2. SD/CSS - The Basics: Oct.2009 Understanding Self-Directed Services (SD) Using Consolidated Supports and Services (CSS) The Basics

3. SD/CSS - The Basics: Oct.2009 Principles of Self-Determination A philosophy that is based upon: Freedom Authority Support Responsibility Self-Advocacy Self-Direction increases responsibility

4. SD/CSS - The Basics: Oct.2009

5. State Funded Services (100%) State Funded Services Resources to Support the Person Ex: Transition funding Individual Support and Services (ISS) Family Supports and Services (FSS) At Home Services Person Living at Home (Care at Home Waiver)

6. SD/CSS - The Basics: Oct.2009 OMR Services and Supports Options Family Ed & training Day Hab Pre- Voc Respite Adaptive Equipment Community Habiltation Envir onmental Mods C SS FMS /FEA Residential Habilitation Brokerage Supported Employment Medicaid Program Home and Community Based Waiver (HCBS) 50% Fed 50% State Care at Home

7. SD/CSS - The Basics: Oct.2009 CSS is a Home and Community Based Waiver Services (HCBS) People must be deemed eligible for OMRDD services – contact your local DDSO regarding the eligibility determination process. Most supports and services for individuals and families are provided through OMRDD’s Home and Community Based Services (HCBS) Waiver. Most services (both HCBS and State Plan services) are paid for by Medicaid.

8. SD/CSS - The Basics: Oct.2009 Features of SD/CSS CSS is an OMRDD HCBS Waiver Service SD/CSS allows people to self-direct and manage their supports and services based on a unique plan(Person-centered Plan) and individual, portable budget. The individualized budgets (called Personal Resource Accounts) are managed through a Fiscal Management Services/ Employer/Agent. SD/CSS is a fiscal partnership: the person’s wages, income and assets are combined with government funding.

9. SD/CSS - The Basics: Oct.2009 Features of SD/CSS con’t: Housing costs vs. service costs Personal allowance monies are retained by the person OMRDD/DOB approvals: Extraordinary Funding Request (EFR). ( currently EFR not viable) There is an absolute cap on SD/CSS Pilot budgets

10. SD/CSS - The Basics: Oct.2009 Most importantly: CSS begins with the Person “Nothing about us without us!” The person is at the center Chooses circle of support & directs activities Increased sense of control and decision- making Satisfaction with choices Focus on relationships, contribution & community

11. SD/CSS - The Basics: Oct.2009 The Circle of Support (C.O.S) The Circle is the key decision-making group and requirement of CSS They meet regularly to plan, support, advise the person Replaces other system structures and is a key to safeguarding, plan implementation and management & budget For the SD/CSS Project, the Medicaid Service Coordinator is a required member A mix of professional and natural supports, freely chosen No set number – size relates to needs Membership may change over time

12. SD/CSS - The Basics: Oct.2009 Developing a Person Centered Plan Based on a capacity view of a person’s interests preferences, abilities, and dreams Requires a group of people committed to a powerful vision of the person’s future Promotes the use of natural support system Results in quality of life improvements that reflect personal outcomes Builds in safeguards

13. SD/CSS - The Basics: Oct.2009 Getting Started - Getting Help: What is a Start-up Broker? Families and MSCs often don’t have the time or ability to do all the tasks associated with getting a SD/CSS application and plan completed. Startup Brokers can be an(independent Contractors, or unpaid parents, or agency representatives) hired by the person for a negotiated price based on the person’s needs (100% state funded) or they can be unpaid Assists the person to develop the Self- Determination/Consolidated Supports and Services (CSS) application and initial SD/CSS service plan Tasks are separate from those of your Medicaid Service Coordinator

14. SD/CSS - The Basics: Oct.2009 Start-Up vs Support Broker Tasks Start-up Broker  Authors CSS Plan & designs Services and Support  Creates Budget  Advises Family & Friends and the Circle of Support  Conduct Person- Centered Planning Process Support Broker  Maintains the CSS Plan objectives  Revises the CSS plan as needed  Revisits the PCP plan  Revises Budget as needed  Assists with the recruitment, retention, training of staff

