* the consumers' desire for CD-PAS and their varying abilities and desires for choice, autonomy, and control,
* states' duty to ensure that applicable federal and state tax and labor laws and regulations are followed and CD-PAS programs and funding are properly administered,
* states' desire not to be the employer of record of CD-PAS attendants, and
A number of states have found that they can contract with a new provider type, the ISO, to provide the range of fiscal, administrative, and support services to enable consumers of varying desires and abilities to effectively manage their CD-PAS. In the same way that consumers now buy tax, accounting, and payroll services from such organizations as H&R Block and Paychex, Inc., consumers with disabilities and chronic conditions in many state and Medic-aid-funded CD-PAS programs can now obtain the intermediary services they need to manage their own personal assistance services.
This is the most cost efficient method of administering a CD-PAS program and provides consumers with the highest level of consumer direction.
This ISO model may provide supportive services to consumers, such as skills and self-advocacy training, assistance with criminal background checks, development of emergency backup service plans, and maintenance of an attendant registry that assists consumers in performing the employment-related administrative and supervisory tasks associated with their CD-PAS. Supportive services may be provided by a distinct vendor or through another ISO model offering a range of services (e.g., Agency with Choice or Spectrum ISO).
The National Rehabilitation Hospital Research Center (NRH-RC), with a 3-year grant (1994-1997) from the National Institute on Disability and Rehabilitation Research (NIDRR), conducted a series of consumer surveys to determine the effect of Virginia's CD-PAS program on a wide variety of consumer outcomes.(1)
NRH-RC's evaluation of the Virginia CD-PAS program was designed as a quasi-experimental comparison of individuals with disabilities receiving consumer-directed PAS and a similar group of individuals on the waiting list to receive services.
Individuals meeting the eligibility criteria to receive consumer-directed PAS are removed from the waiting list and entered into the CD-PAS program based on certain risk-based criteria.
The NRH-RC evaluation team was interested in determining the relationship between the receipt of CD-PAS and a variety of outcomes categories through a comparison of the PAS and waiting list groups.
After controlling for the fact that the PAS group was more severely disabled and in poorer health than those on the waiting list, it was found that those receiving CD-PAS had significantly greater feelings of control over their lives than those not receiving consumer-directed services.
In the first round of the survey, 22 percent of CD-PAS recipients were employed, compared to 11 percent of those on the waiting list, despite the fact that those in the PAS group tended to have more severe disabilities and to be in poorer health.