Medicaid’s Consumer Direction Options Consumer Direction Regional Conferences - June, 2006...

Medicaid’s Consumer Direction Options

Consumer Direction Regional Conferences - June, 2006

Sponsored byColorado Department of Health Care Policy

and FinancingIndependence Plus Grant #18-P-92019/8-

01

What is Consumer Direction?

• Consumer Direction is a philosophy and orientation to the delivery of Home and Community Based Services (HCBS) whereby informed consumers make choices about the services they receive. They can assess their own needs, determine how and by whom these needs should be met, and monitor the quality of services.

Background

1995 - Individuals with disabilities and advocates began discussing

alternative approaches to providing attendant services

to consumers in Colorado.

1996- S.B. 96-178 – CDAS program2002 – S.B. 02-027 – IHSS service option2002 – H.B. 02-1039- CDCE program2005 – H.B. 05-1243- Consumer Direction Service

Option in all HCBS waivers

Options• In Home Support Services – “agency with choice”

service option available to HCBS-EBD and Children’s HCBS clients only.

• Consumer Directed Care for the Elderly (CDCE) –An HCBS program designed to offer clients 55 years and older and/or their authorized representative the opportunity to direct their personal care and homemaker services. Currently being piloted in Adams, Arapahoe, Denver, Douglas, Elbert, Mesa, San Juan, La Plata and Archuleta counties.

• Consumer Directed Attendant Support – An 1115 waiver designed to offer clients 18 years and older the opportunity to direct their attendant support services.

Key Features

• Exemption of the Nurse Practice Act• Flexibility• Control• Choice• Responsibility• Monthly Allocation Budget• Training

Stakeholders & Partnerships

• Advisory Committee• Consumers – (Clients)• Single Entry Point (SEP) agencies• Intermediary Service Organization • In Home Support Services provider

agencies • The Department

Services

• Attendant support – in home care and other supportive activities to assist eligible individuals to accomplish daily living tasks.

Services

Health Maintenance Activities • Those routine and repetitive activities

of daily living which are necessary for health and normal bodily function.

• An individual with a disability would carry out these activities if he/she were physically able.

Examples: bowel/bladder care, blood glucose monitoring, medication administration, vent care

Services

• Personal Care – bathing, dressing, grooming, nail care

• Homemaker - routine light

housecleaning, meal preparation, laundry, shopping

IHSS

• Eligibility– Determined by the SEP or Certified

Case manager– Physician Statement– Completed Authorized Representative

Form, if applicable

IHSS

• Services– Health Maintenance Activities– Personal Care– Homemaker

IHSS

• Service Delivery– Services are provided by an attendant, under

direction of the consumer, a parent or guardian of a child, or an authorized representative.

– Attendant must be employed by an IHSS provider agency

– A consumer, parent or Authorized Representative can choose the certified IHSS agency;

– The IHSS agency hires an attendant of the consumer and/or authorized representative’s choice OR

– The IHSS agency can provide an attendant from their pool of available works, with consumer and/or Authorized Representative approval

CDCE

Eligibility– Determined by the SEP

• 55 years and older• Meet HCBS-EBD eligibility criteria

Clients interested in directing personal support services must:

• Provide a Physician Statement of Consumer Capability

• Authorized Representative form, if applicable • Complete Personal Support Management Training

CDCE Services

• Adult Day• Alternative Care

Facility• Electronic

Monitoring• Home Modification• Non Medical

Transportation

• Homemaker• Personal Care• Personal Support

(Self-Directed)• Respite

CDCE

• Consumers and/or Authorized Representatives are responsible for recruiting, hiring, and determining wages for their personal support attendants.

• Consumers are required to manage their personal support services within the monthly allocation determined by the SEP.

• Attendants are employed through Accent Intermediary (ISO). Accent serves as an Employer of Record for attendants employed through the CDCE program and provides accounting, personnel, and training services to CDCE clients.

CDAS

Eligibility– Determined by the Department

• 18 years old• Eligible for Medicaid in Colorado• Demonstrate a need for Attendant

Support• Provide a Physician Statement of

Consumer Capability and Authorized Representative form, if applicable

• Complete Attendant Support Management Training

CDAS

Services

• Health Maintenance Activities• Personal Care • Homemaker

– Clients and/or Authorized Representatives are responsible for recruiting, hiring, and determining wages for their attendants.

– Clients are required to manage their Attendant Support services within the monthly allocation determined by the Department.

– Attendants are employed through Accent Intermediary (ISO). Accent serves as an Employer of Record for attendants employed through the CDAS program and provides accounting and personnel services to CDAS clients.

CDAS

Fund for Additional Services • A key program feature that allows

clients to purchase items and/or services that promote independence and improve conditions related to their disability that are not covered through other Medicaid programs with unspent program funds.

What’s next?

The Department is working on amending each HCBS waiver to include a Consumer Directed Attendant Support Service option.

The HCBS-EBD waiver amendment is completed and will be submitted to Centers for Medicare and Medicaid Services for approval.

Contact Information

•IHSS George Good-

deCurnou(303) 866-2704George.good-decurnou@state.co.us

• CDAS & CDCEAggie Berens(303) 866-3358

aggie.berens@state.co.us