The 3 options of Self-determination

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You are eligible for public mental health services. Now what? You can choose how to have your services delivered. In addition to its more traditional services like day programs or group homes, Network180 offers three different types of self-direction (SD) arrangements. Each one provides you a different level of control over and responsibility for those services. In all self-direction arrangements, services cannot be provided in a segregated setting, but must be delivered in your home and/or your community.

• Provider with Choice – In a provider with choice arrangement, you choose one of the agencies in the Network180 network of care to deliver the services you are eligible for. Your supports coordinator or case manager can tell you who these agencies are. The agency that will employ your staff.

 You negotiate with the agency about how, when, where and by whom your services will be delivered. You may want to meet or interview a staff person before he or she works with you. You may want the staff to follow some “house rules” like not smoking in your house or not borrowing your phone. You may want your services delivered in the morning or the evening. You may want to set up a way to deal with a staff person you do not like. Your agreement with the agency is put in writing and signed by you and the agency.

You will have an individual services budget (ISB). Every month you review the documentation the agency’s employees are required to keep and verify that payment should be made to the agency. You will receive a monthly report from the agency showing how many units of service you have used, how many you have left and how much your services cost.

• Purchase of Services – In a purchase of services agreement, you choose an agency that is not part of the Network180 network of care to provide the services you are eligible for. Your agreement to use a purchase of services arrangement is put in writing and outlines the responsibilities of both you and Network180. The agency you choose is the employer of your staff, but you have control over how, when, where and by whom services are provided. You sign a contract with the agency that outlines your role and the agency’s role. You may want to include specifics about house rules, how to deal with staff you don’t like, when you want services delivered and other important details, just like in a provider with choice arrangement.

You will have an individual services budget and Network180 will provide a fiscal intermediary (FI) to help you manage it. Every month you review the documentation the employees are required to keep and verify services were provided according to your individualized services plan and that payment should be made to the agency. Once the fiscal intermediary knows you have authorized payment and the agency has provided an invoice, the agency is paid for providing the services to you. The fiscal intermediary will provide you with a monthly report showing how many units of services you have used, how many you have left and how much your services cost.

• Employer of Record – In an employer of record arrangement, you are the employer. Your agreement to be an employer of record is put in writing and outlines the responsibilities of both you and Network180. This arrangement gives you the most responsibility and control over your services and who provides them.  You recruit, interview, hire, schedule, evaluate and manage the employees who deliver the services you are eligible for. You determine when, how, where and by whom your services are provided. Your employees must meet certain criteria, go through back ground checks, attend training and sign employment agreements and Medicaid Provider agreements.

You will have an individual service budget. A fiscal intermediary helps you by being an “employer agent.” This means the FI can help you manage your budget and will do things like process payroll and deposit taxes. The fiscal intermediary also works with you on a schedule and pay rates for your employees that allow you to stay within the parameters of your budget.

Every month you review the documentation the employees are required to keep, including Medicaid documentation and time cards. You verify services were provided according to your plan of services and that payment should be made to the employee. The fiscal intermediary will provide you with a monthly report showing how many units of services you have used, how many you have left and how much your services cost.

Other Things to Remember about Self-Direction Arrangements: Using a self-direction arrangement is your choice. If you decide you no longer want to use a SD arrangement, you will still be eligible for services. Your services will be provided in a different way.

If you decide you do not like the type of SD arrangement you start with, you can try a different type of SD arrangement.

Using a SD arrangement does not free you, agencies or employees from having to comply with state and federal laws and regulations such as Medicaid and labor laws. Your supports coordinator or case manager will help you to understand and fulfill your responsibilities under these laws and regulations.