1. Medicaid’s Consumer Direction Options Consumer Direction Regional Conferences - June, 2006 Sponsored by Colorado Department of Health Care Policy and Financing Independence Plus Grant #18-P-92019/8-01

2. What is Consumer Direction? Consumer Direction is a philosophy and orientation to the delivery of Home and Community Based Services (HCBS) whereby informed consumers make choices about the services they receive. They can assess their own needs, determine how and by whom these needs should be met, and monitor the quality of services.

3. Background 1995 - Individuals with disabilities and advocates began discussing alternative approaches to providing attendant services to consumers in Colorado. 1996- S.B. 96-178 – CDAS program 2002 – S.B. 02-027 – IHSS service option 2002 – H.B. 02-1039- CDCE program 2005 – H.B. 05-1243- Consumer Direction Service Option in all HCBS waivers

4. Options In Home Support Services – “agency with choice” service option available to HCBS-EBD and Children’s HCBS clients only. Consumer Directed Care for the Elderly (CDCE) –An HCBS program designed to offer clients 55 years and older and/or their authorized representative the opportunity to direct their personal care and homemaker services. Currently being piloted in Adams, Arapahoe, Denver, Douglas, Elbert, Mesa, San Juan, La Plata and Archuleta counties. Consumer Directed Attendant Support – An 1115 waiver designed to offer clients 18 years and older the opportunity to direct their attendant support services.

5. Key Features Exemption of the Nurse Practice Act Flexibility Control Choice Responsibility Monthly Allocation Budget Training

6. Stakeholders & Partnerships Advisory Committee Consumers – (Clients) Single Entry Point (SEP) agencies Intermediary Service Organization In Home Support Services provider agencies The Department

7. Services Attendant support – in home care and other supportive activities to assist eligible individuals to accomplish daily living tasks.

8. Services Health Maintenance Activities Those routine and repetitive activities of daily living which are necessary for health and normal bodily function. An individual with a disability would carry out these activities if he/she were physically able. Examples: bowel/bladder care, blood glucose monitoring, medication administration, vent care

9. Services Personal Care – bathing, dressing, grooming, nail care Homemaker - routine light housecleaning, meal preparation, laundry, shopping

10. IHSS Eligibility –Determined by the SEP or Certified Case manager –Physician Statement –Completed Authorized Representative Form, if applicable

11. IHSS Services –Health Maintenance Activities –Personal Care –Homemaker

12. IHSS Service Delivery –Services are provided by an attendant, under direction of the consumer, a parent or guardian of a child, or an authorized representative. –Attendant must be employed by an IHSS provider agency –A consumer, parent or Authorized Representative can choose the certified IHSS agency; –The IHSS agency hires an attendant of the consumer and/or authorized representative’s choice OR –The IHSS agency can provide an attendant from their pool of available works, with consumer and/or Authorized Representative approval

13. CDCE Eligibility –Determined by the SEP 55 years and older Meet HCBS-EBD eligibility criteria Clients interested in directing personal support services must: Provide a Physician Statement of Consumer Capability Authorized Representative form, if applicable Complete Personal Support Management Training

14. CDCE Services Adult Day Alternative Care Facility Electronic Monitoring Home Modification Non Medical Transportation Homemaker Personal Care Personal Support (Self-Directed) Respite

15. CDCE Consumers and/or Authorized Representatives are responsible for recruiting, hiring, and determining wages for their personal support attendants. Consumers are required to manage their personal support services within the monthly allocation determined by the SEP. Attendants are employed through Accent Intermediary (ISO). Accent serves as an Employer of Record for attendants employed through the CDCE program and provides accounting, personnel, and training services to CDCE clients.

16. CDAS Eligibility –Determined by the Department 18 years old Eligible for Medicaid in Colorado Demonstrate a need for Attendant Support Provide a Physician Statement of Consumer Capability and Authorized Representative form, if applicable Complete Attendant Support Management Training

17. CDAS Services Health Maintenance Activities Personal Care Homemaker –Clients and/or Authorized Representatives are responsible for recruiting, hiring, and determining wages for their attendants. –Clients are required to manage their Attendant Support services within the monthly allocation determined by the Department. –Attendants are employed through Accent Intermediary (ISO). Accent serves as an Employer of Record for attendants employed through the CDAS program and provides accounting and personnel services to CDAS clients.

18. CDAS Fund for Additional Services A key program feature that allows clients to purchase items and/or services that promote independence and improve conditions related to their disability that are not covered through other Medicaid programs with unspent program funds.

19. What’s next? The Department is working on amending each HCBS waiver to include a Consumer Directed Attendant Support Service option. The HCBS-EBD waiver amendment is completed and will be submitted to Centers for Medicare and Medicaid Services for approval.

20. Contact Information IHSS George Good- deCurnou (303) 866-2704 George.good- decurnou@state.co.us CDAS & CDCE Aggie Berens (303) 866-3358 aggie.berens@state. co.us