DENNIS FITZGIBBONS: This afternoon in this section, we're going to be look at business relationships, vendor contract agreements. Page three. Establishing fees-for-service in a business relationship. Any business relationship is shaped by the design of the enterprise and the initiation. A response to a request for a proposal or a grant opportunity with a government non-profit or for-profit entity would have certain deliverables that are generally pretty clean and clear and with an opportunity for clarification in the process of bidding and learning more about what's expected from the person or the source offering the request. A contract with a public or private entity to provides services would have a different, perhaps a different approach. An example there might be Alpha One's community development block grant program. Originally, we had to apply for that to a more local RFP process but the requirements were not spelled out by CDBG. We actually had to define what they were ourselves in order to account for how we were going to spend the money that was involved. And there's a partnership with another entity. This might fit our agreement with Prudential that we had, which pretty much was a give-and-take type of negotiation. It was more done in collaboration and partnership, versus at the request of something they went looking for. And as a result the rates of payment, et cetera were somewhat negotiable. They weren't set in stone like an RFP would be. And then in a business start up or acquisition, where a CIL is starting from scratch with their own resources, really it's all an internal process. You're not having to meet any kind of requirements from whoever has issued an RFP or partnership organization that has certain expectations of you. The expectations are all our own when it's starting at that kind of source where it's just us involved in developing the program. So each of these are fee-for-service opportunities, but each would have a distinct form, based on the relationships that are sort of the beginning of the program or service. Typically, when you're responding to a request for proposal, they are non-negotiable when it comes to financial and programmatic reporting requirements. I think I'm getting tired. Starting to trip over my words here. These are usually specified in the original RFP. And by applying for and accepting the award, you're committed to those requirements. Not seen one yet where you could change that in mid-stream. You measure reporting requirements against your capacity to determine if you need to add staff, add technology resources or outside support to meet the contract. Because maybe you don't have the capacity. Maybe you want to hire a contractor or some other individual or business to subcontract with if that's allowed by the RFP. Will you need to develop these to support ventures? You might. Sometimes you have the capacity, sometimes you may want to do it and take advantage of it and go to those outside resources if you need to, if you can afford to. In the contract-based fee-for-service enterprises, much like with Prudential again, those terms for performance expectations and financial reporting were dealt with between us. And that was really easy in terms of what the costs were going to be. We suggested a rate per independent living assessment. They accepted the rate. There was no negotiating whatsoever. Maybe wonder if we could have gotten more, but you take what you get. A year later, they came back and only for convenience sake they didn't want to have to look at hourly billing type things. And for whatever reason, it was their end, their financial management didn't like that format. They just wanted a per assessment bill. So they said, we'd like you to bundle this together into one cost. We suggested a cost based on the average of time it has been for us to do that. And they agreed with that as well. There was no negotiating, really, just a matter of us coming up with a higher price to include all the hours for doing an assessment. The toughest thing we had with them was being approved for using internet to share information. I have never seen more complications on protecting privacy of information than I did with working with these folks. It was layers upon layers of people within their organization that wanted to have their eyes on the proof of our ability to protect information if it came into us, then was sent back to them. And I really think it was a few months before we could actually get that worked out. Thankfully the only cost was to our IT manager who almost lost their mind trying to do it. But it did work out. If payments for services are based on a performance metric such as units sold or units of service delivered, make sure you have the capacity to link performance and billing. And we've run into that problem in the past, where you're delivering a service. Somehow between the service being performed and the finance department having the information they need to bill it out, something's lost. You're losing time. You're not getting paid fast enough, but you may not also be transferring the details of what to bill and who to bill. And hopefully we've got those kind of things cleared up. Now in a partnership-based fee-for-service enterprise, that, again, should be highly negotiable in terms of both performance expectations and financial and programmatic reporting, depending on the ownership terms of partnership. Generally if you're partnering with someone, either you or they are going have access to the resources that are paying for the services, more than likely. So you've got to come to the agreement on who's managing what aspect of this particular program. Do you have an example on that? KATHIE KNOBLE-IVERSON: I do. Right now, we partner with a local women's shelter. They receive division of housing funds that are from HUD and it comes to a group called the Continuum of Care. It's regarding homelessness in our region. And we felt really lucky to be a sub-contract of the YWCA of La Crosse. And what happened was they weren't being a good keeper of, monitoring what changes were coming down the pike that would affect us as vendors. And we found out way after the fact they got an audit that we hadn't been tracking funds right, we hadn't been putting in correct information into a statewide database. And it was all because of the person that was managing, actually the director left and there was nobody there. And so it just became a nightmare for $10,000. It took probably that much of our staff time to clean up the mess. So if you ever partner with anybody, make sure you understand what their expectations are from the buyer. Because that's the link we missed. We knew what our expectations were from our subcontractor, but not from their buyer. DENNIS FITZGIBBONS: Great example. And that's bullet two. Performance payment, risk allocation and benefit distribution should be included in the agreement. So everybody knows what's expected and how it should work. And partnerships based on clearly articulated agreements of roles, responsibilities and risks and benefits are best. Startup and acquisition-based fee-for-service enterprises, again, things you are going to do on your own. Now you are controlling your own fate. You're determining what your performance expectations are and your financial and programmatic reporting. Because they're going to be internally driven. You can use other contracts or services you've done for models. Because some of them can be pretty sharp and clear. But you want to really make sure you're measuring what's important for, maybe you want to spin this off later. You may want to sell it to other buyers. You may want to sell the business entirely. But if you can demonstrate the effectiveness of what you do, it's going to come in handy down the line. And internal business metrics must drive your decision. All those things, again, is it costing too much? Are we making money? All the different variables that come in. You've got to continue to look at those things as you go make those decisions on a regular basis. And ideally, this should be modeled in order to provide benchmarks. And you can set this up on, say in the first quarter. This is where we want to be. In one year, we want to be here. And then measure yourself against those benchmarks and change those accordingly too. And you want to have that exit strategy in place, should that just not work out for you as an organization. KATHIE KNOBLE-IVERSON: And you know, a lot of contracts that you're going to get, there will be an exit strategy in there. Sometimes it's called something, how to cancel a contract, you need to be aware of that. We had a contract that we were providing some in-home supports to a couple of unique consumers. And we didn't realize we had to give them 90-day notice. Even though we could not find employees to provide the service. We were so lucky to get out of that relationship without getting fined or something worse that they would end all our contracts. But we didn't realize, they could give us 30-day notice, but we had to give them 90-day notice. And we continued to provide the service, but when we are in trouble with recruitment, when we cannot find somebody that's going to do that job, we immediately bring them into the mix and make sure we have a backup plan and that is that a lot of us end up going out and doing services. But we're getting better at finding the folks to do this unique service that we're offering. AUDIENCE MEMBER: Can you back up just a minute and tell me the difference between an agreement versus a contract, legally? DENNIS FITZGIBBONS: I don't know that there's a whole lot of difference. People call things an agreement sometimes and sometimes it's a contract. It would depend on who it's with. We have multiple contracts and