Cathy Cope Melissa Hulbert Centers for Medicare & Medicaid Services
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- Enduring Systems Improvements
- New Policies to Enable and Support PASS and Self-Directed PASS
- Increased Options for Self-Directed PASS
- Increased Access to PASS
- Improved PASS Quality for Persons with Serious Mental Illness
- New Methods to Help Participants Recruit and Retain Workers
- Systems Improvements Beyond the Grant Period
1Section One. OverviewAmong the long-term services and supports that enable individuals with disabilities to live independently in the community, personal assistance is the most important. Every state provides personal assistance services and supports (PASS) through a Medicaid waiver program, the State Plan, or both. The goal of the Community-Integrated Personal Assistance Services and Supports (CPASS) grants was to help states design systems that not only offer basic PASS but also afford service users maximum control over the selection of their workers and the manner in which services are provided. In FY 2003, the Centers for Medicare & Medicaid Services (CMS) funded eight CPASS grants, as listed in Exhibit 1-1. Exhibit 1-1. FY 2003 CPASS Grantees
Enduring Systems ImprovementsIn addition to their numerous accomplishments, all but one of the CPASS Grantees reported enduring improvements in their states’ PASS systems, as shown in Exhibit 1-2. This section describes the Grantees’ enduring improvements in these five areas. Exhibit 1-2. Enduring Improvements of the CPASS Grantees
Section Two provides more detailed information about each state’s grant initiatives—both their accomplishments and their enduring changes. Grantees’ accomplishments were preliminary steps in the process of bringing about enduring systems improvements. For example, designing and implementing a pilot program for self-directed services is an accomplishment, whereas enacting legislation requiring a new self-directed services option to be available in all Medicaid waiver programs is an enduring systems improvement. New Policies to Enable and Support PASS and Self-Directed PASSRestrictive Nurse Practice Acts (NPAs) can pose a major barrier to community living for persons with disabilities who also have nursing/medical needs. If a state’s Nurse Practice Act mandates that only licensed personnel can perform specific nursing tasks, the cost can be prohibitive, particularly for individuals who need such tasks on a daily basis or multiple times per day. Although Nebraska’s Nurse Practice Act had been amended about 15 years ago to allow individuals to direct their personal assistants to perform health maintenance activities such as medication administration, this provision was not reflected in Medicaid policy. Nebraska grant staff worked to incorporate relevant provisions of the State’s Nurse Practice Act into Medicaid regulations; now Medicaid beneficiaries can direct all of their care, including health maintenance activities such as insulin injections and catheterization. In addition, Medicaid program staff developed assessment and care plans based on a self-direction model rather than a medical model, which case managers are mandated to use. Increased Options for Self-Directed PASSThere are several self-direction service models, which vary in the extent of control and responsibility they give to program participants. At one end of the continuum, the agency-with-choice model allows participants to select their workers and to determine how and when services are provided, while having an agency be the legal employer responsible for all tax withholding and payments. The agency-with-choice service model is attractive to individuals who do not want to assume the responsibility for handling these employer tasks. At the other end of the continuum is the employer/budget authority service model, which allows participants to both employ their own workers and to manage an individual budget to pay their workers and to purchase other goods and services they need to live in the community. Ideally, programs will offer a range of self-direction service models to allow participants to select the model that best fits their needs and abilities. Prior to receiving the CPASS grant, Texas’s Medicaid State Plan Primary Home Care program (offered under the State Plan Personal Care option) gave participants the ability to employ their workers and direct an individual budget. The major goal of the State’s CPASS grant was to implement an agency-with-choice service model—the Service Responsibility Option—in the same program. Information obtained through early grant activities informed the State’s self-direction policy, and in September 2007 the State enacted legislation requiring that the Service Responsibility Option be available not just in Medicaid State Plan services but in all of the State’s Medicaid waiver programs, as well as in its managed care programs. Grant staff later developed the regulatory infrastructure to implement the Service Responsibility Option statewide, and regional and local services staff developed policies and procedures outlining the responsibilities of case managers to facilitate access to and the use of the new option. Subsequently, the Department of Aging and Disability Services staff and the Health and Human Services Commission developed a State Plan Amendment to add Support Consultation as a State Plan service (a requirement of the Service Responsibility Option). Support Consultation Services include skills training and assistance in meeting employer responsibilities and program requirements, such as the development and implementation of backup plans. The Amendment was submitted to CMS on March 30, 2008, and is currently on hold until another State Plan Amendment regarding self-directed services has been approved. Grant staff also developed a comprehensive range of outreach, education, and training materials about the new option. Grant staff in Massachusetts conducted a workshop for state legislators and their staff about self-direction, which informed their decision to draft legislation requiring the Department of Mental Retardation (DMR) and the Executive Office of Elder Affairs to develop a plan for offering self-direction in the programs they administer. Grant activities also supported efforts to enact self-determination legislation that requires the DMR to develop recommendations for implementing a self-determination model whereby program participants will personally control (with appropriate assistance) a targeted amount of dollars in an individual budget. The governor signed this legislation into law in September 2008. Increased Access to PASSPersons with serious mental illness (SMI) can be excluded from PASS programs if the eligibility criteria for these programs do not recognize their specific functional limitations; for example, by requiring that applicants have physical limitations such as the inability to dress or bathe themselves. Oregon expanded Personal Care Services (PCS) offered through the Medicaid State Plan to serve persons with serious mental illness by revising the eligibility criteria to include functional limitations common among this population. The State PCS manual was also revised to illustrate ways in which the eligibility criteria apply to persons with serious mental illness. State policies can pose a barrier to community living if they require PASS to be provided in a person’s home in order to be reimbursed, as was the case in Nebraska. Grant staff worked to amend Nebraska’s regulations to allow Medicaid reimbursement for PASS provided in the workplace, eliminating a barrier to employment for people who receive PASS through the Medicaid program. Massachusetts awarded two mini-grants to community organizations to better understand the cultural factors that influence participation in self-directed services options. As a result of activities conducted under one of these mini-grants, access to PASS for the Latino community in Holyoke, Massachusetts, was increased by helping a range of community service providers to offer culturally appropriate services.
