1. April 4, 2017

2. Community Navigator Services NC Innovations Waiver
Why It’s So Important

3. Training Objectives What the NC Innovations Waiver is intended to do
Philosophy of Self-Determination
The Member’s Life in the Community
Importance of Self Determination, Self-Direction and Rights Education
Role of the Member/Legally Responsible Person (LRP)
Role of the Community Navigator
Importance of Community Navigator Services
Role of the Care Coordinator
Role of Cardinal Innovations
Advantages of Self-Direction
This training will provide basic information about Individual and Family Directed Supports and why your role as Community Navigator is so important in supporting a Member’s goal to Self-Direct their services. After this training, we hope Community Navigator Provider Agencies will walk away with a better understanding of:
What the NC Innovations Waiver is intended to do
Philosophy of Self-Determination
The Member’s Life in the Community
Importance of Self Determination, Self-Direction and Rights Education
Role of the Member/Legally Responsible Person (LRP)
Role of the Community Navigator
Importance of Community Navigator Services
Role of the Care Coordinator
Role of Cardinal Innovations
Advantages of Self-Direction

4. What the NC Innovations Waiver is intended to do
To value and support members;
To promote practices and tools that result in real-life outcomes;
To offer service options that will facilitate each member’s ability to live in a home of their choice, have employment or engage in a purposeful day;
To provide the opportunity for member’s to direct their services to the extent they choose;
To provide educational opportunities and support the development of stronger natural support networks;
It’s important to understand the philosophy behind the Innovations Waiver to better facilitate Individual and Family Directed Supports. Some of the important things the NC Innovations Waiver is intended to do are:
To value and support members to be fully functioning in their community
To promote practices and tools that results in real life outcomes for members
To offer service options that will facilitate each member’s ability to live in homes of their choice, have employment or engage in a purposeful day of their choice and achieve their life goals
To provide the opportunity for all members to direct their services to the extent that they choose
To provide educational opportunities and support to foster the development of stronger natural support networks and enable members to be less reliant on formal support systems
What the Waiver is intended to do is continued on the following slide.

5. What the NC Innovations Waiver is intended to do
To ensure the well-being and safety of members;
To maximize self-determination, self-advocacy and self-sufficiency;
To increase opportunities for community integration through work, life-long learning, recreation and socialization;
To deliver person-centered services that leverage natural and community supports; and
To provide quality services and improve outcomes.
What the Waiver intends:
To ensure the well-being and safety of Members;
To maximize self-determination, self-advocacy and self-sufficiency;
To increase opportunities for community integration through work, life-long learning, recreation and socialization;
To deliver person-centered services that leverage natural and community supports; and
To provide quality services and improve outcomes.

6. This slide outlines some of the Goals of the Innovations Waiver
This slide outlines some of the Goals of the Innovations Waiver. This highlights some of the incremental steps of how members can increase their level of independence.
Through receiving quality services from providers that support the member’s goals, while assisting a member to identify and use community and natural supports, encouraging members to advocate for themselves, and take part in their community through work, life-long learning, volunteering, and social and recreational events. This all contributes to the member being an active, engaged part of their community. The Community Navigator is a vital service that supports & encourages the member through this process.

7. Philosophy of Self-Determination
Empowers members to gain control over selecting the services or supports that meet their unique needs to create a satisfying and personally meaningful life;
It is both person-centered and person-directed;
The key components are: Freedom, Authority, Autonomy, Responsibility and Confirmation;
The Individual and Family Directed Supports (IFDS) Option is based on the Philosophy of Self-Determination. Self-Determination empowers members to gain control over selecting the services or supports that meet their unique needs. It is a process that varies from person to person according to what each member feels is necessary and desirable to create a satisfying and personally meaningful life. Self-Determination is both person-centered and person-directed.
The key of components of Self-Direction are:
Freedom: The ability of an individual, together with freely chosen family and friends, to plan a life with necessary supports rather than purchase or conform to a set program.
Authority: The ability of a person with a disability (with a social support network or circle if needed) to control a certain sum of money in order to purchase services.
Autonomy: The arranging of resources and personnel -- both formal and informal -- to assist an individual with a disability to live a life in the community rich in personal and community affiliations.
Responsibility: The recognition of a person’s valued role in community through competitive employment, organizational affiliations, spiritual development, and general caring of others in the community as well as accountability for spending public dollars in ways that are life-enhancing for persons with disabilities.
Confirmation: The recognition of the importance of the leadership of self-advocates in the Self-Determination movement.
The Philosophy of Self-Determination is continued on the following slide.

