Solution Review

Challenges

With changes to the West Virginia Title XIX MR/DD Waiver Program, the health center was facing new laws that would impose penalties if they failed to schedule employees with the correct certifications and training. The organization could have been forced to repay up to 100% of their services if employees were scheduled incorrectly due to the Title XIX Penalties.

Solution

The Celayix rules based scheduling solution enabled the organization to implement a system that scheduled only qualified employees; essentially excluding anyone that would trigger the Title XIX penalties.

Comprehensive Health Services

The health center is a non-profit organization servicing individuals with various types of disabilities. They provide outpatient services to meet client needs in the areas of crisis intervention, mental health, addiction recovery, and developmental disabilities services.

Their developmental disabilities department provides care and assistance to people who fall under West Virginia’s Title XIX MR/DD Waiver Program. This statewide program provides compensated services to individuals with mental or developmental disabilities, in their home and community as an alternative to receiving services in a centralized facility. Title XIX outlines everything from:

  • Who is eligible for care,
  • How organizations implement care,
  • Compensation of the providers of MR/DD services.

Therefore, the organization had a large portion of their workforce that required a sophisticated set of skills to service their clients at various locations.

“There was an immediate attraction to Celayix due to the fact that we could essentially lock-out employees without the correct certifications.”

Scheduling Coordinator
Compliance Issues

Changes to Title XIX stated that providers of MD/DD services could face potential penalties if care was not provided by an individual with the correct certifications. According to the changes, failure to maintain required documentation on provider certifications could result in the disallowance of any amounts paid to the organization though the State.

For this organization, this meant that if they accidentally scheduled an employee in their DD department that had an expired qualification or certification, they would be forced to repay the State for their services.

With some employees requiring up to 20 certifications for various clients, scheduling to avoid the Title XIX Penalties was extremely complicated.

Certifications Managed Through Optimized Scheduling

The organization began researching solutions that could help manage the complex scheduling rules of their organization. The system needed to be able to track employee certifications, and schedule employees correctly for the patient’s needs in multiple locations across a wide service area.

“We met with several vendors; however there was an immediate attraction to Celayix due to the fact that we could essentially lock-out employees without the correct certifications”,

said the organization’s DD Scheduling Coordinator.

Celayix allows the automation of scheduling to include the employee’s availability, and simplifies the certification verification process. If last minute changes to the schedule are needed due to a staff member calling in sick, the schedule coordinator cannot schedule another employee without the needed certifications. Now, if the state audits the organization for their certification of their employees, they have a detailed record to combat any potential Title XIX Penalties.

With Celayix, they not only comply with the law, but save thousands of dollars in potential penalties.

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