agreements with the Department of Health and Human Services in Maine. But they're pretty much interchangeable. And again, I think it would depend on the source. So that is why I would advise having those outside eyes of an attorney or someone to look at things too. So they would have a better understanding of if there's any difference between the two for you. So some of the steps to become a vendor are, and I'm sure you know most of these. Establish a process for seeking opportunities to contract. And there's lots of ways to do it. There's, the internet is a great source. Using search engines to zone in on different types of things that might be out there. Newspapers, of course, governments required to post RFPs. I would recommend highly, and you can speak to this too, Kathie, but we've always had an individual who's keeping an eye on those things. We had a grant writer many years ago who is the sharpest tack in the box in the state for looking for resources. She didn't work for us but she contracted with us. But she knew us probably better than we knew us. And she knew how to write about us in a way that made us incredibly appealing. And she knew where to find money. So she was worth her weight in what she charged for an hourly rate. And literally wrote several million dollars' worth of grants for us over the course of about 12 years. Just, sorry to lose her. Still have someone to watch things for us and got federal register and lots and lots of places to look for those resources. KATHIE KNOBLE-IVERSON: And based on relationships again, going to continue to come back to that. We have several counties who will call us or send us an e-mail and say, you might be interested in what's on our website. Because otherwise, you have to check it every day, other than if you catch it in the newspaper. So, again, you can just say, is there a chance. We also asked a couple counties that aren't as familiar with, we've never done an RFP in their county, what their procedure is, what their process is. And she said, would you like to be on a list of people that gets informed when there's anything, I said, yeah, of course we would. And you won't find out if you don't ask. What people's processes are and if you've never responded to an RFP. That's the first thing I did as a director after I wrote the grant to start the agency is responded to a DVR RFP, a federal one, which was RSA, actually. It's a learning process. And it really hones your skills about talking about your organization. And helps you figure out if you haven't already, what your organization values. Yet helps you figure out what this, by reading the RFP, you figure out what they value real quickly. And it's a really good learning process. Even if you don't get it. Takes time. DENNIS FITZGIBBONS: Great process. KATHIE KNOBLE-IVERSON: It's a great process. DENNIS FITZGIBBONS: Couple of the best day I've had at Alpha One were when we were looking at an RFP that was very exciting to us and we filled the room with different employees, the grant writer I described and a couple of other folks we knew, a couple of consumers, and it was an RFP that Robert Wood Johnson put out back in the '90s. And we ended up writing a response to this particular RFP because we had inside information from an old contact I had in Massachusetts that Robert Wood Johnson was very interested in nursing home transition. So with that tip, we were able to sit in a room, look at this RFP and brainstorm, how would we approach this. And the end result was probably the best grant we ever wrote. It was crystal clear on what we intended to do, what we wanted to change in the system, et cetera and ended up with a 3-year $500,000 grant to do that. And it was a great way to do systems change. It was a great way to do core independent living work, helping people get out of nursing homes. And it was a great team building activity for the people around that table who brainstormed all the different things to be part of that grant application. So even, whether you get them or not, as Kathie said, they're a great exercise. Because, then we take ideas that don't get funded and we put them in a drawer and wait for an RFP to come along that's going to fit that. Maybe it has got to be tweaked a little bit. It's going to be a good idea. If it's a good idea today and it's not funded, it's still going to be a good idea later. In addition to that, respond to the RFPs if you can. They have to make sense, they should fit with the mission ideally. Network to identify needs for service that fit your core competence and mission. Respond to potential contractors' process to establish CIL as a vendor. Sometimes entities are looking, you just mentioned that. You were invited to be on lists and things like that but in the state of Maine, it allows all kinds of people to be vendors. And there's a very simple process to get on the vendor list. And it's not something we had thought of at one point in time. And we just sort of fell across it and said, let's get on the list. Sometimes it's a matter of just signing up. Sometimes you do have to write a proposal of what you could offer. May want to provide letters of reference from business relationships that you have that are going to speak positively about what you've done. And of course, if it's a specific item you're looking for, you want to provide a budget of estimated costs and the ability to meet any data collection and reporting requirements. And everybody loves data collection now. So having a really super sound system that's going to be flexible enough to do that is important. And it can be a big investment in resources. Initiating contracts and agreements. For an RFP type thing, it's a standard contract offered by the grantor. For a contract with a private or public entity, that will vary from a rigorous standard contract to a less formal MOU, they're called or Memorandum of Understanding. Can be very simple in nature. Partnership with another entity should be negotiated between the parties so that you make sure you know exactly what's expected and last business startup or acquisition, it's all internal benchmarks. Kathie, you're on. KATHIE KNOBLE-IVERSON: Yeah. Some of the more typical terms that are in a contract, if you've never had a contract. Question? Okay. AUDIENCE MEMBER: I was wondering. When writing, when you guys write proposals, I wonder are you writing for programs or trying to find general operating costs. KATHIE KNOBLE-IVERSON: Hard to find general operating costs. It's typically either for something we're already doing or for something new, for us. Sometimes, we found one entity that will pay for general operating funds and that's what we're going to do for our expansion that we're going to talk a little bit about tomorrow. It's really hard to find ones that will just pay you to operate your business. They want some sort of outcome. DENNIS FITZGERALD: There's been a lot of change in the foundation world, in particular in the last few years. They're looking more to fund ideas for new programs or something like that. They don't want to fund operational type things. If you can find one like that, it's great, so we're usually looking at programs. We used to look for other ways to do demonstrations. There are very few ways to do a demonstration project anymore too. KATHIE KNOBLE-IVERSON: I'm going to go through this list. These are a lot of typical contents in a contract. And a lot of it's going to depend on the size of your organization. How many of you have a civil rights compliance plan? One? If you have over 50 employees, it's a federal requirement that you have a civil rights compliance plan. In Wisconsin, if you have over 25, they ask us to do that. So, they're a pain, but you do them. They're online. You fill them out. Typically, you have to have proof that you have one of those. In Wisconsin, if you're going to sign a contract with the state or VR. But your typical contract will contain the funding amount or the reimbursement rate. It can tell you how you're going to get that funding amount. In Wisconsin, if you have a program grant from VR, which is the I&E contract, which is the innovation and expansion grant. We can only bill a quarter of the amount every three months. And why? I have no idea. So you can incur more expenses. Sometimes you might have more expenses up front if you're starting a new service for them. But that's all we can bill. You just have to make sure you're incurring enough expenses on your end. The definition of a unit of service. You need to both be on the same page. Sometimes this goes by the wayside. A new managed care entity came into our region. And we made assumptions about what a unit of service was going to be. And we were wrong. They have a totally different. They have the most bizarre way. They pay per diem. It's the most bizarre way we've ever gotten paid. Sometimes we would come out good, other times, we don't. It evens out, but it was really an unusual, and we did not hear about that until I had our contract sitting in front of me. So we had to sort of go back to the table. Your reporting requirements, your staff training requirements, and you have to monitor both of these. You don't want to get behind if you have to do monthly reports specific to a consumer. That's one thing if you have to do quarterly reports for an overall program. If you have program outcomes that you need to meet and report on, you need to do those and if you have staff training requirements. You need to be on those before your last quarter and you can't find the kind of training. In Wisconsin, if you're going to do comprehensive community services, which is skill training for folks with mental illness. You have to have staff trained 20 hours and they monitor it from our sites. They put the person's name, social security