Training and Oversight in Self-Direction

Some states set standards for self-direction training and oversight.  A consumer generally must adopt a back-up plan for instances when a service provider is unavailable or absent.

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

  • MCO must train consumer on employer responsibilities and management, including hiring, evaluation, supervision, scheduling, and termination: Florida a, Hawaii b
  • MCO will train consumers, as requested, in subjects related to self-direction: Florida c
  • MCO must train applicable staff on self-direction: Florida d
  • MCO must train adequate number of case managers with extensive training in self-direction option: Florida e
  • MCO must submit all new or changed training programs and materials to state for approval thirty days prior to implementation: Hawaii f
  • State must provide training evaluation template for MCOs to provide to service coordinators receiving self-direction training: Florida g
  • Consumer has responsibility to train direct service workers to provide personalized care based on consumer’s needs and preferences: Tennessee h
  • Fiscal agents must train consumers and representatives on self-direction: Tennessee i

  • Consumer must be responsible for developing and implementing back-up plan for instances when direct service worker is unavailable or absent: Tennessee j
  • Service coordinator must include back-up plan, outlining how consumer will address instances when regularly scheduled direct service worker is unavailable: Hawaii k, Florida l, Tennessee m
  • Back-up plans may involve paid and non-paid caregivers: Hawaii n
  • Service coordinator must assist consumer in developing back-up plan: Florida o
  • As part of back-up planning process, service coordinator must inform consumer of MCO network providers and process for accessing them in event of service lapse: Florida p
  • Service coordinator must reassess adequacy of consumer’s back-up plan annually, upon change in consumer’s HCBS needs, and upon change in availability of consumer’s direct service worker: Tennessee q
  • Service coordinator must monitor consumer’s direct service worker for late and missed visits to ensure sufficiency of consumer’s back-up plan: Tennessee r


  • MCO must cover cost of background check for at least one direct service worker and one surrogate per consumer per year: Florida s
  • Direct service worker must agree to applicable MCO policies and procedures, and meet all qualification requirements: Florida t
  • Direct service worker chosen by consumer must enter into agreement with MCO that specifies roles and responsibilities of each party, and empowers MCO to terminate worker for consumer’s health or welfare: Hawaii u
  • MCO may initiate involuntarily disenrollment from self-direction if MCO believes consumer’s needs can no longer be met safely and effectively via self-direction: Tennessee v
  • Service coordinator or fiscal agency must report suspected neglect or abuse of consumer to MCO within 24 hours: Tennessee w
  • Fiscal agent must immediately release consumer’s direct service worker or surrogate if either is suspected of neglect or abuse. Reinstatement possible if investigation does not confirm allegations: Tennessee x

  • MCO must enter into contract with fiscal agent specified to provide assistance to consumer: Tennessee y
  • Fiscal agent must assign supports broker for each consumer: Tennessee ``

  • Supports broker assists consumer with employer functions: Tennessee aa
  • Supports broker must be independent of service coordinator: Tennessee bb
  • MCO must ensure that supports broker is invited to participate in reassessments of consumer: Tennessee cc
  1. Fla. Contract, Atch. II, Exh. 5, p. 21-22.  (back)
  2. Haw. RFP, p. 153.  (back)
  3. Fla. Contract, Atch. II, Exh. 5, p. 21-22.  (back)
  4. Fla. Contract, Atch. II, Exh. 5, p. 21-22.  (back)
  5. Fla. Contract, Atch. II, Exh. 5, p. 20-21.  (back)
  6. Haw. RFP, p. 153.  (back)
  7. Fla. Contract, Atch. II, Exh. 5, p. 20-21.  (back)
  8. Tenn. Contract, p. 162-63.  (back)
  9. Tenn. Contract, p. 164.  (back)
  10. Tenn. Contract, p. 162-63.  (back)
  11. Haw. RFP, p. 152.  (back)
  12. Fla. Contract, Atch. II, Exh. 5, p. 22.  (back)
  13. Tenn. Contract, p. 150.  (back)
  14. Haw. RFP, p. 152.  (back)
  15. Fla. Contract, Atch. II, Exh. 5, p. 22.  (back)
  16. Fla. Contract, Atch. II, Exh. 5, p. 22.  (back)
  17. Tenn. Contract, p. 150.  (back)
  18. Tenn. Contract, p. 150.  (back)
  19. Fla. Contract, Atch. II, Exh. 5, p. 22-23.  (back)
  20. Fla. Contract, Atch. II, Exh. 7, p. 56-57.  (back)
  21. Haw. RFP, p. 151.  (back)
  22. Tenn. Contract, p. 151.  (back)
  23. Tenn. Contract, p. 151.  (back)
  24. Tenn. Contract, p. 151.  (back)
  25. Tenn. Contract, p. 164.  (back)
  26. Tenn. Contract, p. 164.  (back)
  27. Tenn. Contract, p. 22.  (back)
  28. Tenn. Contract, p. 22.  (back)
  29. Tenn. Contract, p. 150.  (back)

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