8. Philosophy of Self-Determination
Promotes personal choice to support members strengths and interests;
Provides choice over the delivery of services, including when, where and how services are provided. For example, members have the authority to recruit, hire, train and supervise staff;
Helps members become more connected in their community;
Provides education and training on decision making, risk taking and natural consequences;
Leads to improved quality of services;
The Community Navigator’s focus is on tangible tasks: teaching problem solving, teaching reasonable choice making, teaching/education on informed decision making – advantages and disadvantages of choices that members may consider as they work towards more independence.

9. Philosophy of Self-Determination
The member is able to say what they want or do not want, have their intentions heard, and make and act on their informed decisions;
True Self-Determination ensures that members learn to have a voice, make choices, problem solve, take reasonable risks, explore possibilities and set goals for their lives; and
The member exercises their rights to privacy, dignity, respect and freedom from coercion, as they begin to truly make decisions about their lives and what they want to do in their daily activities, who they want to socialize with and their surroundings.
Community Navigator’s need to support the person lead a self determined life. This begins with helping members find their voice and learn the skills to make decisions and choices, problem solve, take reasonable risks and explore possibilities. Waiver providers, family, school, community supports all work with the member to begin to learn these skills to apply them in their lives to directing their decisions toward their life goals.
Community Navigator’s will support members to exercise their rights, and make informed independent decisions about how they want to live their day to day lives. This requires us to be respectful of the successes and at times, failures or natural consequences that may occur as the person explores different opportunities.

10. Dignity of Risk
Dignity of risk balances member choice and the responsibilities of their support system. Dignity of risk is reasonable movement to have the opportunity to fully experience the self-respect and self-esteem of being human.
Members learn the skills to become self-determined through real-life experience which involves taking reasonable risks, making mistakes, and reflecting on outcomes. These experiences help a member test his or her strengths and limitations, and identify appropriate short and long-term goals for their life.
A very important value in achieving a Self Determined life is for members to be provided the dignity of risk. Members have the opportunity to experience real life situations and succeed at some while failing at others to determine what they desire in their life. And, to deal with the consequences of decisions made. JUST LIKE EVERYONE ELSE

11. Self-Direction
Is one of most exciting opportunities and powerful tools for members with intellectual and other developmental disabilities;
Empowers members to manage the supports and services they receive, determine who provides the supports, and how and where they are provided;
Research has shown that members who direct their own services are much more satisfied with the services they receive; and
Gives the member choices. It links them to their community. It lets them live the life they want.
The CN plays an integral role when introducing Self Direction to members and empowers the member to examine if they’re interested in having more of a voice in self-directing their services.

12. The Member’s Life Self Determination Dignity of Risk
Self-Direction
Life in the Community
This slide demonstrates who should be the center of it all – the Member.
Again, the Goal of the Innovations Waiver are to support the member to become more independent in their community, by using community and natural supports, while encouraging members to advocate for themselves and be afforded the dignity of risk when making decisions and the consequences associated with those decisions.

13. A Life in the Community - The Commitment of the Waiver
Members expect the same degree of access to services in their lives as people without disabilities.

14. Communities in North Carolina must be places where:
Member rights are respected;
Member homes are not just in the community; they are part of the community;
Members can lead their lives the way they choose, at home and away from home;
A Member is side by side with everyone else at work and making a living wage;
A Member controls personal resources;

15. Communities in North Carolina must be places where:
Members have a choice about services and supports and who provides them;
Members can be with friends and loved ones;
Members feels safe and is healthy;
Members are treated with the dignity and respect; and
Members are a valued part of the community.