number and it pops up every 12 months and we have to turn in what trainings they've been to. And then if they don't meet all the requirements, it pops up again and we need to make sure they have confidentiality training and boundaries training and ethics training and those sorts of things. So definitely do background checks. I don't know how many of, are all of your states requiring background checks for everybody? No? DENNIS FITZGIBBONS: Ours do. KATHIE KNOBLE-IVERSON: We do. Ours are in every aspect. So we changed our philosophy at our agency. Instead of trying to track different programs, one program is every other year. One's four years. VR wants them done every year. Everybody in the agency gets a background check in July. We just are doing it so that no one slips through the cracks. We also have to report, it's something really unique to La Crosse County. We have to report when employees leave and when new employees come on board. If they're going to provide the CCS program. So we have to keep them in their system. It's our responsibility to get them in, not theirs, so. A notice of service termination, that's really important that you understand why a contract or, what the situation would be that a contract would be terminated. And I don't have that on here, but also how you can terminate. If you're in a situation and things just aren't working and you've accepted a lot of money, you have to start to figure out, how are we going to end this relationship? This isn't working for us. If it's philosophical or you're not getting enough referrals or whatever it is. You need to take a look at your contract and know how you would end that relationship. Confidentiality, communication contacts, we always make sure that they have enough names and enough phone numbers and know what people do so that if someone has a billing question, they're not calling the receptionist. Or if someone has a program issue, they're not calling our finance person to complain about a program issue. They need to know who to go to for what kinds of questions that they have. You need to understand the billing process. And then what to do if a mistake, God forbid. I bet none of you make billing mistakes, right? Or your referral source makes billing mistakes. It just happens. It's inherent in the business. And so you need to understand when you can rebill. If you have to wait a whole month, can you rebill once you've caught a problem? Who do you call to find out why it was rejected. A lot of places it depends on how sophisticated it is. If we get something from WPS, they put one of three different codes on there and got to learn to deal with them. If it's La Crosse County. You don't get any explanation. They just said, they reject it. And then you have to pick up the phone and try to track down somebody to find out why it got rejected. So you need to figure that out because you want your money as efficiently to come to you as quickly as possible. If we have a good, clean billing with La Crosse County, we get our money in 17 days. DENNIS FITZGIBBONS: Also a good idea to know who you should talk to when there's a mistake and build that relationship. KATHIE KNOBLE-IVERSON: Yes. DENNIS FITZGIBBONS: So they're responsive and want to help you out. Cause if they don't want to help you out, it can be pretty ugly. KATHIE KNOBLE-IVERSON: We have a new accountant who feels very strongly about collectibles and billing and she got a very serious problem resolved with the VA and sent that person flowers. Because it resolved a huge issue with us. Well, I tell you, she calls us and she is just the best partner we have in the VA when it comes to billing now. And our accountant happens to be a former marine, so they had that in common. So they have really hit it off and it's been so helpful for us. Time frames? When things are due, whether it's billing, sometimes you cant go back. There's terms in your contract you have to read. If it's over 60 days, you might not get paid. You have to find that out. So if you're having trouble in-house, getting time sheets or billing sheets or getting the correct information and that's delayed, you have to know whether you can do a late billing or not. A budget, develop your budget. If you submitted a budget for this project or proof to support your unit rate or whatever it is, you should want that stapled or connected or added into your contract, if you can. And then detailed responsibilities, who's responsible for who. And what's what I said. A lot of contracts are very standard and they're more big picture contracts. Make sure there's something stapled, something somewhere. I was just appalled when I saw the first La Crosse County contract. Just didn't tell us anything. And I go, what's going on? Oh, we forgot the attachment. And it was a two pager with everything laid out about what they needed to know and what we needed to know. So you have to make sure that those are there. Contracts typically contain lots of other info. And this is the anti-terrorism, lobbying. Whether there's any litigation going on in your organization, whether you're civil rights compliant. And this is where you don't want to send, our civil rights compliance plan is about 65 pages long. It's just forms you fill out. But you don't want to have to send that to everybody. So what we get from our state civil rights compliance organization is a letter, assuring that we submitted a completed civil rights compliance, and that's included in our packets when we send that back. A lot of times you're going to get asked for things. They'll say, where's your equal opportunity statement or do you have a grievance process for consumers? It's those sorts of things you might have to send them a copy to prove that you have them and they're utilized in your organization. And take the time to read and understand your contract before you sign it. In La Crosse County, I don't anymore. But it's been the same for years. And I have a nice relationship with the contract folks at La Crosse County. They'll shoot me an e-mail and they'll go, don't sign this until you read number 7A, sub unit 3 and make sure it's okay with you or you can meet the requirements. I don't have that relationship with a lot of other folks but that one I do. So you need to take the time. And sometimes you just want to sign it and get it off your desk or move it on. But you need to know if there's any changes. A lot of people will change the contracts and they don't tell you. DENNIS FITZGIBBONS: They will. And I would also recommend that's another case for when you want another set of eyes on that to look at it. Because we see so many contracts sometimes, you get a little bleary-eyed. KATHIE KNOBLE-IVERSON: Yeah. DENNIS FITZGIBBONS: You want to let someone else go through it with a fresh set. KATHIE KNOBLE-IVERSON: The billing processes vary too. If you're just receiving IL funds or maybe billing Medicaid and you never had a relationship or a contractual relationship with others, billing processes can vary as much as contracts can. Can be a simple invoice at the end of the month, with the hours, the rate and the total. And you get paid. You can sometimes send those out, as I said with DVR, we send them as they're completed. So we always have money coming in. We will not wait to wait to the end of the month. We don't close our books until 15 days after the end of the month. So we do a lot of billing the first five days of the month. And we do another set of billing on the 15th of the month. So we have two types of billing going on. It's the units that we can bill for up front and then the costs related to programs that we can bill later on. Documentation. When do they want that? Do they want it with the form for the bill? A lot of places don't. Because you'll end up with case notes sitting in some financial person's office and you won't get paid because it didn't go to the social worker and they didn't clear it on their billing process. So make sure you know who documentation needs to go to. We have other folks, they want the entire package. It does not go to finance, does not go to program. It goes to the executive director. And they disseminate it. So you have to understand where to send billing. And I told you this earlier. We just got introduced to WPS billing directly to a third party on behalf of a county. And that was a nightmare. And that was our fault. We just didn't demand that we get trained well enough to do that. So make sure you understand if you're doing a third party how to do that billing. And you can also bill, we guess a lot of you in here bill directly to Medicaid already? Yeah. And we have been doing that for years and that is not hard for us. If you're doing it in the beginning, it can be as complicated as the WPS billing. We also have one contract and it's for employment that you cannot bill until there's a successful outcome. And a successful outcome is that person is in a job for 90 days. So again, when we start talking about cash flow, if you get into that kind of situation and that relationship and you wanted to provide that kind of service, you have to be prepared for number one, 90 days, you don't get to bill and then it's going to take another 90 days after you bill to get paid or that the person is going to quit the job before 90 days and you're not going to get paid at all. So those are the kinds of things that can take you down pretty quickly, if you invest real heavily into a program like that that has a lot of risk. We chose to only do one portion of the contract and that's the benefits assessments. Because that happens up front before a person gets into the job market. We let somebody else take that other risk. We weren't willing to do that. No matter what the process, be sure the staff and your accountant understand it. Whoever's responsible