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
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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:
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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:
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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).
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Participant Satisfaction