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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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