Participant Direction Handbook - SPRING 2018 - Georgia Department of Behavioral ...
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Participant Direction Handbook
Participant Direction
Handbook
SPRING 2018
Participant Direction Handbook
Salary, Hours, and Work Schedule: 24
Table of Contents
Writing the Job Description 24
What is Participant Direction? 5
Developing a Job Application 24
What are the NOW and COMP Waivers? 5
Finding Applicants 24
Service Delivery Options 6
Sample Job Description 25
Pros and Cons 6
Sample Job Application 26
Participant Direction is Awesome! 7
Placing an Ad 28
Making the Decision to Utilize Participant
Direction 8 Interviews 29
Who can Direct? 8 Screening Job Applicants 29
Responsibilities 8 During the Interview 29
Getting Started 10 After the Interview 30
7 Steps to Getting Started 10 References 30
Mandatory Training 11 Reference Checks 30
Memo of Understanding (MOU) 11 Reference Check Form 31
The Support Coordinator 12 Hiring 32
Types of Support Coordination 12 Hiring Forms 32
Support Coordination Agencies 13 Driver’s License/First Aid/CPR/CNA
License 32
The Fiscal Agent 14
Training 33
The Role of the Fiscal Agent 14
Confidentiality 34
Fiscal Agents in Georgia 14
Medications 34
Funding 15
Incident Reports 34
Developing and Managing Funds 15
House Rules 34
Employee Wages 15
Timesheets 35
NOW & COMP Services 15
Performance Evaluations 35
Service Rates 18
Sample Employee Review 36
A Life with Dignity 21
Terminations 37
Recruiting, Hiring, Training, and Managing
your Staff 22 Service Vendors 38
Recruiting 22 Selecting Service Vendors 38
Creating a Job Description 22 Qualifications 38
Job Responsibilities: 22 Payments to Vendors 38
Job Qualifications: 23 Responsibilities of Representative 39
Other Qualities: 23 Maintaining Records 39
Participant Direction Handbook
Managing Employees 39 Medical Emergencies 43
Managing Payroll 39 Disaster Plan 43
Time 40 Backup Plans 43
What Problems Might You Encounter? 40 The Support Notebook 43
Scenario #1 40 Additional Resources 44
Scenario #2 41 Glossary 45
Scenario #3 41 Acronyms 46
Scenario #4 41
What does the Waiver do for Nandi? 42
Developing Safety and Backup Plans 43
Participant Direction Handbook
The Participant Direction Handbook was created by the
Georgia Council on Developmental Disabilities and Parent to Parent of Georgia
Funded by a grant from the
Georgia Department of Behavioral Health and Developmental Disabilities
Participant Direction Handbook
the NOW and COMP waiver policies and all
What is Participant Medicaid regulations.
Direction? Most importantly, you are responsible for
Participant direction is sometimes called self- communicating with your support
direction or consumer-direction. You may coordinator, your fiscal agent, and your
have heard it called by these names in other employees when appropriate.
states or programs, but the term participant
direction is used in Georgia. What are the NOW and
Participant direction is not a program or a COMP Waivers?
service or a waiver. Participant direction is a The NOW and COMP waivers are Georgia’s
service delivery option available to Medicaid home and community-based
individuals that receive the New Options services (HCBS) waivers for individuals with
Waiver (NOW) or the Comprehensive intellectual and developmental disabilities
Supports Waiver (COMP) in Georgia. (I/DD). These waivers are designed to
provide a community-based alternative to
institutional care. Services provided in one’s
We are so happy with the own home or community allows more
flexibility, choices, freedoms and generally costs less.
and control that we have HCBS waivers are not entitlement programs.
since we began directing my To qualify for a NOW or COMP Medicaid
daughter’s services. waiver, individuals must meet certain
requirements. The services and supports that
-Karen A., Lilburn, Georgia individuals receive must assist them with
living and participating in their community.
Participant direction means that you direct Waiver services are funded by the federal
your own services and have control over your Centers for Medicare and Medicaid Services
funds. It means that you choose who (CMS) and matching state dollars. In
provides your services and how much you Georgia, the NOW and COMP waivers are
pay for them. It also means that you managed by the Division of Developmental
schedule your own services and decide when Disabilities in the Georgia Department of
and where you will receive them. Behavioral Health and Developmental
Disabilities (DBHDD).
Participant direction also means you have
responsibilities. For more information and to apply for a
NOW or COMP waiver, visit
You have the responsibility of managing your
www.dbhdd.georgia.gov/applying-dd-
annual funds. You are responsible for hiring,
services to see Instructions for
training and managing the employees who
Intellectual/Developmental Disabilities
work for you. You are responsible for record
Services Application, or call your DBHDD
keeping and complying with the
Field Office. To find your DBHDD field
requirements of the fiscal agent. You are also
office, visit www.dbhdd.georgia.gov/field-
responsible for making sure that the services
offices.
you receive are appropriate and comply with
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
Scroll to Provider Manuals. (www.mmis.georgia.gov/portal/)
5
Participant Direction Handbook
Service Delivery Options PROS AND CONS
If you receive services through the NOW Traditional
or COMP waiver, you have the option of Pros Cons
using traditional or participant-directed Someone else
service delivery. You have little
handles the details
control over
Traditional Service Delivery
of managing your
services and
Services and supports are provided by a
budget and your
vendors.
