LOC Process August 2016 HCBS Level of Care

LOC Process August 2016

HCBS Level of Care Process: 1) Funding Request DHS-DD-800 --Updated form (8/16)- • Note expected start date • SSI status* • Current funding source is a dropdown box now • Identify types of services a person may need • Submit form to assigned Program Specialist

HCBS Level of Care Process: *SSI Status: • If not receiving or denied, the Program Specialist will need to send to DICT for approval. This could take a couple weeks. • Remember the last date of any of the signed required documents is the start date, this if DICT approval is required, the DICT date is the earliest date that can count towards a person's start date. EXAMPLE: If a person started services 7/2/16 and the LOC is submitted 7/15/16 and then needs to go through DICT and DICT makes a determination 7/24/16, the earliest that HCBS funding can be provided for the participant is 7/24/16.

Documents Required for LOC: 1) Current Psychological of Qualifying Psycho-educational Evaluation (Documentation shows diagnosis, disability prior to 22, IQ score or related condition, and adaptive behavior) 2) ICAP Eligibility (DHS-DD-ICAP) 3) ICAP Booklet (all sections marked and legible) 4) ICAP Compuscore Sheet 5) Significant Change Request (SCR) as provisional plan of care (DHS-DD 810) 6) HCBS Waiver Rights (DHS-DD-717) 7) HCBS Eligibility Determination Form (DHS-DD-716) All documents must be dated prior to or on the start date of Waiver services. A transfer from provider to provider requires: • Funding Request • SCR(s) • ICAP

Effective Date: • Again, the documents required for LOC must have dates prior to or on the proposed effective date of service for a participant. • If any of the dates are beyond the start date, the date beyond will become the start date for services. • EXAMPLE: DHS-DD-717 wasn't completed until 7/11/16 but a participant started services on 7/4/16, the start date for funding for services will be 7/11/16. Any funding for services provided 7/4 -7/10 will not be paid out. • LOC's cannot be approved until after a participant is receiving a waiver service. Program Specialists can review documentation ahead of that time and provide their impressions of approval, but it cannot be finalized until is goes through the process by the Waiver Manager. • After green light from Waiver Manager, packet goes to DSS and the Benefits Specialist will issue the approval form. • The application to DSS has a 45 day timeframe which can be extended by DSS in some circumstances. It is suggested to submit the 265 at the same time as the LOC to DDD, not the funding request.

ERT: • Eligibility Review Team (ERT): At times the Program Specialist alone is unable to make a determination of eligibility, therefore, the PS may request ERT review the LOC submitted. • The ERT will meet and review, possibly asking for additional information. • Note that this process can take a couple of weeks or longer depending on whether additional information is requested and needs to be reviewed again. • There is no set reoccurring meeting of ERT; sessions are called when LOCs come in. • The ERT approval date will not affect the date of funding for services like the DICT date does, however, if determined participant is not eligible funding will not be able to be provided.

CTS: • Community Training Services (CTS): A General Funds source of funding for services for participant. Same eligibility requirements but as it is state funds there is a bit more flexibility with the usage of these funds. • No Funding Request is necessary for CTS applicants. • Documents Required: • DHS-DD-700 (Financial Eligibility) –Check FY on this document. • DHS-DD-810 (Significant Change Request) functioning as provisional plan of care • Copy of Psychological Evaluation with same criteria as HCBS • DHS-DD-ICAP, signed, dated, and legible • ICAP Booklet • ICAP Compuscore

CTS: • No rate is generated for the person like if a new participant on HCBS. • No approval letter is sent from DSS or DDD. • If moving from HCBS to CTS discharge process must be completed. • Even if a participant had been on HCBS all the above must be sent in.

Questions? Ashley Schlichenmayer-Okroi, Program Specialist II Ashley. Schlichenmayer. Okroi@state. sd. us