How do Support
Brokers fit in
Wisconsin?
Self Directed Supports
in Dane County
Robert Wood Johnson Foundation
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Based on a the Robert Wood Johnson Foundation (RWJF)
Grant in New Hampshire:
In November 1995, the RWJF authorized up to $5 million to
establish the Self-Determination for People with
Developmental Disabilities Program.
The program's goal was to help states implement a more
cost-effective system for serving persons with
developmental disabilities while simultaneously giving
those persons and their families more choice in
determining the services they receive.
The national program office was set up in January 1996.
Wisconsin one of the first states awarded & Dane County
began it’s pilot in January 1997
Consumer Directed Supports
Medicaid Waivers Manual Chapter IV
Allowable Services and Provider Requirements Page IV-59
CONSUMER-DIRECTED SUPPORTS
SPC 609.10
Applies to CIP1A, 1B, BIW (See 609.20 for similar service)
DEFINITION
The provision of a flexible array of services provided to participants that include a specified portion
of the services covered by the waiver. Services are planned and implemented through processes
characterized by:
1. Support for the consumer and those close to the consumer to assist in identifying the
consumer’s goals and means of reaching those goals, in a manner that reflects consumer
preferences as closely as possible;
2. Planning that occurs within the limits of an individualized budget that is based on typical service
costs for Waiver participants with similar needs in similar situations; and
3. An emphasis on identifying and strengthening networks of informal supports and on making use
of generic community resources to the maximum extent possible.
4. Processes and supports for person-centered service planning, implementation, operation and
monitoring that are established through a locally developed county Consumer-directed Services
(CDS) implementation plan that is subject to approval by the department. Based on this plan, a
Memorandum of Understanding (MOU) is executed between the county and department. This
MOU governs county operation of this service.
Case Management
CARE MANAGEMENT/SUPPORT AND SERVICE COORDINATION
(Also known as Case Management)
SPC 604
Applies to CIP 1A/1B, BIW, CIP II, COP-W, CLTS & COR
DEFINITION
Care management/support and service coordination is the provision of service to
locate, manage, coordinate and monitor all waiver program services, additional
services, (regardless of funding source) and informal community supports provided to
eligible applicants/participants and to assure that services are provided in accordance
with program requirements. This service is intended to insure the waiver program
participant’s health and safety by enabling the participant to receive a full range of
appropriate services and supports consistent with his/her assessed needs in a
planned, coordinated, efficient and cost effective manner. While these general
guidelines apply to all care management/support and service coordination provided,
the service activities may be target group or age-specific.
This service includes assistance with establishing financial, functional and all other
aspects of Medicaid waiver eligibility. Service may also include assisting the
participant to access waiver, Medicaid state plan, medical, social and natural
supports and services. Beyond plan development and service coordination activities,
the CM/SSC role includes the primary responsibility to assure participant health and
safety.
Becoming a Support Broker
All support brokers are hired and trained by one of the
seven support broker agencies listed in the previous
section. Once hired and trained by a support broker
agency, brokers then interview with and get selected by
people with disabilities. While each support broker
agency develops its own job descriptions, all have
agreed to the universal elements listed in this section’s
“Job Description”.
Additionally, broker job descriptions get individualized by
the people with disabilities who select them.
Support Broker Role
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Support Brokers will be selected by and work under the direction of
the person receiving support.
People selecting Support Brokers will be urged to select a Support
Broker that is independent of a service provider to minimize the
inherent conflict of these roles.
People can change Support Brokers and will be asked to renew and
sign a contract each year outlining their expectations
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Will meet the minimum qualifications according to the
guidelines of the Medicaid Waiver program.
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Will successfully pass a criminal background check.
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A Support Broker cannot be a legal representative of the
person receiving support.
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Support Brokers must be readily accessible to the individual.
Support Broker Job Description
Purpose: To advocate for adults with developmental and other disabilities
to lead a self-directed life. We believe people with disabilities deserve the
opportunity to direct their own supports while maintaining or improving their
quality of life in their homes and in their community.
