Agency with Choice FMS: Key Operational Characteristics and Quality Assurance and Liability Issues

Participant-directed services (PDS) that use the joint employer, Agency with Choice (AwC) Financial Management Services (FMS) model represents a major paradigm shift in the delivery of home and community-based long-term care services(HCB-LTC), transferring decision-making and managerial authority from professionals to individuals and their families while providing them with employer supports that can extend to the worker. PDS using AwC FMS have been reported in 23 states and in conjunction with 56 PDS programs (Selkow, 2011). This study addresses the key characteristics of, and quality assurance and liability issues that may arise in developing and implementing PDS programs using AwC FMS and the experiences of 13 state PDS programs in eight states and nine AwC FMS organizations. Analysis included a review of state PDS program rules, regulations and operational procedures; Federal and state department of labor (wage and hour, unemployment insurance)laws, Family Medical Leave Act of 1993, EEO/Title VII of the Civil Rights Act of 1964, Americans with Disability Act of 1990, Immigration Reform and Control Act of 1985, Occupational Safety and Health Act of 1970, Employee Retirement Income Security Act of 1974, Affordable Care Act of 2010, state workers' compensation insurance laws, and related case law; existing related tort claims, and conducting telephone interviews with state PDS program managers and management staff. Findings are summarized and promising practices and recommendations for proving PDS using AwC FMS are identified/made.