Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Information and Assistance

10/29/2010

Many terms are used to describe the provision of information and assistance, including counseling, supports brokerage, service coordination, and service consultation. This Primer uses the term counseling. States have broad flexibility to design counseling services in a manner that suits their program, as long as they meet the intent of the service: to provide detailed information to enable individuals to make informed decisions about whether participant direction is right for them, and if it is, to assist them in obtaining and managing their services.

CMS views the roles and responsibilities of the counselor as fundamentally different from those of a case manager. See Table 7-2 for a comparison of services provided by counselors and traditional case managers.

The case manager’s role to oversee and monitor service delivery is often required to ensure that Medicaid or other public programs meet state and Federal health and welfare requirements, and the case management system is often a key component of states’ quality management systems. Consequently, many programs use both case managers and counselors to assist participants, and in such cases it is essential that they understand each other’s respective roles and responsibilities, work collaboratively, and avoid duplication of services. Participants also need to understand the difference between the two roles.

Some programs have one person perform the responsibilities of both roles--either transferring case management functions to counselors, or having case managers assume the counselor role. Whichever approach a state uses, the individuals providing these services--whether counseling, case management, or both--need to meet all applicable job requirements. Prior to approval of a participant direction waiver program, Federal reviewers will ask, at a minimum, the following questions:

  1. Does the program provide participants with information about (a) its benefits, (b) their responsibilities under the program, and (c) their liability if employment-related taxes and workman’s compensation insurance premiums are not paid?

  2. Who provides the above information and what is the process for providing it?

  3. Who oversees the provision of information and assistance?

  4. Is the information provided in a timely manner to permit informed decision making?

  5. If both counselors and traditional case managers are involved, how will their functions be coordinated and how does the program prevent duplication of services?

TABLE 7-2. Examples of Typical Activities of Counselors and Traditional Case Managers
Counselors Traditional Case Managers
Provide information about
  • the person-centered planning process
  • participants’ rights
  • resources, choices, and options
  • responsibilities, risks and/or liabilities associated with participant direction and decision making
  • program limitations or restrictions
  • how to report changes in condition and needs
  • recognizing and reporting critical events, abuse, or neglect
  • the availability of criminal background checks and processes for conducting reference checks

Provide assistance with

  • defining needs, preferences, and goals
  • developing and managing the individual budget
  • developing a backup plan
  • identifying and obtaining services, supports, and resources
  • recruiting, hiring, and managing workers
  • obtaining training in practical skills related to personnel management (e.g., negotiating rates, arranging schedules, training workers, and making changes)
  • assessing the quality of services received
  • Explain the program process, and eligibility criteria
  • Present information about various settings for service delivery: institutional, home, or community-based; and service options: traditional agency or participant direction
  • Conduct an assessment to determine eligibility for services and to develop a service plan, and match needs with resources
  • Implement the service plan
  • Monitor the provision of services
  • Assess the quality of services
  • Ensure cost/budget neutrality, if required
  • Revise the service plan when changes occur
  • Perform periodic assessments and eligibility determinations

For detailed information about counseling services, see the Resources section of this chapter for a link to the chapter on Counseling in the Self-Direction Handbook.

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