Transcript mddforum.org

Community First Choice
Spectrum of Self-Directed Care
Maryland, Medicaid
Office of Health Services
John S. Wilson
April 5, 2012
How We Created the Spectrum
 Reviewed the Person Centered Planning for Consumer Directed Care
resource guide produced by the National Resource Center for ParticipantDirected 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.h
tml
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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 Service
Professional Model
Examples:
KS*, VA*, MO
Interdisciplinary Team
Model
Examples:
NY, AZ†, New Mexico,
KS*, WI, VA*
Description:
Description:
Professional creates plan Participant works with
of service for participants. professional to create
plan of service.
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Self-Directed Participant
Model
Examples:
CA, KS*, VA*
Description:
Participants develop
their own plan of service.
Plan of Service (Supports Broker)
Professional
Model
Supports Broker:
Case Manager
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Interdisciplinary
Team Model
Examples:
Examples:
MO, NY, KS*, VA* WI, VA*, KS*, AZ†,
TN
Description:
Description:
Mandatory case Case manager is
manager is only
supplemented by
participant support mandatory
person.
supports broker.
Self-Directed
Participant Model
Examples:
CA, KS*
Description:
Consumer may
choose someone
to assist but isn't
provided a broker
or consultant
All models employ a case manager as primary participant
support.
Provider Rate Setting
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State
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.
Provider Qualifications
State
Waive-able
Participant
Example:
MO
Examples:
NY, KS*, VA*
Example:
AZ†
Description:
Description:
Providers must meet the Qualifications are set by
minimum level of
state but can be waived.
qualifications set by state.
Description:
Participants develop their
own provider
qualifications. No
mandatory minimum
requirement.
All models allow participants to hire and fire staff
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Monitoring
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Case Manager
Supports Liason
None
Examples:
TN, NY, VA*, KS*, MO
Example:
VA*
Example:
AZ†
Description:
Oversees plan of service.
Description:
Description:
Supports Broker is
Self-reported
tasked with ongoing regularly.
reviews, including
collection of incident
data, to ensure plan
continuity.
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 Options
Provider 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).
Description:
Managing Workers aka “employer
authority”*
• Fiscal/Employer Agent (F/EA)*
• Co-employer / Agency with Choice*
For the purposes of Medicaid funding, a state must offer a • Consultant Broker Services
• Other (Fiscal Conduit, Public
traditional “provider-managed” service delivery option
alongside self-direction and ensure there are no service
Authority/Workforce Council)
breaks during transition periods. This feature recognizes
that not all participants may want to assume the
Individual Budget aka “Budget
responsibilities that self-direction entails.
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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