Department of Health & Human Services Media Affairs Office MEDICAID NEWS A proposed rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services delivered by an agency, was announced today by the Centers for Medicare & Medicaid Services (CMS). Through the rule on display today at the Federal Register, CMS requests public comment on how states could allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers rather than working with personnel employed by an agency. Beneficiaries could even hire qualified family members who may already be familiar with the individual’s needs to perform personal assistance (not medical) services. “This proposal would give Medicaid beneficiaries significant new freedom to determine how their personal assistance services are delivered and by whom,” said Kerry Weems, CMS acting administrator. “As health care is not simply an economic transaction, this proposal represents a fundamental shift that restores a person’s ability to improve their overall health by taking greater control of his or her own decisions,” Weems said. If a state adopts a self-directed personal assistance services state plan option, beneficiaries could receive a cash allowance to hire their own workers to help with such activities as bathing, preparing meals, household chores and other related services that help a person to live independently. Allotments could also be used to purchase items that help foster independence such as a wheelchair ramp or microwave oven. The beneficiaries also have the option to have their cash benefit allotment managed for them. The proposal would put into place a provision of the Deficit Reduction Act of 2005 that allows states to elect a state plan option to provide care in ways that previously required “waivers” of previous Medicaid laws. Such waivers are subject to certain budgetary requirements and are temporary in nature. Before a state could request this change to its state plan, the state must have an existing personal care services benefit, or be operating a home or community-based services waiver program. Furthermore, enrollment in this new state plan option is voluntary and the state must also provide traditional agency-delivered services if the beneficiary wishes to discontinue self-directed care. States choosing this option must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants. States must also train potential participants in ways to manage their budgets and assess their personal care needs. The notice of proposed rulemaking will be published in the January 18, 2008 issue of the Federal Register. There is a 30-day comment period. Comments are due February 19, 2008. Volume 13 Number 9 News: Medicaid The Centers for Medicare & Medicaid Services Jan. 14 released a proposed rule providing guidance to state Medicaid officials who want to administer self-directed personal assistance services (PAS). Self-directed care allows Medicaid recipients needing help with the activities of daily living to select, direct, and manage their needed services under an individualized service plan and budget, according to the proposal set to be published in the Jan. 18 Federal Register. Self-directed care lets recipients retain control and authority over who provides the services, how the services are provided, the hours they work, and their rate of pay. "This proposal would give Medicaid beneficiaries significant new freedom to determine how their personal assistance services are delivered and by whom," Kerry Weems, acting CMS administrator, said in a press statement. "As health care is not simply an economic transaction, this proposal represents a fundamental shift that restores a person's ability to improve their overall health by taking greater control of his or her own decisions." If a state adopts a self-directed personal assistance services state plan option, beneficiaries could receive a cash allowance to hire their own workers to help with such activities as bathing, preparing meals, household chores, and other related services that help a person to live independently, CMS said. Allotments also could be used to purchase items that help foster independence such as a wheelchair ramp or microwave oven. In the 1990s, two national demonstration projects showed the success of self-directed care, including a series of waivers for home and community-based services granted under Section 1915(c) of the Social Security Act, CMS said. Based on this experience, the Deficit Reduction Act of 2005 provided for a new state plan option, codified under Section 1915 (j) of the Social Security Act, that gives states the option to provide payment for certain self-directed personal assistance services. Provisions of Proposed Rule CMS said the proposed rule would implement Section 1915 (j) by setting forth the requirements of the self-directed PAS delivery model and defining how individuals may qualify to participate in a self-directed PAS state plan option. As part of the proposal, CMS said individuals would be allowed to exercise decisionmaking authority in identifying, accessing, managing, and purchasing their PAS. That decisionmaking authority would include, at a minimum, "the purchase of PAS and support for PAS, recruiting workers, hiring and discharging workers, specifying worker qualifications, determining worker duties, scheduling workers, supervising workers, evaluating worker performance, determining the amount paid for a service, support, or item, scheduling when services are provided, identifying service workers, and reviewing and approving invoices." A state would be able to include additional activities in its submitted state plan option request. States choosing this self-directed care option must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants, CMS said. States also must train potential participants in ways to manage their budgets and assess their personal care needs. The use of self-directed PAS is estimated to cost a total of $225 million between fiscal year 2008 and fiscal 2012, of which $127 million would be the federal share, CMS said. Comments on the proposed rule are due Feb. 19. The proposed rule is available.
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