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

Education
Cost & Billing Questions
Remote Support Provider Questions
Remote Support Vendor Questions
Remote Support Implementation Questions
Privacy Questions
Consumers Who Use Remote Support Questions

 

EDUCATION

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):

  1. Meetings with County Boards, Provider agencies, and families to discuss technology possibilities and how they could be beneficial and how they work.
  2. Technology grants to aid in creating a regional or county technology specialist
  3. Tech Tuesdays
  4. Videos and handouts to share with counties, providers, and families
  5. 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
Level One FMR
Self-Empowered SMR
Unpaid Backup Support I/O AMS
Level One FMS
Self-Empowered SMS

 

 

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.

Is it acceptable to authorize both HPC and remote monitoring for a short time to transition an individual/team/guardian into the new service?
HPC services and remote monitoring services cannot be billed at the same time. While an individual may use HPC services and remote monitoring at different times of day, they do not occur simultaneously. However, in a situation in which an individual has 2:1 staffing, remote monitoring may be used to reduce the ratio to 1:1 in addition to remote monitoring. Therefore, while there may only be one staff physically present within the home, the other staff is assisting from a distance.
How is the technology paid for?
All Ohio DD waivers covers the cost for both remote support services and remote support equipment. However, technology is often expensive. While the rule does not include any specific language about how equipment must be paid, the remote support equipment is often leased. This means that rather than paying a one time fee each time equipment is purchased, the cost is distributed across the life-span of the technology making the service more affordable for those using it. This also means that when individuals who use remote support cancel the service, they will not have purchased the equipment and it may be removed to possibly be installed at a different house if it’s still within it’s use life.

REMOTE SUPPORT PROVIDERS

 What kind of certification is required for providers?
Remote monitoring equipment shall be provided by an independent provider or an agency provider that has a medicaid provider agreement with the Ohio department of medicaid
How are other counties providing actual backup staff if someone needs to actually go to the location? Are there provider agencies willing to be the “on-call” person or is it generally family or county board staff?
The rule leaves room for many options. If it is in the individuals best interest to have a family member provide the backup support, then that is a possibility. Alternatively, if it is in the individual best interest they ought to receive backup support from a HPC provider. Normally this is not an additional expense because the provider agency already has someone on-call.
Who reports Unusual Incidents (UI) and Major Unusual Incidents (MUI)? 
During times that a remote support vendor is supporting an individual, it is the responsibility of the remote support vendor to create incident reports. During times that the remote support backup worker (provided by the provider agency) is called into a home the responsibility to report UIs and MUIs transitions to the backup provider. The remote support vendor will not be monitoring during times that the backup worker is present. 
REMOTE SUPPORT VENDORS
What happens when the remote monitoring provider is responding to one individual while another individual requires assistance?
Multiple remote monitoring caregivers are available to respond to requests from any individual for whom services are being provided.
Who is doing the monitoring?
Remote monitoring services are being provided by people who are familiar with the individuals ISP. In many cases, those providing services are Direct Support Professionals or have received the same training. Remote monitoring providers must fill out paperwork in the same way a direct support professional would. The rule specifically states: “Service documentation for remote monitoring shall include…
[the] Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.”
How many homes/individuals does one remote support vendor serve at one time?
This varies from provider to provider for various reasons.  revised rule.
What are the duties of the remote support staff?
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.
The following questions were generated during a Question and answer session for the Technology First Council with vendor agencies
As a vendor, do you play a role in the assessment process?
Vendor A: Yes, we are consulted based on an individual’s goals and needs. We utilize this information, and that provided by the care team, to create an assessment document utilized by our remote caregivers. This document is reviewed as needed, with a minimum of an annual review. 
Vendor B: Absolutely. We have a comprehensive remote support assessment process that consists of an initial discovery form that asks questions about the individual’s needs and wants in order to identify how assistive technology and remote support can best address their needs. Then we request the ISP and use that document in conjunction with the contents of the discovery form to draft a remote support service plan which outlines the devices that will be used and the role each person will play in the individual’s care. Then we meet with their team (existing HPC providers and natural support) to review the remote support service plan to make sure everyone is on the same page when service implementation starts. The remote support service plan can be updated at any point in time to reflect client’s changing needs or changes in their ISP.
What role do you prefer to play in the assessment process?
Vendor A: We prefer to be the technology consultant to share our experiences and make recommendations to meet objectives. As a remote provider, it is crucial to receive information from the individual and her/his care team to provide the most appropriate technological recommendations.
Vendor B: We like to be very hands on in this process. Not only do we want to understand the client’s biggest challenges and motivations for seeking out remote support, but we also want to know what interests and goals they have for themselves and how their existing support system is attempting to assist them with that. There are many technologies and software that can help people learn new ways to learn skills or explore their passions, and we need to be involved in the assessment process in order to understand how to build a system that they want to interact and engage with.
Are you part of the individual plan team? Do you attend team meetings regularly?
Vendor A: We are typically considered part of the planning team, although we do not attend regular team meetings. We are consulted before or after the team meeting regarding recommendations to changes in technology or the individual’s support needs. We have been asked to join planning meetings; however, it is not commonplace.
Vendor B: Once a client has begun using [our services], as the vendor we consider ourselves an integral part of their care team and regularly attend all team meetings. We will often even schedule these meetings ourselves if we feel there is an area of concern that needs to be addressed.
Do you consider the HPC providers to be partners? Why or why not?

