SEP Case Manager’s Role in Consumer Directed Programs

1. SEP Case Manager’s Role in Consumer Directed Programs Consumer Direction Regional Conferences - June, 2006 Sponsored by Colorado Department of Health Care Policy and Financing Independence Plus Grant #XXXXXXXXX

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. Medicaid’s Consumer Directed Options • In Home Support Services (IHSS) – “agency with choice” service option available to HCBS-EBD and Children’s HCBS clients only. Services include homemaker, personal care, and health maintenance activities. • Consumer Directed Care for the Elderly- (CDCE) – An HCBS program designed to offer clients 55 years and older and/or their authorized representatives the opportunity to direct their personal care and homemaker services. This program design uses a financial management services (FMS) organization. • Consumer Directed Attendant Support (CDAS)- An 1115 waiver designed to offer clients 18 years and older and/or their authorized representatives the opportunity to direct their attendant support services which includes homemaker, personal care, home health aide and nursing services. This program design uses a fiscal intermediary organization. This program design uses an ISO organization.

4. Single Entry Point (SEP) • Eligibility Determination for most HCBS programs: • HCBS-EBD • HCBS-PLWA • HCBS-BI • HCBS-MI • C-HCBS • HCBS-CDCE (pilot) SEP Responsibilities Authorization of Home Health Quality Assurance Case Management Referral and Information Distribution Service Coordination

5. Case Manager Responsibilities • Provide information on all consumer directed options to eligible clients • Options and right to choose • Potential benefits and risks

6. IHSS Responsibilities • Enrollment • UTLC 100.2 • Physician Statement • PAR • Coordination • IHSS certified provider agency

7. IHSS Responsibilities – cont’d • Contact Requirements • Same as any other EBD client • Reassessment • EBD criteria • Discontinuation • Must reestablish services • Appeals • Send 803 as with other actions

8. CDAS Responsibilities- cont’d • Enrollment • Refer interested individuals to the Department for application and enrollment processing • Authorize Services • Complete CDAS PAR • Contact Requirements • Twice a month for the first 3 months of participation by telephone and quarterly thereafter • Contact Accent at least at time of reassessment

9. CDAS Responsibilities – cont’d • Reassessments • Complete a face to face interview with the client and/or authorized representative every six months • Document summary on the Benefits Utilization System (BUS) and notify the Department • Submit a completed Physician Statement of Consumer Capability to the Department every six months for the first year of participation and annually thereafter

10. CDAS Responsibilities – cont’d • Discontinuation • Must assist the client in returning to agency provided services • Appeals The Department handles the appeals and sends the 803 to the client

11. CDCE Responsibilities • Enrollment • ULTC 100.2 • Physician Statement/Authorized Representative Statement • PAR & Monthly Allocation

12. CDCE Responsibilities- cont’d • Contact Requirements • Twice a month for the first 3 months of participation by telephone and quarterly thereafter • Contact Accent quarterly • Conduct a face to face interview with the client and/or authorized representative when a change in the designated authorized representative takes place

13. CDCE Responsibilities- cont’d • Reassessments • Complete a face to face interview with the client and/or authorized representative every six months • Obtain a completed Physician Statement of Consumer Capability every six months for the first year of participation and annually thereafter

14. CDCE Responsibilities- cont’d • Discontinuation • Must assist the client in returning to agency provided services • Appeals • Send an 803 to the client

15. IHSS George Good-deCurnou in Denver metro: 303-866-2704 in state: 1-800-221-3843 x 2704 CDAS & CDCE Marie Garcia in Denver metro: 303-866-2755 in state: 1-800-221-3943 x 2755 Contact Information