Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for the Participant Direction Option. The presentation will begin momentarily. Please dial in ahead of time to: 1-888-670-3525 Passcode: 771-963-1696 1
Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC) Participant Direction Option June 6, 2013 2
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Today s Presenter D.D. Pickle Agency for Health Care Administration 6
Purpose The purpose of this presentation is to provide an introduction to the Participant Direction Option (PDO) in the Long-term Care (LTC) Program. 7
PDO Overview The PDO puts the enrollees in control of hiring, training and supervising their direct service workers. Enrollees participating in the PDO must live in their own home or family home. 8
PDO Overview (cont d) The case manager will offer the PDO as well as explain the PDO requirements to enrollees who have at least one of the following services on their care plan: Adult Companion Care Attendant Care Homemaker Intermittent and Skilled Nursing Personal Care. 9
Terms You Should Know Participant Direction Option (PDO) -- An option that is offered by the long-term care plan. Participants choose who will provide their services and how and when their services are provided. Direct service worker -- An employee whom a participant hires to provide his or her PDO services. The direct service worker may be any qualified person the participant chooses, including a neighbor, family member, or friend. Employer/Participant Someone who lives in his or her own home or family home and chooses to participate in the PDO. The participant is also called the employer, which means that they hire, train, schedule, and supervise their direct service worker. Fiscal/Employer Agent (F/EA) -- An entity that takes care of all taxes and pays the direct service workers. The F/EA could be the managed care plan or a vendor. 10
Terms You Should Know (cont d) Participant Agreement - Explains the responsibilities for the participant and the long-term care plan. Participant/Direct Service Worker Agreement -- This agreement explains the responsibilities of the participant, the F/EA, and the direct service worker. Includes the direct service worker s duties, work schedule, and rate of pay. PDO services -- The services an enrollee may choose to self-direct. These services include: Adult Companion Care, Attendant Care, Homemaker, Intermittent and Skilled Nursing, and Personal Care. Representative -- Participants may choose a representative to act on their behalf and manage their employer responsibilities. A representative should be someone the participant trusts, such as a trusted neighbor, family member, or close friend. A representative cannot be paid and may not also be a direct service worker for the participants. 11
Participant Responsibilities Participants are responsible for: Recruiting, interviewing, training and hiring the direct service worker(s) Preparing a job description for the direct service worker(s) Scheduling the direct service worker(s) work hours Contacting the case manager to report an intended termination of a direct service worker(s) Notifying the case manager of the desire to no longer participate in the PDO 12
PDO Case Manager Responsibilities PDO Case Manager responsibilities include: Ensuring participants choosing the PDO understand their roles and responsibilities. Completing the PDO Pre-Screening Tool with each prospective participant and representative, to assess their willingness and ability to manage the PDO responsibilities. Helping the participant to begin the required F/EA documentation. 13
PDO Case Manager Responsibilities (cont d) Training participants on employer responsibilities Ensuring that direct service workers meet any required licensure and certification requirements prior to providing services to participants Helping participants as needed to find and hire direct service workers Maintaining regular contact with the participant 14
Direct Service Worker Responsibilities Direct service worker responsibilities include: Completing criminal background checks, as required by the long-term care plans. Reporting any suspected abuse, neglect, or exploitation of a participant to the long-term are plan and proper authorities. 15
Direct Service Worker Responsibilities (cont d) Communicating with the long-term care plans or the case manager, if the participant is unable to do so, about any change in the participant s condition, including an admission to a health care facility Providing adequate notice if the direct service worker will be unable to provide the scheduled service to the participant Providing a two-week notice to the participant if the direct service worker will be voluntarily terminating employment 16
Fiscal/Employer Agent (F/EA) Responsibilities Each long-term care plan is responsible for providing F/EA services. The F/EA functions include processing payroll and processing, filing, and paying all state and federal taxes on behalf of participants and their direct service workers. The long-term care plan can act as the F/EA, or they may contract with a vendor to complete this responsibility for them. 17
Direct Service Worker Qualifications Direct service workers must be at least 18 years old. Attendant care or intermittent and skilled nursing services must be provided by a registered nurse or licensed practical nurse. 18
Direct Service Worker Qualifications (cont d) It is recommended, but not required, that participants hire direct service workers who are: Trained in infection control Trained in HIPAA privacy standards Certified in CPR and First Aid. 19
How Will the Direct Service Worker Be Paid? Direct service workers will be paid an hourly rate, based on which PDO service is provided. The long-term care plan sets the rate of payment for each PDO service. The F/EA helps take care of many employer responsibilities, which include paying the direct service workers. 20
Background Screening Required for all: Direct service workers Representatives Purpose: To protect the participant To make sure that the direct service worker or representative has not committed certain crimes 21
Emergency Back-Up Plan An emergency back-up plan is needed in case a direct service worker is not able to come to work or stops working for the participant. The participant and case manager are responsible for creating the emergency back-up plan. 22
PDO Satisfaction Surveys Conducted by the Florida Agency for Health Care Administration (AHCA) each year. The AHCA will use the information provided by participants to improve the program. 23
PDO Timing More information about the exact start date of PDO in each region will be forthcoming. 24
Resources Questions can be emailed to: FLMedicaidManagedCare@ahca. myflorida.com Updates about the Statewide Medicaid Managed Care program are posted at: http://ahca.myflorida.com/smmc Upcoming events and news can be found on the News and Events tab. You may sign up for our mailing list by clicking the red Sign Up for Program Updates box on the right hand side of the page. 25
Questions?