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Self Directed Services

Tool Kit

A Resource for Individuals compiled by Community, Work & Independence, Inc.

Funding for this project provided by NYS Office of Mental Retardation and Developmental Disabilities – Workforce Development Grant

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Tool Kit GoalsThis tool kit contains resources to assist

individuals with self directing support services

The tool kit will: provide background and educational

information about self directed services highlight benefits and responsibilities

associated with self directed services highlight the types of resources available

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What are Self Directed Services?

Self direction of publicly funded support services is a relatively new philosophical approach

The driving force behind this approach is to allow individuals input and control, to the greatest extend possible, in meeting their needs for a meaningful life

Successful self direction requires competence, cooperation and commitment

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Self Directed Choices

Self directing programs allow consumer input: Choosing an agency to assist with co-managing Choosing workers to provide the direct services Setting wages and hours Directing goals and activities of service

OMRDD currently offers self direction of services for At Home Residential Habilitation and In Home Respite services

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Benefits of Self Direction

Empowers individuals and allows greater control over life

Provides a more individual approach to individual needs

Assists with worker shortagesIncreases availability of services in rural

regionsAllows individuals to remain living at home

longer

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Responsibilities of Self Direction

Individuals “co-manage” the responsibilities in a self directed service model By choosing an agency, individuals are

choosing their co-manager Individuals act as the employing manager Agencies act as the fiscal intermediary and

often provide the needed clinical component necessary for funding

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Employing Manager

The employing manager (individual) is responsible for recruitment, hiring, training, setting wages (within a range), scheduling, performance evaluation, discipline and dismissal of direct care workers.

It is key for the employing manager to work closely and communicate with the fiscal intermediary to ensure services run smoothly and all areas of the program are in compliance with state and federal laws.

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Self Directing Other

If an individual is unable or unwilling to assume the responsibilities associated with self directed services, a Self Directing Other may be designated to fulfill these responsibilities. This individual is often a family member, but

that is not a requirement. It cannot be an employee of fiscal intermediary

agency that serves the individual in any other capacity through the agency.

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Fiscal Intermediary Definition A fiscal intermediary manages funds, makes payments,

and accounts for expenditures made on behalf of the consumer as directed by the consumer, family, or circle of support.

The fiscal intermediary is not a direct service provider, but handles the business end of securing services and supports.

A fiscal intermediary must be able to provide payroll services, bill payments, benefit administration, contract negotiation, rate setting functions, and record keeping services.

Without a fiscal intermediary, the individual or family could be affected by state and federal labor laws, be responsible for filing tax records, and have additional obligations with regard to the Social Security Administration.*

•http://www.dds.cahwnet.gov/SDS/docs/FiscalIntermediary.pdf

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Employer of Record

The fiscal intermediary is the employer of record for persons providing support services and is responsible for completing tax, labor, and social security documents as needed.

The employer agent calculates and files tax documents, distributes wages to support providers, manages workers’ compensation, disability, and benefit insurances, and verifies citizenship/legal alien status of support providers along with all other background checks required by the funding source.

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Fiscal Conduit

The fiscal intermediary also acts as a Fiscal Conduit and completes administrative tasks, such as collecting time sheets, submitting invoices, billing the funding source etc.

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Operational Structure

Self directed services operate with four primary components

Personnel ConsiderationsFiscal ConsiderationsCompliance ConsiderationsService and Support Considerations

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Personnel Considerations

RecruitmentHiringSchedulingManagingEvaluatingDiscipliningDismissing

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Recruitment/Hiring

Selecting the right person for the job is key to successful outcomes Canvas for potential employees

Newspaper ads, area bulletin boards, word of mouth, internet, local colleges

Set up an interviewing and reference checking system

Be aware of legal dos and don’ts

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SelectionConcepts to keep in mind

Compatibility Experience and Competence Work history Potential conflicts Communication Style

Certain family members are not eligible for hire through self directed programs: Spouse, natural or adoptive parent,

son/daughter, son/daughter-in-law

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Sample Recruitment/Hiring ResourcesRecruitment\Interview QuestionsRecruitment\Employment interviewing and

evaluation formRecruitment\Interpersonal Skills Job Interv

iewRecruitment\Practical tips for interviewing j

ob candidatesRecruitment\Illegal Interview Questions

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Sample Recruitment/Hiring Resources

Recruitment\Reference Checking Recruitment\Reference Check Guide Recruitment\Employee Recruitment Best Practic

es U.S. Equal Employment Opportunity

Commission

http://www.eeoc.gov/ Americans with Disabilities Act

http://www.ada.gov/

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Managing

Management styles vary from person to person, but there are some basics to managing people that all good managers should be aware of. All styles will be complimented by applying: Consistency Logic Honesty Clear expectations

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Managing

There are numerous facets to managing people. Some of the more typical duties include: Scheduling Monitoring timesheets/shift reports Evaluating performance Disciplining

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Sample Managing Resources

Managing\Basic rules to follow with at-will Employees

Managing\Employee feedback scriptManaging\Sample absence policiesManaging\Sample tardiness policyManaging\Progressive discipline checklistManaging\Sample verbal warningManaging\Sample written warning form

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Sample Managing Resources

Managing\Effective Employee EvalManaging\About Employee Evaluation

An excellent resource that can be overlooked is the co-managing agency.

