Self-Direction for Providers

OPWDD is committed to helping people with developmental disabilities have as much control as possible over how they receive their supports and services. Self-directed services offer the greatest amount of control in how, where, and by whom services are provided. A broad range of options are available through self-direction. A person can choose to develop a plan that is customized in a way that best meets their interests and needs.

The self-direction participant accepts responsibility for co-management of their supports and services. The amount of responsibility varies depending on the level of authority the participant chooses to exercise. Authority is a term used by the Centers for Medicaid and Medicare Services (CMS) to describe the control that a person receiving services uses when they choose to self-direct their services. Participants have a range of options for choosing the level of self-direction authority that they wish to have. There are two types of self-direction authority: Employer Authority and Budget Authority. A person may choose to have either one or both types of authority.

Employer Authority

The person hires, schedules and supervises the staff who support them. They determine the activities that will be supported and the way that support will be provided. Services are provided to the person by agency staff under a co-employment model. In a co-employment model, the person can choose to hire staff, train staff regarding their interests, monitor and provide feedback to staff, and end staff services if they are not consistent with the person’s expectations. If a person chooses to self-hire their staff, they gain Budget Authority and determine the compensation of those staff.

Budget Authority

The person who is self-directing with Budget Authority must work within a Personal Resource Account (PRA) and develop a Self-Direction Budget. The person makes choices about the goods and services they wish to receive and selects who is paid to provide them or how they are purchased. A person who maintains Budget Authority and works within a Personal Resource Account may access needed goods or services through Individual Directed Goods and Services (IDGS). A Fiscal Intermediary (FI) works with the person to complete billing and payment for goods and services identified in the budget. A person who chooses to have Budget Authority can receive and budget for services that are agency supported, self-hired, or direct provider purchased.

Fiscal Intermediary (FI) Support

OPWDD offers a 3-part training series for Fiscal Intermediary agencies to help ensure that all Fiscal Intermediary agency staff are trained to deliver services in a consistent way.

The trainings cover several topics, including billing and claiming, best practices and how to overcome common challenges. The trainings describe existing policy and practice.

All three trainings are available on the Statewide Learning Management System (SLMS).

The course information for this 3-part series:

1. Module 1: Fiscal Intermediary Contract Status Update, Billing and Claiming Overview, and Self-Hired Billing is available in the SLMS under class code OPWDD-EL-FI-M1. View Module 1 training.
2. Module 2: The Fiscal Intermediary Service and Recent Updates is available in the SLMS under class code OPWDD-EL-FI-M2. View Module 2 training.
3. Module 3: Fiscal Intermediary Best Practices, Overcoming Challenges, and Resources is available in the SLMS under class code OPWDD-EL-FI-M3. View Module 3 training.

Frequently Asked Questions:

Q: Are Fiscal Intermediary agencies exempt from compliance with Medicaid and NYS regulations?

A: No, Fiscal Intermediary agencies are held to the same compliance standards as all other OPWDD service providers and providers of Medicaid-funded services. As certified non-profit providers of OPWDD Home and Community Based Services Waiver services, Fiscal Intermediary agencies are responsible for adhering to all relevant regulations, policies and guidance. This includes oversight by various entities, including the Centers for Medicaid and Medicare Services, OPWDD (including the Division of Quality Improvement and the Office of Audit Services, etc.) and other regulatory bodies. Fiscal Intermediary agencies must ensure compliance with Medicaid and corporate regulations, as outlined in OPWDD guidance and directives, to maintain the integrity and quality of services provided to people who self-direct.

Community Classes

The Community Class category is designed for use in improving and maintaining community inclusion and integration by reimbursing for publicly available classes that teach a specific subject related to a person’s needs and goals (e.g., Art, Dance, Exercise, Cooking, Computer Training). OPWDD policy stipulates that people who self-direct their budgets must use community classes that adhere to the specified requirements. Community Classes are eligible for Self-Direction Individual Directed Goods and Services funding when:

• The class occurs in an integrated community setting,
• Class enrollment is open to anyone with or without a disability,
• Class content does not duplicate any Medicaid State Plan or Waiver service, and
• The class provides instruction to the person by teaching them a specific subject related to the person’s needs and goals, for example, dance, exercise, or cooking.

