SelfDirection Part 2 Quiz.docx

Individual Budget Authorizations are the amount of Medicaid/MCO funds under the control of the member to be used to hire an attendant and/or purchase goods & services to reduce human reliance or promote independence. ​ Individual Budget Authorizations must be consistent and equitably determined...

Individual Budget Authorizations are the amount of Medicaid/MCO funds under the control of the member to be used to hire an attendant and/or purchase goods & services to reduce human reliance or promote independence. ​ Individual Budget Authorizations must be consistent and equitably determined across all members.​ Individual Budget Authorizations typically, includes the cost of services that are self-directed.  Self-Direction allows individuals to select whom they wish to provide basic, non-medical assistance with bathing, dressing and grooming.  ​ Self-Direction allows Participants may hire staff to assist with homemaker, errands, meal preparation, chore or transportation.​ The Traditional Model (Agency) home health is provided by personal care agencies and may or may not allow for some of the same tasks to be completed by care givers While the Traditional Model (Agency) have great value, staff shortages and fear of liability may limit an agency's ability to provide all needed services.​ Self-Direction may participants to pay as much and sometimes more than a Traditional home health agency pays their workers.​ About 40% of elderly have designated an Authorized Representative Financial Management Services Providers are selected through a competitive bidding process.   The States that offer Self-Direction programs fund the costs of most FMS in two ways – as a service or as an administrative cost.   State Programs may limit FMS enrollment and select one or multiple FMS providers to offer services for their self-direction programs.   The responsibilities of the FMS are documented in a contract between the state and the FMS provider they select.  ​ If a managed care organization (MCO) is used to implement the self-direction program, the (MCO) will contract directly with the FMS provider.​ A risk of Self-Direction is additional responsibilities related to the member managing his or her own services and supports or being an employer.​ A risk of Self-Direction is not completely understanding program rules and responsibilities resulting in misuse of funds or not following program rules. For example, inability to stay within the allotted budget to pay for worker. ​ A risk of Self-Direction is of exploitation. ​ A risk of Self-Direction is the pressure to hire a family member when the member does not want to hire this person.​ A risk of Self-Direction is the pressure to pay someone for doing work they did not do.​ A risk of Self-Direction is neglect/self-neglect. ​ A risk of Self-Direction is the Provider not performing the work required, completing inadequate work or Providers not showing up . A risk of Self-Direction is Participant or Member not adequately managing personal health issues.​ Self-directing is growing in the Medicaid and Managed Care markets.​ There is attention to private pay and long-term health insurance companies to adopt self-direction.​ Training varies for care givers among programs from no training to 40 hours of intensive required training prior to hire.​ Financial Management Services have become more sophisticated ( mobile applications for timesheet submissions, electronic service plans allowing for immediate changes, real-time view of budgets online, and electronic voice verification systems (a requirement in 2019) to verify worker/participant/location/tasks of service.