CMS Empowers "Personal Assistant Services" in Medicaid

On September 29, 2008, the Centers for Medicare & Medicaid Services issued a Press Release entitled "CMS Issues Final Rule to Empower Medicaid Beneficiaries to Direct Personal Assistance Services."

The final rule, published on October 3, 2008, provides guidance to states that want to administer self-directed personal assistance services through individual State Plans, as described in the Press Release:

A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was announced today by the Centers for Medicare & Medicaid Services (CMS).

The rule, on display today [09/29/08] at the Federal Register, guides states who wish to allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers. Beneficiaries could even hire qualified family members who may already be familiar with the individual’s needs to perform personal assistance (not medical) services. * * *

The referenced final rule was published in the Federal Register on October 3, 2008 (Vol. 73, No. 193, pp. 57853-57886). See: Medicaid Program; Self-Directed Personal Assistance Services Program State Plan Option (Cash and Counseling); Final Rule.

The press release quoted Kerry Weems, CMS acting administrator: “As health care is not simply an economic transaction, this plan represents a fundamental shift that restores a person’s ability to improve their overall health by taking greater control of his or her own decisions.”

The Press Release announced the possibilities for "self-directed personal assistance services" funded by Medicaid if a state would opt to join that program for its qualifying recipients:

If a state adopts a self-directed personal assistance services state plan option, beneficiaries could receive a cash allowance to hire their own workers to help with such activities as bathing, preparing meals, household chores and other related services that help a person to live independently. Allotments could also be used to purchase items that help foster independence such as a wheelchair ramp or microwave oven. The beneficiaries also have the option to have their cash benefit allotment managed for them.

The rule would put into place a provision of the Deficit Reduction Act of 2005 that allows states to elect a state plan option to provide care in ways that previously required waivers of existing Medicaid laws. Such waivers are subject to certain budgetary requirements and are temporary in nature. * * *

What would be required from a state opting into this program?

Before a state could request this change to its state plan, it must have an existing personal care services benefit, or be operating a home or community-based services waiver program.

Enrollment in this new state plan option is voluntary and the state must also provide traditional agency-delivered services if the beneficiary wishes to discontinue self-directed care.

States choosing this option must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants. States must also furnish sufficient information, training, counseling and assistance to participants in order to help them effectively manage their budgets and their personal assistance services. * * *

Will Pennsylvania opt in? That will be up to the Pennsylvania Department of Public Welfare in its State Plan submission to CMS. DPW has been receptive to development of such innovative, cost-saving programs in the past few years. See: Workshop Presentation, Medicaid Rehab Option (2005, 68 slides).

The CMS rule on self-directed personal assistance services will become effective on November 3, 2008.