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Home Care Options

Agency-Directed Care vs. Self-Directed Care

Home and Community-Based Services (HCBS) provide opportunities for you to receive services in your own home.

What are your choices?

You may choose agency-directed personal care or self-directed personal care.

If you choose agency-directed personal care, your agency of choice will choose the personal care provider who will support you in agreement with your needs. The agency will be responsible for training, hiring, and evaluating your personal care providers.

This is for people who choose to stay in their own homes, but do not want the responsibility of finding, hiring, training, scheduling and managing their own care providers.

If you choose self-directed personal care, you will be responsible for many choices in your care as a member receiving Home and Community Based Services. When you self-direct, you are responsible for finding, selecting, training, managing, paying and dismissing your personal care providers.

Self-directing your services allows you the freedom to choose, employ and schedule the personal care providers who support you. Under the Financial Management Services (FMS) model in Kansas, a self-directing member must acquire a Federal Employer Identification Number (FEIN) and be the sole employer. See your FMS provider for more information and assistance.

When self-directing, you have the right to choose:

  • Your personal care provider(s)
  • How and when you will receive services in accordance with your Plan of Care/Integrated Service Plan
  • Your FMS provider
  • How much you pay caregivers

See the list of self-directed responsibilities further below.

Communication

Your case manager, KanCare clearinghouse representative and FMS provider will help answer your questions and provide information to you.

You need to inform them of your needs and changes. This includes:

  • Address
  • Living arrangements
  • Marital status
  • Assets/income
  • Health insurance coverage
  • Hospitalizations
  • Nursing facility placements
  • Need for more or fewer hours of service (contact your Sunflower case manager)

You must contact your case manager and the KanCare clearinghouse within 10 calendar days if any of the above changes occur.

When choosing self-directed care, it is your responsibility to:

  • Obtain a Federal Employer Identification Number and provide this to your selected FMS provider. The FMS provider will assist in obtaining FEIN.
  • Select your personal care providers and replacements. Hiring, supervising, training and firing them will be your responsibility.
  • Determine the pay of your employees
  • Follow rules set by the service agreement you have with your FMS provider, including payment of client obligation.
  • Collect basic information from your personal care provider. This includes work history and any relevant training. The FMS provider is required to run background checks on all care providers and inform you of the results. If you hire someone who is found to have a prohibited offense, they cannot be paid using Medicaid funds.
  • Refer your chosen care provider to your chosen FMS provider for registration.
  • Make sure the hours scheduled are within the number of monthly hours approved in your Integrated Service Plan. Caregivers will not be paid by the FMS provider for more than the approved monthly hours.
  • Monitor the care provider to make sure tasks are performed as authorized.
  • If your caregiver is to perform health maintenance activities, you must obtain a note from your physician or an RN that you are able to train your provider(s) to do these activities.
  • Maintain coverage in accordance with your Integrated Service Plan. This includes assigning replacement caregivers during a caregiver’s absences.
  • Give your care provider basic instruction and training on duties, like how you wish specific tasks to be done. CPR and lifting-technique training is also recommended for your caregivers. You can also seek help in the form of information and assistance from the FMS provider.
  • Let your Sunflower care manager know of any changes, such as medical condition, eligibility or needs, that may affect your services.
  • Make sure your care provider performs the services that you need and for which Sunflower is paying. If your caregiver is not doing these services, or if there is a situation of confirmed abuse, neglect or exploitation, your Sunflower care manager may request from you a plan to correct the situation. How you address issues with your caregivers will be up to you. However, if the services for which Sunflower is paying continue to not be provided, or if you remain in a situation of confirmed abuse, neglect or misuse, Sunflower has the option to move your services to be directed by an agency that you choose.

Information your personal care provider needs to know

  • Tasks listed on the Needs Assessment are the only services that can be billed.
  • Personal companionship is not a covered HCBS benefit.
  • Caregivers cannot charge the member, family, or other entities for the services provided, as shown on the Needs Assessment. The care providers must accept the amount, paid by the member through the FMS provider, as payment in full.
  • Caregivers may not do any tasks for which they are not trained, including Health Maintenance Activities.
  • Caregivers are encouraged to obtain and use basic care training, such as CPR and appropriate lifting techniques. Training may be offered through local agencies (home health, American Red Cross, county health department and vocation-technical schools).
  • Providing incorrect information to the FMS provider (whether on a timesheet or through Authenticare) may be fraud and may be a punishable crime.

Note: Generally speaking, provision of HCBS is not allowed during a hospitalization or nursing home stay. Payment for services during this time may require specific justifications, waivers, or exceptions granted by the state of Kansas.

The right to self-direct comes with rules and responsibilities. If you do not comply with them, your option to self-direct HCBS could be removed and agency-directed services will be offered.

Helpful Resources

When you choose to self-direct your care, there are resources available to help you understand your rights and responsibilities.

Case Manager: Reviews your needs and authorizes services.

Aging & Disability Resource Centers: Completes functional eligibility determination for HCBS.

Financial Management Services Provider: Makes sure payment is made to your care provider (FMS providers are approved by the State to provide Fiscal Management Services)