Grant staff also developed public education materials regarding self-directed PASS and a website for marketing the PASS training curriculum to mental health service users and PCAs. The website provides information for service users on how to choose and supervise their PCAs and on their rights as consumers. The evaluation instrument for the curriculum has been incorporated into the Office of Mental Health and the Department of Health and Hospitals policies and procedures for ongoing program evaluations. To help improve workforce professionalism, PCA certification requires completion of the curriculum’s skills component. New Methods to Help Participants Recruit and Retain WorkersA major barrier to community living and the provision of high-quality PASS is the widespread shortage of qualified workers, known in different states by a multitude of names: personal assistants, personal care attendants, direct service workers, paid caregivers, direct support professionals, and others. Thus, efforts to improve access to PASS often include efforts to help participants find workers. One of the advantages of self-direction programs is that they allow participants to hire friends, neighbors, and relatives, which helps to alleviate worker shortages. However, not all participants have this option—and even those who do, still need to find reliable workers to provide services when their regular workers are unable to work or need respite. Two Grantees’ initiatives were aimed at helping participants find workers. Arizona created consumer-owned and –operated service brokerages known as Human Service Cooperatives (HSCs®) and developed a Federated HSC Development and Support Center (Federated HSC®) to provide technical assistance to HSCs in Arizona and other states. HSC Companies use both standard advertising methods and other approaches to help members find and share workers. For example, the use of affordable Internet communications has facilitated the development of “grapevine systems” through which members can contact one another and coordinate scheduling and staff sharing to ensure coverage. The HSC Companies also help members to purchase adaptive equipment and supplies from local businesses. To enable other states to replicate the HSC supports brokerage model, the Grantee developed business start-up tools, education, training, and outreach/marketing materials. In collaboration with staff of the State’s Medicaid Infrastructure grant, Connecticut’s grant staff developed a contractual agreement with http://rewardingwork.org to create a Connecticut-specific web page for use by Connecticut personal assistants and self-directing participants. Between January 2005 and September 2007, 2,082 personal assistants from Connecticut registered on the Rewarding Work website. Grant funds paid to operate the link for the grant’s duration, and when the grant ended the Department of Developmental Services paid an additional fee to enable its case managers to use the site for another year. Self-directing participants who could not afford the annual fee were also able to use the website for another year under this agreement. In addition, grant staff developed personal assistant recruitment and outreach materials in print and video formats and in different languages for use in high schools, community colleges, and other educational settings. Staff distributed materials to provider agencies and disability groups and used excerpts from the video for TV and radio public service announcements. The Department of Developmental Services is continuing to use these materials, and all grant materials are posted on the website of the University of Connecticut A.J. Pappanikou Center for Excellence in Developmental Disabilities. To assist participants who want to direct their services, grant staff also created a training curriculum entitled You Are the Employer that covers all aspects of hiring and management. The curriculum is available on various websites, in print, and on CDs, in both English and Spanish. A second curriculum was developed specifically for hiring workers to provide services to participants in programs operated by the Department of Developmental Services. Systems Improvements Beyond the Grant PeriodVirginia’s grant staff conducted a survey of self-directing participants in the State’s waiver programs. Based on their high satisfaction rates and an increase in the number of people using self-directed services in the past few years, Virginia is now planning to increase self-direction options, including one allowing participants to direct an individual budget. Directory: sites -> nasuad -> files -> hcbs -> files sites -> 587 Return function, r i(X) r i(0) r i(1) r i(2) r i(3) 1 0 2 4 6 Thermal Station, I 2 0 1 5 6 3 0 3 5 6 10 sites -> Glossary for Chapter 1 Algorithm sites -> North Carolina Inclusion Initiative Mapping Where Children with ieps are Being Served Purpose sites -> Northern England’s set-jetting locations sites -> Physical custody of 1033 program property accountibility form statement of Physical Custody: By signing for the below 1033 property I am a Law Enforcement Officer of the aforementioned Law Enforcement Agency sites -> Nstructions for Acquiring Excess Equipment online, through the 1033 Program sites -> Memorandum of agreement files -> Acronyms introduction: The most important fact about acronyms and professional jargon is that it is not necessary for any of this work. In fact Download 2.18 Mb. Share with your friends:
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