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Consumer-Directed Services

Sample Contract Language

States use a variety of approaches to including consumer-directed options into their MLTSS programs.

  1. Tennessee provides an example of a state that requires the MLTSS vendor to contract with a consumer-direction support vendor.
  2. For another example of a state that requires its MLTSS contractors to offer both a Fiscal/Employer Agent model and an Agency with Choice model, see provisions of the Texas Star+Plus contract.
  3. For an example of a more explicit and directive contract language that includes, for example, a requirement that MLTSS contractors offer and document members' choices about consumer-directed services, see provisions of the Wisconsin contract.


link to pdf file


Library Resources

  1. O’Keeffe et al, 2010UNDERSTANDING MEDICAID HOME AND COMMUNITY SERVICES: A PRIMER 2010 EDITION. “Chapter 7:  Participant-Directed Services and Supports.” U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, October 29, 2010.

  2. Crisp, S., Doty, P., Flanagan, S., Smith, G., O’Keeffe, J., et al. (2009). Developing and Implementing Self-Di­rection Programs and Policies: A Handbook. Chestnut Hill, MA: National Resource Center for Participant-Directed Services.

    This publication was developed to provide state staff, policymakers, service providers, program participants, and other stakeholders with a single comprehensive source of information about participant direction pro­grams and policies.

    Available as the full handbook at



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