2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Long-Term Careavailable services, and helps the member developand implement an annual care plan that identifiesthe services and support necessary to meet themember’s choices, abilities, and needs. This careplan drives the authorization of Agency-BasedCommunity Benefit services available to eachmember.Self-Directed Community BenefitSelf-direction in Presbyterian Centennial Careaffords members the opportunity to have choiceand control over how Self-Directed CommunityBenefit (SDCB) services are provided, whoprovides the services, and how much providers arepaid for providing care in accordance with a rangeof rates per service established by HSD.Presbyterian supports consumer-directed deliveryof personal care and HCBS. Member self-directionprovides the opportunity for members to personallydirect the purchase of long-term care supports andservices and manage their budgets in a way thatpromotes self-advocacy and independence.The services of a support broker are available toassist members in understanding and using thebenefit as well as developing and managing theirbudget.Support brokers are consultant agencies whocurrently support the State of New Mexico’s Mi Viaprogram (the state’s Medicaid self-directed waiverprogram). Several of these broker agencies havebeen contracted by Presbyterian to provideCentennial Care members who opt for the SDCBwith the expert help they need to develop andmanage their benefit’s details. The support brokersPresbyterian contracts with include the largest,which supports approximately 80% of the currentMi Via participants.Members who opt for the SDCB will receive helpfrom their care coordinators in establishing arelationship with a support broker.Under Presbyterian Centennial Care, the followingHCBS are available for self-direction:Behavior support consultationCustomized community support servicesEmergency responseEmployment supportsEnvironmental modificationsHome health aideHomemaker/personal careNutritional counselingPrivate duty nursing for adultsRelated goodsRespiteSkilled maintenance therapy servicesSpecialized therapiesTransportation (non-medical)Presbyterian provides members who elect theSDCB service delivery option with the informationand assistance necessary to develop a budgetbased on member preferences, assessed need,and the resources available to the member. Thisbudget is developed in coordination with themember’s care plan and takes into account theservices covered, the member’s natural or informalsupports, and living situation. The support brokermakes available the worksheets and other tools10-42014 Practitioner and Provider Manual - Ver. 3