Self Direction in North Carolina I/DD Waivers

1. Self Direction in North Carolina I/DD Waivers Renee’ Rader, MA Program Manager Division of Mental Health, Developmental Disabilities and Substance Abuse Services Best Practice and Innovations Team June 11, 2012

2. Guiding Principles for North Carolina Freedom Authority Responsibility Support Confirmation Nerney, T. & Shumway, D. (1996). Beyond Managed Care: Self Determination for Persons with Disabilities. Concord, New Hampshire; University of New Hampshire

3. Intellectual and Developmental Disabilities Waivers • CAP MR/DD Waiver Statewide since 2008 • CAP I/DD Waiver to replace Statewide (July 2012?) • Innovations Waiver – Currently available in 1915 (b)(c) waiver sites (PBH, Western Highlands, ECBH) • Innovations will replace CAP I/DD completely in January 2013

4. CAP I/DD Model of Self Direction Currently only offered in Supports Waiver (up to $17,500 based on need) Anticipated implementation in Comprehensive waiver (up to $135,000 based on need) – July 1, 2012

5. CAP I/DD Model of Self Direction Agency with Choice model Individual (or legally responsible person) assumes shared responsibility for the hiring and management of the employees who provide the services GT Financial is the employer of record Individual (or LRP) is considered the managing employer

6. CAP I/DD Model of Self Direction • Budget limits and limits on sets of services still apply

7. CAP I/DD Model of Self Direction Other people involved Community Resource Consultant Representative (sometimes) Case Manager LME

8. CAP I/DD Model of Self Direction Services that can be self directed include: Home and Community Supports Personal Care Respite Transportation Individual and Caregiver Training Individual Goods and Services Supported Employment (Comp waiver only – anticipated to begin July 1, 2012)

9. Individual Goods and Services Related to a goal Increase independence or substitute human assistance Promote community living and inclusion Directed exclusively toward the participant CAP I/DD - $1,000 / waiver year Innovations - $2,000 / waiver year

10. Examples Laundry services for an adult who lives alone Cooking class Bus pass Reaching devices for person using wheel chair (when not covered under DME / Medicaid) Microwave for someone unable to use stove Specialized therapies (i.e. therapeutic horse back riding)

11. Not Covered Room and board Experimental treatments Social or recreational purchases not related to a need or a goal

12. CHOICE Can self direct some or all services Can opt in or out at any time Can choose to have a representative (may be required in some instances) **Self Direction is for ANYONE who is interested in having more control of their services and how their service dollars are spent

13. Why have people chosen to self direct? Dissatisfied with agency services Want more hours of services Interested in hiring people they know from the community

14. What have people liked about self direction? Better informed – especially about their budget and how their service dollars are spent More consistent staff Support of the Community Resource Consultant Sense of partnership and teamwork

15. What have been the challenges for Self Direction? Only offered in Supports Waiver Perceived as being a lot of work Finding and retaining quality staff Confusion and concerns about upcoming changes

16. Innovations – things that are the same Based on same principles Both use an Agency with Choice Model Same types of services can be self directed Can self direct any or all services Choice Budget limit Community Resource Consultant functions provided by Community Guide Representative may be requested or required Care Coordinator fulfills the administrative case management functions

17. Innovations – Things that are different Referred to as “Individual and Family Directed Services” Agency with Choice is now an actual provider agency (rather than a fiscal intermediary such as GT Financial) Agency sets pay rates Agency provides QP supervision Can self direct services that weren’t available in the CAP I/DD waiver (Community Guide, Community Networking) Individual Goods and Services higher limit available Requires monthly monitoring of services by Care Coordinator

18. Benefits Innovations Agency with Choice Back-up staff Less work for participant – agency recruits and hires staff with the support of participant; agency provides QP supervision

19. Perceived Drawbacks – Innovations Agency With Choice Individuals and families report concern: Less control over budget Unable to set pay rate for staff Agency with Choice makes final hiring and firing decisions

20. Employer of Record Model - Innovations • Currently available in PBH areas only • Will be available for all Innovations wavier participants within 2 years of Innovations implementation (by January 2015?) • Very similar to current CAP I/DD model • No ‘agency’ involvement

21. How to participate? CAP MR/DD or CAP I/DD Contact your LME Innovations Contact your Care Coordinator Will be offered this option annually at ISP planning meeting Requesting additional information does not obligate one to participate

22. Questions?? Contact: Renee’ Rader renee.rader@dhhs.nc.gov 919-715-2774 http://www.ncdhhs.gov/mhddsas/providers/supportswaiver/index.htm