Often a conversation with an experienced manager or HR staff person will point you in the right direction.

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Dismissal A situation may arise when dismissal of a direct

care worker is necessary. Never an easy decision or situation, it should be approached thoughtfully. Below are some sample resources for guidance:

Dismissal\Checklist of general concerns related to termination

Dismissal\Termination meeting checklist Dismissal\Behaviors to avoid during a

termination meeting Dismissal\How to Fire With Compassion and

Class

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Fiscal Considerations

Funding It is paramount to keep in mind that the dollars

supporting the services are public dollars, more often than not – MEDICAID

Public dollars require a high level of accountability

Documentation must be timely and in order All parties must be aware of compliance

requirements and be able to identify instances of fraud

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Documentation

Fiscal documentation Timesheets – the backbone of payroll

Indicates hours worked, benefit time (if applicable) Authorization by the worker, consumer and program

coordinator

Service documentation Shift report – services rendered

Indicates what services were provided and what the outcome(s) was

Medicaid is paying for the service delivered

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Documentation

Service Documentation (continued)

The Office of Mental Retardation and Developmental Disabilities (OMRDD) has specific service documentation requirements:

Proper notation of service in the Individual Service Plan (ISP) by the Service Coordinator

Development & maintenance of the Habilitation Plan by the agency QMRP

Shift reports completed by the direct care worker Monthly summary of services and outcomes by the QMRP Signed Memorandum of Understanding outlining

responsibilities

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Documentation

Below are samples of required service documentation for OMRDD Forms\AHRH-SD

DAILY NOTE Forms\AHRH-SD PLAN Forms\SD-AHRH MOU

2009

TABS ID :

MONTHLY SUMMARY NOTE - AT HOME RESIDENTIAL HABILITATION

SIGNATURE OF STAFF PERSON REVIEWING THE NOTE TITLE DATE (mm/dd/yyyy)

Consumer Response (Progress toward Valued Outcomes/Goals):

DATE (mm/dd/yyyy)SIGNATURE OF STAFF PERSON WRITING THE NOTE TITLE

Provide a narrative that summarizes the implementation of the At Home Residential Habilitation Services Plan, and addresses the consumer's response to the services provided and any issues or concerns.

Staff Intervention:

CONSUMER NAME:

AGENCY: MONTH / YR OF SERV. DELIVERY :

MEDICAID # :

Community, Work & Independence, Inc.

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Compliance

The laws – local, state and federal – are numerous and clear about the proper usage of public funds. Knowledge of and compliance with these laws is mandatory.

The consequences of non-compliance (FRAUD) can run the gamut: termination of workers, loss of services, paybacks, ineligibility to be a Medicaid provider or to work in a Medicaid program

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Examples of Fraud

Forged signaturesInaccurate or false times on timesheets or

shift reportsSubmitting overlapping hours worked for

two or more programsPre-filling documentation ahead of service

delivery

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CWI’s Corporate Compliance Plan

All parties involved with any service that is paid with public dollars should be aware of the laws governing fiscal compliance, how to identify fraud and the consequences of fraud.

CC\Corporate Compliance Power Point!CWI Code of Conduct

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Service Design

No one knows more about what support services an individual needs than the person in need.

Participate fully in the Individual Service Plan Meeting! Make sure you self advocate or have the Self Directing

Other advocate for what is needed and how services should be designed, including: When How By Whom

Review the Habilitation Plan closely to ensure it mirrors what is needed. Make sure all direct care workers are familiar with the plan.

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Support Resources

Self directing individuals are not expected to “go it alone” and should reach out to available resources when necessary.

Below are some of the resources that can be of assistance:

Agency InternetSupport Groups

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Agency

Remember, the agency is your co-manager. Take advantage of the expertise and resources available.

Timely communication is essential and often prevents a small concern from growing into a large concern.

The agency may also be able to tap into other resources more easily than you for answers, for example, the funding source, legal advisor or law enforcement.

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Internet The internet has information about almost

anything….just take a look! If you don’t have access to the internet check out your

local library or school Use a search engine, such as Google, to get started.

http://www.google.com/support/websearch/bin/answer.py?hl=en&answer=134479

Keep in mind that different states have different rules. It is always a good idea to double check information from the internet from questionable sources.

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Support Groups Whether it is you that requires support services

or you are a caregiver of someone who requires support services, a little understanding, empathy and conversation with someone who “has been there” can be invaluable.

Look in your area for local support groups. Places to start include: Department of Social Services Office for the Aging Developmental Disabilities Service Organization (DDSO) NYSARC School District Religious Institutions

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The quality of Self Directed services is related directly to the quality of the

management of services.

We hope this presentation has provided you with some valuable resources and

wish you a successful participation in the a Self Directed Services Program.