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How do Support Brokers fit in Wisconsin?
Self Directed Supports in Dane County
Robert Wood Johnson Foundation Based on a the Robert Wood Johnson Foundation (RWJF)
Grant in New Hampshire: In November 1995, the RWJF authorized up to $5 million to
establish the Self-Determination for People with Developmental Disabilities Program.
The program's goal was to help states implement a more cost-effective system for serving persons with developmental disabilities while simultaneously giving those persons and their families more choice in determining the services they receive.
The national program office was set up in January 1996. Wisconsin one of the first states awarded & Dane County
began it’s pilot in January 1997
Consumer Directed SupportsMedicaid Waivers Manual Chapter IVAllowable Services and Provider Requirements Page IV-59
CONSUMER-DIRECTED SUPPORTSSPC 609.10
Applies to CIP1A, 1B, BIW (See 609.20 for similar service)DEFINITION
The provision of a flexible array of services provided to participants that include a specified portion of the services covered by the waiver. Services are planned and implemented through processes characterized by:
1. Support for the consumer and those close to the consumer to assist in identifying the consumer’s goals and means of reaching those goals, in a manner that reflects consumer preferences as closely as possible;
2. Planning that occurs within the limits of an individualized budget that is based on typical service costs for Waiver participants with similar needs in similar situations; and
3. An emphasis on identifying and strengthening networks of informal supports and on making use of generic community resources to the maximum extent possible.
4. Processes and supports for person-centered service planning, implementation, operation and monitoring that are established through a locally developed county Consumer-directed Services (CDS) implementation plan that is subject to approval by the department. Based on this plan, a Memorandum of Understanding (MOU) is executed between the county and department. This MOU governs county operation of this service.
Case Management CARE MANAGEMENT/SUPPORT AND SERVICE COORDINATION
(Also known as Case Management)SPC 604
Applies to CIP 1A/1B, BIW, CIP II, COP-W, CLTS & COR
DEFINITIONCare management/support and service coordination is the provision of service to locate, manage, coordinate and monitor all waiver program services, additional services, (regardless of funding source) and informal community supports provided to eligible applicants/participants and to assure that services are provided in accordance with program requirements. This service is intended to insure the waiver program participant’s health and safety by enabling the participant to receive a full range of appropriate services and supports consistent with his/her assessed needs in a planned, coordinated, efficient and cost effective manner. While these general guidelines apply to all care management/support and service coordination provided, the service activities may be target group or age-specific.
This service includes assistance with establishing financial, functional and all other aspects of Medicaid waiver eligibility. Service may also include assisting the participant to access waiver, Medicaid state plan, medical, social and natural supports and services. Beyond plan development and service coordination activities, the CM/SSC role includes the primary responsibility to assure participant health and safety.
Becoming a Support Broker
All support brokers are hired and trained by one of the seven support broker agencies listed in the previous section. Once hired and trained by a support broker agency, brokers then interview with and get selected by people with disabilities. While each support broker agency develops its own job descriptions, all have agreed to the universal elements listed in this section’s “Job Description”.
Additionally, broker job descriptions get individualized by the people with disabilities who select them.
Support Broker Role Support Brokers will be selected by and work under
the direction of the person receiving support.
People selecting Support Brokers will be urged to select a Support Broker that is independent of a service provider to minimize the inherent conflict of these roles.
People can change Support Brokers and will be asked to renew and sign a contract each year outlining their expectations
Will meet the minimum qualifications according to the guidelines of the Medicaid Waiver program.
Will successfully pass a criminal background check.
A Support Broker cannot be a legal representative of the person receiving support.
Support Brokers must be readily accessible to the individual.
Support Broker Job Description
Purpose: To advocate for adults with developmental and other disabilities to lead a self-directed life. We believe people with disabilities deserve the opportunity to direct their own supports while maintaining or improving their quality of life in their homes and in their community.
Duties and Responsibilities Planning Training Fiscal Responsibility – public funding and personal funds (e.g. benefits) Communication Mandatory Reporting Paperwork Documentation Knowledge of Community Resources Team Building and Conflict Resolution
Independence Plus Waiver
How do Support Brokers fit
in Wisconsin?
