Consolidated Supports and Services

Text from OMRDD’s HCBS Waiver Agreement with HCFA

Consolidated Supports and Services

Definition: Consolidated Supports and Services includes resources, supports and services to individuals with developmental disabilities in order to improve and maintain the individuals' opportunities for full membership in the community. In comparison with traditional practices around agencies' provision of services, persons with developmental disabilities have increased authority to control the resources associated with this service and other resources at their disposal, with the help of freely chosen circles of support. Circles should have both paid and unpaid members. Members who are paid staff may assist the individuals to develop and maintain unpaid circle members. Circles may include family, friends, clergy, community members, advocates, other self-advocates, a service coordinator or a personal agent and/or a service broker, other direct care staff and professional staff. The individuals may change any aspect of their supports to pursue the variety and intensity of supports that the individuals desire and need in order to achieve their personal goals and valued outcomes, and to prevent institutionalization. Supports and services must be self-determined, self-directed, and/or person-centered.

With the exception of service coordination and plan of care support services, all long-term care related support services provided to a person selecting Consolidated Supports and Services must be accounted for through this service. Paid supports and services may not involve duplication of payments to any provider for services rendered.

An Individualized Service Plan (ISP) is required. It profiles the person, his or her personal goals and valued outcomes and the supports and services that are needed to live successfully in the community. Natural and generic community supports are included as well as paid supports. All paid long term care services and supports, including Medicaid services, are outlined in the ISP. The service provider, frequency, duration and effective date of all services and supports must be described in the ISP. This plan includes details that demonstrate that they are not duplicative and how they help support the person to pursue his or her valued outcomes. A Consolidated Support and Service Plan must be attached to the ISP. This plan takes the valued outcomes of the ISP and indicates how they will be achieved. It may be written by a designee of the individual and the circle of support and is reviewed by the service coordinator. The plan must be approved by the DDSO director or his or her designee. Services may include any and all services authorized under the HCB waiver as well as any additional services needed to achieve and sustain full community participation and integration.

Budgeting for service and support options selected is done by the individual with the help of his or her circle of support, using a standard budget worksheet. A resource allocation, called a Personal Resource Account (PRA), is established for each individual. Spending, on a yearly basis, may not exceed the PRA except with the prior approval of the DDSO Director or his or her designee.

Resources may be managed through a fiscal intermediary who is a financial administrator for the individual and can serve as the employer of record. The fiscal intermediary is a voluntary agency authorized to provide Medicaid and HCB waiver services, but does not provide any services to those it serves as a fiscal intermediary. Exceptions require DDSO Director approval. The fiscal intermediary may also negotiate and contract with another traditional voluntary agency to provide standard Medicaid or HCB Waiver services at an individual rate.

Unit of Service: The unit of service for consolidated supports and services is one month.

Allowable Activities:

1) Any activity that supports an independent, fulfilling life in the community, including, but not limited to: living, working, socializing, recreating, personal growth, and maintenance of safety and health.

2) Changing any aspect of their supports to achieve evolving personal goals and valued outcomes, and to prevent institutionalization.

3) Hiring people with or without connections to the human service field but with skills useful to the consumers in achieving desired outcomes.

4) Learning to make informed choices and to self advocate for personal outcomes.

Assurances:

1) Paid supports and services will not involve duplication of payments to any provider for services rendered.

2) Federal Financial Participation (FFP) for consolidated supports and services does not include the cost of room and board except when there is a live-in caretaker in the consumer's own home.

3) Consumers' parents, spouses or domestic partners, legal guardians or siblings under the age of eighteen may not receive payment for services.

Service Standards

1) An Individualized Service Plan (ISP) articulates the supports and services required for the person to achieve his or her desired outcomes and to avoid institutionalization.

2) The outcomes and the means to attain them that are in the ISP reflect the wishes of the consumer and those assisting in the planning.

3) The consumer is aided in the planning process by a group of persons, often referred to "the circle of support." These people are chosen by and committed to the consumer and the attainment of his or her personalized outcomes. The group should include both paid staff and unpaid family and friends.

4) The major service standard is the satisfaction of the consumer and his or her circle of support with the supports and services they choose.

5) With a change in plans that involve purchased services, the consumer's resources follow him or her to allow the purchase of services from a different provider.

6) The limit to spending on supports and services is set by the Personal Resource Account (PRA) amount established by the state. Within this limit, the individual is encouraged to be as creative as possible and to use as many natural supports as possible. The PRA limit is negotiable with the state when a plan cannot be supported by the original PRA amount.

7) The state approves the ISP, the associated Consolidated Supports and Services Plan and the Personal Resource Account.

Provider Qualifications

1) Providers of Consolidated Supports and Services shall be able to demonstrate the involvement of a QMRP in the development of the ISP, and in the delivery, management or supervision of the service.

2) A consumer may choose to receive services from a state-approved provider of developmental services. These providers must meet the general standards set by the state.

3) Individuals not affiliated with a state-approved provider who provide supports must be at least eighteen years of age, have a high school diploma or equivalent (GED or life experience) and have training specific to the needs of the consumer.

4) The provider must be twenty-one years of age if the consumer lives in the provider's home.

5) Family members may provide supports and services. However, the consumer's parents, spouse or domestic partner, legal guardian or sibling under the age of eighteen may not receive payment for services.

6) Providers of clinical services must be properly licensed by the State Education Department.

7) Fiscal intermediaries must be designated by the state and under contract to perform such services.