Medicaid-approved provider agency. In
staff.
this model, you will choose a company to You can live in
provide the waiver services. The residential settings Cost of services is
company will hire all caregivers and such as group higher due to
support staff, and provide the other homes or host agency overhead.
waiver services, such as diapers, respite, homes.
etc. The company will manage your Provider can
You have little
funds, and determine how many hours of advocate for
control over
support you will receive and how much increases in budget,
choosing support
the staff will be paid. The company is based on your
staff.
responsible for complying with waiver needs.
regulations. You do not need to You have no control
have the skills over salary of your
required to direct. support staff.
Participant-Directed Model
Services and supports are provided by
workers and vendors whom you hire.
Participant Direction
You determine their pay, schedule their
Pros Cons
hours, and process their payroll. You
You choose and You are responsible
choose vendors for other services, and
control the cost of for paperwork and
you are responsible for processing their
service vendors. details.
invoices. You are responsible for
You choose how You cannot live in a
managing your budget and complying
much you will pay group home or host
with waiver regulations.
your support staff. home.
NOTE: It is possible for you to direct some You have the You have sole
of your services and receive some freedom to hire, responsibility for
traditional services. As an example, you train, and supervise the lengthy process
might choose to direct the community your support staff in of recruiting, hiring,
living supports you receive in your home, the way that works and supervising
but during the day, you might attend a for you. your support staff.
day support program that is managed by You manage your You are responsible
a traditional provider. budget so that it for managing your
will fit your needs. budget so that it
It is important to know that you have a works for you the
choice. The following charts may help entire year.
you decide which method will work best
for you.
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
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6
Participant Direction Handbook
Kori is especially proud of his volunteer work
Participant Direction at the nursing home. While there, he
is Awesome! interacts with the residents and helps out by
setting up the dining tables and assisting
K
ori’s mom knew when he was with wheelchair transport. The nursing
diagnosed with a developmental home even chose Kori to be honored at a
disability at 16 months that he would volunteer appreciation luncheon.
need some type of assistance as an adult.
Her goal for Kori was for him to be as Kori receives community living support,
independent as possible despite his individual community access, group
disabilities, so that he could live and enjoy community access, respite, speech and
life within the community. language therapy, and day supports.
“Participant direction is the bomb! To me, it
is the only way to go in order to make sure
that my son is getting the best possible
services,” reports his mother, who acts as his
representative. “The reason that we decided
to participant direct was because it became
apparent that the money he receives from the
waiver would go further if I could make some
of the decisions about how it was spent.
The waiver has helped Kori to be more
independent and to enjoy his life. He has
been able to develop relationships with his
caregivers and others in the community that
are independent of those within his family.
His self-worth and confidence have increased
and he is enjoying his life much more. It has
given his family the opportunity for some
freedom from the daily caregiving that can
Today, Kori is an adult who lives with his overwhelm the lives of family members of
family and is involved in his community, those with disabilities.
thanks to the supports and services he
receives from Georgia’s COMP Waiver. Kori Kori’s mother loves that participant direction
volunteers at the local nursing home, visits allows her and Kori to choose the caregivers
the local shops and restaurants, and attends that work best with him. In doing so, she is
social gatherings. Kori’s rich life is dependent able to know that when he is with his
on the direct support professionals that caregivers, he is their number one priority
enable him to move about the community and can feel comfortable and relieved that he
with ease, assist him in preparing and eating is in good hands. For her, this is everything.
the food he buys at the local grocery store,
transport him to various locations, and assist
with toileting and bathing.
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
Scroll to Provider Manuals. (www.mmis.georgia.gov/portal/)
7
Participant Direction Handbook
− Managing staff. To be able to
Making the Decision successfully recruit, hire and manage
to Utilize Participant your staff, you should have good
communication skills and have clear
Direction rules and expectations.
When deciding to direct, the first thing you
− Monitor Funds. It will be important to
will want to do is determine who is going to
be able to make sure that you stay within
manage these responsibilities. This person is
a monthly and annual budget to ensure
called the participant direction
that the amount of the waiver funds lasts
representative. This person is very important
through the year. This will require you
and should be chosen with care.
to take time each month to review your
expenses and anticipate future costs.
Who can Direct?
− Work with a Fiscal Agent. Your fiscal
− The individual who has the waiver
agent will assist you with monitoring
(participant); or
your budget and paying for your staff and
− A designated representative of the services. Fiscal supports are a required
individual who has the waiver. This service with participant direction, so be
representative can be anyone you choose, prepared to learn the rules and follow
except a paid employee who is providing them.
other waiver services.
− Work with a Support Coordinator.
Your support coordinator will assist you
Responsibilities
with developing an individual support
Once you have determined that you are plan (ISP) and monitoring your supports
eligible to direct the NOW or COMP and services. Support coordination is a
services, you will need to decide if you are required service, so be prepared to
willing and able to fulfill the responsibilities communicate your needs and any issues
of the job. The person who is responsible with your support coordinator.
will need to be able to handle:
− Work with the Participant Direction
− Paperwork. The paperwork can seem Manager and Other Staff at DBHDD.
overwhelming to some people and may Most questions regarding participant
prove to be a barrier to successfully direction can be answered by your
managing participant direction. support coordinator. For additional
Organization and attention to details are information, contact DBHDD’s Division
skills that will help you manage the of Developmental Disabilities at 404-657-
paperwork. 2252.
