Definitions
Budget Authority: The participant has a budget they are responsible for managing. The budget may include goods, wages for staff (within state rules), or other services.
Centers for Medicare and Medicaid Services: Known as CMS, this is the federal entity that administers health care programs, including those listed under Self-Direction in this section. CMS operates under the Department of Health and Human Services.
Employer Authority: Participants are responsible for hiring, supervising, and firing their workers.
Financial Management Services: Also known as FMS, Fiscal Intermediary, Financial Management Services Agency, Fiscal Support Entity, and other names. This entity is responsible for assisting the participant in being the employer.
Individual Directed Goods and Services: Often referred to as goods and services, these are items that meet the following criteria:
- Follow federal requirements
- Are included in the participant’s plan, often approval is needed before the purchase is made
- Decrease human assistance
- Increase independence and community inclusion
- Are within the approved budget
Information and Assistance: Also known as Support Broker, Support Coordinator, Consultant Services, and other names. This entity supports and empowers the participant according to their individual needs. They have many tasks such as:
- Providing assistance in developing the person-centered plan and budget
- Manage the participant’s services and workers
- Perform the responsibilities of an employer, as assigned
Participant: This is the person who is eligible for services and chooses to self-direct.
Representative: This person is often appointed by the participant to assist them in managing their services. Sometimes this person is referred to as the managing party or responsible party.
Self-Direction: A Medicaid service where the participant (or their representative) is responsible to decide who, what, when, how and where their services are delivered. Services are delivered in the home, community, and wherever natural life takes the participant, within the rules of the program. These services are offered under a spectrum of control depending on the state’s design, including Agency with Choice or Fiscal Employer Agent, and according to the following CMS authorities:
A note about self-direction
Self-directed services are designed according to the respective authority and according to how the state designs the program. Each authority is listed in this section, under self-direction.