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What is the Consumer Choices Option?

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Presentation on theme: "What is the Consumer Choices Option?"— Presentation transcript:


2 What is the Consumer Choices Option?

3 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

4 What is new? Financial Management Service provider to help manage the individual budget Additional counseling and advice through and Independent Support Broker

5 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

6 Service options Self-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

7 How is the $$$ calculated that the consumer will receive
Consumers’ individual budget amount will be based on dollars 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

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

9 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

10 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

11 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

12 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

13 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.

14 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

15 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

16 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

17 “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

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