Contractor's Capacity
The contractor's readiness to offer and support the model of consumer-directed services is demonstrated by capacity in the following areas.
Offering and Documenting
A process for offering and documenting members' choice to self direct. In order to choose self-directed options, beneficiaries must know about them. You can direct your MLTSS contractors to include information about consumer-directed options as part of a new member orientation, and in member handbooks. In addition to these general information requirements, you can require that consumer-directed options be discussed and documented as part of the service planning process.
Supporting Members
Mechanisms for supporting members to self-select, hire, supervise, and manage their workers. The mechanisms vary depending on policy decisions the state has made, but include two models.
- In a Fiscal/Employer Agent model, the member is the employer, and is supported in the employer role by a state-recognized organization that performs payroll and bill payment tasks. If the state is offering this model in its traditional HCBS programs, you will want the MLTSS contractor to recognize the Fiscal/Employer Agent as a support provider.
- In an Agency with Choice model, a provider agency is the employer, but agrees to co-management of the workers with the member. If the state is offering this model in its traditional HCBS programs, you will want to ensure that your MLTSS contractor networks include a sufficient supply of providers willing to offer the Agency with Choice model.
Informing and Assisting
Information and assistance with consumer-direction. Medicaid allows payment for the costs of personalized assistance to persons who need help in directing their services. This includes help understanding service options, finding and managing workers, and accessing other community services. Depending on how your state currently offers this assistance, you may decide to require MLTSS contractors to provide it through means of their choosing, or through the same mechanism used in the traditional HCBS system. For example, if your state uses a supports brokering agency to provide this function, you may direct your MLTSS contractors to use the same organizations.