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Self-directed Personal Assistance Services (PAS)

HCBS Authority: 
1915(j)
Applicable CFR Sections: 
42 CFR §441.450-484
Purpose: 

Provides a State Plan participant-directed option to individuals otherwise eligible for State Plan Personal Care or §1915(c) services.

Medicaid Requirements That May Be Waived: 
  • Statewideness
  • Comparability
Application Process: 

State plan amendment submitted on pre-print.

Preprint (PDF)

 

Approval Duration: 

One-time approval. Changes must be submitted to CMS and approved.

Reporting: 

Annual report on the number of individuals and total expenditures.

States must provide an evaluation of the overall impact on the health and welfare of participating individuals compared to non-participants every 3 years.

Administration & Operation: 

Administered by the Single State Medicaid Agency (SSMA).

Provider Agreements: 

Required between providers and the SSMA.

Delegation allowed to a provider agency under the Organized Health Care Delivery System or Provider of Financial Management Services. Requires written specification of delegated activity.

Medicaid Eligibility: 

Must be Medicaid eligible for and receiving services under either state plan requirements or eligible for and receiving services under a §1915(c) HCBS waiver

Public Input: 

Must follow notice requirements for State plan amendments.

Target Groups: 

May define and limit the target group(s) served.

Other Unique Requirements: 

Must either operate a HCBS waiver covering PAS or have an approved state plan amendment for “traditional” PAS.

PAS is not available to an individual who resides in a home or property that is owned, operated, or controlled by a provider of services who is not related to the individual by blood or marriage.

Case Management: 

State must describe safeguards in place to mitigate conflicts if service providers do service plans under 42 CFR §441.468(d)

Person-centered planning requirements apply under 42 CFR §441.468(b)

Limits on Numbers Served: 

Allowed.

Waiting Lists: 
Allowed.
Combining Service Populations: 
States may combine service populations.
Caps on Individual Resource Allocations or Budgets: 
May determine process for setting individual budgets for participant-directed services.
Allowable Services: 
  • Personal care or related services.
  • Home and community-based services otherwise available to the participant under the state plan or an approved §1915(c) waiver.
  • At state’s discretion, items that increase an individual’s independence or substitute for human assistance.
Allowable Participant Settings: 

42 CFR §441.460 Participant living arrangements.

(a) Self-directed PAS are not available to an individual who resides in a home or property that is owned, operated, or controlled by a provider of services who is not related to the individual by blood or marriage.

(b) States may specify additional restrictions on a participant’s living arrangements if they have been approved by CMS.

Provider Qualifications: 

No statement required as to provider qualifications in the 1915(j) preprint.

Participant-directed Services: 
Required.
Hiring of Legally Responsible Individuals: 
Allowed at the State’s discretion.
Cash Payments to Participants: 
Direct cash payments are permitted.
Financial Management Services: 

Required. May be offered directly by the SSMA. Reimbursable only as an administrative function. Service reimbursement is not available.

Employer Status for Participant Direction: 

Participant may be the employer of record under a Fiscal/Employer Agent model or the entity may be the employer of record under an Agency with Choice model

Goods and Services: 
Permitted as a service.
Direct Payment of Providers: 

Required.

May pay recipient cash.

Provider Payments: 

Payment item must be listed in the service plan (plan of care), provided by an enrolled provider, and provided prior to reimbursement.

Cost Requirements: 

None. Benefit limits may apply.

Quality Management: 

Requires a quality assurance and improvement plan including how state conducts discovery, remediation, and quality improvement.

State must provide system performance measures, outcome measures, and satisfaction measures that will be monitored and evaluated.

Interaction with State Plan Services, Waivers & Amendments: 

State must either operate a HCBS waiver covering PAS or have an approved state plan amendment for “traditional” PAS.

Individuals voluntarily or involuntarily dis-enrolled from §1915(j) must have access to other PAS services under the state plan or §1915(c).

Individuals may be eligible for and receive State plan, §1915(c), §1915(i), §1915(j)/§1915(k) services simultaneously.

May be combined with other waivers such as 1915(a) or (b).