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
Scroll to Provider Manuals. (www.mmis.georgia.gov/portal/)
8
Participant Direction Handbook
− Be informed on the Waiver Manuals. − Comprehensive Supports Waivers
It is important that you be familiar with Program (COMP) – Part III,
the NOW and COMP waiver manuals Chapters 1900-3500 (This contains
and stay up-to-date on all policy changes. the policies and procedures for
Manuals change on a quarterly basis. additional services in the COMP
The exact name of the manuals can also waiver.)
change, but they can always be identified
by the title including the type of waiver, − New Options Waiver Program
the words Part III, and the specific (NOW) – Part III 3500 (This
chapters contained within the manual. contains the policies and procedures
The waiver manuals can be found on the services in the NOW waiver.)
Georgia Department of Community
Health’s (DCH) GAMMIS Portal at
www.mmis.georgia.gov/portal/ Click on
“Provider Information” in the banner at
The best tip I can
the top of the page. Then scroll down to give a family who
“Provider Manuals.” There you will find: is just starting
− Comprehensive Supports Waivers this process is to
Program (COMP) and New Options
reach out to
Waiver Program (NOW) –
Chapters 600-1200 (This contains someone who has been through
the general policies and procedures the experience, and get coaching
for both the COMP/NOW waivers.)
from them. After all, there is no
− Comprehensive Supports Waivers better teacher than someone who
Program (COMP) – Part III,
Chapters 1300-3500 (This contains
has walked the same walk.
the policies and procedures for
-Sitara N., Marietta, Georgia
services in the COMP waiver.)
Call Parent-to-Parent at 1-800-229-2038 or
770-451-5484 to be matched with a
supporting parent who has experience with
participant direction.
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
Scroll to Provider Manuals. (www.mmis.georgia.gov/portal/)
9Participant Direction Handbook
Getting Started
Once you have decided that you want to Work with your support
direct your services, you will need to take coordinator to develop an
some steps to get the ball rolling.
Step 5 individual service plan (ISP)
based on your needs. If you
7 Steps to Getting Started already have an ISP and are
changing from a traditional
The first step is to contact provider service delivery
your support coordinator model, you will need to
and let them know that coordinate the change of
Step 1 you would like to direct service and ISP with your
your services. For more support coordinator. The
information, go to The ISP will include funding
Support Coordinator allocations for each service.
If you are new to the waiver
Next, you will need to and choose participant
choose someone to be direction, your ISP will be
Step 2 your representative. Do developed based on
you want to do it yourself, directing your services.
or do you want a family
member or friend to assist Once your ISP has been
you? approved and you have
Step 6 completed the enrollment
process with your fiscal
For more information, go agent, you will be ready to
to Making the Decision begin recruiting staff. For
to Utilize Participant more information, go to
Direction Recruiting, Hiring,
Training, and Managing
Register and attend
your Staff
mandatory training, and
Step 3 sign the memo of If needed, select service
understanding. For more vendors for other services
information, go to and complete necessary
Step 7
Mandatory Training documentation with your
chosen fiscal agent. For
Choose a fiscal agent to be
more information, go to
stipulated in the ISP. Sign
Service Vendors
Step 4 up with the financial
support services provider.
For more information, go
to The Fiscal Agent
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
Scroll to Provider Manuals. (www.mmis.georgia.gov/portal/)
10Participant Direction Handbook
Mandatory Training
DBHDD requires that you or your designated The mandatory training
representative complete a mandatory is a wonderful opportunity
training before you can begin participant to ask questions face-to-
direction.
face with a DBHDD
During the training, you will learn what your representative. Come with
roles and responsibilities are, as well as what
a list of questions, and then
services are available under the NOW and
COMP waivers. The trainings are designed don’t be afraid to ask them.
to ensure that you understand the It is likely others have the
participant direction service delivery option same questions.
and your role, authorities, and
responsibilities. -Cynthia W., Canton, Georgia
Trainings are offered both online and in-
person and must be completed prior to
developing the ISP for participant direction.
For more information and to register for one
Memo of
of these trainings, go to the Developmental Understanding (MOU)
Disabilities Training Announcement page at
In addition to attending the required training
www.dbhdd.georgia.gov/developmental-
session, you will be required to sign a “memo
disabilities-training-announcements-0, and
of understanding” or MOU before you begin
look for Participant Direction New
participant direction. This document will be
Enrollment Training.
reviewed and signed during the training
session and then again annually at the ISP
meeting.
The MOU is a document that states the
terms and conditions of participant direction.
Your signature on the document means that
you understand the terms and conditions,
and that you agree to adhere to them.
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
Scroll to Provider Manuals. (www.mmis.georgia.gov/portal/)
11Participant Direction Handbook
The Support Types of Support
Coordinator Coordination
The purpose of support coordination is to
Support coordination is not only an
oversee the health, safety, and well-being of
important part of your waiver package, but it
waiver participants. In addition, support
is a required service for all NOW and COMP
coordinators are required to track the use
waivers. Your support coordinator is
and outcomes of services identified in the
available to assist you in deciding if
ISP. There are two types of support
participant direction is right for you.
coordination for individuals receiving
Together, you can talk about the benefits,
services through the COMP waiver:
risks, and responsibilities.
