Participant-Directed Goods and Services, often called PDGS, is a service available through the Level One and SELF waivers that promotes independence and inclusion. It can help a person with services, equipment, or supplies they need when other programs or resources are not available.
When to Apply this Service
The person’s service and support administrator, or SSA, will assess them for a need for Participant-Directed Goods and Services. Service planning should include a conversation about all of the resources available to meet the needs identified in the assessment and what the person wants to achieve. The SSA can add PDGS to the individual service plan when other resources cannot meet the person’s needs or support what they want to achieve.
Requirements of PDGS
Because every person has different needs and different resources available, there is no list of exactly what PDGS will cover. Instead, the service, equipment, or supplies must
- address a need clearly identified through an assessment,
- be something that helps the person directly and is not something purchased for people who support them, and
- be something the person needs to stay healthy and safe and cannot buy for themselves.
PDGS is required to do at least one of the following:
- Decrease the need for other Medicaid home and community-based services;
- Advance participation in the community;
- Increase safety at home;
- Increase independence;
- Improve cognitive, social, or behavioral functions; or
- Assist to develop or maintain personal, social, or physical skills
PDGS cannot be used for “specialized services”. Programs and services that are designed and operated to serve primarily a person with a developmental disability are considered “specialized services”.
Certain services and items are not allowed to use PDGS funding. They include
- Experimental treatments, including items considered by the federal food and drug administration as experimental or investigational or not approved to treat a specific condition.
- Pools, spas, or saunas
- Food, tobacco, or alcohol
- Internet service
- Items of General Utility
- Home modifications of general utility or add to the total square footage of the home
- Items that are illegal or otherwise prohibited through federal or state regulations
- Items used solely for entertainment or recreational purposes
- Duplicate items that the person already has available to them
- Repair or replacement of previously approved equipment or supplies damaged because of misuse, abuse, or negligence
Providing this Service
County Board Review of PDGS Requests
County boards complete a local review for PDGS purchases totaling $500 or more.
Department Review of PDGS Requests
DODD review is required for the following
- Playsets and equipment typically used for recreation or entertainment requested for the therapeutic or habilitative benefit of the person
- Home modifications over $10,000
- Items available through other waiver services, through Medicaid state plan and Ohio’s Early and Periodic Screening, Diagnostic & Treatment (EPSDT) program/Healthchek, or as educational benefits provided under the Individuals with Disabilities Education Act (IDEA)
Training Requirements for this Service
OAC 5123:2-9-45 (C) (1) states that OAC 5123:2-2-01, the Provider Certification rule that sets standards for provider training and certification, does not apply to providers of participant-directed goods and services.
Billing and Payment Information
Provision of participant-directed goods and services shall be coordinated by a financial management services entity.
Providers of participant-directed goods and services shall be paid no more than their usual and customary charge for the services, equipment, or supplies provided.
Rates and limits for PDGS are contained in the rule's appendix. Under the Level One waiver, PDGS cannot exceed $2,500 per waiver eligibility span.