Aged and Disabled Waiver (ADW) Program Personal Options November 2015

Aged and Disabled Waiver Policy West Virginia State Medicaid Manual  The Aged and Disabled Waiver (ADW) program is defined as a long-term care alternative, which provides services that enable an individual to remain at or return home rather than receive nursing home care.  The program provides services to West Virginia residents at least 18 years of age who choose home and community-based services rather than nursing home placement.  Individuals must be medically and financially qualified to participate in the ADW program. 1

Personal Options Program 2 West Virginia State Medicaid Manual Persons may choose from either the Traditional (Agency) Model or the Participant-Directed Model, known as Personal Options, for service delivery. Traditional Model  Persons receive their services from employees of a certified provider agency.  Persons have individualized service hours based on their assessed level of need. Personal Options  Persons have a choice and control with employer and budget authority. They are able to hire, schedule, supervise and terminate their own employees. Persons are allocated a monthly budget based on their assessed level of need. They develop a spending plan which allocates the number of hours for each provided service.

ADW Levels of Care Conversion Table LevelTraditional HoursPersonal Options Budget AUp to 62$ BUp to 93$ CUp to 124$ DUp to 155$

Service Delivery Model Selection Form 4

Personal Options vs. Traditional Model Personal OptionsTraditional Model 5  Person is the employer  Person hires and manages employee  Person decides employee wage  Person schedules employee work hours  Person’s employee is required to meet state training requirements  Person is assisted by the Resource Consultant to develop a service plan and spending plan  Person is responsible for signing employee timesheet  Person is responsible for maintaining medical and financial eligibility  Agency is the employer  Agency hires and manages employee  Agency decides employee wage  Agency schedules work hours with the person’s wishes in mind  Agency employee is required to meet state training requirements  Agency develops service plan with person’s input  Agency Case Manager is responsible for maintaining person’s medical and financial eligibility

Personal Options DHS-2 6

Durable Power of Attorney 7  A Durable Power of Attorney is required for Personal Options participants when the person has a diagnosis on the Pre-Admission Screening (PAS) form that indicates they have Alzheimer’s, multi- infarct, senile dementia or other related conditions. Since Personal Options is a self-directed program, it is necessary for a decision- maker to act on behalf of the person when hiring/firing an employee, when verifying and signing employee timesheets and to ensure the person is receiving the care provided as indicated on the service plan. The person’s program representative cannot be the person’s employee.

What is Self-Direction? 8 Personal Options is a Self-Directed Program Case Managers and Resource Consultants are there to assist. This is the participant’s program. They decide what services are required and who they want to provide those services.

Purchasing Options 9 Personal Options allows the participant the choice to purchase from the following services:  Personal attendant services  Nursing (assessment and skilled)  Non-Medical transportation

Available Services Case Management 10  Case management activities are indirect services that assist the person in obtaining access to needed ADW services, other State Plan services, as well as medical, social, educational, and other services, regardless of the funding source. Personal Attendant  The personal attendant’s primary function is to provide hands-on personal care assistance outlined in the Service Plan. As time permits, personal attendants may also provide other incidental services such as changing linens, meal preparation and light housekeeping, e.g., sweeping, mopping, dishes and dusting. Non-Medical Transportation  Non-Medical Transportation provides reimbursement for personal attendants that perform essential errands for/or with a person receiving ADW services or to assist the person with accessing community activities.

Skilled Nursing Services Personal Options participants have the ability to select skilled nursing services. 11  Skilled nursing care is health care that is provided when a person needs a Registered Nurse (RN) to manage, observe and evaluate care. Some of their responsibilities may include:  Completing the Person-Centered Assessment Section to determine the need for changes in the service plan upon the individual’s request or upon discharge from an acute care hospital, nursing facility or other residential setting.  Providing member-specific training to personal attendants.  Pre-filling the person’s medication box monthly, if ordered by an physician, physician assistant or Nurse Practitioner per written prescription.  Preparing and submitting material that can assist an ADW participant’s need for an increase in their service level.