Traditional Support Coordination
The role of the coordinator is to evaluate and
assess your individual needs, assist in
The more you coordinating services, and monitor your
are prepared for services and supports.
the support Intensive Support Coordination
coordinator’s This includes the same activities as in
visits, the traditional support coordination, but adds
specialized coordination of waiver, medical,
smoother your meetings will go. and behavioral support services for
For example, have employee individuals with exceptional needs.
activity records and/or annual You will be assigned to either traditional or
funds allocations ready to intensive support coordination based on your
level of need identified through your needs
review. assessment.
-Reiko D., Cherokee County, Georgia
Once you have made the decision to direct
and have attended the mandatory training,
your support coordinator will help you
develop an individual service plan (ISP) and
inform you of the allocated funds. Your
support coordinator will continue to be a
resource, evaluating supports and services
and assisting with changes to the ISP, when
necessary.
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
Scroll to Provider Manuals. (www.mmis.georgia.gov/portal/)
12Participant Direction Handbook
Support Coordination Creative Consulting Services
www.creativeconsultingservices.org/
Agencies 353 Resource Parkway
There are currently seven support Winder, Georgia 30680
coordination agencies with ten locations in 770-868-5949
Georgia.
Georgia Support Services
Benchmark Human Services www.georgiasupport.com/
www.benchmarkhs.com/about/ 101 Walke Dairy Road
530 West Thomas Street, Suite C Dublin, Georgia 31021
Milledgeville, Georgia 31061 478-275-4845
478-451-0557
Professional Case Management
CareStar (PCSA)
www.carestar.com/ www.pcsasc.com/
3312 Northside Drive 2404 Bemiss Road
Suite A140 Valdosta, Georgia 31602
Macon, Georgia 31210 229-241-1540
478-314-7770
Compass Coordination
www.compasstn.org/georgia
1124 N. Tennessee Street
Suite 104
Cartersville Georgia 30201
678-372-6626
Columbus Community Services
www.columbusorg.com/Community-
Services/Support-Coordination
2470 Windy Hill Road, Suite 448
Marietta, Georgia 30067
770-916-1091
1453 Greene Street, Suite B
Augusta, Georgia 30901
706-736-0401
235 Roosevelt Avenue, Suite 455
Albany, Georgia 31701
229-435-3212
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
Scroll to Provider Manuals. (www.mmis.georgia.gov/portal/)
13Participant Direction Handbook
The Fiscal Agent The Role of the Fiscal Agent
Once you have attended the required − Perform payroll responsibilities.
training and signed the MOU, you will need
− Make sure necessary paperwork is
to choose a fiscal agent to manage your
completed on new-hire employees.
waiver funds. A fiscal agent or intermediary
is a company that acts on behalf of another
− Withhold taxes in compliance with state
party by performing various financial duties.
and federal laws.
In participant direction, the fiscal agent is the
financial support service provider who acts − Track and monitor individual fund
on your behalf to manage the financial expenditures.
aspects of the waiver and make sure you are
complying with federal and state payroll − Make sure your funds are distributed as
requirements. The fiscal agent issues vendor authorized in the ISP.
and payroll checks and pays withholdings to
state and federal agencies. You are required Fiscal Agents in Georgia
to have a fiscal agent if you direct the NOW
or COMP waiver. Acumen Fiscal Agent, LLC
www.acumenfiscalagent.com
Katrina Simisnean, Program Manager
(Based in Lawrenceville, Georgia)
I chose our fiscal 4542 E. Inverness Ave, Ste 210
Mesa, Arizona 85206
agent by getting
Direct: 480-339-3506
recommendations Toll free: 1-877-211-3738
from other Fax: 1-888-249-7023
Email: katrinasi@acumen2.net
parents. I also
looked to see what experience Continuum Fiscal Services
www.continuumfs.com
they had as a fiscal agent in Kyle Capers, Program Administrator
other states. 260 Peachtree Street, NW – Suite 1500
Atlanta, Georgia 30303
-Sitara N., Marietta, Georgia 678-974-7942
Fax: 1-855-872-3728
Public Partnerships, LLC
www.publicpartnerships.com
Chantielle D. Tally, Program Administrator
2849 Paces Ferry Road, Suite 630
Atlanta, Georgia 30339
1-901-208-2907
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
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14Participant Direction Handbook
EMPLOYEE WAGES
Funding
One of the most important decisions you will
As part of your ISP, you will be allocated
make when managing funds is determining
funds for the different services you receive.
how much you will pay your employees. The
Your individual needs, along with evaluation
amount of their hourly pay will determine
and assessment results, determine the
how many hours of service you can receive
amount of the funds allocated for each
during the year.
service. Funding is allocated annually on
your birthday. When deciding how much you will pay them,
you will also need to figure in your costs as
Developing and their employer. By law, employers need to
Managing Funds pay a portion of an employee’s Social Security
and Medicare taxes, as well as federal and
Once you know your funding allocation for state unemployment taxes. Workers’
each service, you will work with the fiscal compensation insurance is also an employer-
agent to use the funds. The fiscal agent will related cost.
be responsible for keeping you updated on
how the funds are being spent. You are This means that for every $1.00 you pay in
responsible for managing the funds, so that wages, you must add the additional employer
they can provide needed services for the costs. As an example, let’s say the employer
entire year. costs are 20 cents per dollar. This means that
if a employee makes $10.00 an hour, the cost
The waivers specify the maximum amount of to you would be $12.00 for every hour they
funding for each of the services, but not every worked.
individual will receive funding at the service
maximum. You will not be able to spend It is very important to remember and include
more than is allocated in your funds for any the employer costs when determining the
service. For example, if you have $1.000.00 hourly pay of staff and the hours of service
allocated for incontinent supplies, you will not you need. Your fiscal agent will be able to
be able to spend more than $1,000, regardless provide you with more information and give
of the NOW and COMP waivers’ maximum for you the specific employer costs.
this category.
