Current through Register Vol. 18, September 20, 2024
(1) Enrolled members in the waiver program
must be offered an opportunity to utilize self-directed services as a
co-employer. Once an enrolled member's comprehensive assessment and PCRP
process have been completed and needed waiver services are identified, the
enrolled member may select the specific services they wish to self-direct from
the list of services indicated in (10). The enrolled member may also receive
some of the services in their PCRP through traditional supports and services
from a provider agency, as long as no services are duplicated. The entities
responsible for supporting self-direction include case managers, the QIO, and
the provider agencies.
(2) Services
may be directed by:
(a) an enrolled member who
has the capacity to self-direct, as determined by the department or the
department's designee;
(b) a legal
representative of the enrolled member, including a parent, spouse, or legal
guardian; or
(c) a nonlegal
representative freely chosen by the enrolled member or the enrolled member's
legal representative.
(3)
The person directing the services must:
(a)
be 18 years of age or olde;
(b)
successfully complete required training for self-direction; and
(c) if acting in the capacity of a
representative, demonstrate understanding of the enrolled member's needs and
preferences.
(4) If an
enrolled member indicates an interest in the self-directed option, the case
management team is responsible for referring the enrolled member to the QIO.
The QIO must assign a health care professional to:
(a) conduct a capacity interview over the
telephone; and
(b) certify that the
enrolled member, legal representative, or nonlegal personal representative is
capable of managing the tasks and understands the risks involved. An approved
capacity determination is required to self-direct services.
(5) The case management teams must:
(a) assist the enrolled member to develop an
emergency backup plan, identifying and mitigating risks or potential risks, and
monitor the health and safety of the enrolled member. Agency-based PAS managed
by provider agencies under agreement with Medicaid are not available to
enrolled members who are participating in the self-directed program. The use of
PAS managed by provider agencies is permissible only if the enrolled member's
backup plan fails;
(b) educate
enrolled members regarding self-directed opportunities;
(c) meet with enrolled members to detail the
self-directed service options during the intake process, annual visit, as well
as throughout their service plan year as indicated through assessed
need;
(d) provide assistance for
informed decision-making by enrolled members and their families/representatives
about the election of self-direction with information and training on the
roles, risks, and responsibilities assumed by those who choose
self-direction;
(e) inform enrolled
members they are able to assist with the development of formal/informal
supports, plan development, as well as available resources for self-direction;
and
(f) oversee the service
delivery in the self-direct option.
(6) The enrolled member, the enrolled
member's legal representative, or the nonlegal personal representative must:
(a) advise, train, and support the member, as
identified in the member's Person-Centered Recovery Plan;
(b) assist with recruiting, interviewing,
hiring, training, managing, paying, and dismissing workers; and
(c) understand the shared responsibility
between the enrolled member and the provider agency.
(7) Enrolled members will be able to choose
from several agencies providing personal assistance type services, ensuring
members are successful with the self-direction experience. The provider agency
must:
(a) advise, train, and support the
enrolled member, as identified in the enrolled member's PCRP;
(b) assist with recruiting, interviewing,
hiring, training, managing, paying, and dismissing workers; and
(c) assist with monitoring the health and
welfare of the enrolled member.
(8) Self-directed services can be terminated
when:
(a) the enrolled member chooses not to
self-direct; or
(b) the case
management team or the department identifies an instance where the
self-directed option is not in the best interest of the enrolled member, and a
corrective action does not improve the situation.
(9) The enrolled member must be informed in
writing of the plan to transfer to an agency-based service delivery.
(10) The following services may be
self-directed as a co-employer:
(a) personal
assistance services;
(b) behavioral
intervention assistance; and
(c)
life coach.
AUTH:
53-2-201,
53-6-402, MCA; IMP:
53-6-402,
MCA
