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SELF-DIRECTED CARE OPTIONS REVIEWED BY SUBCOMMITTEE

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Sometimes legislators pass bills that they think are good, but turn out to be a problem when they become law.  That's the case with legislation passed last year that directed the Department of Human Services (DHS) to require providers of personal care under the Consumer-Directed Attendant Care (CDAC) option to be associated with an agency. 

Last year, the Health and Human Services Budget Bill (Senate File 446) directed DHS to implement certain cost savings measures.  The bill stated:

The department shall require transition of the provision by individual providers of personal care under the consumer directed attendant care option to agency-provided personal care services and shall retain the Consumer Choices Option for those individuals able and desiring to self-direct services. 

To implement this legislation, DHS submitted rules for consideration by the Administrative Rules Review Committee, which is made up of ten legislators.  Hundreds of Iowans sent comments on these bills, including providers of the service and people receiving the service.  There was a lot of confusion in this process, because many people thought they would have no other option to self-direct care if they were forced to go through an agency to select a person to provide care.  In addition, the rules prohibited someone from being both a provider of care and a guardian in charge of making decisions for the person.  In many cases, a parent or loved one performs both roles, and this was cause for concern among many individuals.

Because of issues and concerns brought forward, DHS decided to stop the rules and instead work on a plan that would allow for a long-term transition that would allow current individual CDAC providers to continue to provide services to the members they are currently serving.  Two legislators have decided to step in to address the issue legislatively - Senator Mark Chelgren (a Republican from Ottumwa) and Senator Tom Courtney (a Democrat from Burlington).

  • Senate File 2065 by Senator Chelgren eliminates the requirement passed by the Legislature last year, returning everything to the way it is now (individuals can act as CDAC providers and individuals do not have to go through an agency to find a person to provide the services).  The bill also clarifies that a person can be both CDAC provider and legal guardian.

  • Senate File 2066 by Senator Courtney allows a provider of self-directed care services (whether under CDAC or the Consumer Choices Option) to be both provider and legal guardian to the people they serve.  This is both for people currently being served, as well as others that will get these services in the future. In addition, the bill allows anyone currently providing services under CDAC to continue to be able to do so without being aligned with an agency. So the bill "grandfathers in" those currently directing their services with an individual (non-agency) provider.  The bill clarifies that moving forward, people have a choice in self-directed care: 1) they can go through an agency to receive Consumer Directed Attendant Care (CDAC) services, or 2) they can continue to direct their care on their own through the Consumer Choices Option (CCO).  Senator Courtney's plan is very similar to the plan DHS is working on now.

The subcommittee assigned to the bills (Sen. Pam Jochum, Sen. Bill Dotzler, and Sen. Jack Whitver) met to discuss both bills, with about 20 individuals in attendance.  The group will meet again this week to decide what to do, although they have indicated they plan to work from Sen. Courtney's bill.  There were concerns about the dual role of some individuals as as both providers and guardians, and they plan to talk about things that could be done to protect individuals who might encounter providers that are not acting in their best interest.  

Some Background on the Consumer Choices Option: The rules issued last summer did not do anything to the Consumer Choice Option, which is a personal care service that states can offer under the Medicaid State Plan.  The rules that were terminated also dealt with personal care services, but were specific to the HCBS Waivers.  Under the Waiver programs, personal care is provided through the Consumer Directed Attendant Care (CDAC) service.  CDAC can be provided by both agencies and individual providers.  The rules would essentially eliminate CDAC as a waiver service and give members currently receiving CDAC a choice for transitioning to another personal care service in place of CDAC to receive personal care services (not consumer-directed) through an agency provider or continue to self-direct services through the CCO program, which does allow individual or agency providers.