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Overview of the Intellectual Disability and Day Support Waivers

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

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Overview of the Intellectual Disability and Day Support Waivers

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  1. 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

  2. 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

  3. 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

  4. 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

  5. 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)

  6. The Big Picture CMS (Federal) Virginia General Assembly (State) DMAS DBHDS CSBs/BHAs (Local) CSB Support Coordinator Waiver Services Providers

  7. Key Agencies • Single point of entry • Support Coordination Community Services Boards (CSBs) or Behavioral Health Authority (BHAs)

  8. Key Agencies • Community-based • Selected by the individual • Person-centered supports Waiver Service Providers

  9. Key Agencies Department of Behavioral Health & Developmental Services (DBHDS) • Daily Operations • Licensing • Human Rights • Pre-Authorization • Technical Assistance • Training

  10. Key Agencies • Single state agency for Medicaid • Payment to providers • Service audits and fraud • Quality reviews • Appeals Department of Medical Assistance Services (DMAS)

  11. Other Key Agencies • DSS • Public Schools • DARS

  12. ID and DS Waiver Eligibility • Diagnostic • Functional • Financial

  13. 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” Psychological Evaluation Guidance

  14. Diagnostic Eligibility For children under age 6: At Risk or ID ID as demonstrated by evidence of cognitive and adaptive delay OR presence of a syndrome typically associated with 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.”

  15. 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

  16. 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

  17. Financial Eligibility • DSS-determined • Different financial limits for Medicaid Waivers • Based upon the individual’s income only • Possible patient-pay obligation

  18. About the Waivers • Each person requires a slot • Each CSB has an allocation of slots Waiver Slots Just the Facts ID Waiver

  19. About the Waivers Slots Awarded… ID Waiver Day Support Waiver • Based on urgency • Annual allocations • Based on date of need • Limited to 300 slots Day Support Waiver Facts

  20. About the Waivers • CSB submits to DBHDS • Urgent and Non-urgent • DBHDS maintains Statewide WL • All Urgent in state served first If no slot, name placed on a Statewide Waiting List (WL)

  21. About the Waivers ID Waiver Services

  22. ID Waiver Services Consumer Directed ID Waiver Overview

  23. About the Waivers DS Waiver Services

  24. DS Waiver Services Consumer Directed

  25. About the Waivers • Individual selects . . . • Agency-Directed Services or • Consumer-Directed Services or • A Combination of Both

  26. About the Waivers • Allowable support activities • Criteria and limitations • Individual Support Plans

  27. About the Waivers Team Approach • Individual • Family/Legal guardian/AR • Support Coordinator • Waiver service providers • Other providers, as needed • Others, as requested by the individual Just the Facts ID Waiver

  28. People Based upon individual choice: Services Outcomes Activities Staff Supports Places Providers

  29. Available Resources:

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