Supported Decision-Making: A Tool for CMS HCBS Settings Rule Compliance



Jim is 26-year old male with a cognitive disability. He works part-time at a factory and currently lives at home with his parents. However, Jim wants to move into an apartment of his own. His family has concerns about Jim’s ability to make good decisions when he is not living at home and these concerns have prevented Jim from moving out.


Jim and his support team will face more decisions like these as he strives to become more independent. These are a part of daily life and being able to make these types of choices and decisions is key to self-determination. Federal policy makers recognize the importance of a person with IDD being able to make decisions and included a mandate to provide choice in the CMS HCBS Rule. However, many individuals with IDD need support to make decisions. They often have no or limited experience with making decisions, may have a history of making poor decisions, have difficulty understanding the consequences of some decisions, and others may want to make decisions that are not in agreement with family or support team members. Unfortunately, there is not a “one-size fits all” approach to supporting an individual with an intellectual disability to have choice and make decisions, so providers often struggle with how to comply with the CMS HCBS Rule and best provide the needed support and compliance. The good news is that with thoughtful consideration, planning, and using strategies such as a supported-decision making plan, providers can successfully support individuals to have choice, make decisions and live as independently as possible.


Supported Decision-Making is a model for supporting individuals with IDD to make their own decisions that recognizes we all depend on others for help and guidance when needed to make major life decisions.


The Supported Decision-Making model is a four-step model:

  • Step One: The individual chooses who will be involved in support him or her.

  • Step Two: The individual and supporters talk about what types of decisions the individual will need support for and what the support will be. The individual can choose to have support for some decisions and not others.

  • Step Three: The individuals and supporters create a document that outlines how the individual will be supported. This is the Supported Decision -Making agreement.

  • Step Four: The individual and supporters sign the document which can be revised in the future when needed.


To learn more go to http://www.supporteddecisionmaking.org/

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