Community First Choice Spectrum of SelfDirected Care Maryland

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 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 2

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. 3

Plan of Service Professional Model Examples: KS*, VA*, MO Interdisciplinary Team Model Examples: NY, AZ†, New Mexico, KS*, WI, VA* Description: Professional creates plan Participant works with of service for participants. professional to create plan of service. 4 Self-Directed Participant Model Examples: CA, KS*, VA* Description: Participants develop their own plan of service.

Plan of Service (Supports Broker) Professional Model Interdisciplinary Team Model Examples: MO, NY, KS*, VA* WI, VA*, KS*, AZ†, TN Supports Broker: Description: Mandatory case Case manager is only supplemented by participant support mandatory person. supports broker. Case Manager 5 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 State Limits w/ POC Participant receives cash allotment Example: MO Examples: TN, WI, NY Examples: CA, KS, VA*, AZ† Description: State sets the rate. approves a rate range (or Participant has no control. a maximum) that the participant has option of paying providers. 6 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: 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 7

Monitoring 8 Case Manager Supports Liason None Examples: TN, NY, VA*, KS*, MO Example: VA* Example: AZ† Description: Oversees plan of service. 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? 9

Service Delivery Options Provider Managed Self-Direction 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 traditional “provider-managed” service delivery option • Other (Fiscal Conduit, Public 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. 10