CMS Issues Final Rule Enabling Medicaid Beneficiaries To Direct Personal Assistance Services

A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was announced on September 29, 2008 by the Centers for Medicare & Medicaid Services (CMS).

The rule guides states who wish to allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers. Beneficiaries could even hire qualified family members who may already be familiar with the individual’s needs to perform personal assistance (not medical) services.

“This new plan would give Medicaid beneficiaries significant freedom to determine how their personal assistance services are delivered and by whom,” said Kerry Weems, CMS acting administrator.  If a state adopts a self-directed personal assistance services state plan option,  beneficiaries could receive a cash allowance to hire their own workers to help with such activities as bathing, preparing meals, household chores and other related services that help a person to live independently.  Allotments could also be used to purchase items that help foster independence such as a wheelchair ramp or microwave oven.  The beneficiaries also have the option to have their cash benefit allotment managed for them.

States choosing this option must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants.  States must also furnish sufficient information, training, counseling and assistance to participants in order to help them effectively manage their budgets and their personal assistance services. Enrollment in this new state plan option is voluntary and the state must also provide traditional agency-delivered services if the beneficiary wishes to discontinue self-directed care.

The final rule will be effective November 3, 2008.