Consumer-Directed Home <strong>and</strong> Community Services 125Several <strong>of</strong> the research projects have since been completed<strong>and</strong> information on them may be obtained by visitinghttp://aspe.hhs.gov/daltcp/home.htm. Others(e.g., the Cash <strong>and</strong> Counseling Demonstration/Evaluation in Arkansas, New Jersey, <strong>and</strong> Florida thatHHS is co-sponsoring with the Robert Wood JohnsonFoundation) are ongoing. In addition, several newprojects have been launched, most notably the HCBSResource Network, which is jointly sponsored by<strong>ASPE</strong>, HCFA, <strong>and</strong> AAA (all in HHS). Although theoverall goal <strong>of</strong> the network is to promote development<strong>and</strong> improvement <strong>of</strong> state home <strong>and</strong> community servicesystems, the network has a special emphasis onassisting states in designing CD approaches to financing<strong>and</strong> service delivery.10. In many states, the shift to CD home <strong>and</strong> communityservices for people with developmental disabilities isbeing supported by grants <strong>and</strong> other technical assistancefrom the Robert Wood Johnson Foundation.11. Section 1915 ( c)(1) <strong>of</strong> the Social Security Act12. 42 CFR 441.301(b)(1)(i), Section 4442.613. Section 1915(c)(2)(A) <strong>of</strong> the Social Security Act14. Section 1905(a)(24) <strong>of</strong> the Social Security Act15. Section 1902(a)(23) <strong>of</strong> the Social Security Act.16. Section 1902(a)(23) <strong>of</strong> the Social Security Act.17. This topic is addressed in Flanagan, S. A., <strong>and</strong>Green, P. (1997). Consumer-directed personal assistanceservices: Key operational issues for state CD-PAS programsusing intermediary service organizations. Cambridge, MA:The MEDSTAT Group. The authors include an especiallyclear discussion <strong>of</strong> the steps that may be taken toaddress some <strong>of</strong> the problems <strong>and</strong> issues while stillensuring that the health care needs <strong>of</strong> individuals areproperly addressed.18. HCFA Medicaid Manual Transmittal Part 4, No. 73,September 17,1999.19. Olmstead Update Number 3. July 25, 2000. SeeAppendix II for the complete text <strong>of</strong> the letter.20. The conference was a cooperative activity <strong>of</strong> theNational Council on Aging <strong>and</strong> the World Institute onDisability, which was cosponsored by the Administrationon Aging <strong>and</strong> the Office <strong>of</strong> the AssistantSecretary for Planning <strong>and</strong> Evaluation, U.S. DHHS.Annotated BibliographyNational Association <strong>of</strong> State Units on Aging(NASUA) (Draft, 1999). Consumer direction in home<strong>and</strong> community based services (HCBS): An assessmentguide for states. Washington, DC: Author. (85 pages)This guide was developed to help policymakers, consumeradvocates, <strong>and</strong> consumers look broadly at thearray <strong>of</strong> HCBS available in their states <strong>and</strong> identifyways to make services more responsive to consumers'needs <strong>and</strong> preferences. Included are a discussion <strong>of</strong>consumer direction principles <strong>and</strong> practices; benchmarks;a self-assessment instrument; factsheets on keyissues (e.g., Medicaid, nurse practice acts, fiscal intermediaries);<strong>and</strong> a list <strong>of</strong> resources for more detailed information.A free copy <strong>of</strong> the draft guide—or just the set <strong>of</strong> factsheets—isavailable from NASUA, 1225 Eye Street, N.W.,Suite 725, Washington, DC 20005, (202) 898-2578. The finalguide, which will also include states' experience in assessingtheir programs, will be available from NASUA for a nominalcharge early in 2001.Flanagan, S., <strong>and</strong> Green, P. (October 1997). Consumerdirectedpersonal assistance services: Key operationalissues for state CD-PAS programs using intermediaryservice organizations. Prepared for the <strong>Department</strong> <strong>of</strong><strong>Health</strong> <strong>and</strong> <strong>Human</strong> Services, Office <strong>of</strong> the AssistantSecretary for Planning <strong>and</strong> Evaluation (<strong>ASPE</strong>),Division <strong>of</strong> Aging <strong>and</strong> Long-Term Care Policy(DALTCP). Cambridge, MA: The MEDSTAT Group.(69 pages)This policy study identifies practices for intermediaryservice organizations to use when implementing consumer-directedpersonal assistance programs. Thereport is basically an "advice manual" intended forstate program administrators. This report, minus appendices,can be found on the Internet at aspe. hhs.gov/daltcp/reports/cdpas.pdf. The full report <strong>and</strong> appendices may beordered from the Office <strong>of</strong> Disability, Aging, <strong>and</strong> Long-TermCare Policy, Room 424E, H.H. Humphrey Building, 200Independence Avenue, S.W., Washington, DC 20201, fax(202) 401-7733, or via e-mail at DALTCP2@osaspe.dhhs.gov.Doty, P., Kasper, J., <strong>and</strong> Litvak, S. (1996). Consumerdirectedmodels <strong>of</strong> personal care: Lessons fromMedicaid. The Milbank Quarterly 74 (3): 377-409. (32pages)This article compares various uses <strong>of</strong> the Medicaid personalcare services (PCS) option for providing attendantservices to people with disabilities who needassistance with daily living tasks. It uses descriptivedata from a 1984 <strong>and</strong> 1985 World Institute on Disabilitysurvey, <strong>and</strong> subsequent in-depth case studies <strong>of</strong> sixdiverse state Medicaid PCS programs.
126 UNDERSTANDING MEDICAID HOME AND COMMUNITY SERVICES: A PRIMERFlanagan, S. (April 1994). Consumer-directed attendantservices: How states address tax, legal <strong>and</strong> qualityassurance issues. Prepared for the <strong>Department</strong> <strong>of</strong><strong>Health</strong> <strong>and</strong> <strong>Human</strong> Services, Office <strong>of</strong> the AssistantSecretary for Planning <strong>and</strong> Evaluation (<strong>ASPE</strong>), Division<strong>of</strong> Aging <strong>and</strong> Long-Term Care Policy(DALTCP). Cambridge, MA: The MEDSTAT Group.(71 pages)This study reviews 10 federal <strong>and</strong> state-funded consumer-directedattendant in-home care programs.Payment, employment-related taxes, quality assurance,<strong>and</strong> legal liability <strong>of</strong> CD programs are discussed. Theauthors suggest a model <strong>of</strong> consumer-directed care thatincorporates the strongest features <strong>of</strong> the programsexamined. Order the full report from National TechnicalInformation Service (NTIS), <strong>Department</strong> <strong>of</strong> Commerce,5285 Port Royal Road, Springfield, VA 22161, or from theNTIS website, www.ntis.gov.
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