NOW & COMP SERVICES
All services provided under the waiver are
based on the assessed needs specified in the
I monitor hours
ISP.
weekly and review
Participants have the option to self-direct
my remaining funds
COMP and NOW services with the exception
every pay period to of community residential alternative services,
make sure I have enough to last financial support services, prevocational
services, nursing services, nutritional
the entire year. services, and support coordination. For
details on participant direction, refer to the
-Cynthia D., Baconton, Georgia
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
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15Participant Direction Handbook
Provider Manual, Part II Policies and socialization, and adaptive skills required
Procedures for COMP, Chapter 1200. for active participation, and independent
functioning outside your home.
Details of service specifications, provider 7. Community Guide Services (only for
requirements and licensure, covered and participant direction)
non-covered services, and reimbursement Assists participants with defining and
units and rates can be found in the Provider directing their own services and supports
Manual, Part III, COMP/NOW Policies and and meeting the responsibilities of
Procedures. Each service is described in a participant direction.
distinct chapter with a service definition as 8. Community Living Support
well as non-covered items. You are Individually tailored supports that assist
responsible for reviewing and adhering to all with acquisition, retention, or
service requirements. improvement of skills related to a
participant’s continued residence in his or
The participant-directed service model may
her family home.
be selected for any of the following service
9. Environmental Accessibility Adaptation
types.
Physical adaptations to the participant’s
Services supporting needs that result from or family’s home which are necessary to
your developmental disability (must be ensure the health, welfare, and safety of
prescribed by a physician and be provided by a the individual, or which enable the
Georgia-licensed therapist): individual to function with greater
independence in the home.
1. Adult Occupational Therapy 10. Individually Directed Goods and Services
2. Adult Physical Therapy (not otherwise provided through the
3. Adult Speech and Language Therapy COMP waiver or Medicaid State Plan)
Services, equipment, or supplies identified
Other eligible services: by the participant and his or her support
coordinator or interdisciplinary team.
4. Behavioral Supports Consultation 11. Natural Support Training
Professional services that assist Provides training and education to
individuals with significant, intensive individuals who provide unpaid support,
challenging behaviors that interfere with training, companionship, or supervision
activities of daily living, social interaction, to participants.
work, or similar situations. 12. Respite Services
5. Behavioral Supports Provides brief periods of support or relief
Professional services that assist for caregivers of individuals with
individuals with significant, intensive disabilities and includes maintenance
challenging behaviors that interfere with respite for planned or scheduled relief, or
activities of daily living, social interaction, emergency respite for a participant
work, or similar situations, through direct requiring a short period of structured
training and assistance to family and support (typically due to behavioral
support staff. support needs), or due to a family
6. Community Access Services emergency.
Designed to assist you in acquiring, 13. Specialized Medical Equipment
retaining, or improving self-help, Devices, controls, or appliances specified
______________________________________________________________________________
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16Participant Direction Handbook
in the ISP which enable participants to 16. Transportation
increase their abilities to perform Enables participants to gain access to
activities of daily living and to interact waiver and other community services,
more independently with their activities, resources, and organizations
environment. typically used by the general population;
14. Specialized Medical Supplies does not include transportation available
Food supplements, special clothing, through Medicaid non-emergency
diapers, bed wetting protective chucks, transportation, or as an element of
and other authorized supplies that are another waiver service.
specified in the ISP. 17. Vehicle Adaptation
15. Supported Employment Adaptations to the participant’s or
Supports that enable employment of family’s vehicle approved in the ISP, such
participants, for whom competitive as a hydraulic lift, ramps, special seats,
employment at or above the minimum and other modifications to allow for
wage is unlikely, absent the provision of access into and out of the vehicle as well
supports, and who, because of their as safety while moving.
disabilities, need supports to work in a
regular work setting.
______________________________________________________________________________
Visit the GAMMIS website to find the Waiver manuals. Click on Provider Information.
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17Participant Direction Handbook
SERVICE RATES
Service Maximum Rate per unit Annual Limit
Evaluation: $67.21 (Limit 1 per year)
OT Therapeutic Services: $19.76
Adult Occupational Annual Limit for All Adult
(Four 15-minute units per day)
Therapy Therapies - $5,400.00
OT Sensory Integrative Techniques:
$24.46 (Four 15-minute units per day)
Evaluation: $69.34 (Limit 1 per year)
Adult Physical Annual Limit for All Adult
PT Therapeutic Procedure: $20.07 Therapies - $5,400.00
Therapy
(Four 15-minute units per day)
Evaluation: $54.93 (Limit 2 per year)
Speech Language Therapy: $62.53
Adult per unit (One unit equals one visit) Annual Limit for All Adult
Speech/Language Therapies - $5,400.00
Therapy Speech-Generating Device Therapy:
$54.75 (One unit equals one visit with
limit of 8 visits per month)
Behavioral Supports 1 unit equals $1.00 $2,262.00
Consultation
Behavioral Supports 1 unit equals $1.00 $1,800.00
Services
As authorized in individual
Community Access 1 unit equals $1.00 budget up to an annual
Group maximum of $17,856.00
As authorized in individual
Community Access 1 unit equals $1.00 budget up to an annual
Individual maximum of $10,670.00
As authorized in individual
Community Guide 1 unit equals $1.00 budget up to an annual
maximum of $2,000.00
Community Living
Support – Extended As authorized in the individual
budget up to an annual
Community Living maximum of $51,300.00.
