ULTCBC Consumer Direction Workgroup Workgroup Recommendations

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ULTCBC Consumer Direction WorkgroupWorkgroup
Recommendations

• Presented by Workgroup Facilitators
• Roger Fouts, ODJFS
• Sue Fredman, ODJFS

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Members of the workgroup

• Representatives from state agencies that
  participate in the long term care service and
  support system
• Provider organizations and associations
• Local sub-recipient entities and county boards
• Members of the long term care advocacy community,
  including consumers and family representatives

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Workgroups objective

• Charged with making recommendations to the ULTCBC
  that
• Incorporate consumer direction tenets into all
  facets of Ohios long term care service and
  support system and
• Include innovative consumer direction components
  in appropriate parts of the long term care
  service and support system

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Overarching recommendation

• Consumer direction should be implemented
  throughout Ohios long term care service and
  support system, regardless of funding source,
  provider type or care setting.
• Affords choice of and control over the full range
  of long term care services and supports that are
  available to meet their own diverse needs.
• Ohios current long term care system has many
  tenets of consumer direction as evidenced by
  person-centered care programs in nursing
  facilities CDC and ICFs-MR ODAs Assisted
  Living Waiver and CHOICES Ohio Home Care
  ODMR/DD waivers and even in a county levy-funded
  consumer directed care program.

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When acting upon this recommendation

• The Consumers Perspective about Consumer
  Direction
• Administration and Oversight
• Care Management
• Financial Management

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Consumers Perspective

• Participation must be voluntary, flexible enough
  to meet consumers needs, and contingent upon
  whether the consumer and/or authorized
  representative can adequately direct his/her own
  care.
• The concept of dignity of risk and the
  consumers right to make bad decisions is
  inherent in the concept of consumer direction and
  must be embraced in any consumer-directed care
  endeavors implemented by the State.
• Every consumer should be able to direct as much
  of his/her care as he/she has the desire and
  ability to direct.

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Recommendations

• State agencies collaborate to develop a
  comprehensive set of tools and resources for
  consumers and/or authorized representatives
• Consumers should have greater choice regarding
  who they choose to be their paid provider,
  specifically legally responsible family members
• Permit service dollars that are appropriated with
  the consumers budget or cost cap to be used to
  purchase other needed services, e.g. home mods,
  goods and services, etc.
• Investigate and address legal issues around the
  consumers employer status and liability

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Administration and Oversight recommendations

• Coordinated approach that makes use of the most
  appropriate model(s), and/or elements of these
  models to implement in Ohio
• Expansion of opportunities in Ohios current
  1915c
• Development and use of innovative methods to pay
  for goods and services and other selected
  services, e.g. vouchers and/or debit cards, etc
• Expansion of opportunities within the Medicaid
  state plan using 1915j waiver of the DRA
• Expansion of person-centered care programs within
  nursing facilities
• Establishment and maintenance of a statewide
  registry of providers
• Access to an independent consumer-focused
  advocate
• Implementation/coordination of quality assurance
  mechanisms across all systems

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Care management recommendations

• Must be flexible enough to recognize the
  consumers unique needs
• Must embrace person-centered planning as an
  integral component
• Must also include monitoring of and communication
  with the consumer and/or authorized
  representative
• Consumers be granted budget authority to purchase
  needed services identified during the assessment
• Support consumer negotiated rates

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Financial management recommendations

• Examine the various types of FMS entities used in
  the delivery of consumer directed care to
  determine a model(s) to be best suited and
  ascertain the feasibility of the FMS completing
  other administrative functions
• Study the various types of consumer/employer
  status and explore whether the concept of
  employer status should be uniform across systems
• Explore the creation/utilization of organized
  health care delivery systems
• Explore use of limited Medicaid provider
  agreements
• Establishment of safeguards against
  consumer/provider fraud

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Parting thoughts

• Maximum choice and control over the arrangement
  and provision of services
• Proven to be an effective strategy in controlling
  overall costs at the same time increasing quality
  of life and satisfaction
• Emphasizes a commitment to consumer
  participation, empowerment, and advancement of
  consumer rights, responsibilities and
  accountability with regard to personal control
  over service delivery
• Freedom not only to define the life they seek,
  but to be supported by the State of Ohio in their
  desire to take risks and direct their own care
  and services in pursuit of that life