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Consumer Directed Option ( CDO) Survey
1. Survey for Kentucky Residents regarding Waiver Services and Consumer Directed Options
1
. What Waiver Service do you receive or have applied for recently?
What Waiver Service do you receive or have applied for recently?
a. Home Community Based Services
b. Supports for Community Living
c. Acquired Brain Injury
d. Michelle P.
2
. What services are you using or plan to use under Consumer Directed Options?
What services are you using or plan to use under Consumer Directed Options?
a. Assistance with meals, laundry, household care
b. Daily living – bathing, eating, dressing, personal
c. Money Management
d. Medication Management
e. Respite
f. Leisure/Recreation/Social community activities
g. Other:
Other (please specify)
3
. Have you received or plan to receive any goods or services through the waiver?
Have you received or plan to receive any goods or services through the waiver?
a. Yes
b. No
c. If so, what do you receive or plan to receive:
Other (please specify)
4
. Have you chosen community day support services through CDO?
Have you chosen community day support services through CDO?
a. Yes
b. No
c. If not, why did you choose not to direct these services?
Other (please specify)
5
. Do you know what agency financially manages your budget – (support spending plan, consumer funds)?
Do you know what agency financially manages your budget – (support spending plan, consumer funds)?
a. Yes
b. No
c. If not, who pays your employees?
Other (please specify)
6
. Have you had any problems with getting people paid for services provided to you or the person you represent since beginning CDO?
Have you had any problems with getting people paid for services provided to you or the person you represent since beginning CDO?
a. Yes
b. No
c. If so, what problems have you experienced?
Other (please specify)
7
. How often do you receive a copy of your budget including your current balances?
How often do you receive a copy of your budget including your current balances?
a. Every two weeks
b. Monthly
c. Every Three Months
d. Never
e. Other:
Other (please specify)
8
. When planning your budget, how was the amount to be paid for services decided?
When planning your budget, how was the amount to be paid for services decided?
a. I planned the amount.
b. Support Broker determined amount to pay
c. No one discussed amounts – was told how much would be allowed.
d. Other:
Other (please specify)
9
. Do you know the Department for Medicaid’s allowed reimbursement amount for each service you receive (What is allowed to be paid under Medicaid for each service?)
Do you know the Department for Medicaid’s allowed reimbursement amount for each service you receive (What is allowed to be paid under Medicaid for each service?)
a. Yes
b. No
c. If yes, how did you learn of this information:
Other (please specify)
10
. If a plan of care is not followed what may happen?
If a plan of care is not followed what may happen?
a. The consumer or representative can explain why plan is not being followed.
b. The consumer or representative can change plans anytime they want without changing the plan of care.
c. The consumer may be terminated from CDO services.
11
. The budget is based on the plan of care for a 12 month period of time. Have you been involved with writing your plan of care and budget?
The budget is based on the plan of care for a 12 month period of time. Have you been involved with writing your plan of care and budget?
a. Yes
b. No
c. If not, who decided your plan of care and/or budget:
Other (please specify)
12
. From the first time you met your Support Broker until you began receiving services, how long did it take?
From the first time you met your Support Broker until you began receiving services, how long did it take?
a. 30 days
b. 45 days
c. 60 days
d. 90 days
e. more than 90 days
f. Still pending since:
Other (please specify)
13
. Who do you plan to hire or have already hired to provide services? Check all that apply
Who do you plan to hire or have already hired to provide services? Check all that apply
a. Parent(s)
b. Spouse
c. Friend
d. Family Member
e. Other Relative
f. Employee of a provider agency
g. Other Person
14
. How many hours a week are you approved/or use CDO services?
How many hours a week are you approved/or use CDO services?
a. 10 to 20 hours
b. 21 to 30 hours
c. 31 to 40 hours
d. Not sure how many hours
e. More than 40 hours.
15
. Your Support Broker is to supply any assistance with CDO or blended services. How often is your Support Broker available to you?
