Consumer Responsibilities and Rights in Self-Direction

In some states, the managed care organization (MCO) must allow the consumer to initiate or terminate self-direction at any time, and give consumer due process appeal rights if self-direction is denied.

Contents – To access the full text, please click each sub-topic.

  • Consumer opting for self-direction must accept responsibility for directly managing care: Florida a
  • Consumer opting for self-direction must accept responsibility for: finding, selecting, scheduling, supervising, evaluating, and discharging providers; and determining provider duties, instructing and training providers in those duties, and verifying time worked: Hawaii b
  • Consumer must provide 10-day advance notification to service coordinator of intent to terminate participation in self-direction: Tennessee c

  • MCO must permit consumer to actively participate in key service plan decisions, service priority decisions, and service evaluation: New Mexico d
  • MCO must recognize and support the amount of self-direction control chosen by consumer: New Mexico e
  • For intimate care services, MCO must offer consumer opportunity to participate in choice, assignment, training, evaluation, and supervision of direct service workers: Wisconsin f
  • Consumer’s family and/or representative, when appropriate, must participate in assessment of consumer for self-direction: New Mexico g
  • Consumer finds, schedules, supervises, evaluates, and discharges providers; verifies time worked by providers, and approves time sheets: Hawaii h, Tennessee i
  • Consumer conducts provider hiring process, which includes developing interview questions, interviewing applicants, and developing service agreement: Hawaii j, Tennessee k
  • Consumer may fire provider for violating service agreement: Hawaii l

  • For consumer choosing self-direction, service coordinator must develop budget that accounts for service needs: Hawaii m
  • Service coordinator must discuss and share budget with consumer: Hawaii n
  • Consumer has flexibility to negotiate direct service worker rates within allocated budget, provided rates meet federal and state requirements: Hawaii o, Tennessee p
  • Cost of worker background checks paid from consumer’s budget: Hawaii q

  • Self-direction providers must meet all state provider requirements: Hawaii r
  • MCO must not require consumer to hire providers from MCO’s network, or otherwise restrict choice of direct service workers: Florida s
  • MCO must have policies outlining when family members may be paid by MCO for services, and policies must reflect goal of supporting and maintaining informal supports: Wisconsin t
  • MCO must maintain minimum monitoring requirements for consumer that hires spouse or parent as direct service worker, including review of expenditures and hours billed: Hawaii u
  • Consumer has right to hire anyone—family, friends, or others—to act as direct service worker, if worker meets contract’s minimum qualifications: Florida v, Hawaii w
  • Family members hired as direct service workers must not provide more than 40 hours of services per week: Hawaii x
  • If hired to provide direct service, consumer’s spouse or parent must meet training and qualification requirements, be paid at market rate, and provide assistance that family ordinarily would not perform: Hawaii y
  • Family member may be paid by the MCO only if providing amount of service that exceeds service level provided to family members without disability, or if family member foregoes outside paid employment: Wisconsin ``

  • Consumer can delegate employer authority to representative/surrogate: Florida aa, Hawaii bb, New Mexico cc, Tennessee dd
  • Consumer can change surrogate at any time: Hawaii ee, Tennessee ff
  • Surrogate appointed by consumer cannot be paid for assuming self-direction employer authority for consumer: Hawaii gg, Tennessee hh
  • Surrogate must have personal relationship with consumer, be present in consumer’s residence on regular basis, and understand consumer’s support needs, daily routine, and medical and functional status: Tennessee ii
  • Surrogate must participate in training program prior to participation in self-direction: Hawaii jj
  • If consumer found to require assistance with self-direction, consumer must designate surrogate in order to participate: Tennessee kk, Hawaii ll
  • Consumer self-assesses to determine whether he or she needs surrogate for self-direction: Hawaii mm
  • If consumer does not complete self-assessment (due to incapacity or other) or fails self-assessment measure, consumer must appoint surrogate in order to participate in self-direction: Hawaii nn
  • Consumer changing surrogate must report change to MCO within five days: Hawaii oo
  • If consumer does not opt for surrogate, service coordinator will assess consumer to determine whether consumer needs surrogate for self-direction: Tennessee pp
  • Service coordinator must confirm that consumer’s surrogate meets qualifications: Tennessee qq
  • Service coordinators can recommend that consumer change surrogate if surrogate is not appropriately fulfilling obligations: Hawaii rr

  • Consumer can choose self-direction at any time once assessed to need services for which self-direction is available: Hawaii ss
  • Consumer may receive services under self-direction option while receiving other services: Hawaii tt
  • Consumer may terminate participation in self-direction at any time: Hawaii uu, Tennessee vv
  • Consumer has due process appeal rights to contest denial of self-direction: Tennessee ww
  1. Fla. Contract, Atch. H, p. 22.  (back)
  2. Haw. RFP, p. 147.  (back)
  3. Tenn. Contract, p. 162.  (back)
  4. N.M. Contract, p. 48.  (back)
  5. N.M. Contract, p. 48.  (back)
  6. Wis. Contract, p. 122.  (back)
  7. N.M. Contract, p. 48.  (back)
  8. Haw. RFP, p. 147.  (back)
  9. Tenn. Contract, p. 162-63.  (back)
  10. Haw. RFP, p. 151.  (back)
  11. Tenn. Contract, p. 162.  (back)
  12. Haw. RFP, p. 151.  (back)
  13. Haw. RFP, p. 149.  (back)
  14. Haw. RFP, p. 149.  (back)
  15. Haw. RFP, p. 149.  (back)
  16. Tenn. Contract, p. 162-63.  (back)
  17. Haw. RFP, p. 152.  (back)
  18. Haw. RFP, p. 151.  (back)
  19. Fla. Contract, Atch. II, Exh. 5, p. 22-23.  (back)
  20. Wis. Contract, p. 122.  (back)
  21. Haw. RFP, p. 151.  (back)
  22. Fla. Contract, Atch. II, Exh. 5, p. 22-23.  (back)
  23. Haw. RFP, p. 150.  (back)
  24. Haw. RFP, p. 150-51.  (back)
  25. Haw. RFP, p. 150-51.  (back)
  26. Wis. Contract, p. 122.  (back)
  27. Fla. Contract, Atch. II, Exh. 5, p. 19.  (back)
  28. Haw. RFP, p. 147.  (back)
  29. N.M. Contract, p. 48.  (back)
  30. Tenn. Contract, p. 163.  (back)
  31. Haw. RFP, p. 149.  (back)
  32. Tenn. Contract, p. 164.  (back)
  33. Haw. RFP, p. 147.  (back)
  34. Tenn. Contract, p. 163.  (back)
  35. Tenn. Contract, p. 163.  (back)
  36. Haw. RFP, p. 153.  (back)
  37. Tenn. Contract, p. 149.  (back)
  38. Haw. RFP, p. 147.  (back)
  39. Haw. RFP, p. 147.  (back)
  40. Haw. RFP, p. 147.  (back)
  41. Haw. RFP, p. 149.  (back)
  42. Tenn. Contract, p. 149.  (back)
  43. Tenn. Contract, p. 163.  (back)
  44. Haw. RFP, p. 149.  (back)
  45. Haw. RFP, p. 153.  (back)
  46. Haw. RFP, p. 153.  (back)
  47. Haw. RFP, p. 153.  (back)
  48. Tenn. Contract, p. 162.  (back)
  49. Tenn. Contract, p. 162.  (back)

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