Self Directed Community Benefit

Self Directed Community Benefit

What we call recipients of SDCB services: Members

SDCB members get Support Broker services from AAA Participant Direction

The SDCB program is managed by Centennial Care Managed Care Organizations (MCO) under contract with the Human Services Department (HSD)/Medical Assistance Division (MAD). AAAPD has a contract with Western Sky to provide SDCB Support Broker services to their members. We are considered a Support Broker Agency.

The member’s MCO Care Coordinator (CC) completes a Comprehensive Needs Assessment (CNA) to determine member’s eligibility for the Community Benefit (long-term care). Members will have a physical disability, brain injury, chronic health condition or be elderly.

If eligible for the Community Benefit, the member receives Agency-Base Community Benefit (ABCB) services for 120 days. At any time during these 120 days, the member may request to be transferred to Self-Directed Community Benefit (SDCB) program but won’t be able to start the SDCB program until after the 120 days.

The MCO Care Coordinator gives member a list of Support Broker Agencies to choose from and a selection form. The member selects AAA Participant Direction and the Care Coordinator sends us the selection form. This is how they select AAAPD.

Member has already completed the financial eligibility process with ISD when they come to us for Support Broker services.

Member was already deemed to be medically eligible through the Comprehensive Needs Assessment process, along with the Nursing Facility Level of Care evaluation (NFLOC). This is done by the MCO Care Coordinator

The SDCB member receives a budget amount that is determined by the Comprehensive Needs Assessment. This becomes the budget amount the member has to use to purchase their SDCB services.

Member meets with their SDCB Support Broker for enrollment with AAAPD and orientation to SDCB.

MCO Care Coordinator completes a Self-Direction Self-Assessment Form with the member to determine if the member can be the EOR. If the member has a guardian, they cannot be the EOR. The Support Broker helps member complete an Employer of Record (EOR) Request Form and sign all necessary forms.

The member engages in person-centered planning with their Support Broker.

With their Support Broker, the member develops a Plan/Budget for SDCB services, using person-centered planning and following the description of SDCB services and the range of rates for services. The Support Broker enters the Plan/Budget into working plan status in FOCOSonline and lets the MCO Care Coordinator know that the Plan/Budget is ready for the Care Coordinator to review and submit. The Care Coordinator reviews the Plan/Budget for errors and to make sure everything meets the criteria for approval and service descriptions. The Care Coordinator then submits the Plan/Budget to the MCO’s Utilization Team for approval.

The member completes a SDCB back-up plan. The plan is embedded in the applicable SDCB budget goals in FOCOSonline.

The member is not allowed to request SDCB services that would exceed their SDCB budget amount. The only way a member can get an increase in their budget is for the Care Coordinator to complete another CNA and NFLOC that demonstrates a change in the member’s condition.

The MCO’s Utilization Management Team approves or denies each service, support or good that the member has requested. They can also issue a Request for Additional Information (RFI) before they decide to approve or deny an item. The Support Broker helps the member respond to Utilization’s RFI. After Utilization receives and reviews the RFI information, they will approve or deny the item.

The member has options if they don’t feel that the MCO should deny an item:

  • Provide additional information for why the denied item is necessary for reconsideration;
  • The member has to request an Appeal through the MCO before they can request a Medicaid Fair Hearing;
  • If the MCO upholds the denial on Appeal, the member can request a Medicaid Fair Hearing to determine if the denial will hold or be overturned.

The Support Broker contacts the member monthly and visits the member quarterly to track how the implementation of the SSP/Plan is going

Depending on the member’s assigned level of care coordination, Level II or Level III, the CC will contact the member monthly and visit semi-annually (Level II) or visit quarterly (Level III)

If the member wants to make a change in their SDCB budget, the Support Broker helps them do a revision. The revision is entered into working plan status in FOCOSonline and the Care Coordinator is asked to review and submit it to Utilization. The Care Coordinator then submits it to the MCO’s utilization process for approval.

Annually, the Support Broker helps the member complete the financial eligibility process. The MCO Care Coordinator completes the annual CNA and NFLOC assessments. The Support Broker helps the member complete their annual SDCB budget goals and passes this on to the Care Coordinator who reviews and submits to the MCO’s Utilization Team.

Once the SDCB budget is approved, the member/EOR implements the budget with the support of the Financial Management Agency (FMA), which is Conduent. The member will complete Employee Enrollment Packets and Vendor Enrollment Packets and submit to Conduent. To get employees paid, the member/EOR submits timesheets and Payment Request Forms (PRF) to Conduent for payment. The Support Broker educates, guides and assists the participant to implement their SDCB budget.