for documentation going and whoever's responsible for billing. Make sure they understand. And if there's changes that they get that notice. And then provide oversight and monitoring. Whoever, someone, you can't say, oops. We didn't take a look at this. And now we've got six months of receivables that aren't paid. One of the big problems we have is that you can get some really untimely contracts. In Wisconsin, VR is usually six months behind in getting you a contract if you have an agreement with them. It's just their system is so bogged down in red tape that they've told us, go ahead and start the service and I go, can I get that in writing, please? Well, that would be a contract. And I'm going, I need an e-mail, I need something. Because you're going, they promised they'll back-date it, but you have, I would recommend that you have an e-mail from someone who has the power, who is the buyer, so that you can say, oh you sent me this e-mail and we've been incurring expenses for four months and now we need to get paid for that. So if they back-date it, that's fine. If they choose not to back-date it and sometimes when budgets are in question, all of a sudden, things change and if you don't have proof that you had some sort of an agreement, you could be left hanging with a lot of expense that's not going to get paid for. There's always going to be complications in billing. I don't care how smooth and sweet things move. You will have some sort of problem with billing at some point. And you just need to have an internal process to get those resolved. A big one for me is staff turnover. I don't like staff turnover. I like to keep people around because then you lose the expertise that goes with that person. So if you have the ability to create some depth and Medicaid billing, we have a nightmare story about that. Somebody got very ill and was not able to come back to work. She was the only one that knew how to do Medicaid billing. I didn't have anybody trained. I practically drug her out of the hospital and had her come in and train somebody for me. Because we were two months behind. And there was no way. She was too ill. She was never going to come back to work. And after that, that was a long time ago. 12 years ago. And we decided that we will always have a second person that knows how to bill Medicaid. We will always have somebody who knows how to get the data out of MyCIL that we need to support our cost allocation plans or any unusual allocation. So we do now have that. Sometimes you don't know how to do things if you don't practice. Medicaid billing is one. So once every two months, I pull that back up person and they have to do the whole process themselves. So they don't forget how to do it. Otherwise, it's useless if they haven't billed Medicaid for three years and all of a sudden they're put in that position that they have to do it. So it's really important that you have a little bit of expertise. And a problem that Dennis has brought up several different times is either too many or not enough referrals. And they create very different problems. It was like the question that came up earlier about when is it ok to turn away a referral. That is so individualized to your organization, but not having enough referrals is the, you have the same outcome every where. That then you're not generating the income, especially if you have invested some money up front. Once we got a start up grant from an organization. I think you were telling this story, about a business that started up. It was, I can't remember her name. You told the story about the organization having to give back the $20,000 to the foundation because it didn't work and we had a startup program like that. We went to the foundation and said, we're just not getting referrals. And they said, that's okay. That's all right. You did what you were supposed to do. It's not your fault. But that doesn't always happen. That's the only time, I don't like giving money back, do you? DENNIS FITZGIBBONS: I hate it. Never leave money on the table. KATHIE KNOBLE-IVERSON: No. And that was the only time that happened. And then some things that you can't control is that you have a contractor or a buyer who has really poor communication skills; they don't respond to e-mails; they don't answer phone calls; they really delay a problem that might be on your end because they're not good communicators. And I would suggest that you try to find another person in that organization and develop a relationship with them. Not to undermine them, just a second person that you could go to say, boy, we're really having trouble figuring out why we're not getting referrals. Do you know anybody else I could talk to? And utilize those relationships. We've had a couple of these and it was statewide. Someone within VR. Every independent living center was complaining about this person. And guess what? She's not managing our I&E contracts anymore. She was just, thought she knew better than us. She came out of the school district so she wanted things done like it was done in the school district. It was just not a nice fit. And it wasn't that we disliked her, just wasn't a good fit with what was happening in the state. And so now someone else who really gets centers is managing all the I&E contracts in the state. Does anybody have any questions about contracts so far? Okay. Boring stuff. I know. DENNIS FITZGIBBONS: So important. So now I want to talk about avoiding some potential barriers. Got a new contract, whatever the source might be. You want to assign new responsibilities that result from these contracts. So who's going to do what within the organization. And you know, it's a capacity question. You want to make sure the right person is in the right seat to be delivering services. The right person is monitoring and that all the information is going to flow in the right direction. Make sure staff have the ability to assume responsibilities in a timely manner. Just what Kathie was referring to before. I don't know why, but the state in the last two years has had this regular offer of small grants, all related to money follows the person. I don't know why it can't be in a grant, or a contract or an agreement, but it's been multiple little ones all amounts of about $25,000. So within about a six or 7-month period, we picked up four of those. And one of them was specifically to perform outreach activities for the course of one year. And it was $25,000 to do that. But because we agreed to take on several of these within a several-month period, we are now juggling four different agreements, four different reporting requirements, measures, expectations, et cetera. And we didn't do a good job of making sure someone was assigned to this particular one to make sure it was taken care of. So we got around to month 11, to the end of a one-year agreement and we had underspent the 25,000. We actually spend $11,000. So when all was said and done, it was too late to go out and get somebody on completing all those outreaches. So we had to send the state back $14,000. I thought I would have a stroke. And I took responsibility for it because I didn't make sure that someone was controlling that particular $25,000 grant to get these outreaches done. Surprisingly, the state gave us another one the following year. Which was great. I can tell you we spent every penny of that one. We don't like leaving money on the table. That was a huge error on our part. We told the state it was our error. We did our mea culpas, et cetera, and didn't make excuses just said, hey, we messed up. And it won't happen again. And hopefully it will not happen again. But you have to be mindful and watchful of those kind of things. You want to establish and maintain an accounting system that allows for accurate recording of costs, relating to any new contract, both indirect and direct. I know we already said that several times. KATHIE KNOBLE-IVERSON: Can I ask, do all of you have accountants on staff or do some of you still have bookkeepers? It was like night and day after we went to an accountant. And I know sometimes you can't afford an accountant. We started out with a part-time one and actually purchased the service from a professional organization that sold accounting and they're the ones, we did that in a crisis because I had to let somebody go. And I was like, oh my God, I have this on time? It tells me a thousand times more information than I was getting prior to that because the person didn't have the skills. And so we purchased that service for six months while that same organization helped me look for someone who had the skills we needed who had some non-profit background and it was a wonderful match. So he worked with us until he retired. And now we have a new accountant. Really makes a difference. DENNIS FITZGIBBONS: Huge difference. This will sound strange based on what I said earlier about that money we had to send back, but I suggest organizing a method for triggering the fulfillment of billing and reporting requirements, resulting from these contracts in a timely manner. I would estimate that right now, we probably have about 14 or 15 different agreements with the state or other entities to deliver some type of service or deliverable. And they all have different time periods. Or many of them do. And they have different reporting requirements. They have both performance and financial requirements and they want either monthly, quarterly, annual, final, all kinds of reporting things they want. So we set up a tracking system. Two tracking systems, actually so if one doesn't work, the other does. To trigger a month ahead of time when any report is done that we know that it's due. So we then have a month to get our act together and get that report done. Likewise, for the financial report that has to go