INDEPENDENCE PLUS An Overview of Medicaid�s Self-Directed by L587rDN

VIEWS: 5 PAGES: 27

									4th Annual Training Institute for “New
        Freedom Initiative” Olmstead
                          Coordinators

                Independence Plus and
                Self-Direction at CMS
                         Sept 13, 2004

                              Terry Pratt

                         CMSO/DEHPG
Building a Foundation for
         Success
           • Always know your state
             initiatives.
           • Be mindful that Medicaid
             is only one funding stream.
           • Communicate,
               Collaborate, and
                Coordinate.
                            CMSO/DEHPG
              CMS Tool-Kit
                   • Independence Plus Fact Sheet
                   • NFI: President’s FY2005 Budget
                      & CMS Accomplishments
                   • Web Resources
•Money Follows the Person State Medicaid Director Letter
(Aug 2004)
•President’s NF Commission on Mental Health Fact Sheet
•Promoting Self Determination (Research Paper)
•Medicaid at a Glance
                                         CMSO/DEHPG
 Accomplishments of NFI
Resources (Financial & TA)
  – Promising Practices
  – Independence Plus
  – Real Choice Systems Change
    Grants
  – Direct Service Worker Grants
  – Ticket to Work Activities
  – State Medicaid Director Letters

                                      CMSO/DEHPG
  Independence Plus Initiative:
promotes full access to community

• Based on national pilot projects
• More fully develops self-directed
  practices
• Provides waiver templates
• Allows for individual budget accounts
• Continues to evolve as learning occurs



                                           CMSO/DEHPG
Independence Plus Initiative
 • Programs receive authority through
   the Social Security Act
    – 1915(c)
    – 1115 Demonstrations
    – 1915(b)
    – State Plan
 • Health & welfare are drivers
 • Self-direction is challenging
   interpretations

                                        CMSO/DEHPG
        WHAT IS IP…
    A CMS SELF-DIRECTED
         PROGRAM
                CMS’ Definition of
                Independence Plus:
.          A program that presents
           individuals with the option
           to control and direct
           Medicaid Funds identified in
           an individual budget, and in
           which the participants live in
           their own homes.

                            CMSO/DEHPG
       Independence Plus &
        Self-Determination
INDEPENDENCE PLUS:           SELF-DETERMINATION:
…a Means to an End             …an End

• A set of federal Program   • A philosophical
  Requirements consistent      foundation (freedom,
  with Social Security Act     authority, support,
  that assure a                responsibility) for the
  comprehensive self-          treatment of people with
  direction program with       disabilities in our culture:
  necessary safeguards         related to the Civil Rights
                               and Disabilities Rights
                               Movements
                                              CMSO/DEHPG
      CMS Essential Elements for
     Independence Plus Programs
1. Person Centered
    Planning
2. Individual Budgeting
3. Self-Directed Supports
4. Quality Assurance &
    Improvement

                            CMSO/DEHPG
   Person-Centered Planning
• Participant directs the planning process (including
  who participates, where/when held)
• Includes paid and non-paid supports and services
• Written plan identifies strengths, capacities,
  preferences, needs, desired outcomes, planning
  goals, and emergency back-up plans of the
  participant;
• Include Psychiatric Advance Directives for
  persons with mental illnesses.

                                          CMSO/DEHPG
       Self-Directed Budget
• Self-Directed budget includes the portion of the
  service budget that a person can self-direct
• Method of determination should be open to public
  inspection
• Allows person to move money within approved
  service categories
• Procedures in place to request changes as needs
  change.
• Part of the overall planning process

                                       CMSO/DEHPG
 Self-Directed Budget (cont.)
• May exclude emergency services
• Include psychosocial rehabilitation dollars
• May only amount to $400 - $500/month of
  self-directed budget
• Question: Is there enough money to help
  with recovery goals?


                                    CMSO/DEHPG
   Self-Directed Supports
Financial Management
• Assistance with locating and securing supports
  and services
• Assistance with managing finances in self-
  directed budget
• Purchases goods and services on behalf of
  participant
• Performs payroll/personnel functions as
  necessary

                                     CMSO/DEHPG
Self-Directed Supports (cont.)
Independent support-brokerage assists with:
  – Navigating the system
  – Locating supports and services
  – Person-centered planning process (including
    budgeting)
  – Managing personnel as necessary



                                       CMSO/DEHPG
Quality Management




                 CMSO/DEHPG
                    Recovery
• People experiencing mental illnesses can regain a sense of
  hope, meaning, and purpose in life. This is accomplished
  in part through:
   – Meaningful relationships
   – Meaningful work
   – Freedom in working with limitations
   – Independent living in a community of choice
   – Relationships with others who have similar experiences
   – Harnessing the strengths inherent in each person



                                               CMSO/DEHPG
 Working Together: Self-Determination,
    Recovery, Independence Plus
• Independence Plus helps create the conditions for
  self-determination.

• Recovery outlines some of the things that are
  included in a self-determined life.

• Everyone can self-direct, recover, and live a self-
  determined life with the proper supports!


                                          CMSO/DEHPG
   What Services Can be
 Controlled in Self-Direction?
A few alternatives:
  –   Micro-enterprise support
  –   Supported Employment
  –   Personal Assistance
  –   Transportation
  –   Housing supports
  –   Peer Supports


                                 CMSO/DEHPG
   Fostering the Transition to Self-
Direction: Consumer Owned Supports
• People may be reluctant to take on an individual budget
  right away.

• Consumer owned and operated services and supports may
  help create a culture of ownership and empowerment.

• There is no prohibition on consumer owned organizations
  contracting directly with service providers.



                                               CMSO/DEHPG
   A Few Examples of Consumer
Owned/Operated Services and Supports

• Drop-in Centers
• Independent Person-Centered Planning
  Facilitators
• Peer Support Services
• Consumer Cooperatives



                                 CMSO/DEHPG
Money Follows the Person (MFP)

• MFP: System of flexible financing; enables
  available funds to move with the individual;
  market-based approach;gives more choice to
  individuals.

• August 17, 2004: State Medicaid Directors
  Letter on MFP – focused on addressing areas of
  confusion that may be impeding state efforts.


                                        CMSO/DEHPG
    Continuum of Self-Directed
            Models

•   Traditional Model
•   Traditional Model Supporting Choice
•   Agency with Choice Model
•   Fiscal/Employer Agent



                                   CMSO/DEHPG
CMS NEXT STEPS FOR
  SELF-DIRECTION
       One web-based,
          streamlined
         application in
          place of two
             with….
      – Instructions
      – Technical Guide
         WHAT CAN
       A PERSON DO??
• Be a part of the decision making
• Know Social Security Act, CMS Regs,
  and current interpretations
• Agree on an approach & work in
  partnership with your state to develop a
  comprehensive self-directed program
• Where disagreement exists, find
  common ground;
• Question interpretation of laws and regs:
  know whose interpretation it is.
                                         CMSO/DEHPG
     WHAT CAN WE DO
     COLLECTIVELY?
• Continue our
  commitment
• Partnership & dialogue
• Focus on individuals
• Passion

                           CMSO/DEHPG
   Helpful Web Sites for
 Communicating with CMS
• www.cms.hhs.gov/newfreedom
• www.cms.hhs/independenceplus
• selfdirectionwaiver@cms.hhs.gov
• selfdirectiondemo@cms.hhs.gov
• www.cms.hhs.gov/states/letters/
           Words of
    Martin Luther King, Jr.:

“Injustice anywhere
is a threat to
justice everywhere.”

                        CMSO/DEHPG

								
To top