Common Themes In Self-Determination
Expand people’s choices
Enable people to control the money spent on their support and services
Conceptual ShiftPrevious System Self-Determination
Concept Person as recipient to Person as manager
AdministrativeStructure
Program Centered to Individual Centered
Case Management Assigned to Chosen
Payment SystemMoney held by
Countyto
Money held byPerson
Provider Role Respond to County to Respond to Person
ChoiceLimited to
Contracted Providersto Open
Contracting Slots to Individual Agreements
Planning Process Provider Case Manager toBroker facilitated person centered
planning
Quality AssuranceBased on
Minimum Standardsto
Based on person's expectations and outcomes
Mobility Training & Independent LivingActivities of Daily
Living Skills Training
Mobility Training & Independent LivingActivities of Daily
Living Skills Training
Waisman Center Community TIESCrisis/Behavioral
Intervention
Waisman Center Community TIESCrisis/Behavioral
Intervention
Mental Health CenterCounseling, Groups,
Psychiatric Consultation
Mental Health CenterCounseling, Groups,
Psychiatric Consultation
Dane CountyAdult Community Services
Intake & Eligibility
Dane CountyAdult Community Services
Intake & Eligibility
United Cerebral PalsyAssessment & Planning
One time funding
United Cerebral PalsyAssessment & Planning
One time funding
Person/Familywith
Presenting Need
Responsive Solutions, Inc.
On-call Crisis Staff Environmental
Modifications/Adaptations
Responsive Solutions, Inc.
On-call Crisis Staff Environmental
Modifications/Adaptations
How Adults are SupportedLiving arrangements
Number Served
Number of Providers
Live with family 247Live with roommate (s) 670Living alone, in cluster 59Living alone, come-in support 97Living alone with behavioral support 51AFH Licensed 3-4 42 3AFH Certified 42 32CBRF 2 2Out of County 4 2
Total 1214 18
Day SupportNumber Served
Number of Providers
Supported Employment/Self-Employed 909 13Facility-Based (Sheltered/Adult Day Care) 305 3
Total 1214 14
14
Independent Consulting Agency (ICA)- TMG
Develop Individual Support PlanThe person directs their funding
based on this plan
Individual Service plan developed.Funding is approved based on RAD
ADRC
IndependentConsultant –
Assigned by ICA
MCO(s)
Care Manager
Current terrain in Wisconsin
Group Project
Jim
IRIS Cri du Chat, MR, poor coordination,
behavioral issues Jim lives at home with his parents
(guardians) who provide all of his supports: personal cares, house cleaning, transportation, medical appointments and keeping Jim safe.
Supports Mom and Dad
Summer Camp staff
Church friends
Respite Staff
Therapist
Concerns Paperwork
questions about benefitsTime to research questions and resolve issues
Finding resources and following up with potential providers
Ongoing planning
Craig IRIS Muscular Dystrophy, sleep disorder, back
pain, cataracts Staff and Craig’s wife help with: personal
cares, house cleaning, transportation, help set up my medical appointments, and always attend these appointments with me.
Supports
Wife
Father
Staff he knows and trusts
Muscular Dystrophy Association
Concerns
Gets anxious about paperwork:Timesheets letters from Medicare and Medicaid
Keeping track of recommendations from his many doctors.
Dawn
IRIS TBI with some physical impairments Father is guardian and lives out of county. Lives alone with residential “come-in” support
for house cleaning and organizing finances. Employed with support from a vocational
provider.
Supports
Dad and Step-Mom
Siblings
Residential Staff
Vocational Staff
Concerns
Liaison discussions between providers, family (guardian) and Dawn.
Financial negotiations with providers.
Paperwork questions especially benefits.
No proximity of guardian.
Presenter Information
Alexa Butzbaugh – Progressive Community Services
(608) 848-8305 Kevin Keisling – Avenues to Community Inc.
(608) 663-8390 Ext. 436
