Understanding Self-Directed Services (SD) Using Consolidated Supports and Services (CSS)

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Understanding Self-Directed Services (SD) Using
Consolidated Supports and Services (CSS)

• The Basics

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Principles of Self-Determination

• A philosophy that is based upon
• Freedom
• Authority
• Support
• Responsibility
• Self-Advocacy
• Self-Direction increases responsibility

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State Funded Services (100)
State Funded Services
Resources to Support the Person Ex Transition
funding
Individual Support and Services (ISS)
Family Supports and Services (FSS)
At Home Services Person Living at Home (Care at
Home Waiver)
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OMR Services and Supports Options
Home and Community Based Waiver (HCBS)
Care at Home
50 State
50 Fed
FMS /FEA
Pre- Voc
Day Hab
Envir onmental Mods

Family Ed training
Respite
CSS
Brokerage
Adaptive Equipment
Supported Employment Medicaid Program

Community Habiltation
Residential Habilitation
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CSS is a Home and Community Based Waiver
Services (HCBS)

• People must be deemed eligible for OMRDD services
  contact your local DDSO regarding the
  eligibility determination process.
• Most supports and services for individuals and
  families are provided through OMRDDs Home and
  Community Based Services (HCBS) Waiver.
• Most services (both HCBS and State Plan services)
  are paid for by Medicaid.

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Features of SD/CSS

• CSS is an OMRDD HCBS Waiver Service
• SD/CSS allows people to self-direct and manage
  their supports and services based on a unique
  plan(Person-centered Plan) and individual,
  portable budget.
• The individualized budgets (called Personal
  Resource Accounts) are managed through a Fiscal
  Management Services/ Employer/Agent.
• SD/CSS is a fiscal partnership the persons
  wages, income and assets are combined with
  government funding.

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Features of SD/CSS cont

• Housing costs vs. service costs
• Personal allowance monies are retained by the
  person
• OMRDD/DOB approvals Extraordinary Funding
  Request (EFR). ( currently EFR not viable)
• There is an absolute cap on SD/CSS Pilot budgets

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Most importantly CSS begins with the Person

• Nothing about us without us!
• The person is at the center
• Chooses circle of support directs activities
• Increased sense of control and decision-making
• Satisfaction with choices
• Focus on relationships, contribution community

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The Circle of Support (C.O.S)

• The Circle is the key decision-making group and
  requirement of CSS
• They meet regularly to plan, support, advise the
  person
• Replaces other system structures and is a key to
  safeguarding, plan implementation and management
  budget
• For the SD/CSS Project, the Medicaid Service
  Coordinator is a required member
• A mix of professional and natural supports,
  freely chosen
• No set number size relates to needs
• Membership may change over time

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Developing a Person Centered Plan

• Based on a capacity view of a persons interests
  preferences, abilities, and dreams
• Requires a group of people committed to a
  powerful vision of the persons future
• Promotes the use of natural support system
• Results in quality of life improvements that
  reflect personal outcomes
• Builds in safeguards

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Getting Started - Getting Help What is a
Start-up Broker?

• Families and MSCs often dont have the time or
  ability to do all the tasks associated with
  getting a SD/CSS application and plan completed.
• Startup Brokers can be an(independent
  Contractors, or unpaid parents, or agency
  representatives) hired by the person for a
  negotiated price based on the persons needs
  (100 state funded) or they can be unpaid
• Assists the person to develop the
  Self-Determination/Consolidated Supports and
  Services (CSS) application and initial SD/CSS
  service plan
• Tasks are separate from those of your Medicaid
  Service Coordinator

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Start-Up vs Support Broker Tasks

• Start-up Broker
• Authors CSS Plan designs Services and Support
• Creates Budget
• Advises Family Friends and the Circle of
  Support
• Conduct Person-Centered Planning Process

• Support Broker
• Maintains the CSS Plan objectives
• Revises the CSS plan as needed
• Revisits the PCP plan
• Revises Budget as needed
• Assists with the recruitment, retention, training
  of staff

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What can a Start-up Broker do with you?

