Guidance for Self-Directed Care Programs

You may ask yourself, what is the difference between Self-Directed Care and Consumer Directed Care? They are the same, just sometimes referred to as different names depending on the state. This type of service model is an alternative to traditional agency based service model, where the consumer or participant is given the authority to make decisions on his/her care. The participant can recruit, hire, train and manage the worker or caregiver of his/her choosing. CMS refers to this as “employer authority.” Self-Directed Care promotes choice and control; not only can participants choose who will provide the services and when they will be provided, but they can decide how the Medicaid funds in their budget are spent, including how much to pay the worker. This is referred to as “budget authority.”

States have different plans and waivers for providing enrollees with options for Self-Directed Medicaid Services. The options include Home and Community Based Services State Plan 1915(i), Community First Choice 1915(k), Self-Directed Personal Assistance Services State Plan 2915(j), and Home and Community Based Services Waiver Programs 1915(c). Each funding option has different guidelines, but they all have common aspects which include:

Person Centered Planning– CMS requires this assessment process to develop a plan given by the participant for the worker to follow. The plan is used to identify patient needs, abilities, preferences and desired outcomes. In addition, a backup plan is needed in case the worker is out sick.

Service Plan– This care plan is a written document that indicates the services to be provided in order for the participant to remain in the community.

Individualized Budget- The amount of money the participant has to spend and it is developed based on the person-centered planning process and the service plan.

Each state is required to provide guidance and support to the participant in the program. A support broker or consultant is a contact between the participants and assists with all aspects of the program. In addition, Financial Management Services are available to the participant to ensure payroll and budget is on track and done properly. The state monitors the performance and outcomes of individuals to ensure the program is successful.

Under the 21st Century Cures Act mandate, all Medicaid Personal Care Services Programs will be required to use an Electronic visit verification (EVV) system to verify visits. Self-Directed services fall under this category even though their care delivery model isn’t like traditional homecare. Since most visits are not scheduled, EVV systems must be flexible in capturing the required EVV data. The required data elements include: Type of service, individual receiving services, date of the services, location of the service delivery, individual providing the service, and the time the service begins and ends. Sandata’s Santrax® Self-Directed Care offering is Cures Act compliant and helps empower each participant to have control over his/her long term care delivery while automating existing manual efforts. Sandata’s been providing Self-Directed Care programs for over 10 years, and currently supports over 30,000 Self-Directed Clients. If you’re interested in learning more, please contact us and we will be happy to discuss our EVV for Consumer Directed Care Services. mspinelli@sandata.com