Independence Plus

State policy makers and consumer advocates are advancing programs and policies to support community living for all individuals. Operationalizing principles of “self direction,” “consumer direction,” or “participant direction” entails many details. This State Policy in Practice technical assistance document offers concrete information and specific state examples on ways to implement participant-directed planning and individualized budgeting.

Under Independence Plus Medicaid programs, states must assure that necessary safeguards have been taken to protect the health and welfare of persons receiving services. A key component of participant-direction includes individualized backup planning to ensure that essential supports are available in situations that pose a risk of harm to the participants. These examples are instructive to other states that are considering Independence Plus applications.

This report describes the FY 2002 and FY 2003 Grantees’ challenges and progress using information provided by the Grantees during the reporting period October 1, 2003 to September 30, 2004. The report describes grant activities in four major LTC systems areas: Access to Long-Term Care Services and Supports, Services, Supports, and Housing, Administrative and Monitoring Infrastructure and Long-Term Care Service and Support Workforce

This is the first in a series of classic information documents.

South Carolina developed a simplified provider agreement to make Medicaid enrollment easier for providers that normally do not provide Medicaid services. The State piloted the agreement in an Independence Plus Medicaid Home and Community-Based Services Waiver and in a Nursing Home Transition Grant. The six-item agreement contains only the minimum federal requirements for Medicaid providers and can allow Medicaid participants to receive services, equipment, etc. from non-traditional providers.

The Independence Plus Initiative was established to give states expanded opportunities within Medicaid to allow for consumer direction of long-term services and supports. The consumer direction movement continues to evolve rapidly, and this calls for federal and state resources to evaluate new and changing programs. This issue paper explores the difference between IP and Cash and Counseling, the 1115 demonstration, IP and HCBS Waivers, and outlines policy implications.

This website is the site for the Maine Quality Choices grant. Maine’s Work Group for Community-Based Living includes a broad array of consumer and state representatives from five departments (Transportation, Labor, Education, Human Services, and Behavioral and Developmental Services). The website offers information on the Work Group, Accessing Services, Community Living, Data Integration, Person-Centered Services, Quality Improvement, Workforce and a Project Index.

The New Freedom Initiative, announced in February 2001, called for a comprehensive assessment of federal policies, programs, statutes, and regulations to identify barriers that impede community living for disabled individuals—and for recommended solutions. In October 2004 CMS awarded an additional $30 million in Real Choice Systems Change Grants—this money in addition to the 188 grants for over $158 million between fiscal years 2001-03. This report highlights accomplishments of those programs.

Recent health policy shifts and practice changes have explored consumer-directed health care. The National Council on Disability decided to research & evaluate the evidence base in order to offer a clear picture of the initiatives strengths and weaknesses. This study includes a systematic review of the literature (both print & Web-based) on consumer-directed and -oriented care. The study also addresses questions and researches the variety of models, preferences, outcomes and cost-effectiveness.

Real Needs-Real Costs With an Eye Toward the Future: A Process for Developing Service Plans and Individual Budgets was presented on October 12, 2004 at a teleconference for CMS Independence Plus Grantees. The presentation draws on 6 years of prior experience in developing Consumer Directed Programs for adults at the Area Agency of Greater Nashua.