• Assist with Circle Development
• Facilitate Person Centered Planning
• Identify Community Connections Resources
• Design weekly schedule support
• Develop Individualized Budget
• Work with DDSO Liaison to
• finalize application

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Support Brokers

• When the plan is approved, then the real work
  begins!
• Independent Contractors can also be hired to help
  the individual and Circle of Support implement
  the CSS plan.
• Some of the most common duties that Support
  Brokers assist participants with include
• Hiring
• Interviewing
• Training
• CSS Documentation
• Updating and Revising the CSS Plan and Budget

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Service Coordinators may help brokers with

• Assist with individual support agreements
• Planning
• Health and safety decisions
• Monitoring quality and satisfaction

• Circle development and maintenance
• Identify generic community connections and
  resources
• Budgeting, paperwork
• Working with a fiscal management agency
• Assisting with hiring and firing supports

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Developing the SD/CSS Plan

• Individual begins putting together an
  application/plan with the assistance of their
  SUB, Circle of Support, and MSC
• DDSO is available to assist throughout the
  process
• Identifies what the person wants to do and
  captures all the supports and services needed to
  achieve outcomes
• If plan is developed before individual leaves
  school, a copy of their IEP must be attached to
  identify supports provided by SED.
• Identifies areas where additional safeguards need
  to be addressed and how they will be addressed
• DDSO local review and approval of CSS plans

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The Individual Budget

• Used to pay for supports and services,
  appropriate to Medicaid
• Cannot pay for personal expenses related to
  entertainment/diversion
• CSS itself not designed to pay for housing
• Collaborative use of personal
• resources and benefits
• Funds are administered through a
• Fiscal Management Services (FMS) Agency

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The Individual Budget

• Captures all the costs needed to
• support the plan
• Staffing costs
• Staff Training
• Transportation

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Typical RES Supports may include

• Home Safety and Accident Prevention (Evacuation)
• Using adaptive equipment in the home
• Home-based communication skills development

• Independent Living Skills Training Development
• Personal/Health Management
• Hygiene and Grooming
• Day Planning Organization
• Skill Building related to household management
• Meal Prep/Cooking
• Grocery Shopping
• Laundry
• Cleaning
• Household Budgeting
• Getting to know navigating your neighborhood

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Typical OTR Supports may include

• Habilitative and educational equipment
• Entrepreneurship
• Personal care

• Job development
• Job coaching
• Adult education
• Transportation
• Community inclusion
• Social skills development
• Exercise/wellness

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The Fiscal Management Service Agency

• Assists the participant in managing the supports
  and services portion of the budget
• Draws down resources from emedNY OMRDD to
  establish Personal Resource Account
• Pays the bills based on the most current approved
  plan
• Is the employer of record for hired supports
• Background checks/fingerprinting
• Health insurance
• Training
• Tracks expenditures provides monthly
• financial statements to the participant and
  DDSO
• liaisons
• Is a waiver service provided by a
• not-for-profit entity

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Managing Your Self Determination Plan Budget
(Managing Employer vs. Employer of Record)

• MANAGING EMPLOYER/CSS Participant
• SD/CSS participants act as the managing
  employer of their services and supports
• Individuals are responsible for hiring and
  training their staff
• Determines the job duties and schedule for their
  workers
• Signs off on time sheets for staff

• EMPLOYER OF RECORD
• FEA acts as the employer of record for SD/CSS
  participant
• Conducts criminal background checks
• Collects time sheets and service documentation
• Maintains payroll for staff and is responsible
  for workers compensation and other benefits

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Quality, Satisfaction, Oversight

• Responsibilities of the person and his or her
  circle everyone has a role in quality
• Focus on personal satisfaction with ones life
• Emphasize balance health, safety, risk
• Existing rules and regulations may apply