Home and Community Based Children’s Habilitation ... Waiver Training for...tension including WATSU • Must be a treatment strategy for an identified medical or behavior need and

Home and Community Based Children’s Habilitation Residential

Program (HCBS-CHRP) Waiver

Training for Service Agencies

Presented by Michele Craig and Nancy Harris

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July 15, 2019

Our Mission

Improving health care access and outcomes for the people we serve

while demonstrating sound stewardship of financial

resources

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• Background

• Eligibility

• HCBS-CHRP Services & ProviderTypes

• Regulations

• Case Management

• Coordination with Other Systems

• Provider Enrollment & Billing

• Frequently Asked Questions

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Agenda

Current state through June 30, 2019

• Eligibility limited to childrenwith intellectual anddevelopmental disabilities(I/DD) and complex supportneeds involved in child welfare

• Waiver case management by theCounty Departments of HumanServices

• Waiver administered by theColorado Department of HumanService (CDHS)

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BackgroundEffective July 1, 2019

• Eligibility expanded toinclude children with I/DDwith complex support needsnot in child welfare

• Waiver case management byCase Management Agencies-Community Centered Boards(CCB)

• Waiver administered byHealth Care Policy andFinancing (HCPF)

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BackgroundEffective July 1, 2019 (cont’d)

Addition of two new waiver services designed to support the child/youth to remain in the family home or transition back to the family home from out of home placement:

Intensive Support

And

Transition Support

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Moving Forward

Children accessing

CHRP who are in child-welfare

Children accessing CHRP who are NOT in

child-welfare

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Eligibility

Children and youth ages birth (0) through twenty (20):

• Determined to meet developmental disability criteria

• Meets Intermediate Care Facility for Individuals withIntellectual Disabilities (ICF/IID)(as defined in 42 CFR §440.150)

• Has extraordinary needs that put them at risk of, or in need of,out of home placement

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Eligibility

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Eligibility

Extraordinary needs:

Complex Behavior Supports: Needs that occur related to a diagnosis by a licensed physician, psychiatrist, or psychologist that includes one or more substantial disorders of the cognitive, volitional or emotional process that grossly impairs judgment or capacity to recognize reality or to control behavior.

Complex Medical Supports: Needs that occur as a result of a chronic medical condition as diagnosed by a licensed physician that has lasted or is expected to last twelve (12) months, requires skilled care, and that without intervention may result in a severely life altering condition.

• Parent’s income not consideredfor Medicaid financial eligibility

• Social Security Income (SSI) notrequired

• Need SSA disabilitydetermination or Arborapplication

• If child/youth is receivingHabilitation services, they willneed an income source for roomand board and likely need toapply for SSI financial eligibility

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Financial Eligibility

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HCBS-CHRP Services

• Habilitation

• Respite

• Supported CommunityConnections

• Massage Therapy

• Hippotherapy

• Movement Therapy

• Intensive Support

• Transition Support

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Services

• Twenty-four (24) hour residentialservice

• Independent living training

• Self-advocacy training

• Cognitive services

• Emergency assistance

• Community access supports

• Follow-up supports for counseling,behavior, or other therapeuticinterventions

• Medical and health care supports

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Habilitation

• Child Placement Agency (CPA)

Certified Foster Care Home (serviceagency must provide the case managera copy of the certification)

Group Home

• Residential Child Care Facility (RCCF)

• Kinship Home

• Medicaid Enrolled Provider- must bein a Foster Care Home certified by aCounty Department of HumanServices and approved to provideResidential Habilitation for the HCBS-Developmental Disabilities waiver

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Habilitation-Provider Types

Please see the full text of the waiver for provider qualifications: www.colorado.gov/hcpf/childrens-habilitation-residential-program-waiver-chrp

https://www.colorado.gov/pacific/hcpf/childrens-habilitation-residential-program-waiver-chrp

CHRP Participant Child Welfare- not CHRP Total Children

1 2 3

2 0 2

3 0 3*

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Capacity Limits- Foster Care Home

