Participant Direction 201: Support Brokerage in Participant - PowerPoint PPT Presentation

Participant Direction 201: Support Brokerage in Participant Direction Services Suzanne Crisp, Director of Program Design and Implementation Merle Edwards-Orr, Director of Veteran Initiatives May 29, 2015

Goals for Today  Examine the functions to support individuals self-directing  Except Financial Management Service (FMS)  Classify the functions  Identify specific tasks for each functional area  Introduce conflict of interest  Examine the various models  Quality oversight – what does this look like?  Hear from Kansas and New Jersey  Open Q&A 2

Functions to Support Participants

Why a Support System?  Required for all authorities:  Information and Assistance (I&A)  Financial Management Services (FMS)  Studies have found this system is essential to a successful self- directed program  When participants have questions, they must know where to go  When supports are not available, how do you monitor and measure the integrity of your program? 4

Supporting the Individual Level I – Case Management  Through the person-centered planning process:  Assesses functional, social, and behavioral needs  Develops service/recovery plan  Determines individual budget allocation  Monitors the provision of services  Links participant with community resources  Safeguards health and welfare 5

Supporting the Individual Level 2  Distinct support system to self-direction  Provides information, assistance, and support through the person-centered planning process  Tasks include:  Providing orientation to self-direction  Explaining program permissibles  Making informed hiring and managing decisions  Identifying additional supports  Assisting with training staff  Developing a back-up plan for emergency situations  Assisting with FMS negotiations 6

Information and Assistance: Definition  The service/function that assists the participant (or the participant’s family or representative, as appropriate) in arranging for, directing and managing services  The service is available to assist in identifying immediate and long-term needs, developing options to meet those needs and accessing identified supports and services  Offers practical skills training to enable families and participants to independently direct and manage waiver services. Examples of skills training include providing information on recruiting and hiring personal care workers, managing workers, and providing information on effective communication and problem-solving Instructions and Technical Guidance for 1915(c) Home and Community Based Waivers, Centers for Medicare & Medicaid Services

Information and Assistance: Definition  The service/function includes providing information to ensure that participants understand the responsibilities involved with directing their services  The extent of the assistance furnished to the participant or family is specified in the service plan  This service does not duplicate other waiver services, including case management Instructions and Technical Guidance for 1915(c) Home and Community Based Waivers, Centers for Medicare & Medicaid Services

Information and Assistance: Purpose and Functions  These supports are made available to participants to help them manage their waiver services  For example, assistance might be provided to help the participant locate workers who furnish direct supports or in crafting the service plan.  The type and extent of the supports that must be available to participants depends on the nature of the participant direction opportunities provided under the waiver. Instructions and Technical Guidance for 1915(c) Home and Community Based Waivers, Centers for Medicare & Medicaid Services

CMS Guidance to States Information may be provided to participant about:  Person-centered planning and how it is applied;  Range and scope of individual choices and options;  Process for changing the plan of care and individual budget;  Grievance process;  Risks and responsibilities of self-direction;  Freedom of choice of providers;  Individual rights;  Reassessment and review schedules; and,  Such other subjects pertinent to the participant and/or family in managing and directing services. Instructions and Technical Guidance for 1915(c) Home and Community Based Waivers, Centers for Medicare & Medicaid Services

CMS Guidance to States Assistance may be provided to the participant with:  Defining goals, needs and preferences, identifying and accessing services, supports and resources;  Practical skills training (e.g., hiring, managing and terminating workers, problem solving, conflict resolution)  Development of risk management agreements;  Development of an emergency back up plan;  Recognizing and reporting critical events;  Independent advocacy, to assist in filing grievances and complaints when necessary; and,  Other areas related to managing services and supports . Instructions and Technical Guidance for 1915(c) Home and Community Based Waivers, Centers for Medicare & Medicaid Services

Support Brokerage Models

Model A  I and A absorbed by the  CM conducts orientation. existing case management  Provides information and assistance – ongoing basis function  CM is trained on self-  Findings:  Cost neutral direction  Adds to CM workload  Offers the option during  CM selects who she/he assessments and might work with reassessments  Disincentive for CM to take on labor intensive  If option selected by individuals individual, CM processes  Due to time limitations, I enrollment and A may not be realized  Weak program = weak results 13

Model B  I and A provided by a new  Findings: functional area  Frequently role confusion  Added as a support service  Cost of the new function either as a service (FMAP may be an issue  What type of training is Available) or administrative involved? function (50% match rate)  Who monitors the new  Provider qualifications function? manage who provides.  Quality oversight must be  Often times, family embedded in the program members may provide  Works in concert with the case manager 14

Model C  I and A contracted to a for-  Findings:  Cost may be an issue profit or non-profit entity  Role clarification critical  Selected by a Request for  Communication path to Proposal (RFP) method CM essential  Contract stipulates the day-  What type of training? to-day operations of I and A  Who monitors performance?  Quality oversight must be embedded in the system  If one vendor supplies all I and A – must ensure a back-up plan is in place 15

Model D  Emerging trend to contract  Findings:  Communication between with the FMS entity the participant, financial  Along with processing staff and I and A staff more payroll and managing the streamlined individual budget absorbed  Greater opportunity to duties of I and A identify fraud, abuse, or  Has a greater opportunity to mis-use of funding offer a complete picture of  Monitoring may be more challenging the activities and actions of  Quality system must be those self-directing embedded in the program 16

Conflict of Interest & Managing the Moving Parts

Conflict of Interest Policy  Providers of HCBS for the individual, or those who have an interest in or are employed by a provider of HCBS for the individual must not provide case management or develop the person-centered service plan.  Providers may be allowed if the State demonstrates that the only willing and qualified entity to provide case management and/or develop person- centered service plans in a geographic area also provides HCBS.  In these cases, the State must devise conflict of interest protections …which must be approved by CMS. Individuals must be provided with a clear and accessible alternative dispute resolution process.”  42 CFR §441.301

Managing all the Moving Parts  Define roles and responsibilities  Develop policies and procedures  Conduct training  Create communication paths  Everyone needs to be part of the person-centered planning process  Include the FMS staff  Identify how the functions will be monitored and by whom  Apply measurable performance standards  Require each function to submit data on activity 19

Research Study & Findings 20

Research Study “Multi - State Survey of Support Brokers”  Purpose: learn how supports brokers are prepared for and carry out their duties. Survey n=140  Findings:  Inconsistent understanding of role  Inconsistent or lack of training  Low comfort level in helping participants with SD  Recommendations:  Training – periodic and on-going request  Assisting with employer related duties  Managing hired workers  Update on program policies, procedures & options  Role definition  Difference between case management and supports brokerage 21

Findings from Managed Care Studies  Frequently, I and A is subsumed by the case manager or service coordinator.  Interviews with service coordinators reveal often times I and A is lost and issues are referred to the FMS and often time never resolved.  Service coordinators lack standardized training.  Confusion about their role with self-direction.  Service coordinators control level of time and enthusiasm committed to self-direction. 22

Quality Oversight 23