Remote Support Frequently Asked Questions for Professionals
Some of the following are questions that were generated for a session titled “Technology First and Remote Support” held at the 2017 Spring OACB conference
Given that education is so important, what is being done to educate families and drive that market?
From the Ohio Department of Developmental Disabilities (DODD):
- Meetings with County Boards, Provider agencies, and families to discuss technology possibilities and how they could be beneficial and how they work.
- Technology grants to aid in creating a regional or county technology specialist
- Tech Tuesdays
- Videos and handouts to share with counties, providers, and families
- Multiple presentations across Ohio
What strategies would you recommend for addressing the fear on the part of the families, individuals receiving services, SSAs and Boards? What has worked?
From DODD: Education is still the biggest factor. Having families meet with other families that are in similar situations and have successfully utilized technology has had great success. Virtual rooms are a new strategy where technology is staged in a home like setting which allows interested parties to come and see the equipment and how it works together.
COST & BILLING
How does the billing for remote support work?
Backup support must be in place before remote support services can be billed through the waiver.
There are two kinds of backup supports, paid and unpaid. Paid backup support means that a provider agency is on call when in home staffing is needed. This staff needs to be available to report to the site within a “reasonable amount of time”. What constitutes a reasonable amount of time is individual specific and would be addressed in the Individual Plan.
Unpaid backup support does not use a provider agency when staff are needed to report to the home. Natural supports are used instead. They are still expected to report in a reasonable amount of time.
Paid backup Support (PBS) is billed through PAWS (Payment Authorization for Waiver Services) by the provider agency providing the backup. This provider agency contracts with a vendor company doing the actual monitoring. The vending company then bills the provider agency for hours served.
In un-paid backup support, the vendor company will bill the wavier directly for any hours delivered.
Remote Support Equipment is billed by the vendor company. The cost of all equipment, installation, maintenance, and a reasonable fee are prorated over a 24-month period. The waiver is then charged this fee on a monthly basis.
Are there situations where billing overlaps between remote support and Home maker Personal Care (HPC) Provider?
Yes. When a call is made to provide in home service both PBS and HPC can be billed at that time until the staff arrives at the home. The same applies when staff leave the home and head back to their starting point after Paid Backup Supports (PBS) has been re-established.
If person starts with vendor “A”, who installs technology in the home that is paid for through the waiver, then the person parts ways with vendor “A” and engages vendor “B,” can the new vendor use the original equipment of must it be replaced?
The equipment is leased from the vendor, so the vendor would remove the equipment when their date of service ends.
What codes are used for billing backup support?
|Paid Backup Support||I/O||AMR|
|Unpaid Backup Support||I/O||AMS|
What codes are used for billing remote support equipment?
|Equipment codes/limits||I/O||AML||$5,000/Span (Equipment only)|
|Level One||FML||$7,500/3 years (Equipment & Service)|
|Self-Directed||SML||$25,000/Span (Equipment & Service)|
The remote monitoring equipment vendor is required to calculate the amount to be billed for remote monitoring equipment and to provide a monthly “lease” amount to be billed to the waiver. This amount is the vendors’ cost to procure the equipment plus a setup and maintenance fee divided by the useful life (i.e. 36 months). No other equipment costs are required and lump sum payments are permitted.
REMOTE SUPPORT PROVIDERS
Remote monitoring is done in real time, not through a recording, by awake staff at another location. While remote support services are being provided, the remote support staff will not have other duties other than providing remote support services.
Vendor A: Absolutely! We are an extension of the HPC care team; it is essential to collaborate when providing this level of service. Partnerships with HPC providers allow for increased growth and understanding of what options are available and encourage the provider to continually challenge what the technology is capable of.
Vendor B: We do consider HPC providers to be our partners because we don’t think of remote support only as a “safety net” system meant to detect falls and emergencies. We intentionally partner with HPC providers to better understand our clients’ needs and trending behaviors to identify areas where technology and remote support staff can help a client learn the skills they need to achieve their desired level of independence. Additionally, we want to provide the HPC providers with any tools and resources and the insight they need to augment their ability to provide care with often limited resources. We for example often help with coverage verification, quality control, etc.
If OSOC (on Site on Call) staff are replaced with Remote Supports, the HPC provider will need to adapt. Will remote supports providers support an increase in HPC rates?
