1. What is Agency with Choice? Tammy Spigarelli, UPCAP Area Agency on Aging Region 11 Elaine Taverna, Center for Self- determination

2. MI Choice Waiver tammy & elaine to do Self-determination Minimum Operating Standards for MI Choice Waiver Program Services

3. Advantages of Agency with Choice- tammy Person Centered and Person Directed Authority over funding for staff moves to the individual Co- management responsibilities Emergency Backup Pay & Fringe benefits for staff Staff retention

4. How it Differs from Umbrella Agency- tammy Individual is co-employer Individual not agency sets employee wage and develops the job description/duties. With assistance from system, Individual responsible for training, supervising, and evaluating performance.

5. Staff Support Options- elaine & tammy Independent Direct Hire Agency with Choice

6. Role of Agency with Choice - tammy Employer of Record Financial Management ( optional in Aging Required in CMH) Human Resources Criminal Background checks Supportive services

7. Role of the Participant- elaine Co management Recruiting and selection of workers Development of job duties Authorization of payment Setting employee wage Hiring and firing

8. AWC Requirements- tammyu Agreements Fiscal Intermediary (optional in aging required in CMH) Contract with waiver agency in Aging ( contracts directly with the individual in CMH) Meets criteria identified in Technical advisory and Minimum Operating Standards for MI Choice Waiver Programs Can be a Medicaid provider Demonstrates competency (readiness survey)

9. Implementation issues- elaine & tammy Balancing duties of employer Liability Flexibility Person-directed Conflict of interest

10. Lessons Learned- elaine Designing a system with stakeholder input Importance of written agreements that clearly define roles and have signatures Clearly communicated process and procedures that address liability issues Internal systems that provide for efficiency Understanding the budget and working with the fiscal ( if applicable)

11. Lessons Learned- tammy Most people are not able to find backup staff when direct hire is not able to work and cannot manage staff without assistance, AWC provides for these needs When people have authority and control over who and how people work for them staff retention and customer satisfaction increases People are safer, healthier and condition stabilizes

12. Substantiated Rights Complaints in Traditional Provider Contracts (Unlicensed) Homes vs. Licensed Group Homes

13. Lessons Learned Over cost shifting or savings Costs are reduced to AWC as staff retention increases In Aging, A Fiscal Intermediary is optional and not required. In CMH the funding is separated from the provider agency to deter conflict of interest

14. CMH Provider example of Declining Revenues With Increased Membership

15. CMH Provider Seven Year Comparison of Total Number of People Living in Licensed vs. Own Home Licensed Own Home

16. CMH Provider example of Average Staffing Costs Per Person: Self-Directed Budgets vs. Licensed Group Homes

17. Direct Support Staff Turnover Study Provider: Enhance, Inc. 2007 Licensed Group Homes: 87% Not Licensed SIP/Extended: 42% Newly Self-Directed: 38% Established Self-Directed: 18%! Latest Self-Directed Wayne County: 0%! Similar Data reported by AHS Inc.

18. Lessons Learned- tammy & elaine Communication to internal and external stakeholders Training and education Importance of evaluation and continuous quality improvement Marketing and Public Relations Success Stories