with it. If you can establish that within the organization, it's going to save you a lot of heartache and sleepless nights so that you can get these things done on time, accurately and delivered when they're looking for it. Nothing worse than a phone call a month after a report is due that it hasn't been sent in yet and they're looking for it. You want to always be impressing people that you're on time with good reports. KATHIE KNOBLE-IVERSON: We use an Excel spreadsheet for the financial. Our new accountant set that up. And our program, our IL director said, that's really sweet, how do you do that? And then we matched it. It pops up on our computers now. And, to several people. And so my IL coordinator who I supervise, I also get the notice. So, I can go, so-you got your quarterly reports done yet? Just really helpful. It's a really nice management tool to make sure you can get things out the door when they need to be. DENNIS FITZGIBBONS: Make sure you want to fulfill any responsibility of in-kind commitments you made in any agreement. You might be offering space, you might be offering the time of the executive director, to be involved to a certain level or some other person or employee, whatever that in-kind contribution is, you want make sure you can document how that occurred, when that occurred so that it's all there for someone to see. And I say a final report to a funder. You want to establish a method for monitoring total spending against a contract funding to avoid any over and under. I just talked about leaving money on the table. And you certainly don't want to overbill. Because that's going to create issues as well. Evaluate the ability to meet cash flow needs while awaiting reimbursement when the contract is reimbursement-based. And retain records and support cost or fee-based units charged to contracts. Save those records. Most contracts or agreements will probably have some requirement for how long you should save them. You might want to add a couple years to that for safety's sake or reasons to refer back to something. KATHIE KNOBLE-IVERSON: Always understand how far back a funding source can come back and audit you. In Wisconsin, Medicaid can come back seven years and audit. They can either do a desk audit, an on-site audit. But we have to keep our records, even for participants who have died, we have to keep them forever. DENNIS FITZGIBBONS: We had so many records we had to rent a storage facility. KATHIE KNOBLE-IVERSON: I bet. DENNIS FITZGIBBONS: So integrating new fee-for-service programs into the CIL. Business planning has to measure core competence and staff capacity against requirements for any new enterprise. The new business ideally will fit within the mission of the CIL and therefore the fit of the enterprise should be evaluated before any business relationship is finalized. But, remember, outside of the mission can still work. You can still create programs that may not be directly related to your mission. They can be successful. But I believe from our experience it's more difficult when you start doing something that's sort of natural to independent living and the business we're in, it's much more difficult. Fee-for-service enterprise should be integrated into company financials as a new cost center with the tracking of both direct and indirect cost. Cost allocation methods are applied to new contracts in a manner consistent with established contracts. That consistency is very important. Accountants love that anyway. So if you have an accountant, you can rely on that kind of solid allocation of costs and accounting for all costs that are involved. And communication is key no matter what. Communicate changes to staff, board and constituents. When we start any new program, no matter what the source is, we create a cheat sheet for everybody involved within the organization. What it is, who's involved, who it serves, what the program's about, why we applied for it, when is it going to be in place, who's the lead person on it, how it's going to work and a few other details as well. But everybody gets that so they have a full understanding of what's involved. AUDIENCE MEMBER: Can you go back and talk a little bit more about in-kind contributions? Are you ever able to use staff time or are you talking actual product services? Can you just expand on that? DENNIS FITZGIBBONS: As a matter of practice, when we apply for most things, we always, even if it's not called for, we will write in in-kind contributions from Alpha One. Funders love to see that kind of thing. You got some skin in the game, so to speak. KATHIE KNOBLE-IVERSON: You get extra points. DENNIS FITZGIBBONS: Yeah. They like to see that you're giving something too. So it's easy to contribute the time of executive director or the time of, say, someone in finance who is going to be managing some of the things like that. Granted, you may not then capture some of those administrative costs you want to, but there's other ways to get those things incorporated. So you're giving something to get something. And it could also be the use of space, could be, Kathie's got some examples, but there's lots of things that you're already doing anyway that are fixed costs that you can just throw in as in-kind contributions. KATHIE KNOBLE-IVERSON: A lot of grants ask either for in-kind or a match. Now, our public service commission in Wisconsin, you have to have a dollar-for-dollar match in order to ask them for money. So it can get complicated, but in Wisconsin, we happen to have an assistive technology grant that all the centers get and all of us use that grant as our match. In-kind is a little different. If, for example, just using assistive technology again, we pay for the rental space for our loan closets in it. Huge space. And so we put that in as an in-kind donation, that we're storing everybody's, all the assistive technology we have, but the assistive technology we have for this particular program, which is telephones are also stored in that space. So we identify that area as some in-kind donation. DENNIS FITZGIBBONS: Does that answer your question? Managing staff changes resulting from new programs is a major consideration. Communication and buy-in is essential. So letting people know what it's about, what we're going to be doing and if it impacts someone directly, they really need to buy into it. If you don't have that full buy-in from a staff person, it can sink a program or certainly set it back quite a ways before you understand that I think we already shared some examples of that. Very important. That's why communication is key, especially up front. Even if you decide to apply for something. It's good to start behaving as if you've got it and talking to people who would be involved if in fact you do get it. So they have had some advance notice, you can generate some excitement around the idea, instead of going into somebody's office and saying, well we got this grant the other day and you're in charge. Certainly want to get the buy-in enthusiasm right away. KATHIE KNOBLE-IVERSON: We've had some staff that are really influential in our organization who didn't like what we were doing. And I tell ya, that can cause all kinds of internal issues and so I sometimes get really excited about opportunities and I have had to learn this, okay. Let's get in a room and if you don't agree with me, let's get in a room and duke it out. I don't have to win here. This isn't a contest, but I need to understand why you think this wouldn't be good for our organization. And I'm going to use an example. We had an opportunity to respond to an RFP to be rep payee for folks through social security and my IL director was just like, I don't want to talk about it. I don't think it's appropriate. Blah, blah, blah. And I was just like, we could make some money, let's do this. Well once I sat down with her and looked at the contract requirements, it really smacked in the face of IL. Consumers were not in control. They didn't get copies of the reports. She had't read that though. It reinforced why she didn't like it. And it changed my mind. We chose not to go after that. And of course, the local sheltered workshop is now doing it. It's those kind of things that you need to get out. Alicia does not have a problem telling me what she thinks. But if you get into an environment where you have folks that are quieter or don't feel that they have an opportunity to help assess whether it's an appropriate fit for your organization, that's why we let as many people as possible. If we get an RFP, I throw it on their desk and say, go into a room someplace and take an hour and a half and go through this. And figure out whether you think this is a good fit for us. I've had to do that with our new fundraiser and marketing person. Sometimes, she's just looking at the money and not how it fits with our mission. And she's really getting it. But we have to- It's something everybody should get an opportunity to take a look at something so you can make a well-informed group decision about whether it fits. DENNIS FITZGIBBONS: So set clear expectations about staff roles and responsibilities and measure and evaluate the implementation to make adjustments as needed. We're in the world of being adaptable. We're helping people be adaptable in their lives. We have to do that as a business as well. Nothing stays the same from month to month to month. So we have to be always checking in, making adjustments as we go. KATHIE KNOBLE-IVERSON: We also need to really take a look at your accounting procedures. And your finance department. And you need to assess your current situation. Do you have someone that's part-time or full-time. Is the new business that your thinking, or the new service you're going to create put more demand on that office or is it something that's going