CHRP Participant Adult DD/SLS waiver participant

Total Children and Adults

1 2 3

2 1 3

*Requires Approval by CDHS/HCPF

CHRP Participant Child Welfare Participant, Non-CHRP

Total Children

1 8 9

2 5 7

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Capacity Limits- Group Home

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Reimbursement RatesFoster Care Home

Support Level Rate (Per Diem)

Foster Home Level 1 $56.67






Group Home

Support Level Rate (Per Diem)

Group Home Level 1 $83.09






www.colorado.gov/hcpf/provider-rates-fee-schedule

https://www.colorado.gov/hcpf/provider-rates-fee-schedule

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ICAP Assessment• Inventory for Child and Agency Planning (ICAP)

• Determines Support Need Level

• Respondents can be those that have known the individual for at least 3 months and sees them on a daily basis

• ICAP should be reviewed annually

• A new ICAP may be completed without requesting permission from HCPF

• Support Level Review process Operational Memo 19-026:www.colorado.gov/hcpf/2019-memo-series-communications

https://www.colorado.gov/pacific/hcpf/2019-memo-series-communications

• For the short-term relief of theprimary caregiver

• May be provided in a family home,the community, a Foster CareHome, a group home, and/or aRCCF

• Service Limit: Not more thanseven (7) consecutive days permonth, not to exceed twenty-eight(28) days per calendar year*

• Respite may not be billed on thesame day as Habilitation services

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Respite

• Child Placement Agency

Foster Care Home

Group Home

• Foster Home

• Medicaid Enrolled Provider-approved to provide Respitein the HCBS- Children’sExtensive Support (CES)waiver

• RCCF

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Respite-Provider TypesPlease see the full text of the waiver for provider qualifications: www.colorado.gov/hcpf/childrens-habilitation-residential-program-waiver-chrp

Daily rate at 10 Hours $213.72

15 Minute Unit $5.40




• One-on-one supports todeliver instruction fordocumented severe behaviorproblems exhibited by thechild or youth in thecommunity

• Service must be provided in asetting in the communitywhere the child or youthinteracts with individualswithout disabilities

• Service is limited to five (5)hours per week

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Supported Community Connections


• Medicaid Enrolled Provider-approved to provideCommunity Connector inthe HCBS-CES waiver

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Supported Community Connections-Provider Types


15 minute unit $9.85




• The physical manipulation ofmuscles to ease musclecontractures, spasms, extension,muscle relaxation, and muscletension including WATSU

• Must be a treatment strategy foran identified medical or behaviorneed and recommended orprescribed by a therapist orphysician

• Recommending therapist orphysician must monitor theprogress and effectiveness atleast quarterly

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Massage Therapy

Provider Type: Medicaid Enrolled Provider.


15 minute unit $19.12




• Therapeutic treatment strategythat uses the movement of a horseto assist in thedevelopment/enhancement ofskills including gross motor,sensory integration, attention,cognitive, social, behavioral, andcommunication skills

• Must be a treatment strategy foran identified medical or behaviorneed and recommended orprescribed by a therapist orphysician

• Recommending therapist orphysician must monitor theprogress and effectiveness at leastquarterly

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Hippotherapy



15 minute unit

$21.44 Individual

$9.20 Group




• The use of music and/or dance as atherapeutic tool for the habilitation,rehabilitation, and maintenance ofbehavioral, developmental,physical, social, communication,pain management, cognition, andgross motor skills

• Must be a treatment strategy for anidentified medical or behavior needand recommended or prescribed bya therapist or physician

• Recommending therapist orphysician must monitor the progressand effectiveness at least quarterly

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Movement Therapy



15 minute unit

$16.26 Bachelors

$23.59 Masters




• Aligns strategies, interventions,and supports for the child oryouth, and their family to preventthe need for out of homeplacement

• Utilized to maintain stabilization,prevent Crisis situations, and/orde-escalation of Crisis situations

Three Service Components:

• Wraparound Facilitator Plan

• Wraparound Facilitator Monitoring

• In-Home Services

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Intensive Support

New

“Crisis” defined as an event, series of events, and/or state of

being greater than normal severity for the client and/or

family that becomes outside the manageable range for the child or youth and/or their caregivers

and poses a danger to self, family, and/or the community.

