When a participant’s plan contains a Fiscal Intermediary (FI) service with Easter Seals Financial Management (ESFM) as a provider, it must include a Per Member Per Month (PMPM) service. PMPM Service(s) shall be added to the plan to cover the entire span of Easter Seals Financial Management services. PMPM is a monthly service and is prorated for partial months.
● One or more FI services provided by Easter Seals Financial Management must include a PMPM service for the same dates.
● Multiple PMPM services within a plan cannot overlap on any given date.
● The Service in iRecord appears as Per Member Per Month (PMPM) for a participant in a waiver program.
● Medicaid is the only option for the Payment Source.
● The Procedure drop-down lists the following options:
• T2040HI22 – One or more SDEs working 0-40 hrs. per week for the individual or the employer of record (ESNJ) and not electing health benefits
• T2040HI22 – One shared SDE working less than 30 hrs. per week for the individual but 30+ hrs. per week for the employer of record (ESNJ) and electing health benefits
• T2040HI22 – 1 SDE working 30+ hrs. per week for individual OR 2 or more shared SDEs working less than 30 hrs. per week for individual but 30+ hrs. per week for employer, & electing health benefits
• T2040HI22 – Two or more SDEs working 30+ hrs. per week for the individual and electing health benefits
● The Location options are:
• Home
• Community
• Facility
● The Rate is populated based on the selected Procedure and is non-editable. The Unit Type displays Service(s). The Total Units are calculated based on the number of calendar months for the duration of the PMPM service.
● The Total Cost is calculated using the rate for full calendar months and prorated for the days of partial calendar month(s).
● The cost of a PMPM service is taken from the budget types in the order listed below:
1. Supports
2. Emp/Day
3. DSP Service
4. Residential
● The Change Plan Status tile displays red for a PMPM service that has not been matched by the required conditions, as shown in the example below. The following table provides the conditions and the appropriate tooltip message for a PMPM service with a red litmus indicator on the Change Plan Status tile.
Condition |
Message |
No PMPM service in a plan where Easter Seals Financial Management is a provider for one or more of the services. |
Add PMPM Service(s) to the plan |
PMPM service(s) is added to the plan and does not cover the duration of the services provided by Easter Seals Financial Management. |
PMPM does not cover full duration of FI service(s) with Easter Seals Financial Management as the FI |
PMPM service(s) start date is before the start date of the services provided by Easter Seals Financial Management. |
PMPM Service(s) start date cannot be before <start date> (Start date of the FI service with ESFM) |
PMPM service(s) end date is after the end date of the services provided by Easter Seals Financial Management. |
PMPM Service(s) end date cannot be after <end date> (End date of the FI service with ESFM) |
PMPM service is added to a plan without a service provided by Easter Seals Financial Management. |
Remove PMPM Service(s) – No service with Easter Seals Financial Management as the FI |
Two or more PMPM services have dates that overlap in a plan. |
PMPM services dates are overlapping |
A service that has been added to a plan with a defined plan term (such as an annual plan) will continue to display the start date of the full term service in the past, if not approved. A delayed approval of such a plan will retain the service start date. In case the Support Coordinator edits the service and then approves the plan after the actual start date of the annual plan, which results in a gap plan, it is only then that the start date changes with plan approval.
The instructions below indicate the steps for adding Individual Supports full term service to a plan. Currently, this is applicable for CCP and CCP Transition plans.
1. On Plans, select the appropriate outcome
and click 
for the addition of
a PMPM service.
The respective controls are highlighted below.
2. The Service controls appear, as shown below. Enter the appropriate details in the Service section for the PMPM service.
3. Click
and Provider
controls appear, as shown below (with details provided for this section).
Enter the appropriate details of Provider
section.
4. Click
and Details
controls appear, as shown below.
The Rate field is populated based
on the Procedure selected in the
Provider section.
The Unit Type field displays Service(s).
The Rate and Unit
Type fields are non-editable.
Note: Use 
or on
the tile header to browse through Outcome,
Service, Provider
and Details information.
5. A PMPM
service must be included with FI service(s) provided by Easter
Seals Financial Management. With the addition of more than one
PMPM service, the dates of the services must include the time period of
the services provided by Easter Seals
Financial Management and at the same time, the PMPM services cannot
have overlapping dates.
The example below displays a single PMPM service that spans the two Easter Seals Financial Management
services shown in step 1.
Note: Editing the dates of an FI service provided by Easter Seals Financial Management may require the user to also edit the dates of a PMPM service.
6. Click
to save the service in the Outcome.
7. The Plans tab displays the PMPM service.
Note: Please ensure that a PMPM service covers the period for services provided by Easter Seals Financial Management. The service duration must remain distinct (cannot overlap) for more than one PMPM service.