1. ULTCBC CONSUMER DIRECTION WORKGROUP WORKGROUP RECOMMENDATIONS Presented by Workgroup Facilitators: Roger Fouts, ODJFS Sue Fredman, ODJFS

2. Members of the workgroup…  Representatives from state agencies that participate in the long term care service and support system  Provider organizations and associations  Local sub-recipient entities and county boards  Members of the long term care advocacy community, including consumers and family representatives

3. Workgroup’s objective…  Charged with making recommendations to the ULTCBC that:  Incorporate consumer direction tenets into all facets of Ohio’s long term care service and support system; and  Include innovative consumer direction components in appropriate parts of the long term care service and support system

4. Overarching recommendation:  Consumer direction should be implemented throughout Ohio’s long term care service and support system, regardless of funding source, provider type or care setting.  Affords choice of and control over the full range of long term care services and supports that are available to meet their own diverse needs.  Ohio’s current long term care system has many tenets of consumer direction as evidenced by person-centered care programs in nursing facilities; CDC and ICFs-MR; ODA’s Assisted Living Waiver and CHOICES; Ohio Home Care; ODMR/DD waivers; and even in a county levy-funded consumer directed care program.

5. When acting upon this recommendation…  The Consumer’s Perspective about Consumer Direction  Administration and Oversight  Care Management  Financial Management

6. Consumer’s Perspective:  Participation must be voluntary, flexible enough to meet consumer’s needs, and contingent upon whether the consumer and/or authorized representative can adequately direct his/her own care.  The concept of ‘dignity of risk’ and the consumer’s right to make bad decisions is inherent in the concept of consumer direction and must be embraced in any consumer-directed care endeavors implemented by the State.  Every consumer should be able to direct as much of his/her care as he/she has the desire and ability to direct.

7. Recommendations…  State agencies collaborate to develop a comprehensive set of tools and resources for consumers and/or authorized representatives  Consumers should have greater choice regarding who they choose to be their paid provider, specifically legally responsible family members  Permit service dollars that are appropriated with the consumer’s budget or cost cap to be used to purchase other needed services, e.g. home mods, goods and services, etc.  Investigate and address legal issues around the consumer’s employer status and liability

8. Administration and Oversight recommendations…  Coordinated approach that makes use of the most appropriate model(s), and/or elements of these models to implement in Ohio  Expansion of opportunities in Ohio’s current 1915c  Development and use of innovative methods to pay for goods and services and other selected services, e.g. vouchers and/or debit cards, etc  Expansion of opportunities within the Medicaid state plan using 1915j waiver of the DRA  Expansion of person-centered care programs within nursing facilities  Establishment and maintenance of a statewide registry of providers  Access to an independent consumer-focused advocate  Implementation/coordination of quality assurance mechanisms across all systems

9. Care management recommendations…  Must be flexible enough to recognize the consumer’s unique needs  Must embrace person-centered planning as an integral component  Must also include monitoring of and communication with the consumer and/or authorized representative  Consumers be granted budget authority to purchase needed services identified during the assessment  Support consumer negotiated rates

10. Financial management recommendations…  Examine the various types of FMS entities used in the delivery of consumer directed care to determine a model(s) to be best suited and ascertain the feasibility of the FMS completing other administrative functions  Study the various types of consumer/employer status and explore whether the concept of employer status should be uniform across systems  Explore the creation/utilization of organized health care delivery systems  Explore use of ‘limited Medicaid provider agreements’  Establishment of safeguards against consumer/provider fraud

11. Parting thoughts…  Maximum choice and control over the arrangement and provision of services…  Proven to be an effective strategy in controlling overall costs at the same time increasing quality of life and satisfaction  Emphasizes a commitment to consumer participation, empowerment, and advancement of consumer rights, responsibilities and accountability with regard to personal control over service delivery  Freedom not only to define the life they seek, but to be supported by the State of Ohio in their desire to take risks and direct their own care and services in pursuit of that life