INDEPENDENT CHOICES: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities. Consumer-Directed Personal Assistance Services: Key Operational Issues for State CD-PAS Programs Using Intermediary Service Organizations

Susan A. Flanagan and Pamela S. Green
October 24, 1997


This final report provides practical advice to state program administrators regarding the implementation of consumer-directed personal assistance service (CD-PAS) programs and intermediary service organizations (ISOs). In particular, Chapters III, V, and VI, taken together, constitute an informal manual of advice from which state program administrators can design optimal CD-PAS programs using ISOs which are based on sound, regulatory principles and well-drafted contracts. Overall, this final report assists state program administrators in designing CD-PAS programs with ISOs that: (a) comply with applicable federal tax and labor laws; (b) make available supportive services that some consumers may want or need; and (c) allow for the application and enforcement of any limitation or restrictions on consumer direction that may be required by state laws and regulations.

The Executive Summary or Full PDF Report available here, or can be ordered from the HHS Office of Disability, Aging and Long-Term Care Policy, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, DC 20201, Fax: 202-401-7733, E-mail:, Web site: You will need a copy of the Acrobat Reader in order to view this Portable Document Format (PDF) report.