to take an extra 20 minutes a month. Do you have a bookkeeper versus an accountant? We had a bookkeeper for years. But we weren't very sophisticated at that point. When we got into multi levels of billing, it was just time for us to move on and to be able to use. We use Peachtree at our agency. And a bookkeeper didn't know how to utilize Peachtree to its max. And now I have somebody that just came out of college who learned on Peachtree and can run reports that would amaze you. And give you more information than you would ever need to make some really good decisions. And then is your software being used effectively? Or do you have the sophisticated software? I hear people talk about QuickBooks. And QuickBooks has changed drastically in the past couple of years and developed some versions that are a lot more sophisticated. You might be able to start out with something and get a more sophisticated version of what's out there. But you need to be able to have someone who can, if you want to come in and say, okay, I need to know what costs were related to this grant and I need it in the next 15 minutes. Someone needs to know how to get that for you. Audit results, if you need to look at those, you need to listen to your auditors. Need to appreciate what they find. We get a finding every year at our center. And it's a segregation of duties because I have one bookkeeper, one director and nobody else that can sign off on things. So we put some plans in place hoping it would alleviate that finding. Not working. The only way we're going to do it is if I hire another finance person. And we don't have the funds to do that. So we get that finding every year. And we have a plan of correction written that gets the date changed and gets stuck in the audit every year. And don't be afraid. And you've said this several times to get an outside opinion. Have somebody else come in and take a look at your finances. It might cost you $150 to have somebody spend an hour or two or you might get that kind of feedback or recommendations from your auditor. Is that you could probably use a more sophisticated type of software. You might be ready to go to a part-time accountant versus a full-time bookkeeper. It's those kinds of things they can recommend. And then to make sure that you have a good program data collection system in place. I remember when we did everything on paper and I just don't know how we ever did it. Now it is so sweet to have, and we have a procedures around our data collection system, which is MyCIL, that was shared from another independent living center. Deb Langham is the queen of MyCIL in the, I'd say in the country. And she has developed a handbook that goes with MyCIL to help staff utilize MyCIL the way it's supposed to be. She shared that with our whole state. And we use that to train people. And that's one of the first things that people have to figure out quickly is you have a certain amount of time to get your data into the system. Because we need it for all kinds of reports by the end of the month. AUDIENCE MEMBER: Can you put that on the WIKI? KATHIE KNOBLE-IVERSON: I would have to ask Deb. Is Paula in here? I was wondering. She's done some work for ILRU I thought. Deb Langham. Richard, do you know? RICHARD PETTY: The short answer is I don't know that's something that can be released. But we'll check and see if it is. KATHIE KNOBLE-IVERSON: Yeah. I will to, so, let me write it down. One of the things that, if you decide you have the appropriate system in house, is that you still really need to identify what's going to change. And it may just be something as simple as you're going to start getting a few more sheets of paper that have billing situations on it that you add to an invoice or it could be a lot more complicated. Could be a lot more billing at the end of the month. And we try to keep people appraised so they set enough time aside so the billing gets done in a nice time frame. In our state and most counties, if you don't get billing into them by the fifth of the month and they don't care if it's a Saturday or a Sunday. If you don't get it in, you get a whole 30-day process beyond when you would get paid. And in Wisconsin, county boards have to approve all expenses. And then they'll cut the checks. So if a county board meeting is on the 22nd, we would get paid probably, on the 24th. If we don't get that billing in by the fifth, it will be the 24th of the following month that we would get paid. So it's those sorts of things that your accountant or whoever is doing the billing needs to understand. And tracking costs related to the services, monthly reports and not just for the buyer. You want to try to generate some monthly reports that work for you or work for the managers who are out there. Sometimes it really helps to have facts and figures in front of people if you're trying to make a point with a program manager that doesn't know that much about finances. We try really hard to teach everybody about finances and some people, their eyes glaze over and go, I'm sorry. I do not need to know this. I do not want to know this. And my response then is, then you can't complain. If you're not willing to learn about this, be quiet. And sometimes you need the, we talked about this a little bit. Separate time sheets. We don't use time sheets. We use MyCIL. We run reports off MyCIL. And staple them right to the allocation plan every month and it's proof of how we've allocated people's time. Sometime, I even use MyCIL. When I do some startup work or I've written myself into some part of a grant for a particular, might just be for a month. I go in, document what I did, do notes around the activity and put that under that funding source and that gets run off and put into each monthly, every time we close books. You also need to think about future needs. So if you're satisfied with the software you have and the staff person you have, and the finance department, that's cool, but you have to think, okay is billing going to increase 30 percent by the end of the year? Might only increase 10 percent now. But if we're going to have 30 percent more billing. And is it going to take longer to close books at the end of the month because we have new sources of income. So just try to think about what is going to be happening in the future at your organization. And to make changes with your future in mind. If you choose to do some software, that's a little more sophisticated than you have, make sure you're not spending and money and in three years you're going to have to purchase something else, that it fits. DENNIS FITZGIBBONS: I'd like to talk a little bit about upgrading reporting capacity. And this is a real time lesson we've learned at Alpha One over the last year and a half. It was a painful lesson, but it was a good lesson. Kathie's been talking about MyCIL and they use that. We looked at a couple of options like that that are available to independent living centers as databases and we didn't choose either one of those in the last couple of years. But we have been looking for a solution to a very big problem. Up until three months ago, we had three separate data systems at Alpha One. One for our financial management, one for our Medicaid billing, and one for our consumer records. The big problem was that we could never figure out, nor could any of our IT consultants how to make them talk to each other. And so it added so much unnecessary labor and work on a day-to-day basis to communicate things right. And there were so many mistakes made because you couldn't get data from one system to another. And I would just tear my hair out on this. And frankly, we've been looking at this probably for 12 years, trying to find a solution to it. Because of the complexity of the Medicaid billing in particular, but also trying to fit this so that we could generate a 704 report simply. I don't know how well you do it, but for us it's an incredible amount of hours of staff time doing paper audit files to come up with the data near the end of every year to generate that awful report. The report itself isn't awful, it's very informative and helpful, but the process is just a killer for us. Or has been. We went to our IT, we out sourced our IT three years ago as a means to save some money. And we went to them and said, how can we solve this problem? And they came back, here's your solution to your financial management component. And I think these people can probably also build you that consumer record thing too, but when they said I think they can, that was a red flag. And we went through the process of looking at this particular vendor. But through our investigations, we found out that they recommended this vendor because they do business with them all the time. Not because they really thought they could solve the problem. Thankfully we figured that out. So we stopped everything in its tracks and said, no. So we actually hired a consultant, coincidentally, the person who had done all our Medicaid billing for probably 15 years was retiring. So we needed to find someone to replace that individual. So we brought in this consultant to look at this particular job and to create a new job description for us to update it because things have changed so much in 15 years. So we could get the right person with the right skills. Because we knew this person retiring didn't have the computer skills that someone should have. In analyzing this person's position, this person was also able to analyze our outstanding accounts receivable, which was terrible. And for years we believed was the fault of the state of Maine. And through this investigative process, we found that it wasn't the state of Maine's fault. It was this person's who was retiring. Who didn't really know how to do her job effectively. And we had never, shame on us, delved