Current through Register Vol. 50, No. 9, September 20, 2024
A.
Self-direction is a service delivery option which allows beneficiaries (or
their authorized representative) to exercise employer authority in the delivery
of their authorized self-directed services (community living supports).
1. Beneficiaries are informed of all
available services and service delivery options, including self-direction, at
the time of the initial assessment, annually, or as requested by beneficiaries
or their authorized representative. Beneficiaries, who are interested in
self-direction, need only notify their support coordinator, who will facilitate
the enrollment process.
2. A
contracted fiscal/employer agent is responsible for processing the
beneficiary's employer-related payroll, withholding and depositing the required
employment-related taxes, and sending payroll reports to the beneficiary or
his/her authorized representative.
3. Support coordinators assist beneficiaries
by providing the following activities:
a. the
development of the beneficiary's plan of care;
b. organizing the unique resources the
beneficiary needs;
c. training
beneficiaries on their employer responsibilities;
d. completing required forms for
participation in self-direction;
e.
back-up service planning;
f. budget
planning;
g. verifying that
potential employees meet program qualifications; and
h. ensuring beneficiary's needs are being met
through services.
B.Beneficiary Eligibility. Selection of the
self-direction option is strictly voluntary. To be eligible to participate in
the self-direction service option, waiver beneficiaries must:
1. be able to participate in the
self-direction option without a lapse in or decline in quality of care or an
increased risk to health and welfare;
2. complete the training programs (e.g.,
initial enrollment training) designated by OCDD; and
a. - a.ii. Repealed.
3. understand the rights, risks, and
responsibilities of managing his or her own care and effectively managing his
or her plan of care.
NOTE: If the waiver beneficiary is unable to make decisions
independently, the beneficiary must have a willing decision maker (an
authorized representative as listed on the beneficiary's plan of care) who
understands the rights, risks, and responsibilities of managing the care and
supports of the beneficiary within the plan of care.
C. Beneficiary Responsibilities.
Responsibilities of the waiver beneficiary or his or her authorized
representative include the following:
1.
Beneficiaries must adhere to the health and welfare safeguards identified by
the support team, including the following:
a.
the application of a comprehensive monitoring strategy and risk assessment and
management system; and
b.
compliance with the requirement that employees under this option must have
criminal background checks prior to working with waiver
beneficiaries.
2. Waiver
beneficiary's 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 POC to meet his 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.
3. Beneficiaries are informed of the
self-direction option at the time of the initial assessment, annually, or as
requested by beneficiaries or their authorized representative. If the
beneficiary is interested, the support coordinator will provide more
information on the principles of self determination, the services that can be
self-directed, the roles and responsibilities of each service option, the
benefits and risks of each service option, and the process for enrolling in
self-direction.
4. Prior to
enrolling in self-direction, the beneficiary or his/her authorized
representative is trained by the support coordinator on the process for
completing the following duties:
a. best
practices in recruiting, hiring, training, and supervising staff;
b. determining and verifying staff
qualifications;
c. the process for
obtaining criminal background checks on staff;
d. determining the duties of staff based on
the service specifications;
e.
determining the wages for staff within the limits set by the state;
f. scheduling staff and determining the
number of staff needed;
g.
orienting and instructing staff in duties;
h. best practices for evaluating staff
performance;
i. verifying time
worked by staff and approving timesheets;
j. terminating staff, as necessary;
k. emergency preparedness planning;
and
l. back-up planning.
5. This training also includes a
discussion on the differences between self-direction and other service delivery
options (which includes the benefits, risks, and responsibilities associated
with each service option) and the roles and responsibilities of the employer,
support coordinator, and fiscal/employer agent.
6. Beneficiaries who choose self-direction
verify that they have received the required training by signing the service
agreement form.
7. Authorized
representatives may be the employer in the self-directed option but may not
also be the employee.
D.
Termination of Self-Direction Service Option. Termination of participation in
the self-direction service option requires a revision of the POC, 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 option and return to the traditional
provider agency management of services.
a.
Proper arrangements will be made by the support coordinator to ensure that
there is no lapse in services.
b.
Should the request for voluntary withdrawal occur, the beneficiary will receive
counseling and assistance from his or her support coordinator immediately upon
identification of issues or concerns in any of the above situations.
2. Involuntary Termination. The
department may terminate the self-direction service option for a beneficiary
and require him or her to receive provider-managed services under the following
circumstances:
a. the beneficiary does not
receive self-directed services for 90 days or more;
b. the health, safety, or welfare of the
beneficiary is compromised by continued participation in the self-direction
service option;
c. the beneficiary
is no longer able to direct his own care and there is no responsible
representative to direct the care;
d. there is misuse of public funds by the
beneficiary or the authorized representative;
e. over three payment cycles in the period of
a year, the beneficiary or authorized representative:
i. permits employees to work over the hours
approved in the beneficiary's plan of care or allowed by the participant's
program;
ii. places barriers to the
payment of the salaries and related state and federal payroll taxes of direct
support staff;
iii. fails to follow
the personal purchasing plan and the POC;
iv. fails to provide required documentation
of expenditures and related items; or
v. fails to cooperate with the fiscal agent
or support coordinator in preparing any additional documentation of
expenditures; or
f. the
beneficiary or the authorized representative consistently violates Medicaid
program rules or guidelines of the self-direction option.
3. When action is taken to terminate a
beneficiary from self-direction involuntarily, the support coordinator
immediately assists the beneficiary in accessing needed and appropriate
services through the ROW and other available programs, ensuring that no lapse
in necessary services occurs for which the beneficiary is eligible. There is no
denial of services, only the transition to a different payment option. The
beneficiary and support coordinator are provided with a written notice
explaining the reason for the action and citing the policy reference.
E. Employees of beneficiaries in
the self-direction service option are not employees of the fiscal agent or the
department.
1. Employee Qualifications. All
employees under the self-direction option must meet the qualifications for
furnishing personal care services as set forth in LAC 48:I.Chapter 92.
a - c. Repealed.
F. Relief coverage for scheduled
or unscheduled absences, which are not classified as respite care services, can
be covered by other participant-directed providers and the terms can be part of
the agreement between the beneficiary and the primary companion care
provider.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