The purpose of these guidelines is to promote community inclusion and integration by providing access to all that the community has to offer the person being supported by OPWDD services.

Classes that are designed for and offered exclusively to people with developmental disabilities, and are not available to the public, fail to meet these standards.

Additionally, the definition for Individual Directed Goods and Services, which includes the Community Class category, is found in both the Home and Community Based Services Waiver and ADM 2015-05R as: “Individual Directed Goods and Services (IDGS) are services, equipment or supplies not otherwise provided through this waiver or through the Medicaid State Plan that addresses an identified need in an individual’s service plan, which includes improving and maintaining the individual’s opportunities for full membership in the community.”

The service rules ensure that community class programs do not duplicate a State Plan or Waiver service or exhibit the qualities of programs certified for people with developmental disabilities without being licensed, regulated and overseen by OPWDD and its quality assurance activities. This ensures OPWDD consistently addresses the Waiver assurances for all day service options, as required by the Centers for Medicaid and Medicare Services.

Therefore, classes that are intended to provide caregiver relief or to teach adaptive skills to people with developmental disabilities do not qualify for community class reimbursement through self-direction. People should have these kinds of needs met through services like Respite, Day Habilitation or Community Habilitation.

Frequently Asked Questions

Q: During the Fiscal Intermediary training in November 2022, did OPWDD communicate new, unofficial policy/rules related to Individual Directed Goods and Services Community Classes that conflicts with existing Self-Direction Policy?

A: No, that is a misconception. The training aimed to provide guidance for Fiscal Intermediary agencies to ensure compliance with OPWDD rules and guidelines and standardize Fiscal Intermediary operational knowledge.  Module 3 of this training series isn’t intended to remove or limit community classes but rather to ensure Fiscal Intermediary agencies understand their responsibilities in maintaining compliance with existing rules, including those related to community classes.

Q: Is OPWDD limiting the freedom of choice for people who self-direct?

A: Not at all. Self-Direction with OPWDD is intentionally crafted to provide people with significant autonomy and decision-making authority over their services. Those who self-direct have access to a broad array of State Plan and Waiver services, including community classes. They are empowered to determine the scope of these services based on their specific needs and preferences, while adhering to their Self-Direction Budget allocations. Moreover, certain services such as Individual Directed Goods and Services are exclusively available to people who self-direct, further expanding the range of options available for tailoring their support in line with their objectives and ambitions.

Q: Why would a Fiscal Intermediary agency enforce oversight requirements on a community class chosen by the person who is self-directing? Doesn’t the Self-Direction participant have the right to choose how their funding is spent?

A: Fiscal Intermediary agencies must carefully evaluate whether a community class aligns with the intended purpose of promoting community integration. Reimbursement for such classes is contingent upon adherence to specific rules and oversight to ensure compliance with applicable standards, including those in the Home and Community Based Services Waiver and OPWDD Administrative Memoranda. The Home and Community Based Services Waiver, Appendix C C-1/C-3 notes that, “The most typical set of tasks that the FI supports the individual self-directing is with billing and payment of approved goods and services, fiscal accounting and reporting, ensuring Medicaid and corporate compliance, and general administrative supports.” OPWDD ADM 2019-07 also notes that as part of any billing for Fiscal Intermediary services, the Fiscal Intermediary agency must, “Ensure Medicaid and corporate compliance.” Community classes, which fall under the category of Individual Directed Goods and Services, are intended to foster community integration and inclusion by reimbursing publicly available classes that cater to peoples’ needs and objectives. However, these classes must meet certain criteria, including being open to the public and conducted in an integrated setting, to qualify for reimbursement. Furthermore, classes exclusively designed for people with developmental disabilities may not satisfy the standards for community integration and could potentially violate federal Home and Community Based Services Settings rules.

FI Direct Purchasing vs. Reimbursement

Fiscal Intermediary agencies are encouraged to directly purchase items on behalf of people who self-direct, rather than requiring them to incur upfront costs and seek reimbursement. For people with limited cash on hand, the direct payment can be very helpful in helping them to live independently. This practice also ensures timely payments and helps Fiscal Intermediary agencies maintain compliance with Medicaid and corporate regulations.