into it deep enough to find out. But over the course of time, we generated the perfect job description to recruit and hire a person who would take us to the next level on managing this information and data and the billing. And also start to look at the systems we needed to do that. So the end result with this consultant started helping identify systems. Now, in January, we went from three systems to two. And the two systems talk to each other. The system we had in place to do Medicaid billing had two different options. It was designed for medical billing essentially and management of medical type things. So sort of warps your head in trying to get our language around those things. They had a home health module and they had a medical billing module. And they HAD sold us the medical billing module. So again, that didn't fit with what we were doing. Would have fit better in the home health module. But they never told us about that module when we originally bought it. So now we discovered that the home health module is going to solve many of or billing problems. And it could also be used for our consumer data management. And so all of our consumer files can go in there as well. So we have been, little by little, migrating all our files into this system. Been a huge project. Cost us a good chunk of change to hire this consultant for more than a year plus, but the savings that we're going to enjoy, one such thing, for instance, since we started and consumer-directed services, we have billed ever two weeks for the past 30 years for the services. And then the bill goes in, gets reviewed by Medicaid, and they send it back, say, two weeks later. So there's always that lag time there. The new person we hired to take over this job and the consultant figured out with using this new database appropriately that we already had, once the manager looks at case notes being done correctly and all the information in there correctly, clicking a button that they approve. It can be billed then. So now we're able to bill as soon as it's approved real time. And we don't have to wait two weeks. So imagine the change in cash flow there. So we're billing on a daily basis now for these services, getting billed probably two weeks faster than we would have been because we're not waiting to batch everything at the end of two weeks and then send it in. The lessons learned on this have been amazing and the ability to now move all programs eventually, probably not for a few months that they're all in there, but soon all of our information is going to be in two databases versus three and the two databases report back and forth easily together. So if it's not in one, you can get it out of that and get it through the other. It's like a miracle. But it's been a huge relief. It's helped the cash flow, it corrected errors, improved our receivables, averaging about a million dollars and got it down to about $300,000 at any given time. So that was giving us a huge cash flow advantage in managing the operation of the organization. Again, that ability to enhance tracking costs and specific contracts together with general and administrative costs whenever such enhancements are worth the cost of upgrades. It's cost us real money to figure this out correcting these deficiencies we had. It was well worth the investment. And it will pay off dividends over the next few years. KATHIE KNOBLE-IVERSON: And this last page, page 22 is just redundant, but so important. Make sure you have necessary infrastructure, make sure staff understand the requirements, no matter whether they're the accountant or the receptionist or a direct service staff person, provide correct and timely reports and monitor what's going on, especially if it’s a new service. How we doing for time? DENNIS FITZGIBBONS: I think we have a lot of time. What did he say? KATHIE KNOBLE-IVERSON: Half an hour. DENNIS FITZGIBBONS: These are some examples at Alpha One of each type of fee-for-service business relationships that we have on some of the programs I talked about yesterday. In the first one, request for proposal or grant source fee service enterprises, that's where you would find our consumer-directed personal assistance service programs, as well as the critical access program that builds ramps to prevent people from having to move to a more restrictive environment. Examples of contract-based fee-for-service enterprises would be the mPower adaptive equipment loan program and the Return to Life program with Prudential insurance. Under the partnership-based fee-for-service enterprises, we had what was originally known as the Rolling Edge, which later became Alpha One Medical and Renegade Wheelchair. Renegade Wheelchair actually is a different sort of arrangement there in that there are two partners, equal partners in the organization, Alpha One and the inventor of the wheelchair. And then some examples of startup in acquisition-based fee-for-service enterprises are the access consulting we have been doing since 1991. The adaptive driver evaluation and training program. Alpha One Medical, which is now defunct, and Renegade Wheelchair. That's it? Way ahead of schedule. So we can do a little song and dance. A little KATHIE KNOBLE-IVERSON: Any questions? DENNIS FITZGIBBONS: Any further questions? Clarifications? KATHIE KNOBLE-IVERSON: Anything you want us to go back and clarify? AUDIENCE MEMBER: All right. So did your current, Dennis, you answered this, so this would be for you. Did your current database, the MyCIL produce adequate documentation for the billable services to send with the billing or did you create a separate database and I guess at issue is the confidentiality piece. We have worked with people who were very sensitive about their information. And that's the first part of my question. KATHIE KNOBLE-IVERSON: MyCIL creates all the documentation we need for any contract that we have. And it's typically case notes or it's a summary at the end of the month, based on the case notes. We print those off and they go with a billing to a billing site. We've had folks who didn't want any of that shared and we sort of had to try to negotiate with the funder, the buyer of the service. And they can't bill if they don't have that stuff. So it didn't, it became not our problem. It became the buyer's problem. And they worked that out with a couple consumers who really didn't want their information shared. So we have really strict rules around information at our agency. Our MyCIL system though is not locked. Everyone signs a confidentiality agreement and if anyone's ever caught in a consumer's file that they don't have any reason to be there, they would more than likely be dismissed. We have great respect and we do a lot of training around confidentiality in our organization. AUDIENCE MEMBER: Would you recommend that be a discussion of some sort when entering into a contract with a buyer? KATHIE KNOBLE-IVERSON: About confidentiality? AUDIENCE MEMBER: Yes. KATHIE KNOBLE-IVERSON: Always addressed in our contract. AUDIENCE MEMBER: But what you just said is that there may be instances where there's no, the information is protected more so. DENNIS FITZGIBBONS: We have our own internal mechanisms protecting information and the buyer usually has their documented what they wanted and how are you going to do that. But also consumers, sometimes, if they want, a particular service, then they have to accept the fact that the information is going to be shared. And I don't think there's, in some cases they can do much about that. Either you want that service or you don't type of thing. KATHIE KNOBLE-IVERSON: We entered into a whole new realm when we started doing mental health services. And probably ran into more folks than ever that didn't want certain information shared. They have access to their files. We can print off everything that's in MyCIL that's specific to that person and we let them see it if they want it. If it's something specific and, what we found out, we put together a consumer group of mental health services because it was a huge issue at the county and we did some systems change with the county and diagnosis and history and all of that got archived and didn't get put in people's files unless a team felt it was pertinent to be there. And that's what they were afraid of is that we were documenting all this stuff and that that was always going to be in our file. We don't document that stuff. If we get sent that stuff, we ask the consumer if they want it in their file, if they don't it gets shredded. If it's something they want in their file, it goes into a paper file. It doesn't stay on the computer. And our paper files are always locked up. Have to have a key to get into the room to get access to them. So I think the fact that we made some efforts and included people in how they wanted things treated really made a difference about, we haven't had a complaint probably in six years about information that's shared. We have more issues with boundaries than anything else at our agency than confidentiality. DENNIS FITZGIBBONS: We do take a step that with staff, only certain staff have access to certain information. If it's an IL specialist, they have access to consumer files that they're going to be working with consumers. No one else in the organization has access to those files. And likewise, financial information, if you're not in the finance department, you don't have access to that type of information. Especially if it's specific to individuals. Really, not at all. Not everyone has access to the system in general. KATHIE KNOBLE-IVERSON: Our finances is totally separate. Actually keep it on a separate server. But, consumer files, you have to have a password to get in there. I'm the only management, administrative, like our accountant can't get in there. I can, and it's only