Current through Register Vol. 50, No. 9, September 20, 2024
A. The self-direction initiative is a
voluntary, selfdetermination option which allows the beneficiary to coordinate
the delivery of NOW services, as designated by OCDD, through an individual
direct support professional rather than through a licensed, enrolled provider
agency. Selection of this option requires that the beneficiary utilize a
payment mechanism approved by the department to manage the required fiscal
functions that are usually handled by a provider agency.
B. Beneficiary Responsibilities. Waiver
beneficiaries choosing the self-directed service delivery option must
understand the rights, risks and responsibilities of managing his/her own care
and individual budget. If the beneficiary is unable to make decisions
independently, he/she must have an authorized representative who understands
the rights, risks and responsibilities of managing his/her care and supports
within his/her individual budget. Responsibilities of the beneficiary or
authorized representative include:
1.
completion of mandatory trainings, including the rights and responsibilities of
managing his/her own services and supports and individual budget;
2. participation in the self-direction
service delivery option without a lapse in or decline in quality of care or an
increased risk to health and welfare; and
a.
adhere to the health and welfare safeguards identified by the team, including
the application of a comprehensive monitoring strategy and risk assessment and
management systems;
3.
participation in the development and management of the approved personal
purchasing plan:
a. this annual budget is
determined by the recommended service hours listed in the beneficiary's CPOC to
meet his/her needs;
b. the
beneficiary's individual budget includes a potential amount of dollars within
which the beneficiary or his/her authorized representative exercises
decision-making responsibility concerning the selection of services and service
providers.
C.
Termination of the Self-Direction Service Delivery Option. Termination of
participation in the self-direction service delivery option requires a revision
of the CPOC, the elimination of the fiscal agent and the selection of the
Medicaid-enrolled waiver service provider(s) of choice.
1. Voluntary Termination. The waiver
beneficiary may choose at any time to withdraw from the self-direction service
delivery option and return to the traditional provider agency management of
services.
2. Involuntary
Termination. The department may terminate the self-direction service delivery
option for a beneficiary and require him/her to receive provider-managed
services under the following circumstances:
a.
the health or welfare of the beneficiary is compromised by continued
participation in the self-direction service delivery option;
b. the beneficiary is no longer able to
direct his/her own care and there is no responsible representative to direct
the care;
c. there is misuse of
public funds by the beneficiary or the authorized representative; or
d. over three consecutive payment cycles, the
beneficiary or authorized representative:
i.
places barriers to the payment of the salaries and related state and federal
payroll taxes of direct support staff;
ii. fails to follow the Personal Purchasing
Plan;
iii. fails to provide
required documentation of expenditures and related items; or
iv. fails to cooperate with the fiscal agent
or support coordinator in preparing any additional documentation of
expenditures.
D. All services rendered shall be prior
approved and in accordance with the comprehensive plan of care.
E. All services must be documented in service
notes, which describes the services rendered and progress towards the
beneficiary's personal outcomes and his/her comprehensive plan of
care.
F. Service Limits
1. Authorized representatives, legally
responsible individuals, and legal guardians may be the employers in the
self-directed option but may not also be the employees.
2. Legally responsible individuals may only
be paid for services when the care is extraordinary care in comparison to that
of a beneficiary of the same age without a disability and the care is in the
best interest of the beneficiary.
3. Family members who are employed in the
selfdirected option must meet the same standards as direct support staff that
are not related to the beneficiary.
4. Family members who live in the home with
the beneficiary cannot exceed a total of 40 hours per week when employed in the
self-directed option.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
