1. (1) Enrolled members in the waiver program must be offered an opportunity to utilize self-directed services as a co-employer. Once an enrolled member's comprehensive assessment and PCRP process have been completed and needed waiver services are identified, the enrolled member may select the specific services they wish to self-direct from the list of services indicated in (10). The enrolled member may also receive some of the services in their PCRP through traditional supports and services from a provider agency, as long as no services are duplicated. The entities responsible for supporting self-direction include case managers, the QIO, and the provider agencies.

2. (2) Services may be directed by:

   1. (a) an enrolled member who has the capacity to self-direct, as determined by the department or the department's designee;
   2. (b) a legal representative of the enrolled member, including a parent, spouse, or legal guardian; or
   3. (c) a nonlegal representative freely chosen by the enrolled member or the enrolled legal representative.

3. (3) The person directing the services must:

   1. (a) be 18 years of age or older;
   2. (b) successfully complete required training for self-direction; and
   3. (c) if acting in the capacity of a representative, demonstrate understanding of the enrolled member's needs and preferences.

4. (4) If an enrolled member indicates an interest in the self-directed option, the case management team is responsible for referring the enrolled member to the QIO. The QIO must assign a health care professional to:

   1. (a) conduct a capacity interview over the telephone; and
   2. (b) certify that the enrolled member, legal representative, or nonlegal personal representative is capable of managing the tasks and understands the risks involved. An approved capacity determination is required to self-direct services.

5. (5) The case management teams must:

   1. (a) assist the enrolled member to develop an emergency backup plan, identifying and mitigating risks or potential risks, and monitor the health and safety of the enrolled member. Agency-based PAS managed by provider agencies under agreement with Medicaid are not available to enrolled members who are participating in the self-directed program. The use of PAS managed by provider agencies is permissible only if the enrolled member's backup plan fails;
   2. (b) educate enrolled members regarding self-directed opportunities;
   3. (c) meet with enrolled members to detail the self-directed service options during the intake process, annual visit, as well as throughout their service plan year as indicated through assessed need;
   4. (d) provide assistance for informed decision-making by enrolled members and their families/representatives about the election of self-direction with information and training on the roles, risks, and responsibilities assumed by those who choose self-direction;
   5. (e) inform enrolled members they are able to assist with the development of formal/informal supports, plan development, as well as available resources for self-direction; and
   6. (f) oversee the service delivery in the self-direct option.

6. (6) The enrolled member, the enrolled member's legal representative, or the nonlegal personal representative must:

   1. (a) be capable of making choices about activities of daily living, understand the impact of their choices, and assume responsibility for those choices;
   2. (b) be capable of managing all tasks related to service delivery including recruiting, hiring, scheduling, training, directing, and dismissal of attendants; and
   3. (c) understand the shared responsibility between the enrolled member and the provider agency.

7. (7) Enrolled members will be able to choose from several agencies providing personal assistance type services, ensuring members are successful with the self-direction experience. The provider agency must:

   1. (a) advise, train, and support the enrolled member, as identified in the member's PCRP;
   2. (b) assist with recruiting, interviewing, hiring, training, managing, paying, and dismissing workers; and
   3. (c) assist with monitoring the health and welfare of the enrolled member.

8. (8) Self-directed services can be terminated when:

   1. (a) the enrolled member chooses not to self-direct; or
   2. (b) the case management team or the department identifies an instance where the self-directed option is not in the best interest of the enrolled member, and a corrective action does not improve the situation.
9. (9) The enrolled member must be informed in writing of the plan to transfer to an agency-based service delivery.

10. (10) The following services may be self-directed as a co-employer:

    1. (a) personal assistance services;
    2. (b) behavioral intervention assistance; and
    3. (c) life coach.

Authorizing statute(s): 53-2-201, 53-6-402, MCA

Implementing statute(s): 53-6-402, MCA

History: NEW, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234.