides how much it wants to spend on services, and the federal government matches that amount. So, there are both state and federal regulations that all service provider agencies must follow.

In Colorado, eligibility for Medicaid is determined through a Community Centered Board (CCB) using guidelines set by the state; there are 20 CCBs across the state. If you think you might qualify for Medicaid, the first step is to apply for services through your local CCB. Unfortunately, even though you may qualify and are approved for services, Colorado has a very long waiting list – some people have been waiting more than 10 years for Comprehensive Services. The wait list for Supported Living Services (SLS) is generally shorter. When your name comes near the top of the list, your CCB should notify you and inform you of the agencies that provide services in your area. Medicaid funding is “portable” meaning that you can go anywhere in the state for your services, as long as there is a provider willing to work with you there. So, you can choose the provider agency you want, and the area of the state in which you want to live. (Unfortunately, sometimes the CCBs have very little notice that services are available (upon the death of a person in services, or new resources are made available by the state, for example), and you may be asked to make a decision about accepting services with only a few weeks’ notice.)

To decide how much money each person will receive, the CCBs administer an assessment, the Supports Intensity Scale (SIS); your score on the SIS determines the amount of funding available for your services. This is a new process, begun in 2007, and seems to be a fairer method of distributing Medicaid money across the state than the previous “block grant” contracts between the state and the CCBs. It reduces the CCB’s flexibility in administering funds, but it guarantees that a person with a certain level of need will get the same amount of money wherever he or she lives in Colorado.

Comprehensive Services Rates (Residential, Day Program, Vocational and Transportation) for Fiscal Year 2009, which starts July 1, 2008, are based on the SIS. (The state is in the process of running the SIS on all SLS participants, and hopes to have SLS rates based on the SIS by Fiscal Year 2010.)

RESIDENTIAL: There are seven levels of funding, or Tiers: for community placements, Tier one is the lowest and six the highest; Tier 7 is reserved for those in the state Regional Centers. Within each Tier, there are sublevels related to the type of placement: highest funding goes to those in Group Homes, followed by those in apartment settings, with those in Host Homes receiving the least. Funding is based on a “Daily Rate” – Medicaid will pay for each day that a person receives a full day of services.
DAY PROGRAM: There are six Tiers, as above. Payment is made for a “unit” of service, which is 15 minutes. So, a 6-hour day in program would be 24 units.
VOCATIONAL: There are two Tiers; payment is made in 15-minute units.
TRANSPORTATION: Medicaid pays for a round-trip to and from Day Program and/or a Comprehensive Vocational program; there are two Tiers.

For people who do not qualify for Medicaid but still need services, the state offers some non-Medicaid programs:
Adult Residential Services (ARS) – similar to Medicaid comprehensive services, though not as all-inclusive; Residential and Vocational/Day Program services are available SLS/CES – similar to Medicaid SLS/CES services.
For more information and eligibility requirements, please see your local CCB.

Also, private pay is always an option [See #15 below].
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13. How is Carmel monitored?
There are several government agencies that routinely survey our services and records. Most of the paperwork that we require from our staff and Host Home Providers is actually required by state and/or federal regulations. Our Residential services are monitored annually: the local CCB and DDD alternate years; Day Program and Vocational services are monitored annually by the CCB and every three years by DDD.

During an inspection, called a survey, the monitoring team selects a sample of people receiving services to be reviewed. The sample is usually 20% of the total number of people in that service, and represents at least one person from each of several categories (funding level, adaptive equipment, psychiatric medications, restrictive procedures, etc.). Using the entire set of regulations as a guide, the monitoring team reviews all of the records for that person dating back at least the last two years. They also do a home visit to monitor the safety and cleanliness of the home, to review the records there, to interview the staff/provider, and most importantly, to talk to the person receiving services to make sure they are happy with their services.

The monitoring team is primarily looking for trends or patterns of problems with services or documentation: similar errors or lapses in care for more than one or two people. If they find a serious problem or a trend/pattern in a less serious issue, it is called a deficiency. After the survey, DDD or the CCB sends the agency a list of their deficiencies and the agency is given a time frame to develop and submit a plan to correct those deficiencies. Carmel is extremely proud of the fact that our recent DDD surveys have been deficiency-free, or have had only one or two minor problem areas.
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14. How do I enroll my child in services?
Please see the answer to # 11 above. It is recommended that parents of a child with developmental disabilities get their child enrolled at their local CCB as soon as a diagnosis is made. There are services available for children and families: Infant Stimulation and Toddler programs, Family Supports, Children’s Extensive Services (CES); as stated elsewhere, the waiting list for Comprehensive services can be many years, so the earlier a child’s name is placed on this list, the sooner they will be eligible for services. (Contact your CCB for age requirements.) Also, Supported Living Services (SLS) may be available for adults long before Comprehensive services are. In addition, Colorado public schools are required to provide services to people with developmental disabilities until they reach the age of 21, so therapies and training may be available through the school system.
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15. If I don’t receive Medicaid or state funding, can I pay privately for services?
Yes, all of Carmel’s services are available on a private-pay basis. Since there is no government funding, there are not as many regulations (mostly paperwork) that we have to follow, so services can be even more individualized. Medicaid requires agencies to charge private-pay clients more than Medicaid pays for the same service; however, this can be just a few cents or dollars more than the Medicaid rate, so private-pay services are not totally out of reach. We currently contract with several families to provide full residential as well as hourly SLS-type services.
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16. Does Carmel provide services only to people with developmental disabilities?
No. Although the majority of the people we serve have developmental disabilities, we also work with several people with physical or mental health challenges. Many of our vocational clients come to us through DVR for Situational Assessments and/or job placement and training; these people generally are recovering from physical injuries or psychiatric issues and are looking for a new career. Most of our services can be tailored to meet the needs of anyone who requires some extra assistance. We are planning to expand into the home health care field and provide services to seniors and others with similar needs.
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17. Does Carmel have nurses on staff? Who takes care of me if I’m sick?
Each Region office has at least one Nurse Consultant who monitors and oversees all aspects of health care for the people receiving residential services. The Nurse provides all medical training for the people who work directly with clients: Medication Administration, Signs and Symptoms of Illness, G-tube use, Seizures, Diabetic Protocols, Lifting/Transferring, Skin Care and any other training specific to a medical issue. The Nurse keeps in close contact with the direct service providers and our physicians and other medical/dental professionals, and also reviews all Medication Administration Records and other documentation to assure the best quality health care.

The staff or provider who works directly with the person in services is responsible for providing care when a person is ill or injured. They generally call our Nurse to inform him/her of the problem, and then directly contact the physician for guidance or to schedule an appointment. In the Central Region, where we have a larger number of people who do not live in Host Homes, we have an employee who schedules and takes people to medical/dental appointments.
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