Spectrum of Self-Directed Care

Maryland, Medicaid Office of Health Services

John S. WilsonApril 5, 2012

Community First Choice

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How We Created the Spectrum Reviewed the Person Centered Planning for Consumer Directed Care

resource guide produced by the National Resource Center for Participant-Directed Services (NRCPDS).

Incorporated the key concepts of the guide into our analysis after having reviewed other states’ programs.

Analyzed information on self-direction programs referred by community disability advocates.

Resource Guide: http://www.bc.edu/content/bc/schools/gssw/nrcpds/tools/handbook.html

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How the Spectrum Works Analysis of self-direction programs in the following states: Kansas* (KS),

Missouri (MO), Arizona† (AZ), New York (NY), Tennessee (TN), California (CA), Colorado (CO), Virginia* (VA), and Wisconsin (WI).

Matrix consists of three models with varying degrees of state oversight and participant responsibility.

* State allows participants to choose among a variety of models.† Self-direction model is non-Medicaid funded and run by Community

Independent Living Centers.

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Plan of ServiceProfessional Model Interdisciplinary Team

ModelSelf-Directed Participant Model

Examples: KS*, VA*, MO

Examples: NY, AZ†, New Mexico, KS*, WI, VA*

Examples: CA, KS*, VA*

Description: Professional creates plan of service for participants.

Description: Participant works with professional to create plan of service.

Description: Participants develop their own plan of service.

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Plan of Service (Supports Broker)

Professional Model

Interdisciplinary Team Model

Self-Directed Participant Model

Examples: MO, NY, KS*, VA*

Examples: WI, VA*, KS*, AZ†, TN

Examples: CA, KS*

Supports Broker: Description: Mandatory case manager is only participant support person.

Description: Case manager is supplemented by mandatory supports broker.

Description: Consumer may choose someone to assist but isn't provided a broker or consultant

Case Manager All models employ a case manager as primary participant support.

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Provider Rate SettingState Limits w/ POC Participant receives cash

allotment

Example: MO

Examples: TN, WI, NY

Examples: CA, KS, VA*, AZ†

Description: State sets the rate. Participant has no control.

Description: State approves a rate range (or a maximum) that the participant has option of paying providers.

Description: Participants receive monthly allocation and spend according to their plan of service.

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Provider QualificationsState Waive-able Participant

Example: MO

Examples: NY, KS*, VA*

Example: AZ†

Description: Providers must meet the minimum level of qualifications set by state.

Description: Qualifications are set by state but can be waived.

Description: Participants develop their own provider qualifications. No mandatory minimum requirement.

All models allow participants to hire and fire staff

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MonitoringCase Manager Supports Liason None

Examples: TN, NY, VA*, KS*, MO

Example: VA*

Example:AZ†

Description: Oversees plan of service.

Description: Supports Broker is tasked with ongoing reviews, including collection of incident data, to ensure plan continuity.

Description: Self-reported regularly.

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Discussion To recap, models vary in state oversight

and consumer responsibility: Which model would be best for Maryland to

adopt? What suggestions do you have regarding

the models?What concerns do you have about the

models?

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Service Delivery OptionsProvider Managed Self-Direction

Examples: Examples:

Description: Consumer can choose from range of Provider Managed options from traditional agency-based to “hybrid” agency based (described by MDF in other documents).

For the purposes of Medicaid funding, a state must offer a traditional “provider-managed” service delivery option alongside self-direction and ensure there are no service breaks during transition periods. This feature recognizes that not all participants may want to assume the responsibilities that self-direction entails.

Description:Managing Workers aka “employer authority”*•Fiscal/Employer Agent (F/EA)*•Co-employer / Agency with Choice*•Consultant Broker Services•Other (Fiscal Conduit, Public Authority/Workforce Council)

Individual Budget aka “Budget Authority”*

When a state offers self-direction of HCBS, it generally must allow participants to opt into or out of directing their services.