Spectrum of Self-Directed Care Maryland, Medicaid Office of Health Services John S. Wilson April 5, 2012 Community First Choice
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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.
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