Consumer/Participant Direction

First of Three Papers on Unlocking the Code of Effective Systems Change - This paper attempts to create an overall framework for the discussion of systems change and to give a summary of the concepts. Several specific recommendations from other successful programs and the recommendations and guidance of the colloquium participants, can be applied now by any grantee, state, or program to enhance prospects of achieving enduring change in home- and community-based services.

This summary of the Home and Community Based Services (HCBS) State Plan Amendment (SPA) option is based on a review of the Deficit Reduction Act (DRA) and discussion from the April 3, 2006 conference call with CMS staff and Real Choice grantees. The content reflects the Rutgers/NASHP TA collaborations understanding of the legislation and questions raised by grantees. The intent is to highlight what is known about the DRA and some questions about how it will affect States that elect this option.

Beneficiary-managed individual budget model had its origins in the Cash & Counseling Demonstration. This brief describes the evolution of the model since the original demonstration and provides an overview of state activity. Although Medicaid waivers have been required for individual budget model programs to date, the Deficit Reduction Act gives the option to use this model for an expanded range of home and community based services in the Medicaid plans without having to obtain a waiver.

The statehealthfacts.org had recently added a data on states who offer Individual Budget programs. Use this interactive guide to compare and review activities related to participant-directed care. Data includes the program type, program name, CMS waiver authority, includes elderly, and a status update. Current as of January 2006.

What are the opportunities and potential pitfalls of this new policy that makes major changes to the Medicaid program? This paper offers explanation and analysis of the changes to the long-term services policies including: Asset Transfers, Long-term care Partnership Programs, Family Opportunity Act, Money Follows the Person Demonstration, State Option to Provide HCBS Services, Cash and Counseling Option.

On March 31, 2006, HHS Secretary Michael Leavitt outlined new flexibilities available to states under the Deficit Reduction Act (DRA) of 2005 (Pub.L. No. 109-171). Find out how the new DRA provisions may link with other options available under Medicaid to transform long-term care to person-centered care and to expand coverage for individuals with disabilities, increase access to community supports, and promote personal responsibility, independence, and choice.

This report focuses on the current system for critical incident reporting and tracking within long-term care waiver programs. It also includes recommendations from stakeholders on a definition of critical incident and emergency backup, policy recommendations for new mechanisms that would more appropriately address the needs of consumers, and outlines an implementation plan for new critical incident management mechanisms and statewide emergency backup infrastructure.

The Colorado Department of Health Care Policy & Financing contracted with an independent consultant to organize and facilitate six focus groups with consumers of Medicaid waiver services, family members or representatives, and consumer-directed program participants. The focus groups discussed consumer experiences with existing emergency backup and critical incident management systems and identified strengths and potential weaknesses. This report provides results from the focus groups.

With this funding for Systems Transformation, CMS will be awarding several states and non-profit agencies with small supplemental grants. States and other eligible organizations, in partnership with their disability and aging communities, may submit proposals to design and construct systems infrastructure that will result in effective and enduring improvements in community long-term support systems.

This monograph discusses program design considerations to assist as states move toward greater individuality and flexibility in the provision of services and supports. The paper outlines topics to consider when expanding opportunities for participants to choose and direct individual who provide assistance, including the risks/benefits arrangements, provider qualifications, training, person-centered planning, the case manager role, and safeguards to prevent abuse, neglect and exploitation.