Support – Shared 1 unit equals $1.00
Total annual amount of all
services billed cannot exceed
Community Living
$51,300.00 annually.
Support – Personal
Assistance Retainer
Environmental The reimbursement rate is the lower
Lifetime maximum of
Accessibility of three price quotes or the lifetime
$10,400.00
Adaptation maximum.
______________________________________________________________________________
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18Participant Direction Handbook
Financial Support Maximum of $75.00 per month Annual Maximum of $900.00
Services
Individual Directed 1 unit equals $1.00 Maximum of $1,500.00 per year.
Goods and Services
As authorized in individual
Natural Support 1 unit equals $1.00 budget up to an annual
Training maximum of $1,787.00
Respite – Hourly
Respite – Daily As authorized in the individual
budget up to the annual
Category 1 & 1 unit equals $1.00 maximum of $4,608.00 for
Category 2 Category 1 and $6,285.00 for
classification is Category 2 Respite.
determined by
assessment.
The standard Medicaid
reimbursement rate for the
equipment or, in the absence of
a standard Medicaid rate, the
lower of three price quotes.
Annual maximum number of
units is 5,200, unless there is
Specialized Medical 1 unit equals $1.00 approval to exceed the annual
Equipment
maximum up to the lifetime
maximum due to assessed
exceptional needs of the
participant.
Lifetime maximum per
participant is $13,474.76
Annual maximum number of
units is 3,800.00, unless there is
Specialized Medical approval to exceed annual
1 unit equals $1.00
Supplies maximum units due to assessed
exceptional needs of the
participant.
COMP: Annual limit is as
authorized in the individual
Supported
budget up to a maximum of
Employment – Group
$7,065.00.
Supported COMP: Annual limit is
Employment – authorized in the individual
1 unit equals $1.00
Individual budget up to a maximum of
$10,670.00.
Supported NOW: Annual limit is
Employment - authorized in the individual
Individual budget up to maximum of
$17,856.00.
______________________________________________________________________________
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19Participant Direction Handbook
Annual limit is authorized in
the individual budget up to
Transportation 1 unit equals $1.00 annual maximum for all self-
directed Transportation
services of $2,797. 00.
Lifetime maximum per
Vehicle Adaptation 1 unit equals $1.00
participant is $6,240.00
______________________________________________________________________________
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20Participant Direction Handbook
Approximately four years ago, Evan moved
A Life with Dignity his COMP waiver services to the participant
W
hen our son, Evan, was born 34 direction model, so his supports and services
years ago, we were told that he could successfully provide him with greater
would have lifelong independence in his home community of
developmental disabilities. We were not sure Tucker.
what the future would hold for him, but we
pledged as parents and as a family to give Evan now lives successfully in a house with
him a life filled with dignity. two roommates. His roommates also have
disabilities, and they direct their waivers.
Evan attended Smoke Rise Elementary, They each require and receive caregiver
Henderson Middle School, and graduated support and assistance. The roommates pay
from Tucker High School. He was football rent and utilities to subsidize the costs of the
manager of the Tucker Tigers for many years. home. Evan’s caregiver support allows him
to work, plan, and shop for meals and
Evan lives a rich and busy life in his toiletries, complete the daily maintenance
community. For years, Evan participated in tasks of a home, do banking, attend social
Special Olympics swimming, power lifting, and recreational events in the community, go
and basketball. He has participated in to movies, attend church, work out with his
several sports and life/social skill activities personal trainer, attend weekly bowling
and been on overnight trips with local activities, participate in practices with a local
organizations. He has held jobs at a local band, and attend play practice. His favorite
grocery store and other businesses. For a thing to do is go out to eat with friends.
while, he even had his own paper shredding
company! Today, Evan is in his fourth year We call Evan’s home Twin Magnolias for the
working as a stocking clerk in the emergency two magnolia trees that are in front of his
department of a local hospital. house. Evan and his roommates have lived
together successfully with support and
careful planning for three years.
Being able to direct his waiver
has made all the difference, as
this would not be possible
within the traditional service
delivery model.
The magnolia flower is defined
as “dignity.” We have come
very far in realizing this dream
for him and for our family.
______________________________________________________________________________
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21Participant Direction Handbook
− Community assistance
Recruiting, Hiring,
List the tasks you need help with under each
Training, and area. These might include:
Managing your Staff Personal care: Lifting and transferring,
personal grooming, showering, assistance
Recruiting with toileting/diapering, feeding, etc.
One of the most important responsibilities Domestic/household assistance: Fixing
you will have when you self-direct is hiring meals, laundry, vacuuming and dusting,
the right people for your staff. Depending on cleaning the bathroom, dishwashing, etc.
your needs and the availability of support
staff in your area, you may find this to be one Health and safety care: Assisting with
of the most challenging responsibilities as medications, assisting with daily range-of-
well. The following information will help you motion or stretching therapy, care for
make the right choices for you. specialty equipment, etc.
