Home and Community Based Services for the Frail Elderly:

Your Rights and Responsibilities When you Choose to Self-Direct Your Care

September 2008

You have chosen to self-direct your home and community based services. By doing so, you have also chosen to be responsible for many choices in your care as a home and Community Based Services Frail Elderly (HCBS/FE) customer.

The option to self-direct gives you certain rights. You have the right to choose:

Your Personal Care Attendant;
The services you will receive; and
When you will receive those services

It is the responsibility of the Case Manager, SRS worker, and Payroll Agent to help answer your questions and provide information to you.

It is your responsibility to communicate with them about your needs and changes, such as address/living arrangements, marital status, assets/income, health insurance coverage, hospitalizations, nursing facility placement, and the need for more or less hours of service.

You must contact your Case Manager and your SRS worker within 10 calendar days if any of these changes occur.

When you choose to self-direct your care, there are three parties available to assist you in understanding both your rights and responsibilities.

A Case Manager is responsible for determining your functional eligibility for HCBS/FE and assisting you in the management of your plan of care.
Your SRS worker is responsible for determining your financial eligibility for Medicaid.
A Payroll Agent from a Center for Independent Living or a Home Health Agency is responsible for making sure payment is made to your attendant.

Some of your responsibilities when you choose self-directed care are to:

Select your attendants and replacement attendants.
Collect basic information from your attendant, including background information, such as past work history and any relevant training. You have the option to request that your payroll agent run a Kansas Bureau if Investigation criminal record check on your chosen attendant.
Refer your chosen attendant to your chosen payroll agent for registration.
Ensure that assigned hours are within the limits of the Plan of Care and Customer Service Worksheet. Attendants will not be paid for more than the approved hours.
Monitor the attendant to ensure the necessary tasks are performed as authorized.
Maintain continuous coverage in accordance with your Plan of Care. This includes assigning replacement attendants during vacations and other absences of the attendant.
Provide your attendant with basic instruction and training on general duties, for example, how you wish specific tasks to be accomplished. Training is also recommended for your attendants in CPR and lifting techniques.
Maintain seperate time sheets on each attendant working for you, verify hours worked, sign and forward the time sheet to the payroll agent.
Handle any issues or problems that may arise with you attendant, including dismissing of the attendant.
Complete the Physician/RN statement, if needed
Notify the Case Manager of any changes in your medical condition, eligibility or needs, or changes in circumstances, that may affect your services.
Notify the case manager if you desire to discontinue the option to self-direct your services.

Attendant care does not pay for companionship.
Tasks listed on the Customer Service Worksheet (CSW) are the only services that can be submitted for billing.
Attendants cannot charge the customer, family, or other entities for the services provided, as reflected on the CSW. They must accept the amount from the payroll agent as payment in full.
Attendants may not complete any tasks for which they have not been trained. These services must be listed as on the CSW or Physician/RN Statement for Health Maintenance Activities.
Attendants are encouraged to obtain and utilize basic care training, such as CPR and appropriate lifting techniques, which may be available through local agencies (Home Health, Red Cross, County Health Department, Vocational-Technical Schools).
If problems exist with the attendant's ability to perform and provide the services listed on the CSW, and unsuccessful attempts have been made by you and the Case Manager to correct the situation, you may lose your option to self-direct your care.
Attendant care allows for the attendant to accompany the customer to medical appointments, only as indicated on the CSW.
An attendant's initials and signature verify the time sheet is accurate. False information is fraud and is a punishable crime.

Provide information for verification by your SRS worker and Case Manager, as requested.
Understand that if you knowingly submit documents with false information, it is considered fraud and is a punishable crime.
Contact your Case Manager immediately if you feel you are being abused, exploited, or neglected by your caregiver or attendant.
Complete the yearly Medicaid review and submit it to the SRS worker for continued financial eligibility.

The Right to Self-Direct comes with rules and responsibilities. It is important that you understand and comply with these rules and responsibilities or your HCBS/FE services, your option to self-direct, and your Medical Card can be terminated.