Consumer/Participant Direction

HCBS.org News CLIPS highlights the important work related to Real Choice Systems Change Grantees. In each issue, we examine a topic related to home and community-based care by providing an overview of recent papers and publications. The Spring issues provides an overview of the reports available on consumer direction and Cash & Counseling. Models of self-directed personal assistance services have been researched, reviewed and evaluated by many sources. Review the many resources available.

Making a Difference is a quarterly magazine of the Governor’s Council on Developmental Disabilities. The Governor’s Council on Developmental Disabilities collaborates with Georgia’s citizens, public and private advocacy organizations and policymakers to positively influence public policies that enhance the quality of life for people with disabilities and their families.

Interested in how to use media to market your program? Minnesota has developed short video clips to make it easier for consumers to learn about “You Decide. Your Help.” The following video segments show viewers how to use the consumer directed service option to provide the help you need to continue to live at home. These clips give viewers the basic information on what the option is, who is eligible and who to contact for more information.

This table is modified from previous chart received during CMS Presentation at 2003 HCBS Waiver Conference (October 28, 2003 Milwaukee, WI) and in draft form. It compares the 1915c, 1115, or DRA for the following issues: Level of Care/ Eligibility, Combining Populations, Budget Neutrality, Reporting, Renewal, and Evaluation, Support Brokerage, Cash Allowance, Hiring Legally Responsible Individuals, Provider Agreements, Direct Payment to Providers, Payment for Services.

An FMS Membership Issue Brief Summary, this issue brief presents existing fraud detection and prevention methods that directly address a selection of the recommendations offered in the 2012 report Personal Care Services: Trends, Vulnerabilities, and Recommendations for Improvement released by the Department of Health and Human Services Office of Inspector General (OIG).

The purpose of this study was to describe the two ways in which Medicaid offers personal care services to low-income Americans: Medicaid Title XIX Personal Care Services (PCS) optional state plan benefit; and the Medicaid 1915(c) Home and Community-Based Services (HCBS) waivers program. A summary of the findings of this study are presented here as well as the article that appeared in the Health Care Financing Review, Summer 2001.

This summary draws attention to some of the most important aspects of CMS’s recently released guidance for states and stakeholders on the use of managed care for long-term services and supports (MLTSS) as well as transitioning LTSS providers into managed care systems and developing MLTSS programs. CMS identified 10 important elements that should be incorporated into managed LTSS and this document can assist consumers and their representatives in understanding these elements.

The Patient Protection and Affordable Care Act (ACA) requires large employers to provide affordable healthcare coverage to full-time workers as of January 1, 2014. In preparation for the implementation of the the ACA, the NRCPDS looked into how participant direction will be impacted by the new legislation. As a consequence, in the context of participant direction, the employer mandate is likely to apply to certain Financial Management Services (FMS) providers.

This scan was designed to understand facilitators and barriers to self-direction in behavioral health, ascertain interest among stakeholders, adapt the model and outcome measures to better fit the needs of behavioral health consumers, and develop recommendations to inform next steps. The scan was a joint effort conducted over 18 months (Sept 2011-Feb 2013) by researchers from the National Center for Participant-Directed Services, Human Services Research Institute, and University of Maryland.

This report provides background on MLTSS to brief the intellectual and developmental disability community, as well as the President and the Secretary of the Department of Health and Human Services, on managed care and changes in LTSS administration so that they may take action and influence outcomes. The report also contains a number of recommendations related to disability stakeholder engagement, choice and self-determination, consumer protections and rights and quality measurement.