Community Assistance: Connecting to
CREATING A JOB DESCRIPTION
community activities, helping to get together
The first step in recruiting staff is to write a with family and friends, meeting new people,
job description. A good job description will going with me to appointments, helping me
include basic information about the job, such entertain in my home, assisting me with
as the work schedule, the amount the managing my budget, helping me balance my
employee will be paid, and the total hours checkbook, going grocery shopping with or
the person will be expected to work in a for me, assisting me with transportation (like
week. It will also have a clear description of scheduling rides to appointments), etc.
the job responsibilities and the qualifications
for the position. Job responsibilities are the I have found
tasks you want the support person to do. Job
qualifications are the skill and qualities you
staff through
want the person to have. word-of-mouth
and online
JOB RESPONSIBILITIES:
recruiting sites.
To help you write the job responsibilities, it
may help to develop a list of the tasks that I am always on
you will need the support person to assist the lookout for good caregivers
you with. You should use your ISP to help
develop the list. Most tasks will fall under
and keep a file so I can reach out
these four areas: when I need one. I always have
− Personal care
more than one caregiver working
for us so if one leaves, I will not
− Domestic/household assistance
be without care.
− Health and safety care
-Karen D., Peachtree Corners, Georgia
______________________________________________________________________________
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22Participant Direction Handbook
JOB QUALIFICATIONS: to report to work and gives advance
notice or prompt notice of absences.
Your job description will need to include the
skills, qualities, and characteristics you want − The person keeps all necessary records,
your support staff to have. Here are some such as work schedules, time logs, daily
examples of some qualifications you might activities notebook and your calendar of
want to include: appointments. The records are accurate,
neat, and organized.
− The person understands you are the
employer, is willing to take direction − The person is sensitive to your needs,
from you, follow your instructions, learn your self-respect, and your desires while
from you, be trained by you and respect providing a professional level of care.
your wishes.
− The person believes in your goals and is
I look at my
able to support you in achieving them. funds and then
− The person is able to meet all of your
look at the hours
physical needs. The person can transfer I need. Based on
you, move your wheelchair, lift you, these two factors,
move your equipment etc.
I determine the
− The person is able to keep your home maximum amount I can pay my
clean and in order, as well as prepare
meals as directed by you. staff. I let them know it’s the
most I can pay and there may
− The person has dependable
transportation, a valid Georgia driver’s not be an opportunity for a raise.
license, and current car insurance. The
-Sitara N., Marietta, Georgia
person is able to drive you if and when
necessary, as directed by you.
OTHER QUALITIES:
− The person dresses appropriately. Everyone is different, so you may want to
look for certain qualities in a support person
− The person respects your privacy and
that are individualized to you and the others
keeps information about you private.
in your household. You may prefer someone
− The person puts your health and safety who is calm and quiet, or someone who is
first and uses good judgment in keeping upbeat, positive, and outgoing. You may
you from harm. enjoy being around someone with a great
sense of humor or someone who enjoys
− The person remembers and follows watching sports. You should include
emergency policies and procedures. whatever qualities are important to you in
the job description.
− The person shows up on time, is
dependable, and stays for the entire shift.
The person calls when he or she is unable
______________________________________________________________________________
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23Participant Direction Handbook
SALARY, HOURS, AND WORK SCHEDULE: the individual with the waiver, such as: pet or
sibling care, or housekeeping, laundry, or
It is important that the job description state
errands for other household members.
the work schedule, the amount the employee
will be paid, and the total hours the person
DEVELOPING A JOB APPLICATION
will be expected to work in a week. To help
you decide what you need to include you After you have developed a job description,
should determine the following: you need to have a job application for each
applicant to complete.
− How many hours of services you need
The job application will give you the
− How many people it will take to provide following information:
those hours
1. Name
− The hourly wage for the position 2. Address
3. Telephone number
− Whether you have enough money to hire 4. Education and Employment history
all of the people that you need 5. Reference contact information
(Remember to include the employer costs
as well as the hourly wage.) FINDING APPLICANTS
The number of service employees you need One of the challenges of being an employer is
will depend on the answers to those finding qualified applicants for the positions
questions and how many hours each person you have available. You will need to use your
is able to work. If you hire more than one creativity, community resources, and
support staff, you will have a pool of people networks to get the word out.
to draw from during holidays, when someone
needs time off, or when someone is sick. If you want to hire someone from the
community, you can ask your family
WRITING THE JOB DESCRIPTION members, friends, and co-workers if they
know someone who might be interested in
Now that you have determined the working for you. Here are some other ideas
responsibilities, qualifications, and qualities that you might want to consider:
of your support staff and decided what hours
you want them to work and how much you − Place a want ad in the local newspaper or
can pay them, it is time to create a one-page in organizations’ or agencies’ newsletters.
written job description. You will want to
make sure you include these 6 parts: − Contact disability-related groups or
agencies and ask for recommendations.
1. The job title
2. The name of the supervisor − Make a flyer that describes who you are
3. Basic information about the job looking for and post it in libraries, places
4. A list of job responsibilities of worship, daycare centers, colleges and
5. A list of required qualifications universities, and other public areas.
6. A way to contact you
− Contact special education teachers, para-
NOTE: Job responsibilities cannot include pros, and family members.
household duties outside of those needed for
______________________________________________________________________________
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24Participant Direction Handbook
SAMPLE JOB DESCRIPTION
Job Title: Support Staff
Supervisor: Patty Participant Director
Job Summary of the main function/purpose of the position: Responsible for assisting an adult woman
with a disability in her daily activities and routines.
