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Consumer-Directed Services

Applicable Authorities

Federal Medicaid authority allows consumer-directed options through the State Plan personal care services option Section 1905(a)(24), through Section 1915(c) HCBS waivers, and through State Plan HCBS services at Section 1915(i), (j) and (k). For detailed discussion on the specific federal Medicaid requirements of offering consumer direction, see Chapter 7 of Understanding Medicaid Home and Community Services.

To incorporate consumer-directed options into your MLTSS program, you will use one or more of these HCBS authorities in combination with a managed care authority.

Combine Managed Care Authority with HCBS Authority

The managed care authority will allow you to make the option available through MLTSS contractors and to pay the contractors on a capitated basis for all MLTSS services, including those that are consumer-directed. Note that you must continue to meet the requirements of the HCBS options you are including in your program but may choose to meet some of those requirements through your MLTSS contractors. You may, for example, require your MLTSS contractor to include an existing Financial Management Services vendor in its network, and you may also require that the MLTSS contractor's network include an adequate number of agencies willing to provide the Agency with Choice model to beneficiaries.

For further discussion see the Federal Authorities section.



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