Self-Determination
Self-determination embodies the values of person-centered planning and is based on the following four guiding principles that should apply to people with disabilities: 1) The freedom to choose where to live, with whom and the development of a personal lifestyle; 2) The authority to control the supports provided and the money that is spent on the individual's behalf; 3) The support to develop a life dream and reach toward that dream; and 4) The responsibility to use public funds efficiently and to contribute to the community through the expression of responsible citizenship.
Medicaid rules still apply to self-determination. That means medical necessity must be proven. Medical necessity is the scope (what kind), amount (how much and how often) and duration (for how long) of services a person needs based on their current mental health condition. When a request for services is submitted to LifeWays, the medical necessity of those services is reviewed. There must be written proof that without the requested service(s), the consumer's condition would worsen. Medicaid is the payer of last resort. This means that all other natural and community supports must be used before Medicaid will pay for a service.
Referral Process
Consumers can request to receive services via a self-determined arrangement upon entry into services or at any time during the course of treatment. If a new consumer is interested in self-determination, the LifeWays Access Center will follow the normal procedures for eligibility and service referral and specify self-determination. For current consumers, LifeWays Network Providers shall, at the time of person-centered planning or when interest is expressed by the consumer, assist the consumer in making an informed decision to receive services through a self-determined arrangement.
Fiscal Intermediary
All consumers choosing self-determination must have a Fiscal Intermediary (FI). An FI is an accountant. For a fee, the FI handles payroll responsibilities for the consumer-employer (pays providers, handles Worker's Compensation and payroll taxes, supplies employee payroll forms, etc.) The FI is responsible for paying consumer providers based on the Employment Agreement signed by the consumer and provider and time sheets submitted by the provider. The Fiscal Intermediary also provides each self-determined consumer with a monthly budget status report.
The self-determined consumer (and guardian if there is one) meet with their Fiscal Intermediary at the start. At this meeting, the consumer/guardian will review and sign needed paperwork. The Fiscal Intermediary will explain the services they provide and how much those services cost. The Fiscal Intermediary can help the consumer negotiate service rates with their providers. Lower rates allow the consumer to make the most of their service benefit using available budget dollars.
