Participant-Directed Goods and Services is often called PDGS for short. It is a service available through the SELF Waiver that can help a person with services, equipment, or supplies they need when other programs or resources are not available.
When to Apply this Service
Participant-Directed Goods and Services should be addressed in a person's individual service plan when there are no other resources available to meet a need identified in the assessment.
Identifying the Need
During the assessment, a service and support administrator, or SSA, will talk about what the person does during a typical day and areas in which they might need help. SSAs will also ask them about things, such as
- what is working or not working with the their current services,
- what has changed,
- risks to health and safety,
- and the kind of job they have or would like to have.
The results of the assessment will help the person and their SSA to plan services, which are documented in the individual service plan. Service planning should include a conversation about all of the resources available to meet the needs identified in the assessment and the desired outcomes of each service.
Identify Existing Supports
The SSA will help to coordinate all available resources to meet assessed needs, including
- unpaid supports, like family, friends, or neighbors,
- technology that can make tasks easier at home or work,
- services available through private insurance or Ohio Medicaid State Plan benefits,
- local services through a county board of developmental disabilities,
- and services through the SELF waiver.
The conversation should help to establish when PDGS is the only option available to meet a need identified in the person’s assessment.
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 be
- something the person needs to stay healthy and safe,
- be the least expensive item or service that addresses the need,
- and be something that helps the person directly and is not something purchased for people who support them.
It must do at least one of these for the person
- decrease their need for a different service of the SELF Waiver,
- help them to be more involved in their community or family,
- help them to be safer in their home,
- offer them more independence,
- or help them improve personal, social, or physical skills.
Certain services and items are not allowed to use PDGS funding. They include
- experimental treatments,
- items used solely for entertainment or recreation,
- tobacco products or alcohol,
- illegal items,
- duplicate items that are things the person already has available to them,
- home modifications that are not related to an assessed, disability-specific need,
- the repair or replacement of items that were previously approved but have been damaged as a result of abuse, misuse, or negligence,
- items considered by the U.S. Food and Drug Administration as experimental, investigational, or not having been approved to treat a specific condition,
- and specialized services or services designed specifically for people with disabilities that would typically be offered by certified providers.
Example of Service Planning for PDGS
Start with a need identified in the assessment
Include specific information in the service plan about what would help to meet this need.
Kevin needs a variety of sensory activities throughout the day to help him stay calm and relaxed.
Identify existing support
How is this need being addressed now?
To meet this need, Kevin currently
- takes walks every day with his family,
- takes physical therapy twice a week,
- takes gym at school three days a week,
- goes swimming with his dad once a week,
- engages in brushing and joint compression
- has lotion applied three times a day,
- and uses a squishy ball and material swatches at home and school to carry and touch as needed.
Is there a need for more support?
What has been done to try to address the need?
Could additional services in the SELF Waiver help meet the need?
Consider training or education opportunities available through participant or family stability that can help Kevin’s family incorporate a variety of stimulating activities throughout his daily routine.
Kevin still needs more support to get through his day.
Kevin’s team has tried rotating his existing items so they remain effective.
Weighted vests and blankets do not seem effective for him.
Kevin will go swimming a second time each week with a neighbor’s family.
What additional support should be included in the plan?
At school, Kevin finds being in a dark room and watching moving lights very calming.
The team agrees that using a variety of colorful moving lights in Kevin’s room at home could meet his need for additional support and sensory stimulation, as well as be a strategy for times when he feels anxious at home.
What additional services or equipment would help address this need?
The team found three lights that can be rotated in and out of his room to give him a variety of visual stimulation.
Those include a $15 lava lamp, a $43.50 night light projection lamp, and a $34.22 ocean light projector with speakers.
How will this service be provided?
PDGS can be added to a service plan when it is the only resource available to meet an assessed need.
Before including it in the plan, consider all other resources available.
Before listing PDGS as the funding source for the lights in Kevin’s plan, his team considers all other available resources.