Your Support Broker is to supply any assistance with CDO or blended services. How often is your Support Broker available to you?
a. twenty-four hours a day, seven days a week
b. Monday-Friday only
c. Monthly Face to Face Meetings only
d. Only during business hours
e. Other:
Other (please specify)
16
. Do you receive blended services or those through traditional services and those you direct through CDO?
Do you receive blended services or those through traditional services and those you direct through CDO?
a. Yes
b. No
c. If so, what other services do you receive through a waiver?
Other (please specify)
17
. Your staff is required to complete training on the reporting of abuse, neglect or exploitation and on your specific needs, who provided this training?
Your staff is required to complete training on the reporting of abuse, neglect or exploitation and on your specific needs, who provided this training?
a. Support Broker
b. Another employee of a State Agency
c. My staff has never received this training
d. Other
Other (please specify)
18
. If training occurred, where was training provided?
If training occurred, where was training provided?
a. At home
b. At local Comprehensive Care Center
c. Other Location:
Other (please specify)
19
. Consumer Directed Option is available to all persons receiving Home Community Based Services, Acquired Brain Injury, Supports for Community Living or Michelle P. Have you been told that you could not CDO your services? If so, who denied you this option?
Consumer Directed Option is available to all persons receiving Home Community Based Services, Acquired Brain Injury, Supports for Community Living or Michelle P. Have you been told that you could not CDO your services? If so, who denied you this option?
a. Area Aging Agency
b. Support Coordinator
c. Support Broker
d. Program Director
e. Other:
Other (please specify)
20
. Do you have a Person Centered Plan that has been developed by a team that you and your family selected?
Do you have a Person Centered Plan that has been developed by a team that you and your family selected?
a. Yes
b. No
c. If not, are you interested in a Person Centered Plan?
Other (please specify)
21
. From the day you applied for Michelle P., how many days passed before the Support Broker assessed your needs.
From the day you applied for Michelle P., how many days passed before the Support Broker assessed your needs.
a. 1 month
b. 2 months
c. 3 months
d. 4 months
e. more than 120 days or 4 months
22
. FOR MICHELLE P. WAIVER CLIENTS ONLY (Questions 22-25)
The following items: MAP 10, MAP 109, MAP 351 must be submitted to the Department to determine eligibility or authorization for services. Clients are to be assessed within sixty (60 days) of date of prior authorization.
After your assessment, how many days passed before the Support Broker worked with you to develop your Person Centered Plan of Care?
FOR MICHELLE P. WAIVER CLIENTS ONLY (Questions 22-25) The following items: MAP 10, MAP 109, MAP 351 must be submitted to the Department to determine eligibility or authorization for services. Clients are to be assessed within sixty (60 days) of date of prior authorization. After your assessment, how many days passed before the Support Broker worked with you to develop your Person Centered Plan of Care?
a. 15 days
b. 30 days
c. 45 days
d. More than 45 days
23
. When was the budget – support spending plan completed for your plan of care.
When was the budget – support spending plan completed for your plan of care.
a. At the same time the plan was completed.
b. After the plan of care was completed and on a different day.
c. Not sure, was not involved in planning or writing the budget.
d. Other:
Other (please specify)
24
. After plan of care was written, how many days passed before your employees began working for you.
After plan of care was written, how many days passed before your employees began working for you.
a. within one week
b. within two weeks
c. within three weeks
d. within one month
e. more than one month
f. still waiting for approval since:
Other (please specify)
25
. Paperwork is required. Do you have any problems completing necessary paperwork to apply for services or to report the delivery of services to your Support Broker?
Paperwork is required. Do you have any problems completing necessary paperwork to apply for services or to report the delivery of services to your Support Broker?
a. No problems – no difficulty
b. Some problems – slight difficulty
c. Many Problems – More difficulty
d. Numerous Problems – Much Difficulty
e. Too Hard, Too Much, Too Confusing – Extreme Difficulty
26
. Would you recommend Waiver Services or Consumer Directed Options to others?
Would you recommend Waiver Services or Consumer Directed Options to others?
a. Yes
b. No
c. Why or Why Not?
Other (please specify)
27
. Things you would like to see changed concerning Consumer Directed Options.
Things you would like to see changed concerning Consumer Directed Options.
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