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. 

REMOTE SUPPORT IMPLEMENTATION
What happens to the information?
While the rule does not guarantee recordings, it does say that IF recordings are made then they must be retained in the case of an UI or MUI. When there is not an MUI the recordings can be discarded.
What happens if the power goes out?
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.
What happens if there is an emergency?
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?
Remote monitoring equipment includes an indicator to the individual being monitored that the equipment is on and operating. The indicator shall be appropriate to meet the individual’s needs. Sometimes this is as simple as having a light on the device.

 

The following questions were generated during a Question and answer session for the Technology First Council with vendor agencies
How often are you dealing with internet failures, ISP provider failure, end-user error or equipment failures?
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.
What is your response to these issues when they happen?
Vendor B: The following is an excerpt from an existing remote support service plan detailing our plan in case of service failure:
Power Outage
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. 

Internet Failure
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. 
What is the response time to fix the issue? How quickly are the systems serviced when they go down?
Vendor B: Depending on the risk factors for each client, we have built in protocols to identify who should be contacted in case of serious long-term power or internet outage. The protocols outlined above describe our specific responses to service failures.
What can be done to reduce these issues?
Vendor B: Each of our essential pieces of equipment are installed with a backup battery in case of power failure. Additionally, we can install a redundant cellular data connection that can provide backup internet access during intermittent periods of power or internet outage.

PRIVACY 

 How long/where is the information stored?
In the case of an UI  or MUI, documentation is stored for seven years within a secure network system.
Who has access to the information?
The system uses a secure network system that requires authentications, authorization, and encryption of data to ensure that access to computer, video, audio, sensor, and communication is fully protected and access is limited to authorized persons only; those permitted by the ISP.

 Who has access to shut down the equipment?

Remote monitoring equipment will be designed so that it can be turned off only by the authorized people and those specified in the Individual support Plan.
How are people prevented from hacking into the live feeds?
The system uses a secure network system that requires authentications, authorization, and encryption of data to ensure that access to computer, video, audio, sensor, and communication is fully protected and access is limited to authorized persons only.
The following questions were generated during a Question and answer session for the Technology First Council with vendor agencies
What percentage of people you support through remote support have a camera in A.) bedroom and/or B.) Bathroom
Vendor A: Approximately <3%.
Vendor B: (1) Bedroom: 11%  (2)Bathroom: 0% (3) Living room camera: 22%
Are you providing remote support in congregate settings? If so, how’s that going?
Vendor A: Yes. This service is going well overall. For providers responding to our communications requiring on-site support, it allows their staff to be more efficient in how they are supporting multiple individuals. Additionally, we have observed in a number of instances individuals living together advocating for each other with us as the remote support vendor if there is a need (illness, injury, etc.).
Vendor B: Not at the moment

CONSUMERS WHO USE REMOTE SUPPORT

How do I know who is eligible?

All Ohioans with a developmental disabilities waiver are eligible. The person’s support team should assess and discuss whether or not remote monitoring will meet the needs of the individual.