NASHP State Health Policy Conference October 2010 Julia Kenny Assistant Secretary

1. NASHP State Health Policy Conference October 2010 Julia Kenny Assistant Secretary Office for Citizens with Developmental Disabilities Louisiana Department of Health and Hospitals

2. Louisiana Self-Direction Option • CMS approved Louisiana’s “New Opportunities Waiver” effective July 1, 2003. • 1915(c) waiver that allows for consumer direction of home and community based waiver services. • Self-direction is a service delivery option in the NOW, which allows participants to take the leading role in the employment of their service workers. • Participants are in charge of recruiting, hiring, firing, and supervising the people who work for them.

3. Self-Directed Services Approved Under Waiver • OCDD currently only provides individualized and family support through NOW. • OAAS will provide other services through a more comprehensive “Community Choices” waiver next calendar year including: • Support Coordination • Transition Intensive Support Coordination • Transition Service • Personal Assistance Services • Adult Day Health Care • Environmental Accessibility Adaptations • Personal Emergency Response System (PERS)* • Assistive Devices and Medical Supplies* (Includes PERS) • Skilled Maintenance Therapy Services (PT, OT, ST and RT) • Nursing Services • Home Delivered Meal Services • Caregiver Temporary Support Services (Respite) • Non-Medical Transportation

4. Fiscal management • Louisiana OCDD Central Office Fiscal Section began by managing payment and documentation of all IFS direct support workers’ salaries and benefits who were hired by NOW recipients. • OCDD subsequently amended its application from serving as an “agency of choice” to “fiscal management agent.” • RFP process was undertaken and Acumen was chosen to serve as fiscal/employer agent.

5. Duties performed by Acumen • Processes employee time sheets • Generates payroll checks for employees • Conducts criminal background checks • Processes all employment records • Withholds, files, and deposits all necessary taxes in accordance with federal IRS, DOL, and state rules • Provides participants, support coordinators, and OCDD with monthly participation reports • Maintains a toll-free call center for self-direction participants, support coordinators, and others to call for information • Tracks employee training • Offers workman’s compensation coverage • Acts as a billing agent for each DSW under a single provider number, bills Medicaid.

6. Participant Satisfaction • 2009 Survey found that: • 98% were satisfied with services provided by Acumen • 92% were satisfied with the self-direction option • 92% believe they receive the services they need • 85% stated “I have a choice and control over my supports and services”

7. Participation Rates and Retention • Currently, there are 3,341 citizens in 3 regions receiving services under NOW. • Of these citizens, 60 or 1.8% are on self-direction. • Enrollment in SD has tripled since 2003. • In the last 3 weeks, 12 more have applied. • NOW statewide extension will lead to the addition of at least 78 to SD enrollment. • Statewide training initiative is expected to increase utilization rate to 10% or approximately 769 participants. • Adding the SD option to our CC waiver will lead to an approximate increase of 200 participants based on a utilization rate estimate of 20%. • Since 2003, no one has voluntarily chosen to leave self-direction.*

8. Hannah • Higher PCA rate paid for persons with a greater need level ended in 2003. • Through SD she is able to compete for better workers by offering them a higher rate. • She has found that it is much easier to hire and retain qualified workers since she switched from the traditional agency-hired worker to self-direction. • The only new tasks Hannah has to deal with is the additional paperwork associated with new hires, and reviewing and faxing time sheets. • Fiscal agent has been helpful assisting and streamlining these processes. • Challenges: managing backups, training requirements, background checks

9. Challenges • DSW Registry Rule • Billable training hours • Goods and services waiver adjustment to allow for supplies, fax machines, mileage reimbursements, advertising and employee recruitment.

10. Where SD is headed in Louisiana • Statewide expansion of services under NOW. • Inclusion of SD in the Children’s Choice waiver (personal care services). • Residential Options waiver (community living supports; companion care; & community integration transportation).