Duties and Responsibilities
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Planning
Training
Fiscal Responsibility – public funding and personal funds (e.g. benefits)
Communication
Mandatory Reporting
Paperwork Documentation
Knowledge of Community Resources
Team Building and Conflict Resolution
How do Support
Brokers fit
in Wisconsin?
Common Themes In
Self-Determination
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Expand people’s choices
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Enable people to control the money spent
on their support and services
Conceptual Shift
Previous System
Self-Determination
Concept
Person as recipient
to
Person as manager
Administrative
Structure
Program Centered
to
Individual Centered
Case Management
Assigned
to
Chosen
Payment System
Money held by
County
to
Money held by
Person
Provider Role
Respond to County
to
Respond to Person
Choice
Limited to
Contracted Providers
to
Open
Contracting
Slots
to
Individual Agreements
Planning Process
Provider Case Manager
to
Broker facilitated person centered
planning
Quality Assurance
Based on
Minimum Standards
to
Based on
person's expectations and outcomes
Dane County
Adult Community Services
Intake & Eligibility
United Cerebral Palsy
Assessment & Planning
One time funding
Waisman Center
Community TIES
Crisis/Behavioral Intervention
Person/Family
with
Presenting Need
Mobility Training &
Independent Living
Activities of Daily
Living Skills Training
Mental Health Center
Counseling, Groups,
Psychiatric Consultation
Responsive Solutions,
Inc.
On-call Crisis Staff
Environmental
Modifications/Adaptations
How Adults are Supported
Living arrangements
Live with family
Live with roommate (s)
Living alone, in cluster
Living alone, come-in support
Living alone with behavioral support
AFH Licensed 3-4
AFH Certified
CBRF
Out of County
Total
Day Support
Supported Employment/Self-Employed
Facility-Based (Sheltered/Adult Day Care)
Total
Number
Served
247
670
59
97
51
42
42
2
4
Number of
Providers
1214
18
Number
Served
909
305
Number of
Providers
13
3
1214
14
14
3
32
2
2
Current terrain in Wisconsin
ADRC
Independent Consulting
Agency (ICA)- TMG
Independent
Consultant –
Assigned by ICA
Develop Individual Support Plan
The person directs their funding
based on this plan
MCO(s)
Care Manager
Individual Service plan developed.
Funding is approved based on RAD
Group Project
Jim
IRIS
 Cri du Chat, MR, poor coordination,
behavioral issues
 Jim lives at home with his parents
(guardians) who provide all of his
supports: personal cares, house cleaning,
transportation, medical appointments and
keeping Jim safe.
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Supports
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Mom and Dad
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Summer Camp staff
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Church friends
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Respite Staff
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Therapist
Concerns
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Paperwork
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questions about benefits
 Time to research questions and resolve
issues
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Finding resources and following up with
potential providers
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Ongoing planning
Craig
IRIS
 Muscular Dystrophy, sleep disorder, back
pain, cataracts
 Staff and Craig’s wife help with: personal
cares, house cleaning, transportation, help
set up my medical appointments, and
always attend these appointments with
me.
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Supports
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Wife
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Father
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Staff he knows and trusts
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Muscular Dystrophy Association
Concerns
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Gets anxious about paperwork:
 Timesheets
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letters from Medicare and Medicaid
Keeping track of recommendations from
his many doctors.
Dawn
IRIS
 TBI with some physical impairments
 Father is guardian and lives out of county.
 Lives alone with residential “come-in”
support for house cleaning and organizing
finances.
 Employed with support from a vocational
provider.
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Supports
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Dad and Step-Mom
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Siblings
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Residential Staff
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Vocational Staff
Concerns
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Liaison discussions between providers,
family (guardian) and Dawn.
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Financial negotiations with providers.
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Paperwork questions especially benefits.
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No proximity of guardian.
Presenter Information
Alexa Butzbaugh – Progressive Community
Services
[email protected]
(608) 848-8305
 Kevin Keisling – Avenues to Community Inc.
[email protected]
(608) 663-8390 Ext. 436
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Care Manager - In Control Wisconsin