NC Innovations Individual Family Introductory Training Part I: An Overview of Individual/Family

Directed SupportsEffective October 2013“It’s all about choice”

Information provided in this presentation pertains only to the counties in the Cardinal Innovations Region. This information is specific to the Cardinal Innovations Region and may not apply to Local Management Entities (LMEs), providers, stakeholders or individuals outside the Cardinal Innovations catchment area.

Presentation slides are brief, bullet-points of information and should not be used out of context.

Copyright © 2011 Cardinal Innovations. All rights reserved.

Disclaimer

What is Individual and Family Directed Supports?

Self Directed ServicesManaging the Individual and Family Directed BudgetEmploying workers who provide services or managing workers employed by an agencyMore control over servicesBased on the principles of Self Determination

Principles of Self Determination

• Freedom• Authority• Autonomy • Responsibility• Confirmation

Self Direction in a Waiver Environment

• Partners in the implementationCenters for Medicare and

Medicaid (CMS)- Federal Division of Medical Assistance

(DMA)-State• Because we are using Medicaid

dollars (federal and state tax dollars) there are rules around how self direction must occur

Center for Medicare and Medicaid Services (CMS) Requirements in

Self Directed Services

• Information is available to make an informed choice about directing services

CMS Requirements

• Payments cannot be made directly to the individual or the family either to reimburse for expenses incurred or to pay a service provider directly

• Financial Support Agency or Agency With Choice manages funds

CMS Requirements

• Individuals can self direct one or more services

• Service planning is led by the individual

• Independent advocacy is available

• Authority over the Individual and Family Directed Budget

CMS Requirements: Back up staffing

• Two levels of back up staffing are required for each service

• Immediate coverage if the individual can not be left alone

• Who to call if the plan is not working• Ways to manage risk• Emergency responses to weather and

environmental emergencies• Contact numbers• Location of the first aid kit• Plan to test back up plan quarterly• Unique to the individual• Immediately accessible and operational

Who is here to support me?

• Individual and Family • Care Coordinator• Community Guide• Direct Service Professional

(Employee)• Employer of Record or Managing

Employer• Financial Support Agency or

Agency With Choice• Representative

Individual

If the Individual receiving waiver services is not the Employer of Record or Managing Employer, they need to be as involved in the process as much as possible

The Employer of Record or Managing Employer is …

• An individual participating in the NC Innovations Waiver if they are 18 or older and do not have a legal guardian (the individual)

Or• Parent of a child under 18

Or• The legal guardian of an individual

participating in the NC Innovations Waiver

The Employer of Record or Managing Employer may not be

• A Limited Liability Corporation (LLC)

• A Partnership

The Direct Support Professional

• Works for the Employer of Record or the Agency with Choice

• Works when and where you choose within the rules of the Waiver

• Does what you want him or her to do within the rules of the Waiver

• In the Agency with Choice Model, decisions are shared with the Agency

Community Guide

• Empowers Employer to define and direct services

• Understands Employers’ needs and preferences

• May not be the Employer or representative and the family may not be paid to provide service

• Service is mandated for Employers of Record until they demonstrate competence in self-direction duties and may be mandated for Managing Employers

Community Guide Functions

• Links to resources/connects to the community

• Teaches ways to use the Financial Support Agency or Agency with Choice report

• Helps employer develop employees support agreements

• Provides information on recruiting, hiring, managing, training, evaluating and changing support staff

Community Guide will not

• Interview, hire, train or fire employees• Complete employment forms• Find back up employees• Obtain extra money for the Employer if

the budget is overspent• Make decisions for the Employer• Do the duties of the Care Coordinator

Care Coordinator

• Completes assessments• Completes process for appointment of

the Representative, if needed• Completes referrals to Financial

Support Agency and/or helps you include an Agency With Choice and Community Guide in your ISP

• Helps the Employer complete the Individual and Family Support Agreement

Care Coordinator

• Completes the Individual Support Plan (ISP)/ Update to ISP

• Sends the ISP to Utilization Management for approval

• Sends a copy of the approved ISP to team members including Community Guide, Employer and/or Representative

Making Changes

If an Employer needs a change in the ISP or budget they notify the Care Coordinator

Care Coordinator Monitoring or Individual/Family Directed Supports

• Monthly Monitoring• Monitoring Checklist• Natural Supports can assist

in monitoring

Care Coordinator will not

Complete the duties of the Community Guide

Representative

• The Representative is someone who can assist the Employer or Record or Managing Employer in performing some or all of their duties

• Chapter 1 of the Employer Handbook has information about the role of the Representative

Design of NC Innovations Individual/Family Direction

Community

GuideCare Coordinator

CIHS-Systems Manager

Financial Support

Services or Agency With

Choice

Services that can be Individual/Family Directed

• Community Guide• Community Networking• Individual Goods and Services• In-Home Intensive Supports• In-Home Skill Building• Natural Supports Education• Personal Care • Respite • Supported Employment

How the Individual and Family Directed Service (Self Directed) Budget works…

Individual and Family Directed Budget contains the services you choose to self direct (if this Option is chosen)

Pay Rates and Benefits for Employees

• Determined by the Employer of Record or Agency with Choice, depending on model elected

• Pay rate will have floor (minimum wage plus (required taxes) and ceiling (service rate)

Individual Goods and Services

Flexible service; allows for purchase of services/supplies not covered in a Medicaid program that meet the following guidelines:

– Based on an identified need– Decrease need for other Medicaid funded services– Promote community inclusion or increase personal

safety– Individual/family does not have the personal funds to

purchase the item or service.– $2,000 Waiver Year Limit– Must relate to a goal/need– Are provided to or directed exclusively towards the

benefit of the individual

NC Innovations funds cannot be used for:

• Gifts for workers, families or friends• Loans to employees• Rent, mortgage payments, room, board• Payments for someone to be the representative • Clothing• Alcoholic beverages• TV, radio, DVD• Tobacco products• Services that are available without charge from

community organizations• Items that are illegal

NC Innovations funds cannot be used for (continued)

• Special Diet• Experimental Goods and Services• Items which are restrictive under NC G.S. 122C-60 • Items which are social or recreational • Vacation expenses• Services covered by a third party or services that

are the responsibility of a Non-Medicaid program or service provider

• Training materials for NC Innovations goals

This is not an exhaustive list

Individual/Family Directed Option: Service Options

• Provider Directed• Individual/Family Directed

Two Models of Individual/Family Directed Supports

• Employer of Record• Agency with Choice

(Managing Employer)

Advantages of Each Option/Model

• Most Control: Employer of Record Model

• Moderate Control: Agency with Choice Model

• Least Control: Provider Directed Services Option

Changing Options or Models

• If the individual tries an option or a model and is not satisfied they can change.

• The individual has the flexibility to direct only the services that they choose.

Which model do you want to choose?

• Agency With Choice• Employer of Record • Want to consider both

models

Next Module(s)

Agency with Choice Model and/or Employer of Record Model