15. SD/CSS - The Basics: Oct.2009 What can a Start-up Broker do with you? Assist with Circle Development Facilitate Person Centered Planning Identify Community Connections & Resources Design weekly schedule & support Develop Individualized Budget Work with DDSO Liaison to finalize application

16. SD/CSS - The Basics: Oct.2009 Support Brokers When the plan is approved, then the real work begins! Independent Contractors can also be hired to help the individual and Circle of Support implement the CSS plan. Some of the most common duties that Support Brokers assist participants with include:  Hiring  Interviewing  Training  CSS Documentation  Updating and Revising the CSS Plan and Budget

17. SD/CSS - The Basics: Oct.2009 Service Coordinators may help brokers with: Circle development and maintenance Identify generic community connections and resources Budgeting, paperwork Working with a fiscal management agency Assisting with hiring and firing supports Assist with individual support agreements Planning Health and safety decisions Monitoring quality and satisfaction

18. SD/CSS - The Basics: Oct.2009 Developing the SD/CSS Plan Individual begins putting together an application/plan with the assistance of their SUB, Circle of Support, and MSC DDSO is available to assist throughout the process Identifies what the person wants to do and captures all the supports and services needed to achieve outcomes If plan is developed before individual leaves school, a copy of their IEP must be attached to identify supports provided by SED. Identifies areas where additional safeguards need to be addressed and how they will be addressed DDSO local review and approval of CSS plans

19. SD/CSS - The Basics: Oct.2009 The Individual Budget Used to pay for supports and services, appropriate to Medicaid Cannot pay for personal expenses related to entertainment/diversion CSS itself not designed to pay for housing Collaborative use of personal resources and benefits Funds are administered through a Fiscal Management Services (FMS) Agency

20. SD/CSS - The Basics: Oct.2009 The Individual Budget Captures all the costs needed to support the plan  Staffing costs  Staff Training  Transportation

21. SD/CSS - The Basics: Oct.2009 Typical RES Supports may include: Independent Living Skills Training & Development  Personal/Health Management  Hygiene and Grooming  Day Planning & Organization Skill Building related to household management  Meal Prep/Cooking  Grocery Shopping  Laundry  Cleaning Household Budgeting Getting to know & navigating your neighborhood Home Safety and Accident Prevention (Evacuation) Using adaptive equipment in the home Home-based communication skills development

22. SD/CSS - The Basics: Oct.2009 Typical OTR Supports may include:  Job development  Job coaching  Adult education  Transportation  Community inclusion  Social skills development  Exercise/wellness  Habilitative and educational equipment  Entrepreneurship  Personal care

23. SD/CSS - The Basics: Oct.2009 The Fiscal Management Service Agency Assists the participant in managing the supports and services portion of the budget Draws down resources from emedNY & OMRDD to establish Personal Resource Account Pays the bills based on the most current approved plan Is the employer of record for hired supports Background checks/fingerprinting Health insurance Training Tracks expenditures & provides monthly financial statements to the participant and DDSO liaisons Is a waiver service provided by a not-for-profit entity

24. SD/CSS - The Basics: Oct.2009 Managing Your Self Determination Plan & Budget (Managing Employer vs. Employer of Record) MANAGING EMPLOYER/CSS Participant  SD/CSS participants act as the “managing employer” of their services and supports  Individuals are responsible for hiring and training their staff  Determines the job duties and schedule for their workers  Signs off on time sheets for staff EMPLOYER OF RECORD  FEA acts as the “employer of record” for SD/CSS participant  Conducts criminal background checks  Collects time sheets and service documentation  Maintains payroll for staff and is responsible for workers compensation and other benefits

25. SD/CSS - The Basics: Oct.2009 Quality, Satisfaction, Oversight Responsibilities of the person and his or her circle – everyone has a role in quality Focus on personal satisfaction with ones life Emphasize balance: health, safety, risk Existing rules and regulations may apply