1. A. The self-direction initiative is a voluntary, self-determination option which allows the participant to coordinate the delivery of personal assistance services through an individual direct support professional rather than through a licensed, enrolled provider. Selection of this option requires that the participant utilize a payment mechanism approved by the department to manage the required fiscal functions that are usually handled by a traditional direct service provider.
2. B. Participant Responsibilities. Waiver participants choosing the self-directed services option must understand the rights, risks, and responsibilities of managing their own care and individual budget. If the participant is unable to make decisions independently, he/she must have a responsible representative who understands the rights, risks, and responsibilities of managing his/her care and supports within his/her individual budget.

3. C. Termination of the Self-Direction Service Option. Termination of participation in the self-direction service option requires a revision of the POC, the elimination of the fiscal agent and the selection of the Medicaid-enrolled waiver service provider(s) of choice.

   1. 1. Voluntary Termination. A waiver participant may choose at any time to withdraw from the self-direction service option and return to the traditional direct service provider.

   2. 2. Involuntary Termination. The department may terminate the self-direction service option for a participant and require him/her to receive provider-managed services under the following circumstances:

      1. a. the health or welfare of the participant is compromised by continued participation in the self-directed option;
      2. b. the participant is no longer able to direct his/her own care and there is no responsible representative to direct the care;
      3. c. there is misuse of public funds by the participant or the responsible representative; or

      4. d. the participant or responsible representative:

         1. i. places barriers to the payment of the salaries and related state and federal payroll taxes of direct support staff;
         2. ii. fails to follow the POC;
         3. iii. fails to provide required documentation;
         4. iv. fails to cooperate with the department, fiscal agent or support coordinator;
         5. v. violates Medicaid Program rules or guidelines of the self-direction option; or
         6. vi. fails to receive self-directed services for 90 calendar days or more.

4. D. Employee Qualifications. All employees under the self-direction option must:

   1. 1. meet the minimum age requirement per LAC 48:I.Chapter 92;
   2. 2. pass required criminal history background and database checks; and
   3. 3. be able to complete the tasks identified in the plan of care.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 37:3523 (December 2011), amended LR 39:321 (February 2013), LR 39:1779 (July 2013), amended by the Department of Health, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 44:1900 (October 2018), LR: 49:1726 (October 2023), LR 50:787 (June 2024), LR 51:298 (February 2025).