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Member directed models or options allow members to have more control over
how certain services are provided, including services like attendant care,
personal care and housekeeping. The models are not a service, but rather
define the way in which services are delivered. Member-directed options
are available to most Arizona Long Term Care System (ALTCS) members who
live in their own home. The options are not available to members who live
in an alternative residential setting or nursing facility. ALTCS members
or their representatives are encouraged to contact their case manager to
learn more about and consider member-directed options.
Section 1915 (k) of the Social Security Act allows states to provide community-based
attendant supports and services to individuals with disabilities who require an
institutional level of care at a 6% enhanced Federal match, so long as certain
federal requirements of the program are met. AHCCCS is utilizing this opportunity
to adopt a new member-direct option called "Agency with Choice."
Agency with Choice is a new member-directed option that will be available to
home-based ALTCS members beginning on January 1, 2013. Under the Agency with
Choice option, the provider agency and the member enter into a co-employment
relationship and share employer-based responsibilities for the paid caregiver.
The provider agency maintains the authority to hire and fire the caregiver and
provide or arrange for the required minimum standardized training for the
caregiver. The member, or their individual representative, may choose to assume
one or more of the following employer-based responsibilities:
The Agency with Choice model is being developed in collaboration with a council
comprised of ALTCS members, providers, community stakeholders and contractors, known
as the Development and Implementation Council. The Council’s primary function is to
work with AHCCCS to develop the State Plan Amendment that will be submitted to the
Centers for Medicare and Medicaid Services, outlining the Agency with Choice
member-directed model. Additionally, the Council will provide input on the
programmatic changes AHCCCS will need to make in order to implement the new model,
including policy and form changes.
The following are links to information and resources pertaining to AHCCCS'
development work on the initiative. Additional information will be posted once
it is made available. If you have any questions about the Agency with Choice
member-directed model in general or the resources on this page, please contact
Dara Johnson (Program Development Officer) at 602-417-4362 or
Self Directed Attendant Care (SDAC) is a member-directed option that has been
available to members since 2008. Under the SDAC option, the member or member’s
legal guardian serves as the legal employer of the paid caregiver and assumes
all employer-based responsibilities. The member or member’s legal guardian is
supported by a Fiscal Employer Agent that takes care of the taxes, payroll
withholding and paychecks for the caregiver.
SDAC Brochure [PDF, 137KB]