Framework for Building State Level Personal Assistance Services Infrastructure

Elements: specific issue areas related to the provision of a comprehensive PAS system of supports for workers

Goals: stakeholder-identified statements about desired service provisions

Questions to Consider: targeted questions to inform whether goals are being met



Questions to Consider

ACCESS: Do services exist?

Location of Service Provision
(State Plan)


Services are available inside and outside the home in any setting.

§Are there limitations to the settings in which services are offered?
§Are services available inside the home only?
§Are services offered outside the home available at the worksite?
§Are services offered outside the home limited to medical appointments or non-employment activities only?

Location of Service Provision
(HCB Waivers)

Services are available throughout the state, both inside and outside the home, in any setting.

§Are services available statewide?
§What geographical limitations are there to the availability of services?
§Are there limitations to the settings in which services are offered?
§Are services available inside the home only?
§Are services offered outside the home available at the worksite?
§Are services offered outside the home limited to medical appointments or non-employment activities only?

Cost-sharing Mechanisms

Premiums, co-pays, and other cost-sharing obligations are affordable and equitable.

§Are cost sharing obligations a barrier to obtaining services?
§Have program staffs conducted a fiscal impact analysis of the impact of cost sharing obligations?
§Do program personnel and other decision makers understand the fiscal impact of the existing structure and proposed changes?

Program Entry

Entry points to access services are clear to consumers and other stakeholders.

§Do program staffs understand where, how and to whom PAS services are offered within the state?
§Are consumers aware of entry points for services?
§Are consumers provided information about services available to support employment?

ELIGIBILITY: Who qualifies for services and how is the determination made?

Population Served
(State Plan)

Services are provided to all individuals without regard to type or level of disability.

§What limitations are there to the populations served?
§Are services provided to all individuals without limitations and without regard to type or level of disability?
§Are services only provided to individuals with certain disabilities?
§Are services only provided to individuals requiring a certain level of care?

Eligibility Categories Covered (Waivers)

Waiver services are available to Medicaid Buy-In participants.

§Are waiver services automatically available to members of the Medicaid Buy-In (if the state has a Medicaid Buy-In)?

Functional Assessment

Functional assessments use objective, need-based criteria to identify PAS needs and intensity of services

§Does the assessment take into account work-related needs?
§Do limitations on the amount of services authorized based on ADL/IADL or Level of Care needs interfere with consumers’ employment goals?
§Does the assessment gather information useful in assessing different types of disabilities, including psychiatric disabilities?
§Is physician or nurse authorization required?
§Is the consumer, or his/her representative when desired, involved in the assessment and service planning process?
§Is the same agency or provider that conducts the assessment also responsible for providing services (raising conflict of interest issues)?
§Are there any barriers to the appeals process for consumers who want to challenge assessment results?

Program Entry

The eligibility process maximizes consumers’ access to services through the appropriate program.

§Are eligibility criteria coordinated across different programs in different administrative homes (VR, DHS, Medicaid, etc.)?
§Is there a simplified application process for PAS across agencies/programs?


ADEQUACY: Is the service available in ways that support workers employment goals?

Hours of Service Available (State Plan)

Services are available (without caps) for 40 hours/week or more.

§How many hours per month are services offered?
§How many hours per week are services offered?

Hours of Service Available (Waivers)

Services are available for 40 hours/week or more.

§How many hours per month are services offered?
§How many hours per week are services offered?

Sufficiency (Waivers)

Services are of adequate size.

§Are services adequate to cover individuals that need them?
Are eligible consumers on waiting lists?

Consumer Control

Consumers exercise the level of control they desire over their own services.

§Do consumers have the option of controlling his/her services?
§Do programs maximize the number of consumers directing their own services?
§Is technical assistance available to consumers as needed in hiring, managing, and training their assistants?
§Are state training or certification requirements consistent with consumers’ needs and choices?
§Have liability issues been addressed?

Personal Assistants Workforce

An adequate, qualified workforce of personal assistants is available and accessible.

§Are there enough personal assistants in the workforce to meet consumers’ needs?
§Do personal assistants have access to health care/benefits they need?
§Are personal assistants able to provide services at the workplace (logistics)?
§Do state training or certification requirements prevent qualified workers from entering the field?
§Are mechanisms in place, such as registries, to facilitate consumers’ access to qualified assistants?
§Are family members eligible to be paid assistants?

Employer Responsibilities

Employers comply with reasonable accommodation responsibilities.

§Are employers aware of reasonable accommodation guidelines?
§Are employers in compliance with reasonable accommodation guidelines?
§Has the state developed information detailing the differences and likenesses between publicly-funded/department-provided services and those defined by reasonable accommodation?

Disability Group

Services are appropriate to meet the needs of people with different disabilities.

§Has the state identified different service configurations for different eligibility groups?
§Do programs and services available reflect different needs of eligibility groups?

Program Services

Consumers receive the type and amount of services they need to meet their employment goals.

§Do the services provided meet the needs of workers with disabilities, including issues like transportation?
§Are available hours sufficient to meet the consumer’s work-related needs?


POLICY DEVELOPMENT: What is the process for developing policy?

Inclusive Process

Policy decisions are made with input from people with disabilities and their representatives.

§Does the program facilitate consumer and other key stakeholder involvement in the policymaking process?
§Are program staffs able to identify key issues of concern and challenges related to services for workers with disabilities?
§Does the program employ people with disabilities as advisors, consultants, program designers and trainers?
§Is preference given to people with disabilities and organizations of people with disabilities in awarding grants and contracts?
§Does the program conduct on-going meetings with people with disabilities and consumer groups?
§Are people with disabilities involved with program design, delivery, and continuous improvement?

Developing Partnerships

The program actively partners with other agencies and organizations to meet PAS goals.

§Have program staffs built relationships between agencies and organizations relevant to PAS issues for workers with disabilities? (e.g. Medicaid, VR, Independent Living Centers, Olmstead initiatives, Real Choices projects, New Freedom initiatives, etc.)
§Do agencies and organizations work together to coordinate and maximize PAS resources?


PERFORMANCE MONITORING & EVALUATION: What mechanisms are in place to access the need for, availability and quality of services?

Performance Monitoring System

Program administrators have a plan for gathering, analyzing and reporting information to monitor the availability and use of PAS.

§Has a comprehensive monitoring plan been developed?
§Have appropriate performance indicators been identified?
§Do the PAS performance benchmarks encompass all the dimensions of service provision, including access, availability, quality, and site of service?
§Are processes in place to provide on-going feedback to policy decision makers about access, availability and quality of PAS
§Do people with disabilities and other stakeholders participate in all aspects of the performance monitoring system?

Data, Data Systems

Program administrators have access to needed data to conduct an on-going assessment of the performance of PAS.

§Do available information systems have indicators that can measure and monitor work-related needs and service utilization in the workplace?
§Are data available to monitor access, availability and quality of personal assistance services?
§Is data capacity adequate?
§Are data sharing agreements in place to meet performance monitoring goals?
§Are data collection methods adequate and appropriate to assess consumer experience and satisfaction with PAS?

Consumer Satisfaction

Consumer feedback and satisfaction are an integral part of the performance monitoring system.

§Are processes in place to collect consumer experience and satisfaction with PAS services?
§Are data collection methods appropriate for monitoring consumer satisfaction with PAS over time?
§Are efforts to obtain consumer feedback about PAS reaching all consumers in the target population?
§Are consumer appeals regarding service denials monitored on an on-going basis?