16. Community Connections
Support the member in identifying what they want to do and how to be more active in their community and access resources to get them there.
Assist the member with locating and accessing non-Medicaid community supports and resources that are related to achieving the member’s life goals.
Assist with exploring options for independent living, including renting or purchasing a personal residence or assisting with purchasing furnishings for the member’s personal residence.
Examples community integration and community supports & resources - what does the member want to do and determine steps on how to achieve it
Volunteer opportunities
Job opportunities
Social events

17. Importance of Educating on Rights, Self-Determination, and Self-Direction
Explains the components of Self-Determination and Self-Direction as outlined in the NC Innovations Waiver;
Encourages and supports the Member to consider Self-Direction;
Increases a member’s independence through knowledge and support to achieve their dreams/hopes;
Introduces options to member on how to direct their services; and
Explains the differences between Provider Directed and Self-Directed Services (Employer of Record and Agency with Choice).
It is very important as Community Navigator Providers to educate and inform members on the options available to them and educate members that there is support available if they choose this exciting option that will help member lead more independent lives.

18. Role of Member/Legally Responsible Person (LRP)
Has more control in managing their services
Chooses where to live, work and volunteer.
Manages their services and their schedule.
Authority to recruit, hire, train and supervise staff.
Makes decisions about managing their services on their own or with some level of support. It is more about the level of management the member wants to have over the process.
More flexibility to choose their supports and services, their staff and how they receive services (EOR only).
Examples are:
The member meets, recruit, hires direct support professionals.
The member assists in training new employees on daily routines and preferences.
The member helps develop employee schedules.

19. Role of the Member/Legally Responsible Person (LRP)
Chooses to participate in Individual and Family Directed Supports
Chooses the model of Individual and Family Directed Supports
Can receive only one model at a time but may change models/return to Provider Directed Services at any time
Participate in Training and Assessments
Perform duties of model elected

20. Role of the Community Navigator
Supports members, representatives and employers who Self-Direct
Completes Annual Informational Session on Rights and Self-Determination
Completes Annual Informational Session on Self-Direction (prior to choosing a model)
Provides information, coaching, support and assistance with recruiting, hiring, managing, training, and evaluating staff. Maintaining records, scheduling, setting staff pay rates and record keeping
Specific outcomes/functions/goals that are specified in ISP
Coordinate services with Agency of Choice or with the Financial Support Services provider (EOR model only)
Employers who choose the Employer of Record Model are required to use Community Navigator Services when they first start to self-direct services. Once an Employer demonstrates that competence in self-directing services, the Employer may or may not need to use Community Navigator Services. The member’s team will discuss more about using Community Navigator Services if a member or legally responsible person decides to self-direct services.
It is very important to remember that the Community Navigator is the person who provides assistance when self-directing services.
The Community Navigator Informational Session(s) should include an overview of the services options. If the member is not interested, no further action is needed. If the member is interested in hearing more, the member will move forward into more specific training about the model they choose.
Members need to understand that the Care Coordinator cannot provide this assistance so it is very important to choose to include Community Navigator Services in the ISP if they need this assistance.
In the information session(s), Community Navigators will want to include in your discussion the two models of Individual/Family Directed Supports:
Employer of Record means that the person or their family are the employer of the staff that provide their services.
The member has the most control in the Employer of Record Model (IFDS).
Agency with Choice means that the agency embraces the philosophy of Self Direction and allows the member or family to work with the Agency to hire and manage staff. The member has moderate control in the Agency With Choice Model (IFDS)
If the member elects Individual and Family Directed Supports, the member will need to decide which model to use. The member has the least control In the Provider Directed Services Option.

21. Why Community Navigator is Important in Self-Direction
Promotes self-determination, supports the member in making life choices as they strive to become more independent;
Provides advocacy and identifies opportunities to become a part of the member’s community;
Provides support to member’s and planning teams in developing social networks and connections within local communities;
Emphasizes, promotes and coordinates the use of community resources to address the member’s needs in addition to paid services;

22. Why Community Navigator is Important in Self-Direction
Services may be intermittent and fade as community connections develop and skills increase in individual direction;
Assists and supports (rather than direct and manage) the member throughout the service delivery process; and
Enhances, not replaces, existing natural and community resources.