Work Schedule: Monday - Friday 2:30 to 9:00 p.m.;
Saturday 1:00 p.m. to 7:00 p.m.
NOTE: This work schedule is flexible depending on the needs of the employer and may be
shared between several staff members.
Salary Range: $12-15/hour depending on scheduled times and specific duties.
Total Hours Weekly: No more than 40 hours in a week.
Qualifications: Person should be upbeat, positive and outgoing. Looking for someone who is punctual,
female, a non-smoker, and who likes small friendly dogs. Must have a valid Georgia driver’s license and
current CPR and First Aid Certification.
Duties/Responsibilities:
● Assist with bathing, dressing, toileting needs, and personal grooming
● Assist with meal preparation and self-feeding
● Cleanup kitchen and bathroom
● Change bedsheets
● Wash, dry, and fold laundry
● Assist with physical exercise program
● Assist in accessing activities in community locations (swimming pool, restaurants, park, etc.)
Work Environment: Most of the work will be performed in employer’s home, but may also be required in
community settings.
Additional Remarks: Ability to be flexible, adjust work habits based on feedback, and effectively
communicate with employer. Punctuality and reliability are essential qualities for this position.
______________________________________________________________________________
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25Participant Direction Handbook
SAMPLE JOB APPLICATION
PERSONAL INFORMATION:
Last Name ________________________ First Name _________________________ Middle Initial______
Street Address__________________________________________________________________________
City____________________________ State_________ Zip Code______________
Phone Number (_________)__________________________________
Are you eligible to work in the United States? Yes _____ No _____
Are you 18 years of age or older? Yes _____ No _____
Have you ever been convicted of a felony, or a misdemeanor related to theft, fraud, neglect, or violence?
Yes _____ No _____ If Yes, explain _________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Do you have a valid Georgia Driver’s License? Yes _____ No_____
Do you have a current CPR Certification? Yes _____ No_____
Do you have a current First Aid Certification? Yes _____ No _____
POSITION/AVAILABILITY:
Position applied for _____________________________________________________________________
Days/Hours available: Monday __________ Tuesday __________ Wednesday __________
Thursday __________ Friday __________ Saturday __________ Sunday __________
Hours available: from _________________ to _________________
Date you are available to start work: ________________________________________
EDUCATION:
Name and Address of School - Degree/Diploma - Graduation Date:
______________________________________________________________________________________
______________________________________________________________________________________
Skills and Qualifications: Licenses, Skills, Training
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________
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26Participant Direction Handbook
EMPLOYMENT HISTORY:
Employer Name and Address: _____________________________________________________________
Supervisor: ______________________________Phone___________________Email_________________
Position Title: _________________________ Salary___________________________________________
From: ______________ To: ______________
Responsibilities: _________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Reason for Leaving: _____________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
May We Contact Your Present Employer? Yes _____ No _____
References We May Contact: (Name/Title/Address/Phone/Email)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
I certify that information contained in this application is true and complete. I understand that false
information may be grounds for not hiring me or for immediate termination of employment at any point in
the future if I am hired. I authorize the verification of any or all information listed above.
Signature________________________________________ Date__________________________________
______________________________________________________________________________
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27Participant Direction Handbook
PLACING AN AD
Support Staff Needed
To help you with writing an ad, you might Looking for help with my adorable,
want to look at some similar ads and look for high-energy, fun, and sometimes
things you think make them successful. Be challenging 23-year old daughter.
sure to include things that make the job You must be creative and energetic to
interesting to people, such as: flexible hours, keep up with her. Hours are 8:00 a.m.
an interesting person to work with, a great to 5:00 p.m. on weekends and holidays
location, rewarding work, and good in Stockbridge area.
experience. You should also include basic Must be able to lift 100 lbs.
information about hours, pay, duties, the job Duties include assistance with bathing,
name, and a phone number to call. Be sure dressing, toileting and feeding.
to include any personal preferences you Looking for someone who is
might have. These might be male, female, compassionate, trustworthy,
non-smoker, dog or cat lover . . . dependable, and will find joy and fun
in this work. Non-smoker only. Call
There are also some things you do not want
555-5555 for an interview.
to include. For example, it is not a good idea
to list your full name and/or address. Do not
make your ad too wordy by sharing too much
information. In general, you want to keep Support Staff Needed
your ad simple and save details for the Thirty-year old man with disabilities is
interview. Additionally, do not include looking for support staff to assist him
words that may be considered in the evening while he is out having
discriminatory, such as words that relate to fun in the community. Staff person
age or race. will 1) accompany him to social
activities and facilitate appropriate
social interactions; 2) assist him with
selection and purchases of items in
Check out online
stores; and 3) assist with appropriate
job sites such as restaurant behavior, menu selections
Care.com and and bill payments. Must have valid
driver’s license and good driving
Sitter.com. record. Hours are flexible. Johns
Facebook also Creek area. Non-smokers only. Call
555-5555 for an interview.
has a group called “Caregiver
Jobs for Georgia Waivers,” which
might help you find the employee
you are looking for!*
*“DBHDD does not represent, state, or imply an endorsement of any external websites, companies, or other
similar platforms that parents, representatives, and/or individuals use in locating and selecting potential
employees.”
______________________________________________________________________________
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28You can also read
