Download What is Agency with Choice? - Center for Self

What is Agency with Choice?
Tammy Spigarelli, UPCAP Area
Agency on Aging Region 11
Elaine Taverna, Center for Selfdetermination
MI Choice Waiver tammy & elaine to do
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Self-determination
Minimum Operating Standards for MI Choice
Waiver Program Services
Advantages of Agency with Choicetammy
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Person Centered and Person Directed
Authority over funding for staff moves to the
individual
Co- management responsibilities
Emergency Backup
Pay & Fringe benefits for staff
Staff retention
How it Differs from Umbrella Agencytammy
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Individual is co-employer
Individual not agency sets employee wage
and develops the job description/duties.
With assistance from system, Individual
responsible for training, supervising, and
evaluating performance.
Staff Support Options- elaine & tammy
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Independent
Direct Hire
Agency with Choice
Role of Agency with Choice
- tammy
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Employer of Record
Financial Management ( optional in Aging
Required in CMH)
Human Resources
Criminal Background checks
Supportive services
Role of the Participant- elaine
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Co management
Recruiting and selection of workers
Development of job duties
Authorization of payment
Setting employee wage
Hiring and firing
AWC Requirements- tammyu
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Agreements
Fiscal Intermediary (optional in aging required in
CMH)
Contract with waiver agency in Aging ( contracts
directly with the individual in CMH)
Meets criteria identified in Technical advisory and
Minimum Operating Standards for MI Choice Waiver
Programs
Can be a Medicaid provider
Demonstrates competency (readiness survey)
Implementation issues- elaine & tammy
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Balancing duties of employer
Liability
Flexibility
Person-directed
Conflict of interest
Lessons Learned- elaine
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Designing a system with stakeholder input
Importance of written agreements that clearly define
roles and have signatures
Clearly communicated process and procedures that
address liability issues
Internal systems that provide for efficiency
Understanding the budget and working with the
fiscal ( if applicable)
Lessons Learned- tammy
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Most people are not able to find backup staff
when direct hire is not able to work and
cannot manage staff without assistance,
AWC provides for these needs
When people have authority and control over
who and how people work for them staff
retention and customer satisfaction increases
People are safer, healthier and condition
stabilizes
Substantiated Rights Complaints in Traditional
Provider Contracts
(Unlicensed) Homes vs. Licensed Group Homes
Pct of Total Annual
Census
Substantiated Rights Complaints in Own (Unlicensed) Homes vs. Licensed
Group Homes
20.00%
Reported Licensed
15.00%
Substantiated Licensed
10.00%
Reported Unlicensed
5.00%
Substantiated Unlicensed
0.00%
2003
2004
2005
2006
Fiscal Year
2007
2008
2009
Lessons Learned
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Over cost shifting or savings
Costs are reduced to AWC as staff retention
increases
In Aging, A Fiscal Intermediary is optional and
not required.
In CMH the funding is separated from the
provider agency to deter conflict of interest
CMH Provider example of Declining Revenues With
Increased Membership
PMPM Revenues
Membership
6,000
5,000
4,000
3,000
2,000
1,000
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
0
CMH Provider Seven Year Comparison of Total
Number of People Living in Licensed vs. Own
Home
Licensed
Own Home
total people per year
1,500
1,300
1105
1,100
1,009
972
1153
925
900
880
804
700
652
667
884
845
1000
817
746
722
688
500
2002
2003
2004
2005
2006
2007
2008
2009
CMH Provider example of Average Staffing Costs Per Person:
Self-Directed Budgets vs. Licensed Group Homes
Self-Directed
Group Homes
$70,000
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
2003
2004
2005
2006
2007
2008
2009
Direct Support Staff Turnover Study Provider:
Enhance, Inc. 2007
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Licensed Group Homes: 87%
Not Licensed SIP/Extended: 42%
Newly Self-Directed: 38%
Established Self-Directed: 18%!
Latest Self-Directed Wayne County: 0%!
Similar Data reported by AHS Inc.
Lessons Learned- tammy & elaine
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Communication to internal and external
stakeholders
Training and education
Importance of evaluation and continuous
quality improvement
Marketing and Public Relations
Success Stories
Success Stories