for emergencies because I have to go in and document my own time. AUDIENCE MEMBER: And the second part then, did you add the billable contacts under services or a separate program in MyCIL, so when you increased, when you did a program and you had units, did you put those in as an additional service or how is it tracked? KATHIE KNOBLE-IVERSON: We, in Wisconsin as a state, we've negotiated with Michelle Tanabe who is the creator of MyCIL and have got some changes made in our state that are specific to Wisconsin. When we all come on a new funding source, we track under funding, we track under service so that we can run the reports that we need at the end of the month. So everybody we've served under CDBG, for example, we have some really stringent reporting requirements for CDBG and it's everybody that's called, everybody that we've opened a file and then we have to have proof that they're low-income. So we can pull all of that out of reports out of MyCIL to make sure it goes along every month with our report. So it's things like that that we've customized, the database. And now we're thinking about changing the whole state. AUDIENCE MEMBER: Question, I wanted to ask and haven't heard it brought up, but in Missouri, if you're going to contract with the state of Missouri for employment, mental health, whatever it might be, you have to be CARF accredited. I have not heard that and we're understanding that several federal contracts or fee-for-service programs also require that accreditation but, I would just like to know what, I havent heard that come up and wondered if any one of you have had, with your state contracts, because you've repeatedly talked about state contracts and whatever, if you're having to deal with that. DENNIS FITZGIBBONS: No. Not in our state. PAULA MCELWEE: I'd like to speak to that, if I could… DENNIS FITZGIBBONS: Okay. PAULA MCELWEE: And I can tell you more about that later, if you'd like. It is true that in Missouri for employment programs only, they are requiring that accreditation for the employment piece. Now a couple of centers in Missouri have decided to apply standards from other sections, not just employment because that has an administrative piece and so forth. In California, what they did was, they said, you must be CARF accredited if you have an employment program, unless you're an independent living center. And my suggestion would be that if you would feel that that's something you could advocate for in your state, that's a good conversation to have, right? So what they did is they have their resource specialist for California come in and do the review in the same way they would do the oversight of any employment program without an external review. In Wisconsin, they've decided voluntarily to do this peer review back and forth with each other. And there are some other options too for internal or external reviews, some of which are required, some of which are not. Whatever is being required tough in your state, I guarantee you, other states are doing it differently. Not all states do it the same. So when it comes to what's required with the certifications, that's also true of other things. You were talking about your accessibility specialists. What certifications would they need or not and so forth. So it is very different. I have done some of those CARF surveys in Missouri, by the way. AUDIENCE MEMBER: Been problems because we're also told it's mental health. It's any contract with the state of Missouri. And that came from DVR. PAULA MCELWEE: I don't know how DVR would know about the contract with mental health, do you? AUDIENCE MEMBER: They're from the oversight of the CILs. PAULA MCELWEE: The last I knew, that was not the case, but I can check for you and get back to you on that. AUDIENCE MEMBER: Toni Fabro who is the IL director through DVR in Missouri, it came from her at a recent SILC meeting. PAULA MCELWEE: CARF has been in the accreditation business for, I don't know, 50 years almost now. Came out of a vocational background. But they are in medical, they're in youth, they're in aging, they're in everything. They have different standards and different things going on in all those different areas. They do use a peer review process so at least one of your surveyors would be somebody with IL background. But they struggle with that because the IL community has not embraced them so they have trouble finding people with IL background to do the surveys. And I've known a number of a surveys that were delayed and delayed and delayed until they could get the one or two or three people who had that background to come on board. KATHIE KNOBLE-IVERSON: Paula, in Wisconsin, CARF was the word flying around almost 18 years ago and that's when we came up with our own peer review. The state was thinking about getting, somehow that all the centers had to get some sort of certification. PAULA MCELWEE: And Michigan did it for a while. Florida's talked about it. And the input from the field that created the current standards, the ones 18 years ago, not so much, but the current standards are right out of the Rehab Act. But that doesn't make the process good or fair and it's an advocacy thing on your local level to work that out state by state. Because state by state, that will vary so much. AUDIENCE MEMBER: Thank you. DENNIS FITZGIBBONS: Yes, thank you. Any other questions? Yeah. AUDIENCE MEMBER: Dennis, I was wondering if you could share what are the two systems that you are using now. DENNIS FITZGIBBONS: They're off the shelf. Let's see if I can remember the name. The one we're using for the Medicaid billing and now using for consumer records, it's called CareVoyant. I hear chuckling. Not clair, but Care. And the financial management is Sage 300. And that's been a little bit more difficult to make the switch to than the Sage 200, but they were no longer supporting that, which sort of precipitated the recent move of all these things in the past year plus. But the accountant is adjusting. AUDIENCE MEMBER: Thank you. DENNIS FITZGIBBONS: Against her will. AUDIENCE MEMBER: And she said that the Sage 300 does your Medicaid billing? DENNIS FITZGIBBONS: Sage 300 tracks a lot of the personal attendant information. But the billing is done through CareVoyant, plus another go-between software that the state requires between them and the Medicaid system. AUDIENCE MEMBER: In Missouri, we're doing like three-pieces for our Medicaid billing directly to them and we bill in-house. And we're just trying to find one software that will do it instead of piecing together 2 or 3 different softwares. DENNIS FITZGIBBONS: This CareVoyant, now that we're using it correctly looks like it's a real God-send. So might be worth looking at if it would fit your system. It may not because not all the Medicaid systems do things alike either. KATHIE KNOBLE-IVERSON: In Wisconsin, the state provides that you download their software and everybody has to use what they have. And bless their hearts, they'll make a change and forget to tell people. So everybody's in the same boat in Wisconsin, we use the same access point. Any other questions? Karen, did you have anything? KAREN EBER DAVIS: I would like to revisit a question I was going to ask you this morning. Collectively, you have somewhere in the multiple decades of experience of doing fee-for-service. And so tomorrow, magically, you wake up and you find that you are in a new center that has never done fee-for-service. You don't have any of your old contacts, it's a new state, everything's new, what would you do to develop fee-for-services? KATHIE KNOBLE-IVERSON: I'd be beating the sidewalks trying to figure out quickly who funds what in your environment. It depends on how big the environment is. If I came into a new city and that's where a lot of business took place, I would really start with human services, find their voc rehab sites and start to develop relationships with those folks immediately. And then find out who manages the city, if there's a city foundation, if there's local foundations, who does their city planning. If you're used to accessing those points, once you start doing fee-for-service, you're going to figure that out that there's a lot of similar opportunities in every county that you support. KAREN EBER DAVIS: Dennis? DENNIS FITZGIBBONS: I would take a different approach. I would assess the center itself on what its strengths and weaknesses are and what the assets are and sort of what the history is, the philosophy, how they operate and really get a sense of who in the center is really good at what, what may be some of the untapped skills are and really get some real basis for where you can start with the people you already have in place and find out if there's any excess capacity within that. KAREN EBER DAVIS: Thank you both. KATHIE KNOBLE-IVERSON: You would also hope that the staff that are there have some level of relationship. And I think that's really interesting in some businesses. And I'm not just using independent living centers. Only the upper management does the networking. Maybe only the executive director or somebody else belongs to a professional women's group or a executive group or a finance group and I think then people miss that opportunity to figure out how to network and how to, we encourage everybody, we'll pay for membership fees, for lunches if that's what they have do to participate in a group to get everybody that wants to, we don't force people to do it. Anybody that wants to start some sort of networking on a level that they're comfortable with. KAREN EBER DAVIS: I find in my work too that some of the up and coming non-profits have all of their staff involved in recognizing and finding opportunities for income, no matter what kind it is. And that some training is going on. So yes, being out in the community too.