Direct payments also allow the Fiscal Intermediary agency to know exactly how and when payments are made, information that can help them achieve more timely billing. 

Frequently Asked Question

Q: Do OPWDD self-direction participants have to pay upfront for allowable items and then seek reimbursement?

A: Direct purchasing by a Fiscal Intermediary agency is an alternative to people paying upfront for items and then seeking reimbursement from their Fiscal Intermediary. This approach is common, especially for services like Housing Subsidies, where payments are often made directly to landlords. While some services, like Family Reimbursed Respite, may require upfront payments by families, most other reimbursement services can be effectuated directly by Fiscal Intermediary agencies. However, it's essential to note that some Fiscal Intermediary agencies may have slightly different internal policies regarding upfront payments, so people who self-direct should discuss their preferences and options with their Fiscal Intermediary agency.

FI Contract Survey and Contract Amendments

April 2024 FI Contract Survey

To facilitate contract amendments for 2024 and inform the next FI contract cycle, all FIs are required to complete the FI survey. This survey gathers essential information related to FI contract spending patterns and trends. The survey must be completed and submitted to OPWDD in advance of any contract amendment request.

FIs should complete and submit their survey to [email protected] by May 2nd, 2024, with the subject line “[FI Name] FI Contract Survey”. If you provide services in multiple regions, submit only one survey for all regions served.

A pre-recorded webinar that walks through the completion of the survey is available by clicking on this link.

FI Contract Amendment Requests

FI providers requesting a contract increase after phase II amendments must follow the process described below. FI Contract Amendments are facilitated through the Regional Field Offices (RFO). Any inquiries regarding the process, timeline, and expectations should be directed to the local RFO Leadership.

Submitting an Amendment Request

1. Complete amendment requests must include:
   • A detailed, written request for additional funds with a justification of need
   • Where relevant, documentation supporting the request. Examples of additional documentation include evidence to demonstrate contract expenditures in addition to what is reflected in the Statewide Financial System (SFS) and agency policy and procedure documents related to contract management.
2. Contract Amendment Requests should be submitted to the respective Regional Field Office Self-Direction Unit (SDU) Regional Mailboxes with the subject line: “[FI Name] Request for Contract Amendment.”
   • RFO1 – [email protected]
   • RFO2 – [email protected]
   • RFO3 – [email protected]
   • RFO4 – [email protected]
   • RFO5 – [email protected]
3. RFOs will acknowledge receipt of the request and indicate that it has been escalated to local leadership for further review.
4. The provider’s request will be reviewed by RFO Leadership. If necessary, the RFO will request additional information to enable a thorough assessment.
5. RFO Directors will elevate the contract increase request, supporting documentation and statement of local support (or denial) to Central Office for consideration.

What is a Support Broker?
Support Brokers (“Brokers”) assist people with developmental disabilities who choose to self-direct their Office for People with Developmental Disabilities (OPWDD) services with Budget Authority to develop a Circle of Support and complete and manage a Self-Direction Budget. Self-Direction provides individuals more direct responsibility in managing their supports and services. People who participate in Self-Direction may self-hire and manage their own staff supports (employer authority) and decide on the supports and services they need and how the funding allowed for these supports and services is allocated (budget authority).

How Can I Become a Support Broker?
Potential support brokers must attend a series of four classes provided by the OPWDD regional offices. These classes are Self-Advocacy/Self-Determination; Person-Centered Planning; Broker Training Institute; and Self-Direction Budget/Template. Interested potential brokers can register for these trainings in the Statewide Learning Management System (SLMS). More information on SLMS can be found on the SLMS training page. After meeting all training requirements, potential brokers may apply to become authorized and provide paid services either independently or through an agency. Brokers must apply for reauthorization annually and provide verification of ongoing professional development.

Family members who reside in the same household as the person who self-directs their services or who are the parents of the person may NOT be paid for providing Broker services. If a family member of a person with ID/DD is interested in providing unpaid Broker service for that person, they must meet the initial Broker training requirements as described above.

Where Can I find more information?
Additional information about Support Brokers and how to become a Support Broker may be obtained from your regional Self-Direction liaisons. To connect with a regional Self-Direction liaison, please contact your Regional Office.