Self-Determination

1. Self-Determination Ellen Sugrue Hyman Self-Determination Development Coordinator MDCH Mental Health and Substance Abuse Administration

2. Self-Determination What is Self-Determination? Self-determination is a set of concepts and values that people with disabilities should have the freedom and support to decide how they live and participate in the community

3. Self-Determination Policy and Practice Guideline • The Michigan Department of Community Health (MDCH) requires that PIHP/CMHSPs offer arrangements that support self-determination. These requirements are described in the Self-Determination Policy and Practice Guideline (www.michigan.gov/documents/SelfDeterminationPolicy_70262_7.pdf).

4. Principles of Self-Determination • Freedom The opportunity for individuals to plan a life with necessary supports • Authority The ability of individual to control budgeted $ to purchase supports • Support The arranging of resources and personnel—both informal and formal—that will assist an individual to achieve meaningful community participation • Responsibility Acceptance of valued community role and accountability for public dollars

5. Arrangements that support Self-Determination • PIHP/CMHSP authorizes funding based on the IPOS and delegates to the participant the authority to manage • the individual budget, • choose and manage qualified providers, and • determine service delivery • PIHP/CMHSP provides on-going support and assistance to participants

6. Budget Authority • Authority to manage and control the funds in the individual budget pursuant to the IPOS with the support of the fiscal intermediary.

7. Employer Authority • Authority to directly employ workers or directly contract with chosen providers. • The fiscal intermediary handles payment based on participant approval. • The participant has a contract with each employee and service provider.

8. Who Can Take On Employer and/or Budget Authority? • General Directive—The participant can if • The participant has the desire to • The participant has the ability to • If the participant does not have the ability, friends and family members can perform employer duties on behalf of the participant

9. Person Centered Planning “Person-centered planning’ means a process for planning and supporting the individual receiving services that builds upon the individual’s capacity to engage in activities that promote community life and that honors the individual’s preferences, choices and abilities. MCL 330.1700 (g)

10. Person-Centered Planning • Person-Centered Planning is a process for planning with and supporting the individual receiving services. The process builds upon the individual’s capacity to engage in activities that promote community life and honor’s the individual’s preferences, choices and abilities.

11. Person-Centered Planning Process • The person-centered planning process is a way to develop a plan for the person’s whole life, but it is also the way that a service plan for waiver services and supports is developed. • The supports coordinator is responsible for development of the service plan and authorization of services and supports.

12. Self-Determination and Person-Centered Planning When a person is planning to participate in arrangements that support self-determination, the planning process must address: • the participant’s need for information, guidance, and support • Health and Safety Issues (e.g. Back-up) Arrangements that are directly determined and controlled by the participant do not necessarily include the contingency plans that are often built into traditional provider arrangements

13. Individual Plan of Services & Supports (IPOS) • The individual plan of services and supports are the medicaid-covered services and supports, developed through the person-centered planning process, determined to be medically necessary, and identified in amount, scope and duration.

14. Individual Budget • The individual budget authorized by the PIHP/CMHSP provides a defined amount of resources sufficient to implement the participant’s IPOS, which may be directed by the individual to pursue his or her IPOS’s goals and outcomes

15. Individual Budget Implementation Individuals: • Determines the amount paid for each service in accordance with the PIHP/CMHSP policies • Schedules when services are provided • Identifies and contracts with workers/service providers • Reviews and approve worker invoices/ provider invoices

16. The Role of the PIHP/CMHSP • The PIHP/CMHSP supports participants by offering methods to implement arrangements that support self-determination in a participant-friendly manner, making the methods as easy to use as possible. • Choice Voucher System • Agency with Choice

17. Choice Voucher System • The Choice Voucher System is a set of arrangements that enable individuals accessing mental health or developmental disability services (participants) to direct their services and supports. • CVS Technical Advisory (http://www.michigan.gov/documents/mdch/Choice_Voucher_System_Transmittal_9_30_08_251403_7.pdf).

18. Choice Voucher System • Methods and Tools • Self-Determination Agreement • Direct Participant-Provider Contracting • Qualified Independent Fiscal Intermediary

19. Direct Participant-Provider Contracting • The Choice Voucher System enables participants to directly employ workers or directly contract with chosen providers • The fiscal intermediary handles payment based on participant authorization • The participant has a contract with each employee and service provider

20. Fiscal-Intermediary (FI) A Fiscal Intermediary is an independent legal entity that acts as a fiscal agent of the PIHP/CMHSP for the purpose of assuring financial accountability for the funds comprising a participant’s individual budget and performs essential tasks that support self-determined arrangements for participants

21. FI Functions The fiscal intermediary has four basic areas of performance: • Function as the employer agent for participants directly employing workers to assure compliance with payroll tax and insurance requirements. • Ensure compliance with requirements related to management of public funds, the direct employment of workers by participants, and contracting for other authorized goods and services, including assuring compliance with provider requirements.

