Requirements in Self-Direction

In many states, a consumer has a self-direction option that allows him or her to have significant control over services provided at home.  “Employer authority” allows the consumer to control decisions relating to hiring, firing, and training.  “Budget authority” gives the consumer significant discretion over how money is spent, as long as the cost of those services does not exceed a specified budget.

The managed care organization (MCO) generally must provide assistance as necessary to help consumers to set up and maintain a self-direction option.  In some cases, a consumer’s family members or friends can provide the services.

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

  • MCO must educate consumer about self-direction option, and specifically designate staff and/or participating providers to perform task: Florida a
  • MCO must make additional and ongoing self-direction programs available at request of consumer, or his/her surrogate or service coordinator: Hawaii b
  • If assessment indicates that self-direction is available, service coordinator must inform consumer about self-direction option: Hawaii c

  • MCO must provide call centers, managed by self-direction-trained MCO staff, for assisting consumers and providers: Florida d
  • MCO must assist consumer, as needed, in finding and hiring direct service workers: Florida e
  • MCO must assist consumer in resolving disputes with direct service workers: Florida f
  • MCO must assist consumer by performing required self-direction administrative duties, including: paying providers, performing background checks, monitoring completion of time sheets, and managing tax filing: Hawaii g
  • MCO may delegate self-direction administrative duties to other entities: Hawaii h
  • Service coordinator must assist consumer in accessing available resources and support, and facilitating self-direction: Hawaii i
  • Service coordinator will assist consumer in finding replacement surrogate if consumer’s prior surrogate is released due to suspected neglect or abuse: Tennessee j
  • Fiscal agent must assist consumer in finding replacement direct service worker if prior direct service worker is released due to suspected neglect or abuse: Tennessee k

  • Self-direction limited to adult companion care, attendant care, homemaker services, intermittent and skilled nursing, and personal care: Florida l
  • Self-direction limited to personal assistance services, attendant care, and respite care: Hawaii m
  • Self-direction limited to attendant care, personal care, homemaker service, in-home respite care, companion care services, and/or any other services specified in law: Tennessee n

  • Prior to participation in self-direction, consumers must be referred by service coordinator to fiscal agent: Tennessee o
  • Consumer must participate in training program prior to participating in self-direction: Hawaii p
  • Consumer must initiate self-direction within 60 days of referral by service coordinator: Tennessee q
  • MCO may impose reasonable limitations on frequency with which consumer can opt into self-direction: Tennessee r

  • MCO must authorize consumer for eligible HCBS within two days of notification from fiscal agent that consumer’s requirements for self-direction have been met: Tennessee s
  • MCO must maintain adequate number of service coordinators to authorize consumer services, including self-direction; recommended range of consumers per service coordinator is 125 to 175: Tennessee t

  • Service coordinator must monitor consumer’s overall well-being and sufficiency of care plan: Hawaii u, Tennessee v
  • Service coordinator must annually determine, and document, consumer’s interest in continuing self-direction: Tennessee w
  • Service coordinator must develop and update consumer-signed risk agreement which identifies risks associated with consumer’s participation in self-direction, potential consequences of risks, and measures to mitigate risks: Tennessee x

  • MCO must establish and follow written policies and procedures on self-direction: Hawaii y, New Mexico ``
  • MCO must submit self-direction policies and procedures, and any changes, to state for review and approval: Hawaii aa
  • MCO must establish processes that allow for efficient exchange of information between MCO and consumer’s fiscal agent: Tennessee bb
  1. Fla. Contract, p. 53.  (back)
  2. Haw. RFP, p. 153.  (back)
  3. Haw. RFP, p. 147.  (back)
  4. Fla. Contract, Atch. II, Exh. 5, p. 20-21.  (back)
  5. Fla. Contract, Atch. II, Exh. 5, p. 21-22.  (back)
  6. Fla. Contract, Atch. II, Exh. 5, p. 21-22.  (back)
  7. Haw. RFP, p. 152.  (back)
  8. Haw. RFP, p. 152.  (back)
  9. Haw. RFP, p. 147.  (back)
  10. Tenn. Contract, p. 151.  (back)
  11. Tenn. Contract, p. 151.  (back)
  12. Fla. Contract, Atch. II, Exh. 5, p. 19-28.  (back)
  13. Haw. RFP, p. 147.  (back)
  14. Tenn. Contract, p. 162.  (back)
  15. Tenn. Contract, p. 149.  (back)
  16. Haw. RFP, p. 153.  (back)
  17. Tenn. Contract, p. 149.  (back)
  18. Tenn. Contract, p. 162.  (back)
  19. Tenn. Contract, p. 150.  (back)
  20. Tenn. Contract, p. 151-52.  (back)
  21. Haw. RFP, p. 147.  (back)
  22. Tenn. Contract, p. 150.  (back)
  23. Tenn. Contract, p. 151.  (back)
  24. Tenn. Contract, p. 150.  (back)
  25. Haw. RFP, p. 153-54.  (back)
  26. N.M. Contract, p. 48.  (back)
  27. Haw. RFP, p. 153-54.  (back)
  28. Tenn. Contract, p. 151.  (back)

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