Challenge
About 10 million Americans need and receive Long-Term Services and Supports (LTSS) for life’s daily activities. Covering a range of ages, the majority of these individuals prefer to stay in home as long as possible. Participant-Directed Services (PDS) are a Home- and Community-Based Services (HCBS) delivery model that offers individuals and their representatives increased choice in LTSS. In DC, LTSS systems are shifting from reliance on institutional care toward providing person-centered HCBS to actively engage the individual and his/her family and local support network. The Department of Health Care Finance (DHCF), which aims to improve health outcomes by providing access to comprehensive, cost-effective, and quality health services for DC residents, is the designated State Medicaid Agency responsible for making payments for services for eligible individuals in the Medicaid program, including the Elderly and Persons with Physical Disabilities Waiver (EPD)/PDS.
Solution
Atlas Research assisted DHCF implement PDS personal care service delivery options for elders and individuals with physical disabilities enrolled in DC’s Medicaid §1915(c) EPD Waiver program. The PDS program, a pathway to improving health outcomes and person-centered planning, will assist individuals at-risk of being admitted to nursing facilities remain in home by providing HCBS. To develop and operationalize PDS, Atlas contracted a Subject Matter Expert (SME) who has over 32 years of experience related to Medicare and Medicaid HCBS programs, finance, and quality assurance issues. The Team assisted DHCF conduct an analysis of components essential to creating a viable PDS program, researching and identifying key components, including: Internal Revenue Service (IRS) and Department of Labor (DOL) regulations, rules, and issues; DC Office of Tax and Revenue (OTR) rules pertaining to PDS programs and domestic service workers and related forms; DC unemployment and workers’ compensation rules; effect of managed LTSS on design and implementation of PDS programs; and DOL interpretation of joint employment.
Result
The Atlas Team supported the development of operating environments and business processes through the completion of outlined deliverables. This included providing guidance regarding the legal, eligibility, demographic, medical, qualitative, and quantitative considerations in operationalizing PDS, identifying and implementing strategies to reduce or eliminate legal, regulatory, and other barriers to execution; preparing comprehensive briefing papers for discussion and decision making; developing standards for PDS counseling; creating a PDS Operations Manual, forming training materials, fact sheets, and presentations; and providing language for any amendments to the current EPD Waiver. The Team prepared comprehensive briefing papers to inform project structure, and met with OTR, Department of Employment Services (DOES), and Department of Insurance (DOI) personnel to obtain information and ensure compliance. Key stakeholder roles and responsibilities have been determined, and PDS Program Business Rules have been developed. These materials will inform the RFP for program implementation, which will get PDS up and running in DC.