- Report Published -
|A Study of Consumer-Directed Services|
|Department of Medical Assistance Services|
|HJR 539 (Regular Session, 1995)|
|The 1995 General Assembly passed House Joint Resolution 539 which requests the Department of Medical Assistance Services to evaluate the feasibility and advisability of amending the existing Elderly and Disabled Waiver to allow individuals to hire their own personal attendants. For purposes of this study, this will be referred to as a study of consumer-directed services. The Department of Medical Assistance Services convened a workgroup for the purpose of evaluating the impact of offering a consumer-directed model of Personal Care on consumers, providers and other agencies in the community. The members of the workgroup included: Virginia Association for Home Care, Consumer Representative for Persons with Disabilities, Department for the Aging, Consumer Representative for the Elderly, Department of Social Services, League of Local Social Services Executives, Department of Rehabilitative Services, Department of Rehabilitative Services - OBRA Waiver, Department of Mental Health, Mental Retardation & Substance Abuse Services, Centers for Independent Living, Board of Nursing, Virginia Board for People with Disabilities, and Department of Medical Assistance Services.|
There is consensus among the Workgroup that Virginia could amend its Elderly and Disabled waiver to offer consumers who require assistance with personal care activities an option to receive those services in a consumer-directed model. The following recommendations address the feasibility and advisability of offering a consumer-directed service and are in no way intended to fully outline all the details which must be addressed in an implementation of consumer-directed service. These recommendations were also developed without regard to Congressional Medicaid reform which could impact specific aspects of the design of community-based services. Implementation of these recommendations should be considered in conjunction with the implementation of any Medicaid reform.
• Virginia should offer a consumer-directed model of service to elderly and disabled persons age 18 and over, who have no cognitive impairment and are able to communicate sufficiently to hire, train and provide instruction regarding their needs to attendant staff. The model developed by Pennsylvania can serve as a model.
• This consumer-directed model of service should be offered in conjunction with the agency-directed service model already in place.
• The Medicaid program should use agencies (e.g., providers of home health, personal care, centers for independent living, etc.) to serve as fiscal agents for the consumer-directed service. The IRS recognizes the fiscal agent as an appropriate intermediary for purposes of income tax reporting, payment of social security (FICA taxes), federal and state unemployment taxes.
• The Department of Medical Assistance Services (DMAS) should provide training to the pre-admission screening assessors regarding when the option of consumer-directed service is appropriate. DMAS should also develop clear and simple written communication that outlines the consumer's risks and responsibilities and defines the role the fiscal agent agency plays in a consumer-directed model. This is necessary to minimize the possibility that the consumer underestimates the degree of individual responsibility he or she assumes in this model. There must also be documentation that the consumer has been apprised and understands all rights, responsibilities and risks of managing the personal attendant service and has made an informed choice to assume those risks.
• The consumer-directed program should include training for the consumer that assures that the consumer understands how to manage his or her service. The ideal source for this training is other consumers.
• The requirements for attendants in the consumer-directed model should be: an ability to read and write, a minimum age of 18 years, and willingness to submit to a criminal record check. Although there would be no formal training or education requirements, every attendant should be provided information to assure appropriate introduction to the philosophy of consumer-directed service.
• The fiscal agent should be required to employ or contract with a service coordinator who is responsible for completing periodic reassessments and for authorizing the initial service plan and any subsequent changes in the consumer service plan.
• DMAS should initiate a toll-free consumer telephone line to respond to consumer issues and as a way for someone in the community to communicate concern about a specific consumer's service that may indicate needed follow-up from a service coordinator.
• Reimbursement for the attendant services should include a rate sufficient for the payment of wages, FICA, taxes and a reasonable administrative overhead to the fiscal agent. There should be a separate reimbursement for service coordination and a separate reimbursement for training.
• The attendant should be considered as a physical extension of the consumer's body, compensating for parts of the consumer's own body which no longer function. The mentally alert consumer is completely in control of his or her own service. Therefore, the attendant should be able to provide, at the consumer's direction, any service need without restriction.
• DMAS should explore ways to reinvest any cost savings realized through use of consumer-directed service to use as payment for health insurance premiums for the aides and attendants who provide the direct service. This could improve the viability of the home care delivery system by improving the stability of the workforce.