Required Paperwork for Support Brokers
All of the forms listed below must be completed for each person for whom you provide Support Broker services. Each form serves a unique purpose and must be submitted in a timely manner in order to ensure the quality and continuity of services for the people who have hired you.
A Support Broker completes these forms in conjunction with the person/guardian and provider.
The IFP needs to be reviewed by the Broker Agency Director and the EER is signed and dated by the Support Broker. When completed send to the appropriate person at Dane County or e-mail to DisabilityUnit@countyofdane.com.
- Individual Financial Plan (IFP)
This form must be completed at least once a year at recert time, as well as any time there is a change (increase or decrease) in the consumer’s overall SDS rate and/or a change in residential or vocational providers.
- IFPs should be submitted by the 20th of the month before the recert month. Example: If the recert month is January, the IFP should be submitted by December 20th.
- When a broker first becomes involved with a person, the first IFP should be submitted within first thirty days of hire, in conjunction with a comprehensive support plan.
- Each IFP must always be accompanied by a comprehensive support plan – see below.
The IFP is what the county uses to issue funding to Fiscal Assistance (FA). The amount listed under SDS is divided by twelve and sent to FA on a monthly basis. Without the IFP, FA does not receive the funds to pay the vouchers you submit.
Broker Agencies submit all IFPs electronically to the county. The IFP is reviewed by county staff, corrected if necessary and then approved. Corrections that affect the rate are verified with the Support Broker. The IFP is printed for Fiscal Assistance, signed and sent by courier to Fiscal Assistance. An electronic copy of the IFP is saved at the county in the individual’s electronic folder. It is the responsibility of the Support Broker or Broker Agency to give the “My SDS Budget” reports to consumers and/or their guardians. Copies of the IFP are distributed to the appropriate county personnel and Fiscal Assistance.
- Exceptional Expense Request (EER) & Voucher Form
This request is used for any expense that exceeds the person’s rate. Exceptional expense requests can be for a one-time cost or for on-going support. EERs do not typically extend beyond a six-month time period and they are not a part of a person’s SDS rate. Exceptional Expense Requests are not always approved.
If the EER is approved at a Friday morning SDS meeting, the form will be completed at that time. For an EER where the dollar amount is known, no other paperwork is required. If the EER is an estimated amount, the Support Broker will have to submit invoice(s) to Fiscal Assistance for payment. Only the Support Broker, County DD Program Manager and DD Accountant need to sign an EER Form.
If the EER is approved outside of the SDS meetings, the Support Broker should complete the form as soon as the County Manager has approved the expense. The Support Broker signs and sends the form to the assigned County Manager for signature, who in turn give to Mickey Roiland.
The provider and Support Broker will be sent a copy of the EER, but the Support Broker should also let the provider know what has been approved for payment.
The county sends the money to Fiscal Assistance to pay for vouchers/bills you submit for the expense based on this form. Without an EER, Fiscal Assistance does not receive funds from the county and the provider does not get paid.
Basically, the IFP and the EER are the way you tell the county to send the dollars to Fiscal Assistance for the services you have agreed to pay.
These forms need to be completed with each service provider and sent to Fiscal Assistance when completed:
- Support & Services Agreement/Voucher
This form is signed by the person/guardian, the broker, and the service provider. This document initiates payment for providers. Without this form, a provider will not be paid. It is valid for up to twelve months starting on a person’s waiver recert date or IFP renewal date. Example: A Support & Services Agreement voucher that starts on October 1 (waiver recert date) will end on September 30 of the following year. A new Agreement/Voucher needs to be signed each year. Fiscal Assistance has created a new e-mail address to solely receive SDS vouchers. Please send all SDS vouchers to: email@example.com.
- IFP/Voucher Combination Excel Spreadsheet Workbook
This Excel workbook can be used by the broker to generate all of the forms detailed above. The “combo” can be saved and used for the next update by simply changing the dates. Any questions with using the combo spreadsheet can be answered at Fiscal Assistance. The IFP/Voucher combo can be found at: www.fiscalassistance.org/forms/SDSforms.html.
These forms must be completed on a monthly basis, and may be reviewed during an annual audit:
These are monthly log sheets that the broker uses to record his or her contacts with people. 610s are required in order to bill for broker/case management hours, and must be submitted to Dane County Human Services by the 10th of each month – see 610 Instruction Sheet for Brokers in Section 5. Hours reported on a 610 must agree with the number of hours recorded on case notes.
The 610s are used to calculate how much of your time is spent on each individual you provide brokerage service to. Based on the number of units you report, the county “bills” funding sources for your services.
- Case notes
A support broker needs to maintain written documentation of each contact s/he has with the people for whom s/he provides support broker services. This documentation must correlate with the contacts recorded on 610 forms. All of the essential components must be included – see “Case Noting” in Section 5. Case notes do not need to be submitted to the county, unless requested during an annual audit.
Your case notes are the required documentation for the county to receive federal and state dollars for your services. If there are no notes, the county can be denied the claim for your time.
These documents must be submitted on an annual basis:
- Comprehensive support plan
Each year, support brokers are required to assist people in developing and/or updating their support plans. The formats of each plan vary. Some examples include a PATH, an Essential Lifestyles Plan, a narrative, or a plan based on the template in the Support Broker Resource Manual.
A comprehensive support plan must be completed in order to ensure that each person:
- is living a life that s/he enjoys,
- is moving toward the goals that s/he has set,
- is having his or her safety issues addressed with regard to how s/he wants to live, and
- is meeting the requirements necessary to access funding.
A comprehensive support plan should reflect the services being purchased on the IFP.
After completing a comprehensive support plan, a support broker must submit a copy of the plan along with each IFP as well as each CIP recertification packet. (When submitting an IFP update, a brief paragraph or two can be attached with an explanation of any changes made on the IFP.) The due date is listed in the letter you receive with your recert package. It is due on the 20th of the month before the recert month. For example: if the recert month is April, the due date is March 20th.
- Waiver funding paperwork
If a support broker is hired by a person who is not receiving waiver funding, such as Community Integration Program (CIP), the support broker will receive an initial waiver packet to fill out. (If you need assistance completing this packet, please ask your Agency Director.) The county requires all eligible individuals to apply for waiver funding. For people who qualify for waiver funding, a recertification packet is sent to the support broker every year. This must be completed by the due date, or the person may lose his or her funding.
These documents fulfill requirements of the Medicaid Waiver program.
This must be completed when changes occur in a person’s life:
- DD Client Information Change Form
This form must be completed when a person moves, has a change in service providers, or experiences any other significant change. A support broker who has recently been chosen to provide support broker services for a person will need to submit one of these forms right away. Failure to submit a DD Systems Change Form may inadvertently reduce or eliminate a person’s benefits.[‡]
These forms are due on the 20th of each month but should be completed throughout the month.
|Form||Initially||When changes occur||Monthly||Annually|
|DD Client Information Change Form||X||X
Consumer and/or Guardian address, phone change
|Individual Financial Plan (IFP)||X[†]||X
SDS rate and/or a provider change
At waiver recert or IFP renewal date
|Comprehensive support plan||X[†]||X|
|Exceptional Expense Request (EER)||Only with manager approval|
(CIP-1B,-1A; BIW; etc.)
At waiver recert
|Support & Services Agreement/ Voucher||X||X
Provider or rate change
At waiver recert
|610s and Lapse Report||X
By the 10th of the following month
Must correspond to 610
For further information regarding required paperwork, please consult with your Agency Director. If you have further questions contact the SDS Coordinator or for questions on fiscal paperwork feel free to contact Accountant with Dane County or Fiscal Assistance.