Self-Direction

Self-direction is a service delivery option that allows participants to become the employers of the people they choose to hire to provide supports for them. As the employers, participants are responsible for recruiting, training, supervising, and managing the people they choose to hire. This option gives participants the most control over their supports, but also requires the most responsibility. Self-direction is based on the principles of self-determination, which means that you have the ability or right to make your own decisions, and includes the following:

For more information, contact us at [email protected] or at 1(800) 230-0690.

• Freedom – the opportunity to choose where and with whom you live, as well as how you organize all important aspects of your life
• Authority – the ability to control some targeted amount of public dollars
• Support – the ability to organize support in ways that are unique to you
• Responsibility – the obligation to use public dollars wisely and to contribute to your community
• Confirmation – the recognition that program participants must be a major part of the redesign of the human service system of long-term care

With Self-Direction, you control the amount spent on wages for your employees within the guidelines established by the program in which you are enrolled. With assistance from your support coordinator, you, as the employer, are required to budget payments for wages and required employment-related taxes.

Self-directed Medicaid services means that participants, or their representatives if applicable, have decision-making authority over certain services and take direct responsibility to manage their services with the assistance of a system of available supports. The self-directed service delivery model is an alternative to traditionally delivered and managed services, such as an agency delivery model. Self-direction of services allows participants to have the responsibility for managing all aspects of service delivery in a person-centered planning process.

Self-direction promotes personal choice and control over the delivery of waiver and state plan services, including who provides the services and how services are provided. For example, participants are afforded the decision-making authority to recruit, hire, train and supervise the individuals who furnish their services. The Centers for Medicare & Medicaid Services (CMS) calls this "employer authority." Participants may also have decision-making authority over how the Medicaid funds in a budget are spent.

Self-direction service delivery option is currently available to participants approved for HCBS Waivers as listed below:

Fiscal Employer Agents

Acumen Fiscal Agent
Tina Haines
Executive Director of Acument Louisiana
5416 E. Baseline Rd, Ste 200
Mesa, AZ 85206

Customer Service 1(855) 514-8832
TDD/TTY 1(888) 853-0010
Fax 1(866) 923-5334
Louisiana Acumen Fiscal Agent Website

The Fiscal Employer Agent (FEA) provides financial management services that includes managing and administering payroll and employment-related tasks for HCBS waiver participants enrolled in the self-direction option.  The FEA will assist the participant/employer of record with handling tasks such as payroll processing and tax compliance; worker’s compensation insurance; unemployment insurance; compliance with labor laws and regulations; employee verification and screening; time and attendance tracking; budgeting and financial management; and with ensuring questions from participants, support coordinator, and LDH staff are responded to in a timely manner.

Morning Sun Financial Services
Laci Polotzola
Louisiana Program Administrator
9400 Golden Valley Rd
Golden Valley, MN 55427

Customer Service 1(833) 239-3768
Fax (763) 233-7632
Louisiana Morning Sun Financial Services Website

The Louisiana Department of Health entered into an agreement with two Fiscal Employer Agencies (FEA) who assist participants who have 1915c Community Choices Waivers (CCW) administered by the Office of Aging and Adult Services (OAAS), and the Children’s Choice Waiver (CCW), New Opportunities Waiver (NOW), and Residential Options Waiver (ROW), governed by the Office for Citizens with Developmental Disabilities (OCDD).

Electronic Visit Verification

Electronic Visit Verification or EVV is a way to record the date, time, and place your Self-Direction employees provide services to you.

If you receive paid help around your home and community per your approved HCBS Waiver Service Plan, you will need to use Electronic Visit Verification (EVV). States, including Louisiana, are required to implement EVV or face a penalty from the federal government.  Section 12006(a) of the 21st Century Cures Act mandates that states implement EVV for all Medicaid personal care services (PCS) and home health services (HHCS) that require an in-home visit. This applies to PCS provided under sections 1905(a)(24), 1915(c), 1915(i), 1915(j), 1915(k), and Section 1115; and HHCS provided under 1905(a)(7) of the Social Security Act or a waiver. 

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Critical Incident Reporting

Self-Direction Employers must notify the Fiscal/Employer Agent (FEA) and support coordinator IMMEDIATELY anytime you have a change in your status as defined by your waiver program. Including the following Types of reportable incidents:

• Major Illness
• Major injury
• Abuse (child, adult/elderly)
• Neglect (child, adult/elderly, self)
• Death
• Exploitation/Extortion
• Falls
• Involvement with Law Enforcement
• Involvement with Law Enforcement
• Loss/Destruction of Home
• Major Medication Incidents
• Major Behavioral Incident (Attempted suicide, suicide, Self-endangerment, Elopement/Missing, Self-injury, Property Destruction, Offensive sexual behavior, Sexual Aggression, Physical aggression)

Reporting Abuse, Neglect, Exploitation or Complaints

Physical, sexual or psychological abuse, financial exploitation, or neglect/abandonment of an OCDD program participant must be reported, whether the incident involves a participant in OCDD Home and Community-based services or in a licensed ICF/IDD facility.

• To report abuse, neglect or exploitation of a child (age infant to 17), contact the Louisiana Department of Children & Family Services.
• To report abuse, neglect or exploitation of an adult (age 18-59), please contact the LDH Office of Aging and Adult Services Adult Protective Services.
• To report abuse, neglect or exploitation of an adult age 60 or older, contact the Governor's Office of Elderly Affairs/Elderly Protective Services.
• Nursing home and privately owned intermediate care facilities for individuals with developmental disabilities (ICF/DD) providers, please report allegations of abuse or neglect to Health Standards Section.  
• To file a complaint, concern or dissatisfaction involving services administered by OCDD or its contracted entities, contact your local human services authority or district.