Referral to Fiscal/Employer Agent Referral Packet 12  Once all of the person’s information and approvals have been obtained, a referral packet will be sent to the Fiscal/Employer Agent. The packet will include:  Cover sheet  Person’s information sheet  Participant enrollment form  DHS-2  PAS  PAS Summary  Durable Power of Attorney, if required

Financial Management Services & Supports 13 Personal Options participants are supported by a Fiscal/Employer Agent ( F/EA).  The F/EA acts as a payroll company for the participant’s employees, and  Provides assistance to the participant and their employees through Resource Consultants.

Fiscal/Employer Agent & Resource Consultants 14  Assisting employers with their budgets, spending plans and service plans  Assisting the employer with related tax responsibilities and tax reporting  Monitoring persons’ budget and funds spent and disbursing funds for payment  Submitting claims on behalf of the person/employer  Processing and paying invoices for transportation and services approved in the participant-directed spending plan  Assisting the employer or their representative with hiring and managing employees  Assisting in verifying the worker’s citizenship or legal alien status  Assisting with employee criminal background checks  Collecting and processing worker timesheets  Distributing payroll checks on the person’s behalf  Executing simplified Medicaid provider agreements  Providing orientation/skills training for the employees  Providing ongoing information and assistance to employers  Monitoring and reporting data pertaining to quality and utilization of the Personal Options Financial Management Services as required to Bureau for Medical Services (BMS)  Maintaining monthly contact and six months face-to-face visits with the person Job Description

Personal Attendant Requirements 15  Cardiopulmonary Resuscitation (CPR) training  First Aid training  Occupational Safety and Health Administration (OSHA) training  Personal Attendant skills  Abuse/Neglect/Exploitation training  HIPAA training  Direct Care ethics  Health and welfare for person receiving services  Person-Centered planning and service plan development Initial Training Requirements

Personal Attendant Requirements (Cont.) 16 Annual Training  CPR  First Aid  OSHA  Abuse/Neglect/Exploitation Identification  HIPAA  An additional four hours of training, focusing on enhancing direct care service delivery knowledge and skills must be provided annually. Training must be kept current!

The Service Plan 17

Personal Options Assessment 18

Person’s Spending Plan 19

Personal Attendant Responsibilities 20 The primary responsibility of a personal attendant is to provide hands-on personal care assistance as outlined in the service plan. This may include, but is not limited to, Activities of Daily Living (ADLS) such as:  Bathing  Grooming  Dressing  Eating/meal preparation  Toileting  Transferring  Mobility In addition to the ADLs provided, there may also be a need for essential errands and community activities designed to integrate the person into the community and to ensure their well being.

WV Centralized Hotline To report suspected adult abuse, neglect or exploitation call

Post Test 22 True or False 1.Personal Options is a self-directed program. True or False? 2.CPR and First Aid training are required before a Personal Attendant can begin work. True or False? 3.Case management is a new option for Personal Options. True or False? 4.RN assessment determines your Level of Care. True or False? 5.WV Department of Health and Human Resources determines financial eligibility. True or False? 6.The service plan is written by the person. True or False? 7.The Case Manager makes all decisions for the person. True or False? 8.The Resource Consultants are responsible for the person’s activities of daily living. True or False? 9.The person has to pay the Personal Attendants out of pocket. True or False? 10.In Personal Options, the person hires their own Personal Attendant. True or False?

Training Certificate 23 Aged and Disabled Waiver Training Certificate Name of the Training: Personal Options Date of Training Webinar: Name of the Employee (Worker): Congratulations! You have successfully completed the Aged and Disabled Waiver Personal Options training webinar and passed the post test. Training/Post Test Verification Signature (Agency/Employer): Date: Worker/Employee Signature: Date:

Contacts For information contact: Bureau for Medical Services Phone: WV Bureau of Senior Services Phone: Fax: