Self Help Regarding Consumer Purchase

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					                     Self-Determination Policy & Practice Guideline
                                  UPDATED 1-11-07

    ** PLEASE NOTE: STATEMENTS IN BOLD AND ITALICS ARE ITEMS
              SUGGESTED BY WORK GROUP MEMBERS!**

(Source: Michigan Department of Community Health, Mental Health and Substance
       Abuse Services (2003). Self-Determination Policy & Practice Guideline.
       Lansing, MI: State of Michigan [July 18, 2003])

    Benchmarks of Service Delivery and Supports to Achieve a Meaningful Life

Self-determination is the concept upon which the entire mental health support system
is based. The core elements of self-determination are:

Freedom to choose a meaningful life in the community;
Authority over a targeted amount of dollars;
Support to organize resources in ways that are life enhancing and meaningful to the
individual with a disability;
Responsibility for the wise use of public dollars and recognition of the contribution
individuals with disabilities can make to their communities;
Confirmation of the important leadership role that individuals with disabilities and
their; families must play in a newly re-designed system and support for the self-
advocacy movement

These core elements shall result in support services that promote community inclusion
and participation, independence, and/or productivity as identified in the individual
plan of service as one or more goals developed during the person-centered planning.
The outcome of the support services that the individual consumer has chosen, shall
result in that the person leads a meaningful life. The CMHSP shall make available to
him/her a range of tools such as:

        a flexible support service system that is rapidly responsive to his/her needs,
         wishes and desires;
        a support service system that is operating within the least restrictive, non-
         segregated environments for him/her;
        a personal and individualized budget for his/her support services;
        a fiscal intermediary service that will assist him/her to manage the personal
         budget.
Policy

I. Opportunity to pursue and obtain a plan incorporating arrangements that support self-
   determination shall be established in each Community Mental Health Services
   Program (CMHSP), for adults with developmental disabilities and adults with mental
   illness. Each CMHSP shall develop and make available a set of methods that provide
   opportunities for the consumer to control and direct their specialty mental health
   services and supports arrangements.


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I.1.Each PIHP/CMHSP shall have individuals designated as responsible for
supporting Self Determination, and for ensuring that this Self Determination
Policy and Practice Guideline is implemented, and required evidence is available.
(Examples of Evidence: Job Description, Performance Review, Organizational
Chart)


C. A CMHSP shall assure that full and complete information about self-
   determination and the manner in which it may be accessed and applied is
   provided to each consumer.

C.1. Each PIHP/CMHSP must demonstrate evidence that training on Self
Determination occurs on an ongoing basis and targets a broad range of
stakeholders, including administrative, customer service and clinical staff, as well
as families and those receiving services. Training may be provided in a stand-alone
fashion, or as part of stakeholder meetings. Training must focus on the philosophy
as well as the tools of Self Determination. (Examples of Evidence: Training
announcements/records, results from training satisfaction surveys, information
contained on agency’s website)


C. 2. Each PIHP/CMHSP has a Self Determination policy that is available for
review by a person receiving supports.


C. 3. Information regarding accessing Self Determination Tools (e.g. independent
facilitation, individualized budgets, using fiscal intermediaries, etc. ) is contained
in each PIHP/CMHSP’s Customer Services handbook. Information is in
consumer-friendly, person-first language, and includes a list of Self Determination
resources and contacts, both within and outside the PIHP/CMHSP system.


E. A CHMSP shall actively support and facilitate a consumer’s application of the
   principles of self-determination in the accomplishment of his/her plan of services.

E. 1. Each PIHP/CMHSP must show evidence that consumers are supported to
self-direct their services. There must be evidence in the person centered
plan(NOTE: SUGGESTION HAS BEEN MADE TO LOOK FOR EVIDENCE IN
THE ASSESSMENT OR PRE-PLAN- BY THE TIME IT GETS TO THE PLAN
OF SERVICE IT MAY BE A LITTLE LATE) that:
      the individual has been oriented to self determination and its tools;
      demonstrates that self determination tools (e.g. independent facilitation,
         individualized budgets, consumer hires own staff, consumer using a fiscal
         intermediary or fiscal management system to manage their supports) have
         been offered and are being used, as appropriate in accordance with each
         individual’s situation;


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         Ongoing periodic reviews have occurred to ensure continued progress
         (Examples of Evidence: Results of consumer interviews, chart reviews, pre-
        planning meeting, Individual Plan of Service , Periodic Reviews, etc).

   E. 2.Case reviews must reveal that creative, innovative approaches are being used,
   beyond established tools, and include supports beyond the CMHSP system (NEED
   TO CLARIFY WHAT WE MEAN BY “BEYOND THE CMH SYSTEM”AND
   WHAT WE MEAN BY CREATIVE OR INNOVATIVE). (Examples of evidence:
   Chart reviews)

II. Arrangements that support self-determination shall be made available to each
    consumer for whom an agreement on a plan of authorized specialty mental health
    services and supports, along with an acceptable individual budget, has been reached.

   A. Developmentof an individual budget shall be done in conjunction with
      development of a plan of specialty mental health services and supports, using a
      person-centered planning process.

   B. …the arragements that will, or may, be applied by the consumer to pursue self-
      determination shall be delineated and agreed to by the consumer and the CMHSP.

   D. …A copy of the individual budget must be provided to the consumer prior to the
      onset of a self-determination arrangement.

*Operational guidelines within the execution of the self-determination agreement are
included in this section of the policy.


III. Assuring authority over an individual budget is a core element of self-determination.
     This means that the consumer may use, responsibly, an individual budget as the
     means to authorize and direct their providers of services and supports. A CMHSP
     shall design and implement alternative approaches that consumers electing to use an
     individual budge may use to obtain consumer-selected and –directed provider
     arrangements.

   A. Within prudent purchaser constraints, a consumer shall be able to access any
      willing and qualified provider.

   B. Approaches shall provide for a range of control options up to an including the
      direct retention of consumer-preferred providers through purchase of services
      arrangements between the consumer and the provider.

*Guidance regarding contracting for individualized services or supports is detail within
this section.




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IV. A CMHSP shall assist a consumer pursuing self-determination to select, employ, and
    direct his/her support personnel, to select and retain/ choose qualified provider
    entities, and shall make reasonably available, consistent with MDCH Technical
    Advisory instructions, their access to alternative methods for directing and managing
    support personnel. (UNDER “RETAIN/CHOOSE QUALIFIED PROVIDERS:
    NEED TO BE SURE TO CONSIDER THE SITUATION THAT RURAL CMH’s
    ARE IN)
    A. A CMHSP shall select and make available qualified third-party entities that may
        function as fiscal intermediaries. (Evidence: Provider Directory or brochure that
        includes FIs, copies of contracts with at least 2 FIs, documentation in the
        IPOS)

          Develop standardized description of FI (Fiscal Intermediaries)
          Develop standard operating procedures for FI
          Oversight structure of FIs including monitoring and assessment of abilities
          CMHSP shall identify and describe current contractors
          CMHSP shall develop an annual report of performance of current FIs
          Define and describe alternative possibilities beyond FIs, i.e. banks, credit
           unions, accountants
          Begin recognize FIs as “fiscal management services/entities”
          Localized, community-based entities are best practices…do not force
           individuals to go great distances to employ a FI
          Need standardized established guidelines
               o Role of the FI
               o Standard Contractual requirements
               o Individual budgets
                    (Fee for service or bundled costs?)
               o Medicaid Responsibilities (who does what)
               o Risks
          Must have a formal process for information exchange to help the individual
           understand their budget, to address the FI role for each budget, to set up
           formal processes related to the budgets (who does what: maintain Medicaid
           eligibility, informs all related parties about changes (moving, transportation
           issues, staff changes and issues, etc.)

          Timely payment or authorization for one time costs.


   B. Fiscal intermediaries shall be under contract to the CMHSP or a designated sub-
      contracting entity. (Evidence: Copy of contract)

      Develop standardized (one-page preferably) simple agreement that will be used
       between:
          o CMHSP and FI
          o Individual and FI



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   Minimize the number of contracts being signed by an individual.. at minimum a
    Self-Determination Agreement between the individual and FI is needed. All
    other agreements should be developed on a person-directed basis.

C. A CMHSP shall assure the fiscal intermediary entities are oriented to and
   supportive of the principles of self-determination, and able to work with a range
   of consumer styles and characteristics. The CMHSP shall exercise due diligence
   and establishing the qualifications, characteristics and capabilities of the entity to
   be selected as a fiscal intermediary, and shall manage the use of fiscal
   intermediaries consistent with MDCH Technical Assistance Advisories
   addressing fiscal intermediary arrangements. (Evidence: Evidence of
   RFP/procurement process to secure an FI; evidence of FI contract with PIHP,
   training records of FI, Privileging and Credentialing records, consumer
   satisfaction as noted during annual contract monitoring review)

       “The CMHSP shall exercise due diligence and establishing the
        qualifications, characteristics, and capabilities of the entity…”: As indicated
        earlier in section A, MDCH should develop the criteria for qualifications of
        FIs. This language has been the reason TSG has needed to examine this
        issue.
       This directive establishes that entities should have the capabilities to develop
        ledgers, monthly statements, etc. that are based on the individual’s strengths
        and abilities. To accomplish this objective, FIs would create a monthly
        statement that meets the individual’s style of learning/information.

D. …The CMHSP shall identify and require remedy to any conflicts of interest of
   the entity that, in the judgment of the CMHSP, interfere with the performance of
   its role as a fiscal intermediary. (Evidence: Conflict of interest language in
   RFP/procurement process; Conflict of interest language in own policy, contract
   includes disclosure statement)

       CMHSP’s and/or its core providers must NOT serve as a provider of direct
        service and facilitate the “in-house” FI. A conflict of interest clause must be
        enforced. The notion that “no other FI entity exists” cannot be a suitable
        excuse for operating under a conflict of interest.

E. A CMHSP shall collaborate with and guide the fiscal intermediary and each
   consumer involved in self-determination….It is the obligation of the CMHSP to
   assure that the entities selected to perform intermediary functions are capable of
   meeting and maintaining compliance with the requirements associated with their
   stated functions, including those contained in relevant MDCH Technical
   Assistance Advisories. (Evidence: Evidence from own audits of FIs, or any
   performance reviews)

       It is my understanding that the FI’s have met collectively on very few
        occasions. Should a membership/leadership group be formed of FI’s? Some



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of the FIs do attend the Self-Determination Leadership Series meetings, but
I wonder if this is insufficient technical assistance for the FIs.




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