Consumer Directed Services

Consumer Directed Services (CDS) are home-based health care services offered by Medicaid or Medicaid waiver programs where the consumer (Patient) can hire the caregiver and coordinate the services authorized. Consumer Directed Services are also known as Self Directed Care or Participant Directed Care. Consumer Directed Services programs will allow the consumer (Patient) to select and direct the caregivers to provide the services authorized by Medicaid or Medicaid Waiver Programs. The patient’s ability to choose a family member or a friend to provide the services needed will increase the trust and comfort level with the caregiver. Consumers will still work with a Fiscal Intermediary, usually a Home Care Agency, to manage the payroll for caregivers and billing for the services.

Benefits of Consumer-Directed Services

The most significant benefit of Consumer Directed Service is the flexibility the patient gains to hire caregivers to provide the services authorized. The patient can hire friends or family members to provide the services increasing the flexibility and comfort level of the patient.

During the COVID-19 pandemic, patients may be uncomfortable letting outside Personal Care Attendants come into the house and provide the needed services. Hiring a family member or friend through Consumer Directed Services will make the patient more comfortable and willing to receive services.

One of the challenges with Personal Care Services is matching up the patient service requirements and the availability of Personal Care Attendants to meet these requirements. Patients may have to adapt the services' timing to the caregivers' availability. Consumer Directed Services provide the patient the flexibility in scheduling the caregiver to meet the patient's preferences.

By hiring a family member and providing flexibility in scheduling, patients can help a family member who may go to school or is looking for additional work.

Consumer Directed Services can keep patients receiving care at home instead of receiving the services in a nursing home or other inpatient setting. This will reduce the cost of care for Medicaid and Medicaid Waiver programs.

Growth in Consumer Directed Services

Older adults and people with disabilities needing long-term support prefer home-based services over institutionalized care. Consumer Direction Programs are one of the options for State Medicaid programs to meet the increasing demand while keeping the cost under control.

Programs that incorporate family members who provide care can help support person-centered care for Medicaid enrollees and help states address the demand for long-term services and support. States can use Medicaid or Waiver programs to support enrollees with long-term care needs and their families by developing consumer direction programs that allow family members to be hired to provide care.

States are increasingly using the consumer-directed model to meet the demand. Consumer Directed Services are offered in one form or the other in all 50 states. Consumer Directed Services grew 20% in 2020. With COVID-19 permanently changing how healthcare services are delivered, CDS will continue to grow.

Home Health Care Agencies providing personal care non-medical services under various Medicaid programs can grow by expanding their services to include Consumer Directed Services.

Essential Features for Consumer Directed Services

Through Consumer Directed Services programs, patients can hire their caregivers and manage their schedules for services authorized by Medicaid or Medicaid Waiver programs. Even though the patient can employ the caregiver and schedule the services, home care agencies will act as fiscal intermediaries by managing the payroll for caregivers and billing for the services provided.

This unique situation creates unique scheduling challenges for the agencies. Even though the agencies are responsible for billing and paying for the services, they cannot schedule caregivers like regular employees. Since the patients are scheduling the caregivers, agencies will only have exposure to the schedules or control over schedules once the time sheets are received from the caregivers.

Consumer Directed Services are authorized by Medicaid or Medicaid Waiver programs with limits on the number of hours of services provided per day, week, or month. This adds another layer of challenge to home care agencies. They must limit the services provided under authorized hours even though they have little control over the hiring of caregivers and managing their services.

When services go over authorized hours, the agencies face the uncomfortable task of telling the caregivers that they will not be paid for the services provided over approved hours.

A home care software platform that can handle CDS and other services, Private Duty Nursing, Non-Medical Personal Care, and Home Health, will help agencies manage the growth in Consumer Directed Home Care Services.

Essential Features for Consumer Directed Services

The following are some essential features to support Consumer Directed Home-Based Services

ONE Software, ONE Patient, All Home-Based Services

The Home Care Software platform should be able to handle Consumer Directed Services along with other home-based services under ONE Software and ONE Patient. Using ONE Software for all services will improve the operational efficiency of the agencies and continue to grow.

Scheduling

Since patients are controlling their schedule for Consumer Directed Services, Home Care Agencies cannot pre-schedule these services. Home Care Software should allow caregivers to clock in and out and document services provided without a schedule. Software should also support traditional home care services by scheduling caregivers before services are delivered.

Authorization Alerts

Even though patients coordinate the services and caregivers, they still have to stay within the limits of the services authorized by Medicaid or Waiver programs. Software should provide proactive alerts to caregivers when the services are provided outside of authorized limits. These alerts will reduce potential payroll and billing issues.

Integrated EVV Platform

21st Century Cures Act requires the states to implement an EVV (Electronic Visit Verification) system for services provided at home. Home Care Software platform should be able to collect EVV data when the services are provided without preset schedules and transfer them to state-selected EVV aggregators.

Billing

Home Care Agencies will need flexible and configurable software to meet the disparate requirements of Consumer Directed Services and other services. A configurable claim scrubber will be essential to validate claims based on the requirements of individual programs before submitting the claims. The software should be able to configure the claims to meet the billing requirements of Consumer Directed Services programs.

Payroll

Home Care Agencies will need a flexible and configurable interface to payroll software or service that will meet the payroll requirements of Consumer Directed Services.

Conclusion

CareVoyant understands the demanding requirements of managing Consumer Directed Service while managing other services like Private Duty Nursing, Non-Medical Personal Care, and Home Health. CareVoyant software platform provides tools to help a home health care agency manage Consumer Directed Services and other service lines effectively.

ABOUT CAREVOYANT

CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.

CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.

For more information, please visit CareVoyant.com or call us at 1-888-463-6797.