NASHP State Health Policy Conference October 2010 Julia Kenny Assistant Secretary Office for Citizens with Developmental Disabilities Louisiana Department of Health and Hospitals Louisiana Self-Direction Option • CMS approved Louisiana’s “New Opportunities Waiver” effective July 1, 2003. • 1915(c) waiver that allows for consumer direction of home and community based waiver services. • Self-direction is a service delivery option in the NOW, which allows participants to take the leading role in the employment of their service workers. • Participants are in charge of recruiting, hiring, firing, and supervising the people who work for them. Self-Directed Services Approved Under Waiver • • OCDD currently only provides individualized and family support through NOW. OAAS will provide other services through a more comprehensive “Community Choices” waiver next calendar year including: • • • • • • • • • • • • • Support Coordination Transition Intensive Support Coordination Transition Service Personal Assistance Services Adult Day Health Care Environmental Accessibility Adaptations Personal Emergency Response System (PERS)* Assistive Devices and Medical Supplies* (Includes PERS) Skilled Maintenance Therapy Services (PT, OT, ST and RT) Nursing Services Home Delivered Meal Services Caregiver Temporary Support Services (Respite) Non-Medical Transportation Fiscal management • Louisiana OCDD Central Office Fiscal Section began by managing payment and documentation of all IFS direct support workers’ salaries and benefits who were hired by NOW recipients. • OCDD subsequently amended its application from serving as an “agency of choice” to “fiscal management agent.” • RFP process was undertaken and Acumen was chosen to serve as fiscal/employer agent. Duties performed by Acumen • Processes employee time sheets • Generates payroll checks for employees • Conducts criminal background checks • Processes all employment records • Withholds, files, and deposits all necessary taxes in accordance with federal IRS, DOL, and state rules • Provides participants, support coordinators, and OCDD with monthly participation reports • Maintains a toll-free call center for self-direction participants, support coordinators, and others to call for information • Tracks employee training • Offers workman’s compensation coverage • Acts as a billing agent for each DSW under a single provider number, bills Medicaid. Participant Satisfaction 2009 Survey found that: • • • • 98% were satisfied with services provided by Acumen 92% were satisfied with the self-direction option 92% believe they receive the services they need 85% stated “I have a choice and control over my supports and services” Participation Rates and Retention • Currently, there are 3,341 citizens in 3 regions receiving services under NOW. • Of these citizens, 60 or 1.8% are on self-direction. • Enrollment in SD has tripled since 2003. • In the last 3 weeks, 12 more have applied. • NOW statewide extension will lead to the addition of at least 78 to SD enrollment. • Statewide training initiative is expected to increase utilization rate to 10% or approximately 769 participants. • Adding the SD option to our CC waiver will lead to an approximate increase of 200 participants based on a utilization rate estimate of 20%. • Since 2003, no one has voluntarily chosen to leave self-direction.* Hannah • Higher PCA rate paid for persons with a greater need level ended in 2003. • Through SD she is able to compete for better workers by offering them a higher rate. • She has found that it is much easier to hire and retain qualified workers since she switched from the traditional agency-hired worker to self-direction. • The only new tasks Hannah has to deal with is the additional paperwork associated with new hires, and reviewing and faxing time sheets. • Fiscal agent has been helpful assisting and streamlining these processes. • Challenges: managing backups, training requirements, background checks Challenges • DSW Registry Rule • Billable training hours • Goods and services waiver adjustment to allow for supplies, fax machines, mileage reimbursements, advertising and employee recruitment. Where SD is headed in Louisiana • Statewide expansion of services under NOW. • Inclusion of SD in the Children’s Choice waiver (personal care services). • Residential Options waiver (community living supports; companion care; & community integration transportation).