Participant and Recovery Coach review 2 year historical spending on Behavioral Healthcare (doesn't include inpatient and crisis spending) Spending Plan to Support / Recovery Plan Established Within the individual budget, participant and Recovery Coach establish a spending plan to support the Recovery Plan Freedom Funds Any savings in use of in-plan services can be used to purchase non-traditional services. Care Manager at BH-MCO must authorize all expenditures Table 2 provides a comparison of the self-directed models currently available in Pennsylvania. Table 2: Comparison of SDC Options in Pennsylvania ID Waivers (P/FDS and Consolidated) Attendant Care and Aging OBRA, COMMCARE, Independence CRIF Target Population Ages 3+ with intellectual disability and ICF/ID Level of Care Attendant Care: Physical disability ages 18-59 Nursing Facility level of care Aging: Age 60+ Need Nursing Facility level of care OBRA: 18-59 severe physical developmental disability requiring ICF/ORC Level of Care Commcare: 21+ TBI and Nursing Facility level of care Independence: physical disability Nursing Facility of care Delaware County HealthChoices adults and transition age with a SMI, 18 to 65 years of age, with 295 or 296 DSM IV-R diagnoses. Utilization of Medicaid mental health and/or drug or alcohol services at least once every 3 months over the last 2 years Legally competent to manage own affairs Consenting to treatment and evaluation
Funding Source 1915(c) HCBS Waiver 1915(c) HCBS Waiver 1915(c) HCBS Waiver Traditional Services – Medicaid Plan, Freedom Funds - Non-Medicaid Reinvestment Funds Employer Authority Yes Yes Yes No Budget Authority Yes – but limited to determining worker wages within state wage ranges Yes – but limited to determining worker wages within state wage ranges For people who opt for the Services My Way (Cash and Counseling) model - additional budget authority including the ability to purchase “participant goods and services.” Note: This is not being utilized to any significant extent in PA. Yes – but limited to determining worker wages within state wage ranges Yes. The person develops and manages a budget for the recovery plan. Consumers may use their budget to purchase traditional mental health treatments and services as well as “alternative” (“Freedom Funds”) goods and services that directly support their personal recovery. Individual Budget No Only for Services My Way participants No Yes Allowable Self-Directed Services and Community Habilitation (Unlicensed) Respite Services Broker Attendant Care: Participant and Services, Participant-Directed Community Supports, Personal Assistance Aging: Participant Goods and Services, Participant-Directed Assistance Freedom Funds goods and services.
Employment Support Services Community Supports, Personal Assistance, Respite Goods and Services No Only for people who choose the Services My Way model No Yes Cash Disburse-ment No No No Yes (restricted debit card) Information and Assistance Support Broker is an eligible service. Very few providers of the service statewide Only available through Supports Coordination Only available through Supports Coordination Recovery Coach with specialized training in SDC Financial Manage-ment Services (FMS) Fiscal/Employer (F/EA) is “common law employer,” also known as the “Employer of Record” of his or her staff. responsible to recruit, hire and train staff; determine staff schedules and responsibilities; manage the daily activities of staff; and terminate staff when appropriate. statewide FMS agency (Public Partnerships, LLC or “PPL”). PPL responsible for withholding F/EA is “common law employer,” also known as the “Employer of Record” of his or her staff. responsible to recruit, hire and train staff; determine staff schedules and responsibilities; manage the daily activities of staff; and terminate staff when appropriate. statewide FMS agency (Public Partnerships, LLC or “PPL”). PPL responsible for withholding taxes, paying staff, F/EA is “common law employer,” also known as the “Employer of Record” of his or her staff. responsible to recruit, hire and train staff; determine staff schedules and responsibilities; manage the daily activities of staff; and terminate staff when appropriate. statewide FMS agency (Public Partnerships, LLC or “PPL”). PPL responsible for withholding taxes, paying staff, Fiscal Agent The Fiscal Agent contracts with the County to manage Reinvestment Fund dollars used for alternative goods and services, while Behavioral Health MCO manages Medicaid claims for in-plan services. Fiscal services include: for goods and services (may include debit card account – with established restrictions on purchases) monitoring and reporting of all expenditures
taxes, paying staff, providing workers’ compensation, conducting criminal and child abuse background checks. OR AWC Model acts as the “Managing Employer” in a joint-employment arrangement with the FMS agency. works with FMS agency to recruit qualified staff, train staff, determine workers’ schedules and responsibilities, and manage staff’s daily activities. AWC is responsible for, hiring staff; processing employment documents; obtaining necessary criminal background and child abuse checks; paying staff; and providing providing workers’ compensation, conducting criminal and child abuse background checks. providing workers’ compensation, conducting criminal and child abuse background checks.