Ask Mike - Wanting to establish a PAS programme in Kansas

Dear Starting in Kansas,

Thank you for writing. You state that you want to establish a PAS program and you ask what is required to start. Additionally, you ask if I know a consultant for PAS in Kansas.

It is a bit unclear what you mean by "establish a PAS program". I will assume that you want to become a service provider and want to know what is required to do so. This is a complicated endeavor. I will address some basic issues and encourage you to take a look at similar questions and answers that were included in earlier "Ask Mike" columns, especially "Future Home Health Proprietors" and "Texas Agency Owner". These should be of interest to you.

In Kansas, there are two main types of PAS providers: Home Health Agencies and "Self- directed service provider agencies. Prior to 1992 or so, the only way to provide services was to be a home health agency. This was due to laws and regulations governing the practice of nursing. An exemption to the Nurse Practice Act and related state laws created in 1989, give individuals with disabilities the right to choose to direct and control their PAS without regard to requirements of state nursing laws. When individuals with disabilities exercise this right, they take on the responsibility for, and the risk of, the hands-on delivery of their PAS. Since Kansas does not have a cash and counseling option, the regular Medicaid rules that prevent beneficiaries from receiving direct funding, apply. This means that a provider, as a sort of "middle-man", must be in place to handle fiscal details for individuals who choose to self direct. This is one type of provider in Kansas, the self-directed services provider.

Providers of self-directed services are limited in what they do and who they can serve. As mentioned above, they mainly perform fiscal services for individuals who hire their own workers and direct their own services. Fiscal services include such activities as processing time sheets, billing Medicaid, figuring withholding and paying taxes, paying for unemployment and workers compensation insurance and so on. Some providers also provider varying types of liability insurance such as general liability, sexual harassment liability, or abuse, neglect & exploitation liability. Finally, a few providers of "self-directed", at the option of a consumer offer various kinds of training and related supports. Examples include training on how to manage attendants, or support with ensuring workers perform their tasks adequately, or assistance with dismissing an attendant.

The other type of provider is the traditional home health agency. These agencies are the employer of the attendant workers. Additionally, these agencies are responsible for ensuring that the workers perform their tasks in a quality manner and that the needs of the individuals they serve are met. The workers are typically supervised by a nurse and some of the PAS tasks, themselves, are required to be performed by an RN. In this provider model, all of the responsibility and all of the liability is assumed by the agency. Home Health agencies provide the non-self-directed services. Generally speaking, home health agencies have stricter staffing, oversight and licensing requirements. They hire, train, schedule and supervise the workers and oversee the work that is performed.

Once you select what type of agency you want to operate, then you'll need to think about what populations you want to serve. Almost all of the PAS in Kansas is delivered via Medicaid Waivers. Kansas has six different Waivers that target different populations. If you are not familiar with Medicaid Waivers you might want to take a look at "Understanding Medicaid Home and Community Services: A Primer". This publication by the U.S. Dept. of Health and Human Services (HHS) gives a really thorough overview of Medicaid Waivers; what they are and what they are intended to do. Just type the title, above, into your search engine and it should pop right up. There is also a bunch of real good research in the library on our website.

The Waivers all share many of the same, or similar, requirements for providers ranging from insurance requirements to computer capability for electronic billing. At the same time, however, each Waiver has different requirements that have to be met. You will need to contact the state Medicaid agency, Kansas Health Policy, and you will also need to contact Social and Rehabilitative Services (SRS) and possibly, the Kansas Department on Aging (KDOA) if you want to serve people on the FE Waiver, to get all of the necessary applications, and application advice. You can find the information to do this on our website. Go our Contact Info and Descriptions for Medicaid Waivers. Click on the state of Kansas and listings of the various Waivers and contact information will appear. If you click on the "contact in formation" for the "FE" or "PD" Waivers you will come to the SRS homepage. Scroll down to the bottom of the page and you will see the "Director of Community Support and Services", and her phone number. Try calling her to find out how to get an application and any related details.

The final thing you asked for was a consultant for PAS in Kansas. It is unclear what kind of consultant you want. The PAS Center does not provide recommendations for consultants. You may want to try asking The Director of Community Support and Services.

All the best,

Mike Oxford