Overview of the Intellectual Disability and Day Support
Overview of the Intellectual Disability and Day Support Waivers Provider Training Module 1 Division of Developmental Services Department of Behavioral Health and Developmental Services 2013
ID Waiver Provider Modules 1. Overview of the ID and DS Waivers 2. Becoming an ID Waiver Provider 3. Supporting People in the ID and DS Waivers 4. Introduction to Planning 5. Residential Services 6 PA, Respite and Companion - DBHDS-licensed 7. Employment and other Day Services (Agency Directed) 8. Crisis Stabilization and Supervision 9. Assistive Technology, Environmental Modifications and Transition Services 10. Skilled Nursing 11. Personal Emergency Response System 12. Consumer Directed Services and Services Facilitation 13. Therapeutic Consultation 14. Preauthorization and Reimbursement 15. Monitoring and Oversight 2
About the ID & DS Home & Community Based Waivers • States apply to CMS/Medicaid match • For individuals with intellectual disability • Pays for long-term in-home and community services • Waives certain Federal Medicaid requirements • Two of 6 Home & Community Based Waivers Virginia offers 3
Waiver Highlights • • • Began ID Waiver in 1991 Expanded services in 1994 Added Consumer-Directed Services in 2001 Added Day Support Waiver in 2005 Added MFP in 2008 Added PC Practices and the SIS in 2009 Just the Facts ID Waiver 4
Key Agencies Community Services Boards (CSBs) or Behavioral Health Authority (BHAs) Waiver Service Providers Department of Behavioral Health and Developmental Services (DBHDS) Department of Medical Assistance Services (DMAS) 5
The Big Picture CMS (Federal) Virginia General Assembly (State) DMAS DBHDS CSBs/BHAs (Local) CSB Support Coordinator Waiver Services Providers 6
Key Agencies Community Services Boards (CSBs) or Behavioral Health Authority (BHAs) • Single point of entry • Support Coordination 7
Key Agencies Waiver Service Providers • Community-based • Selected by the individual • Person-centered supports 8
Key Agencies Department of Behavioral Health & Developmental Services (DBHDS) • Pre-Authorization • Daily Operations • Technical Assistance • Licensing • Training • Human Rights 9
Key Agencies Department of Medical Assistance Services (DMAS) • Single state agency for Medicaid • Payment to providers • Service audits and fraud • Quality reviews • Appeals 10
Other Key Agencies • DSS • Public Schools • DARS 11
ID and DS Waiver Eligibility üDiagnostic üFunctional üFinancial 12
Diagnostic Eligibility 6 years or older: psychological evaluation stating diagnosis of intellectual disability Under age 6: psychological or standardized developmental evaluation stating diagnosis of intellectual disability or “at developmental risk” 13 Psychological Evaluation Guidance
Diagnostic Eligibility For children under age 6: At Risk or ID Developmental risk: “presence before, during or after birth of conditions related to the occurrence of a developmental disability and for which no specific developmental disability is identifiable through available diagnostic and evaluative criteria. ” ID as demonstrated by evidence of cognitive and adaptive delay OR presence of a syndrome typically associated with ID 14
Functional Eligibility CSB Support Coordinator (SC) confirms functional eligibility by completing: Level Of Functioning (LOF) Survey Within 45 days of date of request for services 15
Functional Eligibility LOF Survey • Must meet ICF-ID level of care in 2 or more categories • Completed within 6 months prior to start date • Completed annually • Applies to children under 6, too 16
Financial Eligibility DSS-determined • Different financial limits for Medicaid Waivers • Based upon the individual’s income only • Possible patient-pay obligation • 17
About the Waivers Waiver Slots • Each person requires a slot • Each CSB has an allocation of slots Just the Facts ID Waiver 18
About the Waivers Slots Awarded… ID Waiver Based on urgency • Annual allocations • Day Support Waiver Facts Day Support Waiver Based on date of need • Limited to 300 slots • 19
About the Waivers If no slot, name placed on a Statewide Waiting List (WL) • CSB submits to DBHDS • Urgent and Non-urgent • DBHDS maintains Statewide WL • All Urgent in state served first 20
About the Waivers ID Waiver Services 21
ID Waiver Services Residential -Congregate -In-Home Day Support Therapeutic Consultation P ersonal E mergency R esponse S ystem ID Waiver Overview Personal Assistance Respite Companion Pre. Vocational Assistive Technology Transition Services Supported Employment Environmental Modification Service Facilitation Skilled Nursing Crisis Stabilization Self Directed • Respite • Companion Personal Assistance • 22
About the Waivers DS Waiver Services 23
DS Waiver Services Residential -Congregate -In-Home Day Support Therapeutic Consultation P ersonal E mergency R esponse S ystem Personal Assistance Respite Companion Pre. Vocational Assistive Technology Transition Services Supported Employment Environmental Modification Service Facilitation Skilled Nursing Crisis Stabilization Consumer Directed • Respite • Companion • Personal Assistance 24
About the Waivers Individual selects. . . Agency-Directed Services or Self-Directed Services or A Combination of Both 25
About the Waivers • Allowable support activities • Criteria and limitations • Individual Support Plans 26
About the Waivers Team Approach • • • Individual Substitute Decision Maker Support Coordinator Waiver service providers Other providers, as needed Others, as requested by the individual Just the Facts ID Waiver 27
Based upon individual choice: s e c i Serv Staff People Outcomes s t r o p p Su Plac es s e i ivit t c A Provider s 28
Available Resources: Department of Behavioral Health and Developmental Services • Division of Developmental Services • Offices of Licensing and Human Rights http: //www. dbhds. virginia. gov 29
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