Medicaid

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Medicaids Consumer Direction Options

• Consumer Direction Regional Conferences - June,
  2006
• Sponsored by
• Colorado Department of Health Care Policy and
  Financing
• Independence Plus Grant 18-P-92019/8-01

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What is Consumer Direction?

• Consumer Direction is a philosophy and
  orientation to the delivery of Home and Community
  Based Services (HCBS) whereby informed consumers
  make choices about the services they receive.
  They can assess their own needs, determine how
  and by whom these needs should be met, and
  monitor the quality of services.

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Background

• 1995 - Individuals with disabilities and
  advocates began discussing alternative
  approaches to providing attendant services
• to consumers in Colorado.
• 1996- S.B. 96-178 CDAS program
• 2002 S.B. 02-027 IHSS service option
• 2002 H.B. 02-1039- CDCE program
• 2005 H.B. 05-1243- Consumer Direction Service
• Option in all HCBS waivers

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Options

• In Home Support Services agency with choice
  service option available to HCBS-EBD and
  Childrens HCBS clients only.
• Consumer Directed Care for the Elderly (CDCE) An
  HCBS program designed to offer clients 55 years
  and older and/or their authorized representative
  the opportunity to direct their personal care and
  homemaker services. Currently being piloted in
  Adams, Arapahoe, Denver, Douglas, Elbert, Mesa,
  San Juan, La Plata and Archuleta counties.
• Consumer Directed Attendant Support An 1115
  waiver designed to offer clients 18 years and
  older the opportunity to direct their attendant
  support services.

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Key Features

• Exemption of the Nurse Practice Act
• Flexibility
• Control
• Choice
• Responsibility
• Monthly Allocation Budget
• Training

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Stakeholders Partnerships

• Advisory Committee
• Consumers (Clients)
• Single Entry Point (SEP) agencies
• Intermediary Service Organization
• In Home Support Services provider agencies
• The Department

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Services

• Attendant support in home care and other
  supportive activities to assist eligible
  individuals to accomplish daily living tasks.

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Services

• Health Maintenance Activities
• Those routine and repetitive activities
• of daily living which are necessary for health
  and normal bodily function.
• An individual with a disability would carry out
  these activities if he/she were physically able.
  
• Examples bowel/bladder care, blood glucose
  monitoring, medication administration, vent care

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Services

• Personal Care bathing, dressing, grooming, nail
  care
• Homemaker - routine light housecleaning, meal
  preparation, laundry, shopping

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IHSS

• Eligibility
• Determined by the SEP or Certified Case manager
• Physician Statement
• Completed Authorized Representative Form, if
  applicable

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IHSS

• Services
• Health Maintenance Activities
• Personal Care
• Homemaker

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IHSS

• Service Delivery
• Services are provided by an attendant, under
  direction of the consumer, a parent or guardian
  of a child, or an authorized representative.
• Attendant must be employed by an IHSS provider
  agency
• A consumer, parent or Authorized Representative
  can choose the certified IHSS agency
• The IHSS agency hires an attendant of the
  consumer and/or authorized representatives
  choice OR
• The IHSS agency can provide an attendant from
  their pool of available works, with consumer
  and/or Authorized Representative approval

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CDCE

• Eligibility
• Determined by the SEP
• 55 years and older
• Meet HCBS-EBD eligibility criteria
• Clients interested in directing personal support
  services must
• Provide a Physician Statement of Consumer
  Capability
• Authorized Representative form, if applicable
• Complete Personal Support Management Training

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CDCE Services

• Adult Day
• Alternative Care Facility
• Electronic Monitoring
• Home Modification
• Non Medical Transportation

• Homemaker
• Personal Care
• Personal Support (Self-Directed)
• Respite

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CDCE

• Consumers and/or Authorized Representatives are
  responsible for recruiting, hiring, and
  determining wages for their personal support
  attendants.
• Consumers are required to manage their personal
  support services within the monthly allocation
  determined by the SEP.
• Attendants are employed through Accent
  Intermediary (ISO). Accent serves as an Employer
  of Record for attendants employed through the
  CDCE program and provides accounting, personnel,
  and training services to CDCE clients.

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CDAS

• Eligibility
• Determined by the Department
• 18 years old
• Eligible for Medicaid in Colorado
• Demonstrate a need for Attendant Support
• Provide a Physician Statement of Consumer
  Capability and Authorized Representative form, if
  applicable
• Complete Attendant Support Management Training

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CDAS

• Services
• Health Maintenance Activities
• Personal Care
• Homemaker
• Clients and/or Authorized Representatives are
  responsible for recruiting, hiring, and
  determining wages for their attendants.
• Clients are required to manage their Attendant
  Support services within the monthly allocation
  determined by the Department.
• Attendants are employed through Accent
  Intermediary (ISO). Accent serves as an Employer
  of Record for attendants employed through the
  CDAS program and provides accounting and
  personnel services to CDAS clients.

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CDAS

• Fund for Additional Services
• A key program feature that allows clients to
  purchase items and/or services that promote
  independence and improve conditions related to
  their disability that are not covered through
  other Medicaid programs with unspent program
  funds.

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Whats next?

• The Department is working on amending each HCBS
  waiver to include a Consumer Directed Attendant
  Support Service option.
• The HCBS-EBD waiver amendment is completed and
  will be submitted to Centers for Medicare and
  Medicaid Services for approval.

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Contact Information

• IHSS
• George Good-deCurnou
• [phone]
• George.good-decurnou_at_state.co.us

• CDAS CDCE
• Aggie Berens
• [phone]
• aggie.berens_at_state.co.us