Allow members to select individuals of their choice to be PAID caregivers and not force them to outsource caregivers.  Approving service authorization entities must recognize that members have the right to choose their providers to be paid caregivers through their respective waiver benefits.

• CCC+: "The information shall be documented in the individual’s person-centered service plan that service delivery by the family member best meets the individual’s preferences and support needs, and that the individual’s choice of providers has been honored."

• DD: "This information shall be documented in the individual’s person-centered support plan that service delivery by the family member best meets the individual's preferences and support needs, and that the individual's choice of providers has been honored. Concerns that these intents will not or have not been fulfilled should be discussed with DBHDS staff."

Prevent service authorization entities from dispensing personal beliefs that members should not want to be a burden to their legally responsible caregivers.  Prevent service authorization entities from requiring members to continuously be looking for external caregivers during every reauthorization period to provide personal care services that put them at risk for abuse, neglect, or exploitation or inhibit their right to choose their paid provider regardless of live-in/legally responsible status.

Prevent service authorization entities from requiring a member to find a paid caregiver and then expecting that paid caregiver to become natural support of the member because they've been in the life of the member for X# of years.

Prevent service authorization entities from limiting plans of care (POC) based on who the paid caregiver is.  POC are created based on the level of care (LOC) needs of the client not on WHO the paid provider is. Even with the 40hr legally responsible individual (LRI) safeguard, if a client's LOC need is 56hrs, the POC must still be approved at 56hrs and then the LRI could only work 40, and the Employer of Record/Client would need to find additional support for the remainder of the POC.  Prevent Service Authorization entities from determining that just because a member is able to find an external candidate for x# of service hours of their plan of care that the members whole plan can be provided for by the external candidate.  Members often require multiple supportive efforts in their day(s) to meet their needs and members can direct what part of the POC they want/feel comfortable each paid caregiver completing for/with them.

Pay rate is too low for quality caregiving; increase the rates.