Consumer/Participant Direction

States are confronting challenging budgets along with the need to implement health reform. Many are looking to improve long-term care as a way to control costs and serve seniors and people with disabilities in settings they prefer. This newsletter describes provisions in the Affordable Care Act that assist states in expanding HCBS, the growing movement to improve facility-based care, and innovative programs in three states that seek to provide consumer-directed long-term care.

Hiring relatives as caregivers remains a controversial policy issue. This two-state case study reports findings about views from policy experts regarding a policy option to hire family caregivers in HCBS long-term care programs. Policy makers also discussed information needed by other states considering this option and effective approaches to disseminate findings about this option from the Cash & Counseling Demonstration Evaluation.

Presentations from NASHP's 23rd annual conference held October 4-6 in New Orleans are available online. Included are remarks from CMS Administrator Donald Berwick , and presentations such as Health Care Reform: New Options for Rebalancing Long Term Services and Supports, Integrating Care for Dual Eligibles, Reforming State Long Term Services and Supports Programs through Participant Direction, and numerous others. Review the presentations about vital issues in state health policy.

Findings in this report focus on what has been learned about the status of grant implementation and factors that facilitate progress early and throughout the implementation period, and progress on grantees’ goals and achievement of Systems Transformation (ST). It presents results for both FY05 and FY06 ST Grantees, builds on findings from the first annual report and focuses on two different stages of implementation for the FY05 grantees (Year 3) and the FY06 grantees(initial 15-months).

What are the goals of consumer direction? Does mental illness affect consumer direction of community-based care? This presentation addresses these and other tough questions faced in planning and implementing participant-directed programs. Information on consumer assessments, representatives, and common sense approaches and intervention are discussed, as well as additional tools and resources.

Check out this guide geared toward the participant/consumer on how to hire and manage personal assistants. Written with the goal of promoting self-determination, this user-friendly guide helps the consumer understand their role as employer and covers topics such as determining the supports they need, finding workers and the role of the Fiscal Intermediary. It includes sample forms, worksheets, checklists, job descriptions, as well as a glossary and tips for helping to keep organized.

Review findings of a study of outcomes of adults with mental illnesses in the Cash & Counseling program compared to those receiving traditional Medicaid services. Such individuals experienced higher satisfaction with their quality of life and with their paid caregivers, fewer unmet needs, no more injuries or other adverse health outcomes than other patients, no significant differences in total expenditures, and were able to successfully manage the cash option.

This letter informs States of several changes to Section 1915(i) of the Social Security Act (the Act) made by the Affordable Care Act (ACA). These changes, which become effective October 1, 2010, include revised and new 1915(i) provisions for removal of barriers to offering HCBS services through the Medicaid State plan. This letter is intended to provide guidance on important changes to the law including: Number Served & Statewideness, Financial Eligibility, Targeted Benefits and Services.

Read the evaluation report of a training project for case management agencies that coordinate home care and Medicaid waiver services for older residents (Aging Services Access Points). The curriculum encouraged a shift in philosophy and explained the roles of consumers and case managers guided by a consumer-directed philosophy. Results indicated that the regional training was highly effective in achieving its goals. Detailed information about methods of training and evaluation are included.

The Benjamin Rose Institute on Aging sponsored PPAR’s Winter/Spring 2010 issue. It includes seven articles written by national experts describing recent and notable changes in LTC policy, with its increasing emphasis on HCBS services. An introductory essay provides a 30-year review of the evolutionary process of LTC. Consumer-directed initiatives, caregiver and workforce issues, maturation of the service delivery system, and a review of recent state-level initiatives are discussed.