1915(j) Self-Directed Personal Assistance Services State Plan Option

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1 1915(j) Self-Directed Personal Assistance Services State Plan Option What are self-directed PAS? 1 Personal care and related services under the Medicaid State plan, and/or Home and community-based services under section 1915(c) waiver If selected by the State, PAS may also include permissible purchases

2 Section 1915(j) Features Individuals have employer authority - can hire, fire, supervise and manage workers capable of providing the assigned tasks 2 AND Individuals have budget authority - can purchase personal assistance and related services from their budget allocation

3 Section 1915(j) Features 3 Participation is voluntary Can disenroll at any time Participants set their own provider qualifications and train their providers of PAS Participants determine amount paid for a service, support or item

4 Section 1915(j) Features If a State elects the section 1915(j) option: 4 The State could target the population using section 1915(c) waiver services The State could limit the number of individuals who will selfdirect their PAS The State could limit the option to certain areas of the State or offer it statewide

5 Section 1915(j) Features 5 If the State Medicaid agency allows the following, participants can: Hire legally liable relatives (e.g., parents, spouses) Manage a cash disbursement Purchase goods, supports, services or supplies that increase their independence or substitute for human assistance (to the extent expenditures would otherwise be made for the human assistance) Use a discretionary amount of their budgets to purchase items not otherwise delineated in the budget or reserved for permissible purchases Use a representative to help them direct their PAS

6 Section 1915(j): Resources 6 SMD Letters and Preprint Medicaid.gov Medicaid By Topic Optional Benefits

7 1915(k) Community First Choice (CFC): Key Features 7 Section 2401 of the ACA added a new section 1915(k) to the Social Security Act State option to provide person-centered home and community-based attendant services and supports Effective October 1, 2011 States will receive 6 percentage point increase in FMAP Provided on a Statewide basis

8 Who May Receive CFC services? Must be eligible for medical assistance under the State plan Must meet and institutional level of care Must be part of an eligibility group that is entitled to receive nursing facility services; if not, income may not exceed 150% of FPL Enrollment is voluntary 8

9 What Are CFC services? Attendant services and supports to assist in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks through hands-on assistance, supervision, or cueing. Back-up systems (such as electronic devices) or mechanisms to ensure continuity of services and supports. The State must offer a voluntary training to individuals on how to select, manage and dismiss attendants. 9

10 Services - State Options 10 Allow for transition costs such as security deposits for an apartment or utilities, purchasing bedding, basic kitchen supplies, and other necessities required for transition from an institution. Allow for the provision of services that increase independence or substitute for human assistance to the extent that expenditures would have been made for the human assistance.

11 Room and board Excluded Services Special education and related services provided under IDEA and vocational rehab Assistive technology devices and assistive technology services (other than those defined in (a)(3))* Medical supplies and equipment * Home modifications* * These services may be provided if they meet the requirements at (b)(2) 11

12 Beneficiary Focus Utilizes a person-centered plan Consumer -Directed Service Delivery Models: Agency-provider model Self-directed model with a service budget 12 This model may utilize vouchers, direct cash payments and a financial management entity to assist in obtaining services Other service delivery model approved by the Secretary. Services must be provided in a home or community setting, that does not include a nursing facility, institution for mental diseases, or an ICF/IID.

13 State Requirements Maintenance of Existing Expenditures 13 For the first full 12 month period in which the state plan amendment is implemented, the State must maintain or exceed the level of State expenditures for home and community-based attendant services and supports provided to elderly or disabled individuals under the state plan, waivers or demonstrations.

14 State Requirements 14 Collaborate with a Development and Implementation Council that includes a majority of members with disabilities, elderly individuals, and their representatives. Establish and maintain a comprehensive continuous quality assurance system specifically for this service. Collect and report information for Federal oversight and the completion of a Federal evaluation.

15 Data Collection 15 Number of individuals who are estimated to receive CFC during fiscal year Number of individuals that received CFC during preceding year Number individuals served by type of disability, age, gender, education level, and employment status Individuals previously served under other HCBS program under State Plan or waiver

16 CMS Requirements CMS is required by 12/31/15 to conduct an evaluation in order to determine: the effectiveness of this provision in allowing individuals to lead an independent life to the maximum extent possible, the impact on physical and emotional health of individuals receiving these services a comparative analysis of the costs of services provided under Community First Choice and those provided in an institution. An interim report of this evaluation is due to Congress by 12/31/13. 16

17 Community First Choice: Resources 17 Final Regulation published May 7, HCBS Setting Criteria NPRM published May 2, 2012 (comment period closed July 2, 2012)

18 Summary 18 Medicaid is complex, but the complexity offers various avenues/opportunities for increasing home and community-based services

19 Contact Information For more information on 1915(c): 19 Regional Office Representative or Kathy Poisal, , or Marge Sciulli , For more information on 1915(i): Regional Office Representative or Kathy Poisal, , For more information on 1915(j) and/or 1915(k): Regional Office Representative Kenya Cantwell, ,