Consumer-Directed Care CAP/Choice

1. Consumer-Directed CareCAP/Choice Self-Direction Option for CAP/DA

2. What is Consumer-Directed Care? • Truly being in charge of one’s own provision of services by selecting own personal care aide, formal services and actively planning and managing these services independently

3. Consumer-Direction • Consumer-direction offers people choice and control over the types of services, when, where and by whom services are delivered • The consumer takes responsibility for planning and controlling services • The consumer takes on the risk that was previously assumed by provider agencies and case managers.

4. 5 Core principles of self-direction • Freedom – To determine a meaningful life • To identify the amt, frequency and duration of when services are needed, how they are needed and by whom • Authority – To control budget, with assistance and purchase supports • Choose (hire) Personal Assistant who will provide their care. • Train, supervise and evaluate the worker

5. 5 Core principles of self-direction • Support – To obtain formal and informal resources to achieve goals and meet needs • Select individual providers and direct reimbursement for several waiver services • Release/fire the worker should this become necessary

6. 5 Core principles of self-direction • Responsibility –wise use of public funds • Negotiate the rate of pay and other benefits • Engage in a cooperative working arrangement with a Financial Manager who will pay the client’s worker; handle federal/state taxes and other payroll or benefits related to the employment of the worker; and reimburse other service providers under the direction of the participant • Confirmation – empowering client for leadership role he/she now possesses

7. What are the goals of consumer-directed care? • To give individuals choice and control over their services, as much as possible • To be flexible in the use of public funds to meet each individual’s needs • To use public money wisely and appropriately • To support individuals in their homes and communities

8. Levels of Self-Direction • Employer Authority • Participant recruits, hires, supervises, and direct work • Participant fulfill employer/payroll related tasks • May serve as a common law employer

9. Levels of Self-Direction • Budget Authority • Participant manages a budget • Free to make various decisions about purchasing goods and services

10. Features of consumer-direction • Participant-centered planning • Evolves from a process led by a participant • Reflects on participants chosen goals, preferences, needs, strengths, and desired outcomes • Identifies paid and unpaid people and supports in participant’s life • Identifies services, equipment, and supplies needed • Specifies time, place and ways to receive services

11. Features of consumer-direction • Participant budget • Involves participant, case advisor and FM • Identifies participant’s resources, including funding allocations, employment income and other sources • Outlines how funds will be spent on services, supplies, equipment and other needs • Receives funding agency approval for public funds • Must follow funding agency rules

12. Features of consumer-direction • Participant directs own services within funding source rules, the participant decides… • Whom to hire to provide supports • How, when and where supports are provided • What equipment and supplies to buy • From which supplier, store or vendor to purchase items

13. Assurances of consumer-direction • Both informal and formal supports can assist with services as needed, formal/informal supports include: family members & professional staff members chosen by the participant • An emergency back-up plan is required to assure adequate coverage of care needs to assure health, safety and well-being

14. Main Emphasis of Consumer- Direction • Offers more choices • Offers more control • Offers greater flexibility • Offers more responsibility

15. What services are available? • Personal Assistant (aide) • Financial Manager • Participant Goods and Services • Education and Training Services • Assistive Technology • Home Modification and Mobility Aides • Care Advisor • All other CAP/DA services and waiver services

16. Who is eligible? • Individuals eligible for Medicaid under MAA, MAD , MAB • Requires ICF or SNF LOC • Can have health, safety, and well being needs safely met in the home environment • Requires help with personal care, health care, and light household tasks • Meets same criteria under CAP/DA

17. Who is eligible? • Those whom understand the rights and responsibilities of directing one’s own care and are willing to self-direct or select a representative who is willing and capable of assuming this responsibility

18. Key players of Consumer-Direction • The CAP client/employee of record • The representative- person acting on behalf of the participant , when needed • The Personal Assistance- hired person to assist with personal care • The Case Advisor – synonymous to Case Manager • The Financial Manager (FM)- fiscal intermediary

19. How does Consumer Direction Works? • An assessment will be completed and a plan of care developed with the full participation of the participant or participant’s representative • Orientation and training will be provided on consumer-direction to participant and/or representative • Monthly care advisor consultation to offer advice on choices and decisions, community resources and any other area requested by the participant

20. Responsibility of the Consumer • Makes decisions about the best way to meet his/her needs • Selects services, supplies and equipment • Determines the level of help needed from others including the care advisor • Is the “employer of record” • Selects, hires and trains their personal assistant(s)

21. Responsibility of the Consumer • Determines work schedule and supervises worker • Evaluates performance of worker • Dismisses the worker or provide a corrective measure • Determines rate of pay for personal assistant

22. What is the role of the Representative • To make the best decision and choices for the participant/consumer while including the participant/consumer in these decisions • Must • demonstrate a knowledge and understanding of consumer-direction processes • understand the role and tasks of the Personal Assistant • be at least 18 years of age • work collaboratively with the Care Advisor and the Financial Manager

23. What is role of the Personal Assistant • Provides personal care and household maintenance • Works under the direction of the participant • Works when and where the participant chooses • Uses material, equipment and methods selected by the participant

24. What is the role of the Case Advisor? Case Advisor act in the same role as the Case Manager for traditional CAP/DA, but now is a resource and advocacy person • Assists participant in implementing plan and reviewing monthly expenses • Identifies community resources • Teaches participant how to select, train, and supervise personal assistant • Advocates and ensures needs are met • Communicates with others when changes in the plan or budget are needed

25. What is the role of FM? • Processes checks for personal assistant wages and other expenses • Withdraws state and federal taxes from wages • Files required state and federal documents to IRS • Gives participant and CA updates on budget and expenses

26. Supports to the consumer • Resources and training for participants • Option for participants to choose a representative • Grievance process within the agency • Option to return to traditional services • Maintenance of confidentiality • Monitoring by care advisor

27. Supports to the providers • Training for participants on how to manage supports • Hiring agreement between the participant and personal assistant • State and federal laws and regulations for employers

28. Assurances by the FM • Procedures for determining allocations • Rules on allowable services and expenditures • Approval of paid services • Requirements for service and financial reporting • Availability of a financial manager • Audits of records

29. How do we know that consumer-directed supports work? • Independent living programs since 1980’s • Self-determination in MR/DD since mid 1990’s (www.hrsi.org) • These projects show participant satisfaction and improvement in health, relationships, activities and quality of life, at no greater cost • CAP/DA providing CD since 2005 and the programs have been successful

30. What are opinions of providers • Currently provided in all 100 counties • These counties only have good things to say about CDC • Have been beneficial in assuring care needs, improvement in emotional health • Have consistency with care regiment