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Self-Directed Supports Within Managed Care : What? Why? How?

Self-Directed Supports Within Managed Care : What? Why? How?. Dane/Rock Counties January 25, 2007. Self-Determination.

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Self-Directed Supports Within Managed Care : What? Why? How?

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  1. Self-Directed Supports Within Managed Care:What? Why? How? Dane/Rock Counties January 25, 2007

  2. Self-Determination Self-Determination refers to the individual having control over all aspects of his or her life, and exercising basic rights such as citizenship, liberty, and the pursuit of happiness. This impacts activities beyond the scope of long-term care services. Nothing about me without me My Life My Way!

  3. What Are Self-Directed Supports? Self-directed supports are a facet of the larger self-determination philosophy. Stated simply, participants in long-term care programs actively direct the supports and services being provided.

  4. Self-Directed Supports A Statutory requirement within Family Care: “Each person may arrange for, manage and monitor his or her family care benefit directly, or with the assistance of another person.” 

  5. Within the “Member Benefit” Needed support can be directly purchased & managed by an individual or family (Employer Authority) Or, all supports and services can be chosen, developed, and subject to change through the authority of the individual or family& allies. (Budget Authority)

  6. Authority Includes … Within a Fair and Equitable Amount of Funding: • Choosing where to live, who to live with and what to do during the day (Basic American freedoms); • Selecting and, if desired, changing agencies that provide services and support; • Hiring, training, dismissing support workers; • Opportunities to choose or to create unique support and services, individually or collectively.

  7. Why SDS? Growing agreement about the primary Purpose of Long Term Care Funding: To help individuals and families • Receive the support they need, • To craft meaningful lives for themselves and their families in their communities, • In the company of those they care about, in the company of those who care about them.

  8. Why SDS • People want autonomy and relationships while obtaining long term support and health care • Growing Federal adoption of this Purpose • Systems like the cost-effectiveness • Works across age and disability

  9. What Is Managed Long-Term Care? • A capitated rate for each member enrolled. • Must accept all eligible elders and people with developmental or physical disabilities • Provides long-term care services, directly or by contract

  10. Coordinates with other services not included in the Family Care benefit (e.g., acute/primary health) • Includes traditional waiver services and adds to them within a flexible benefit package • Includes traditional state plan services related to LTC including: nursing facilities, therapies, home health, medical equipment and supplies.

  11. Cost-effective services and supports within and outside the defined benefit package. • Service authorization by local teams with access to needed funding • Includes Self-Directed Supports as an option for all members

  12. Merging Managed Care with Self-Directed Supports

  13. Managed Care Meets Self-Directed Supports

  14. Merging Managed Care with Self-Directed Supports • Family Care in Wisconsin • Developmental Disabilities and Mental Health Services in Michigan

  15. The expertise of the system provides Funding … fair, adequate, individual Flexibility … to support the expertise of each person & family Assistance & support and INFORMATION : to plan, imagine, choose, create, evaluate, coordinate, change both from within the system, & from outside the system How?

  16. The expertise of the system provides (2) Assistance & support (continued) co-employment/fiscal intermediaries structure for understanding options and obligations attention to quality outcomes opportunities for discussion, negotiation, creativity How?

  17. The expertise of each person and family allows people to decide … Where to live Who to live with What to do during the day Who to buy support from How to stay connected with important people and places, and How much authority to have over the details of these and other decisions How?

  18. The expertise of our Communities … Will deliberately be sought To maintain individual and family connections To thoughtfully add new connections To Save $ --- To enrich lives How?

  19. Merging Managed Care with Self-Directed Supports

  20. Resources • Self-Directed Supports Report (September, 2006) • Lessons Learned (from CMO Pilots) • DHFS SDS Web Site (in progress, March , 2007) • PACE/Partnership Working Group on SDS • Wisconsin Council on Developmental Disabilities • Dennis Harkins • dwharks@aol.com • 608 576-6848

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