23. Role of the Care Coordinator
Completes Community Navigator assessment;
Refers member to Community Navigator for Annual Informational Session(s);
Invites team members to meetings;
Completes ISP or ISP updates and submit for approval;
Completes and gathers evaluations needed by member;
Monitors the implementation of the ISP;
Explain what assessment is
What kinds of evaluations

24. Role of the Care Coordinator
Sends the ISP or ISP update to Community Navigator, member and Agency With Choice;
Completes the Process for Appointment of a Representative;
Completes the Individual/Family Directed Supports Agreement;
Provides Copies of Service Definitions to the member; and
Provides assistance to member in selecting an Agency With Choice or Financial Support Agency (EOR).

25. Role of Cardinal Innovations
Make available information concerning Orientation, Handbooks and Technical Assistance as needed;
Contract with Community Navigator Provider Agencies, Financial Support Agency and Agencies With Choice;
Develop training curriculum for Individual and Family Directed Supports; and
Determine the need for a Representative and/or Community Navigator Services

26. Role of Cardinal Innovations
Approve the ISP or ISP update;
Approve terminations, including consultation with Division of Medical Assistance (DMA);
Maintain a website with information about Individual and Family Directed Supports; and
Arrange meetings for employers to meet with key support agencies.

27. Services that can be Self-Directed
Community Living and Supports
Community Networking
Individual Goods and Services
Natural Supports Education
Respite
Supported Employment

28. Advantages of Self-Direction
Increases independence and self-sufficiency
Increased choice, flexibility, and control of services
Improved quality of services
Increased opportunities for a more healthy and productive life with better personal outcomes
Increased satisfaction with services
Increased use of people that the member knows as employees
Expanded information to assist in decisions around spending of resources
Authority to hire, train, supervise, and, if necessary, fire employees
Increased partnership between members and professionals
Increased meaningful relationships in the community
As you know, Self Directed Services have been successfully implemented in Home and Community Based Waivers in a number of states, including North Carolina. As we come close to the end of this training, we want to review the advantages of Self Direction that have been mentioned throughout this training. Advantages reported by members include:
Increased independence and self-sufficiency
Increased choice, flexibility, and control of services
Improved quality of services
Increased opportunities for a more healthy and productive life with better personal outcomes
Increased satisfaction with services
Increased use of people that the member knows as employees
Expanded information to assist in decisions around spending of resources
Focused assistance to make member direction possible
Authority to hire, train, supervise, and, if necessary, fire employees
Increased partnership between members and professionals
Increased meaningful relationships in the community

29. Community Navigator Documentation
Community Navigator services require a full service note. The Community Navigator shall complete a daily per event service note.
The provider agency shall maintain service notes signed by the individual providing the service that documents the date of the service, the amount of time involved in the service, and a description of the activities related to the long-range outcomes and the short-range goals.
The requirements of a full service note can be found in the Records Management and Documentation Manual - APSM 45-2; chapters 8 & 9.
With respect to billing of Community Navigator Services, we are finalizing the specifics on modifiers and coding.

30. Information and Resource Links
Cardinal Innovations Website:
Cardinal Innovations Provider Website:
Cardinal Innovations Communication Bulletins:
Cardinal Innovations Home and Community-Based Services (HCBS) Website–
NC Innovations Waiver:

31. Information and Resource Links
NC Innovations Waiver Medicaid Clinical Coverage Policy No: 8-P:
Records Management and Documentation Manual
Gateway to Self-Determination, National Association of State Directors of Developmental Disabilities Services (NASDDDS), Resource Library:
Self-Determination Video:
Choosing Self-Direction Video:
Encourage to use video (two links at bottom are examples) as part of their educational material as a unique tool to educate, support, encourage members to consider Self Directing their services.

32. Thank You!
Thank you all for attending today’s training. If we have any questions in the chat box, we will begin answering those first and then move on to any additional questions that agencies may have.