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NASHP State Health Policy Conference October 2010 Julia Kenny Assistant Secretary PowerPoint PPT Presentation


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NASHP State Health Policy Conference October 2010 Julia Kenny Assistant Secretary Office for Citizens with Developmental Disabilities Louisiana Department of Health and Hospitals. Louisiana Self-Direction Option. CMS approved Louisiana’s “New Opportunities Waiver” effective July 1, 2003.

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NASHP State Health Policy Conference October 2010 Julia Kenny Assistant Secretary

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NASHP State Health Policy Conference

October 2010

Julia Kenny

Assistant Secretary

Office for Citizens with Developmental Disabilities

Louisiana Department of Health and Hospitals


Louisiana Self-Direction Option

  • CMS approved Louisiana’s “New Opportunities Waiver” effective July 1, 2003.

  • 1915(c) waiver that allows for consumer direction of home and community based waiver services.

  • Self-direction is a service delivery option in the NOW, which allows participants to take the leading role in the employment of their service workers.

  • Participants are in charge of recruiting, hiring, firing, and supervising the people who work for them.


Self-Directed Services Approved Under Waiver

  • OCDD currently only provides individualized and family support through NOW.

  • OAAS will provide other services through a more comprehensive “Community Choices” waiver next calendar year including:

    • Support Coordination

    • Transition Intensive Support Coordination

    • Transition Service

    • Personal Assistance Services

    • Adult Day Health Care

    • Environmental Accessibility Adaptations

    • Personal Emergency Response System (PERS)*

    • Assistive Devices and Medical Supplies* (Includes PERS)

    • Skilled Maintenance Therapy Services (PT, OT, ST and RT)

    • Nursing Services

    • Home Delivered Meal Services

    • Caregiver Temporary Support Services (Respite)

    • Non-Medical Transportation


Fiscal management

  • Louisiana OCDD Central Office Fiscal Section began by managing payment and documentation of all IFS direct support workers’ salaries and benefits who were hired by NOW recipients.

  • OCDD subsequently amended its application from serving as an “agency of choice” to “fiscal management agent.”

  • RFP process was undertaken and Acumen was chosen to serve as fiscal/employer agent.


Duties performed by Acumen

  • Processes employee time sheets

  • Generates payroll checks for employees

  • Conducts criminal background checks

  • Processes all employment records

  • Withholds, files, and deposits all necessary taxes in accordance with federal IRS, DOL, and state rules

  • Provides participants, support coordinators, and OCDD with monthly participation reports

  • Maintains a toll-free call center for self-direction participants, support coordinators, and others to call for information

  • Tracks employee training

  • Offers workman’s compensation coverage

  • Acts as a billing agent for each DSW under a single provider number, bills Medicaid.


Participant Satisfaction

  • 2009 Survey found that:

  • 98% were satisfied with services provided by Acumen

  • 92% were satisfied with the self-direction option

  • 92% believe they receive the services they need

  • 85% stated “I have a choice and control over my supports and services”


Participation Rates and Retention

  • Currently, there are 3,341 citizens in 3 regions receiving services under NOW.

  • Of these citizens, 60 or 1.8% are on self-direction.

  • Enrollment in SD has tripled since 2003.

  • In the last 3 weeks, 12 more have applied.

  • NOW statewide extension will lead to the addition of at least 78 to SD enrollment.

  • Statewide training initiative is expected to increase utilization rate to 10% or approximately 769 participants.

  • Adding the SD option to our CC waiver will lead to an approximate increase of 200 participants based on a utilization rate estimate of 20%.

  • Since 2003, no one has voluntarily chosen to leave self-direction.*


Hannah

  • Higher PCA rate paid for persons with a greater need level ended in 2003.

  • Through SD she is able to compete for better workers by offering them a higher rate.

  • She has found that it is much easier to hire and retain qualified workers since she switched from the traditional agency-hired worker to self-direction.

  • The only new tasks Hannah has to deal with is the additional paperwork associated with new hires, and reviewing and faxing time sheets.

  • Fiscal agent has been helpful assisting and streamlining these processes.

  • Challenges: managing backups, training requirements, background checks


Challenges

  • DSW Registry Rule

  • Billable training hours

  • Goods and services waiver adjustment to allow for supplies, fax machines, mileage reimbursements, advertising and employee recruitment.


Where SD is headed in Louisiana

  • Statewide expansion of services under NOW.

  • Inclusion of SD in the Children’s Choice waiver (personal care services).

  • Residential Options waiver (community living supports; companion care; & community integration transportation).


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