When it becomes clear that PDGS is the only option for meeting Kevin’s need, PDGS is listed as the funding source for the lights addressed in Kevin’s plan.
Remember, service, equipment, or supplies through PDGS must
The team found three lights for Kevin that will offer a strategy for his anxiety and additional sensory stimulation.
A $15.00 lava lamp, a $43.50 night light projection lamp, and $34.22 ocean light projector with speakers.
These items were chosen in lieu of a $329 lighted bubble tower, a $70 jelly ball lamp, and $229 magical light display available through a disability-specific catalog.
It also must do at least one of the following:
The lights provide Kevin with an additional strategy for coping with anxiety, which will make things easier at home when interacting with his family.
They will also help to relax him so he can get to sleep at night and provide a variety of sensory stimulation which will help Kevin to have a better day at school and at home.
Providing this Service
Financial Management Services
Financial management services are often called FMS for short. FMS are provided to SELF Waiver participants. FMS can be used with budget authority to help SELF Waiver participants track spending and manage employee payroll responsibilities.
When using PDGS, the agency providing FMS makes approved purchases on behalf of the SELF Waiver participant because money for approved purchases cannot be given directly to the waiver participant.
It is important for people interested in using PDGS to know that the process of authorizing goods and services takes time and includes several steps, such as
- a team conversation,
- a county board of developmental disabilities review,
- and a review by the department in some cases before the purchase can be made.
For this reason, it is important for the team to identify needs that require PDGS as soon as possible and not to wait until the end of the 12-month waiver span to submit a new request. It is possible that a request submitted at the end of the span may be authorized in the new span.
County Board Review of PDGS Requests
Before authorizing PDGS services, equipment, or supplies in a service plan or before submitting a request to the FMS entity, the SSA must ensure the services, equipment, or supplies
- meet PDGS requirements outlined in rule,
- are a medical necessity supported by the results of the person’s assessment,
- and have documentation available to demonstrate no other source is available to meet this need.
More information about documentation can be found in OAC 5123-9-45.
Each county board of developmental disabilities establishes an internal process for reviewing all PDGS requests to ensure consistent, uniform application of the rule in all circumstances.
The review process will verify all required elements of the rule have been met prior to submitting the request to the FMS to be processed.
All SELF Waiver participants should receive information about the review process when they enroll in the waiver and upon requesting PDGS. The notice must include
- a clear statement that PDGS is a Medicaid-funded service and as such is required to comply with all basic Medicaid requirements, including the need to demonstrate the requested item is the least costly alternative available to meet the assessed need and that the service is not available through other resources including the SELF Waiver or Ohio Medicaid State Plan,
- the time limit that the county board has established for completing a review of the PDGS request, which cannot exceed 90 days,
- and information about the ability to request a state hearing if a request is denied.
Department Review of PDGS Requests
Requests for the items listed below must be reviewed by DODD before the financial management services entity can make the purchase.
- Pools, spas, trampolines, and playsets
- Home modifications exceeding $10,000
- Services that may duplicate other services available through the SELF Waiver; Remote Support; Community Respite; Ohio's Early and Periodic Screening, Diagnostic and Treatment (EPSDT), better known as Healthchek; other Ohio Medicaid State Plan services; or Ohio Early Intervention.
Additional details about the request for PDGS may be requested from the county board, including
- assessments conducted prior to submission of the PDGS request that reflect the need for the proposed purchase,
- a copy of the individual service plan, or ISP, that includes references to how the requested item will address this need,
- or evidence of other alternatives, regardless of funding source, considered by the team.
A determination will be issued by DODD within 30 calendar days of receiving all requested information. If upon review, a decision is made that a particular item does not meet criteria for authorization under OAC 5123:2-9-45 or 5160-1-01 regarding Medicaid Medical Necessity, DODD will deny the request and issue due process, informing the person of their right to appeal the decision and to request a hearing.
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.