Vendor A: A provider rate increase can only stand to benefit all involved.
Vendor B: Absolutely. We think HPC has to become a highly skilled job that is able to work alongside high technology assistive devices to provide quality care. We foresee a future where HPC providers are able to work as both an in-person care provider and a skilled remote support technician. This will entail supporting and training them in their line of work with the client’s wellbeing serving as the ultimate goal. We do not intend to replace HPC providers but rather augment their ability to serve their client to the highest degree possible with advanced technology. Remote support is opening up new sources of revenue for agencies and we think that an increase in profit should be shared with HPC providers to increase their satisfaction with their work and help stabilize the workforce. These additional revenues should also be invested in training and retention purposes.
HPC providers tend to have a major influence on individuals they support. How can remote support providers help HPC providers support the idea of remote supports, and vice versa?
Vendor A: Open and continuous communication are key. We have experienced technology being underutilized because on-site staff were not comfortable with it and felt it was management’s area to deal with. After providing training to the staff, with HPC management present, the staff felt much more comfortable with the remote support technology and knew there were resources supporting it. On the opposite site, it is important for remote support providers to be aware of what challenges are impacting each individual, and the HPC provider at large. There may be training requirements that help everyone provider more informed care, budgetary challenges, etc. that are helpful for us to know.
Vendor B: Our goal is not to replace HPC providers but rather to increase their ability to serve their clients well. We intend to empower agencies and their employees to serve their clients better, and not to overpower them or “take their clients away from them.” This are finding this to be a little challenging. But we have plans in place to better help us align ourselves with the HPC providers. We will be releasing a whitepaper on this matter in the next few months. We hope that our respect for their work will be a mutually beneficial relationship that isn’t seen as a competition between two agencies and our shared goal is realized by collaboration and not competition.
Is it really possible that there are no foreseeable capacity issues?
Vendor A: A firm “no” to capacity issues is not realistic. While vendors have infrastructure in place to scale operations, there is always potential for challenges when scaling (e.g. A very large service provider wants to transition rapidly to remote supports).
How forward thinking can these services be in Ohio: Robotics, computer vision, block chain verify. Are we only set up to react?
Vendor B: I think just the fact his question is being asked shows that we are a forward-thinking state. I think all of the listed technologies are within reach. We are already utilizing CV; and in early stages of designing robotic arm, in a year we hope/plan to demonstrate a functioning prototype. Block chain is a perfect solution for a decentralized documentation tracking for ISP and reports, and allowing individuals to move from one vendor to another and take their data with them. We are at a very early stage of trying out a few different architectures of block chain, we will have more on this in a few months.
The monitoring base is equipped with a backup power supply. In case this fails, direct-support staff will be notified and will respond accordingly. In the case of a power outage at the consumer’s residence, direct-support staff will be notified and will respond in a timely manner to ensure that the person is safe.
The provider of remote support services will notify first respondents. A direct support staff will also be contacted and respond accordingly. While the individual awaits emergency services, remote support staff will remain engaged with the individual until the first respondents and direct-support person arrive.
How do you know they are not monitoring during other hours?
Vendor B: The frequency of these errors is largely determined by their location and training to use the equipment and can vary case by case. In each remote support service plan we include a detailed description of our response to these system failures in order to alleviate concerns and ensure a proactive response and client safety.
Remote monitoring system will be operational for at least 8 hours using backup batteries. The central heating/cooling and refrigerator will not be operational during a power outage. We need to make sure client has a Flashlight by their bed side.
- Remote support staff will contact the service provider to report outage.
- Remote support staff stays on the line with service provider until we have an estimated resolution time.
- If the resolution time is more than 3 hours, remote support staff will notify client’s mother, to determine the best course of action.
- If power outage continues after 3 hours we will deploy backup staff.
The internet access at [the individual’s house] is a redundant cable and cellular internet setup to power the Remote Support Equipment that enables Remote Support Services. In case the cable internet is lost, the cellular internet automatically takes over and provides high-speed internet access.
- We will attempt to restore connection within 4 hours. If both internet access points are lost, [Vendor B] will dispatch a backup staff.
- We will contact the internet providers to find a fix immediately and communicate the system status with the care team.
Who has access to shut down the equipment?
CONSUMERS WHO USE REMOTE SUPPORT
How do I know who is eligible?