Self Directed Services

SELF-DIRECTED SERVICES PROCESS

Acumen is the contracted FMS provider who is responsible for the financial management of Self-Directed services for Living Choice and Medically Fragile Members. Prior to implementing any Self-Directed Services (SDS), provider agency case managers should receive training from Acumen; you may contact Acumen at 1-877-211-3738 or via email at customerservice@acumen2.net.

The following are steps taken for enrollment of a Member who has expressed interest or has been offered the option of Self-Directed Services.

Part I of the Process:

The TC/CM is directed to the OHCA website to access the initial forms at www.OKHCA.org.

When the initial forms are completed, please submit to OHCA via secure email medicallyfragilewaiver@okhca.org or Oklahoma.livingchoice@okhca.org and/or fax to 405-530-7265 for review and approval. Below is the list of internal documents required to initiate self-directed services.

• Letter of Intent
• Self-Assessment Survey
• Roles and Responsibilities
• Estimated Budget Summary Worksheet
• Authorized Representative Consent
• Acknowledgement of Informed Choice 
• Transition to Self-Direction
• Self-Directed Goods and Services Expense Form  
• Self-Directed Goods and Services Expenses
• Mileage Form 
• Internal Document Checklist

Services offered under Self-Direction includes:

1.Self-Directed Personal Care                                                   (S5125)

2.Self-Directed Advanced Supportive Restorative                       (S5125TF)

3.Self-Directed Respite Services (2-7hrs)                                  (T1005U4)

4.Self-Directed Respite Services (8+hrs)                                   (S9125U4)

5.Goods and Services                                                                (T1999)

The Case Manager will schedule a meeting with the IDT Team (member, case manager, family representative if designated) to review and discuss the Member’s request and to review the initial forms, which includes, Member/Employer Self-Assessment, Member’s UCAT, Budget Calculation Worksheet (to include PCA, ASR units for the plan year and a budget for goods and services if necessary), Member’s Service Plan and Back-Up Plan.

Member or his/her representative will sign the (Acknowledgment of Informed Choice) form when he/she has agreed to assume responsibility for self-directed services. The Case Manager will inform the Member of his/her rights to terminate SDS at any time.  The Case Manager will either email or fax the completed forms to the LCP, Waiver Program Coordinator or Program Manager to OHCA via secure email medicallyfragilewaiver@okhca.org or Oklahoma.livingchoice@okhca.org, and/or fax to 405-530-7265.

Upon review of the Member’s assessments during the IDT meeting, it is determined that the Member does not meet criteria for self-direction; the Case Manager will ensure that all provider agency services remain in place. The member is sent a letter detailing the reasons for the denial and given the right to appeal the decision; however if it is determined that the Member meets criteria, the TC/CM will notify Acumen of the Member’s intent to self-direct their personal care services.

Part II of the Process:  

Acumen or the TC/CM will direct the member to the Acumen website to obtain the Member/Employer and Employee packets to be completed and returned to them for processing. Acumen along with the Case Manager may assist Member in completing the documents and recruiting their employees as necessary.  
  
Acumen will process background checks for each potential employee.  Case Manager or Member must inform Acumen when there are plans to employ more than one employee and there will be a pay differential. Acumen will conduct the background check and inform the TC/CM and Member when the employee/employees are approved.  (At a minimum it takes 5 days to complete the background check).  
  
Program Manager will email or fax the (Transition to Self-Directed Service Form) to the Case Manager as confirmation that the background checks are complete to begin processing the addendum.  Employees are not allowed to begin work until an approved service plan is received by Acumen. 
  
LC or Waiver Program Coordinators will receive and process the addendum request and submit to OHCA Care Management for review and approval. When approved the LC or Waiver Program Coordinator will fax the approved service plan to the TC/CM and Acumen. 
  
Acumen will prepare a Monthly Budget Summary for each Member according to their service plan (6g) and send to the Case Manager, Member and Program Manager. 

Acumen is responsible for submitting a detail report of all activities related to LC and Waiver Program members participating in self-direction to the Program Manager by the 15^th of each month.

Acumen Informational Documents:

• Acumen Electronic Visit Verification FAQ
• Oklahoma Self-Determination Program (SDP) Payment Schedule - Effective December 16, 2019