22. FI Functions The fiscal intermediary has four basic areas of performance: • Facilitate successful implementation of the arrangements by providing monthly budget status reports to participant and agency and monitoring the use of the budget the parties and meet the needs of the PIHP/CMHSP and participants. • Offer supportive services to enable participants to self-determine and direct the services and supports they need.

23. How Parties Work Together • Agreements • Self-Determination Agreement • Employment Agreement • Purchases of Services Agreement • Medicaid Provider Agreement • Fiscal Intermediary Agreement

24. Self-Determination Agreement • Describes the responsibilities of the PIHP/CMHSP including ways that the it can support the individual in creating and using arrangements that support a choice voucher system. • Describes the authority and responsibilities of the individual. • Provides information about the fiscal intermediary.

25. Self-Determination Agreement • Provides the participant with the necessary information and support so that participants understand the role of the FI and their own responsibilities. • Outlines a mechanism for changing for the agreement, the individual plan of services and supports, or the individual budget. • Ensures that a emergency back-up plan is in place to handle worker absences.

26. Employment Agreement • Describes the Choice Voucher System, the nature of the employment relationship, and the structure of service authorization and payment mechanisms. • Describes the duties required of the employee. • Details the employee’s compensation and benefits. • Outline the rules and regulations affecting the employee’s employment.

27. Purchase of Services Agreement • Used with service providers such as agencies or an individual professional practitioner. • Describes the Choice Voucher System, the nature of the contractual relationship, and the structure of payment mechanism. • Describes the duties required of the service provider. • Details the service provider’s compensation. • Outlines the rules and regulations affecting the provision of services.

28. Medicaid Provider Agreement • The purpose of the Medicaid Provider Agreement is to assure that all providers of services and supports funded by Medicaid agree to comply with the federal Medicaid Requirements. • Every Medicaid provider must complete the Medicaid Provider Agreement and this agreement must be on file with the fiscal intermediary prior to the first payment for services.

29. Medicaid Provider Agreement In the Agreement, the provider agrees to: • keep records of its delivery of services • make those records available for review at the request of the PIHP/CMHSP. • disclose financial ownership interest in related Medicaid-financed provider entities . • provide for ways to assure participants in the Choice Voucher System of its policies related to a participant’s right to refuse treatment.

30. Fiscal Intermediary Agreement • The purpose of this contract is to define the roles and responsibilities the PIHP/CMHSP and the fiscal intermediary. • Specify the FI Functions to support self-determination arrangements for adults with mental illness or developmental disabilities. • The FI assures accountability for the public funds allotted to support these arrangements.

31. Audit Form • Checklist of items that need to be completed for each participant, • Agreements completed and on file • Provider requirements have been met and documentation is on file • Important mechanism to assure that all components are in place.

32. Participant SD Functions • Provide information and documentation necessary for FI & CMHSP to perform duties. • Communicate with the FI and PIHP/CMHSP and seek assistance from these entities as needed. • Provide feedback to FI to enable it to improve its service delivery.

33. Participant SD Functions • Provide all necessary information to the FI regarding all providers of services and supports and ensure that all required documentation and written agreements are in place including a Medicaid Provider Agreement by each service provider.

34. Participant Functions • Manage the use of funds so that expenditures in the aggregate do not exceed the amounts identified in the individual budget and notify the PIHP/CMHSP and FI about any change in circumstances that may require a modification of the IPOS or the individual budget.

35. Agency with Choice Agency with Choice is an arrangement in which an agency handles most employer functions, but the participant has the authority to hire,manage and fire workers.

36. Agency with Choice Separation of Functions • The agency serves as employer of record. • The participant serves as managing employer.

37. Agency Functions • Payroll and benefits • Employee Verification and background checks • Withholding and payment of income, FICA and unemployment insurance taxes • Payment of worker’s compensation insurance • Support services to participants

38. AWC Duties • Maintain an agency-wide back-up system. • Have flexibility in system for participants to create unique job descriptions and set pay rates . • Assist participants with developing and implementing emergency back-up plans.

39. AWC-Participant Duties • Create job descriptions • Hire support workers — workers must meet provider requirements; Agency does checking • Set the terms and conditions of employment (hours and job duties) • Approve payment for workers • Manage workers • Terminate, when necessary, the worker

40. The Results of Self-Determination • Participants have control over their arrangements and resources. • Participants have control over who provides support to them. • Participants are able to pursue their dreams and goals. • Participants achieve community participation and inclusion.