What is the Consumer Choices

Option?

What is new?

• Consumers can directly hire employees to provide services- do not need to be a Medicaid provide

• Consumers can use their Medicaid $$ to purchase goods/services example: a local cleaning service to clean their house

What is new?

• Financial Management Service provider to help manage the individual budget

• Additional counseling and advice through and Independent Support Broker

What remains the same

• All consumers will have a service plan• Skilled services will continue to be

provided by Medicaid providers such as Nursing, Counseling, Home health Aide

Service options

Self-directed Personal CareSelf-directed Personal Care- cleaning, meal preparation, showering assistance, respite

Self-directed Community and Employment Supports-social skills development, career placement,cooking skills development

Individual Directed Goods and Services_-HVM, snow removal, lawn care services

How is the $$$ calculated that the consumer will receive

• Consumers’ individual budget amount will be based on dollars utilized, utilized, statewide for each service, using a statewide average rate per service

-For example a consumer may be authorized $500 a month of respite. Historically MR consumers only use 80% of respite, ISIS will calculate $500 x 80%=400. The consumer will have $400 in their individual budget, but the $500 will apply towards any waiver caps that may exist

• Identify $$$ available for their individual budget, based on their need/service plan• Complete the HCBS consumer choices informed Consent and Risk agreement form –470-4289 with the consumer• Assist the consumer with choosing a independent support broker, and Financial management service•Monitor the usage of all services

Case Manager/Service Worker responsibilities

Consumer Responsibilities • Recruit employees• Select employees• Verify employees qualifications• Specify additional qualifications• Determine employee duties• Determine wages• Provide Workers Compensation (paid with Medicaid $$)• Schedule, train and supervise employees• Communicate needs to the team• Delegate a budget representative if necessary

Financial Management Services Responsibilities

• Receive Medicaid funds electronically• Enter the individual budget into ISIS• Process and pay for all Consumer Choices option services/

invoices-verify to the individual budget• Provide real time individual budget balances• Process Criminal background checks• Conduct all fiscal and payroll responsibilities-process

withholding, FICA, workers comp, monitor timecards• Monitor timecards/invoices ensuring consistency to the

individual budget• Provide monthly statements

Independent Support Broker

Responsibilities • Assist the consumer with developing budget(s)• Monthly contact with consumer for the first 4 months,

quarterly after that• Assist consumer with the employment packet paperwork• Assist as needed with interviewing potential providers,

negotiating rates of pay, and determining employee qualifications

• Assist with developing an emergency backup plan• Review monthly statements from the FMS to ensure

budgeted services are provided

Employee responsibilities

• Provide:– Self-directed personal care– Self-directed community supports and

employment– Individual-directed goods and services

• Authorize required background checks• Provide documentation of training/experience as

requested by the consumer• Provide the services as identified in the employee

agreement• Document services provided on the approved time

sheet

Frequently Asked Questions• Where does the money for the ISB and FMS come

from?– From the individual budget/Medicaid $$

• If the CM/ SW disagrees with the consumers choice of staff who has the final decision?– Ultimately the consumer, if there are concerns, voice

them with the consumer and the team, ISB and continue to monitor if this option is working for the consumer

• What documentation is required?– Every employee hired has to complete a detailed time

card that describes what was done during the time spent.

Frequently Asked Questions• How will HVM work?

– Similar as it does today, the consumer will still need to obtain a bid, the CM/SW will enter that amount into ISIS, provider does not need to be a Medicaid provider

• How do we determine respite units? – It will now need to be done monthly and there

will still be a cap of $7050

Frequently Asked Questions• Is the cost of attending a movie allowable?

– No for the consumer, but can be reimbursed for the provider/employee if services are needed for the consumer

• Can the $$ be used for a vacation?– No, but if needed it can pay for services provided

while on vacation

• Can the money be used to buy a new refrigerator for the family?– As always, Items of convenience can not be purchased

• Can the $$ be used to purchase new clothes for a job interview– No not at this time

Frequently Asked Questions• Does the case manager need to meet with the

employees the consumer hires?– No, not unless the consumer specifically requests this.

• How much time will it take the consumer to get started with Consumer Choices Option?– The consumers must have all of their paperwork into

the FMS by the 25th of the month prior to the month they want to start. If you think it will take them longer to complete their paperwork, have them continue with traditional services until the next month to ensure they do not go without services

“Providing more choice and control to people who are capable of managing very personal daily activities makes a tremendous difference in improving their quality of life” Kevin Mahoney