Crisis may be self-identified, family identified, and/or

identified by an outside party.

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Crisis

Wraparound is an individualized approach to help children with

complex needs. Service providers, support team

members, the child and their family and/or caregiver(s) all work together to help achieve the family’s goals. The team

respects the goals and strengths of the family to help build

confidence and successes for the child and the family at home, in school and in the community.

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Wraparound

“Wraparound Plan”: A single plan that incorporates all

relevant supports, services, strategies, and goals from other service/treatment plans in place

and supports a child or youth and his or her family, including a

plan to maintain stabilization, prevent Crisis, and or for de-escalation of Crisis Situations.

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Wraparound Plan

Includes implementation of therapeutic and/or behavioral

support plans, building life skills, providing guidance to the

child or youth with self-care, learning self-advocacy, and

protective oversight.

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In-Home Support Component

• Aligns strategies, interventions,and supports for the child oryouth, and their family when achild or youth transitions to thefamily home from out of homeplacement

Three Service Components:

• Wraparound Facilitator Plan

• Wraparound Facilitator Monitoring

• In-Home Services

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Transition Support

New


• Medicaid Enrolled Provider

• Residential Child Care Facility

• Specific provider qualificationsfor the Wraparound Facilitatorcertification and trainingrequirements for Direct SupportProfessionals providing In-HomeSupport

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Intensive Support and Transition Support Provider Types

New


15 minute unit

$27.48 Wraparound Facilitator

$7.61 In-Home Support




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Regulations

• Federal HCBS Final SettingsRule applies to HCBS-CHRP asit does for other waivers

• 10 CCR 2505-10 8.508 (HCPF)

• 12 CCR 2509-8 (CDHS)

www.sos.state.co.us/CCR/NumericalDeptList.do

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Regulatory Requirements

https://www.sos.state.co.us/CCR/NumericalDeptList.do

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• Sections of CDHS rule incorporated byreference or cited for Restraints, RightsModifications, Medication Administration,and Client Rights

• Rights modifications: also includes FederalHCBS Settings requirements for informedconsent

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• Incidents meeting the criteria for CriticalIncidents per the waiver must be reported tothe Community Centered Board withintwenty-four (24) hours.

• Investigations of Mistreatment, Abuse,Neglect, and Exploitation are reviewed bythe Human Rights Committee.

• CDHS surveys:

Habilitation and out of home Respite services ina Foster Care Home, Group Home, or RCCF

• Colorado Department of Public Health andEnvironment (CDPHE) surveys:

Respite in the family home, SupportedCommunity Connections, Intensive Support, andTransition Support services

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Case Management

• State Plan

• 15 minute unit increments

• 240 unit limit per fiscal year

• Components:

Assessment

Referral

Service Planning

Monitoring - Quarterly face to face

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Targeted Case Management

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Conflict Free Case Management

The Case Management Agency may not provide HCBS-CHRP case management

and waiver services to the same child/youth.

• Youth may choose to transition outof the HCBS-CHRP from the ageeighteen (18) through (20) to anadult waiver

• Youth must transition out of HCBS-CHRP by age twenty-one (21)

• Youth may choose adult servicesthat they are eligible for and thatbest meet their need

• HCBS-Developmental Disabilities(DD) waiver has reserved capacityfor HCBS-CHRP participants

• Transitions should occur when it isin the best interest of the youth

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Transition from CHRP to Adult Services

• When a child is in ChildWelfare, the decision makingauthority on questions such asselection of provider, place tolive, services, etc. will beindividualized based on eachchild/youth’s unique situation

• Consult with the County ChildWelfare Case Worker todetermine individual decisionmaking authority

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Decision Making- Child Welfare

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Provider Enrollment and Billing

• Currently enrolled Medicaid providers- add provider type 36(HCBS waiver) and CHRP specialty 619

• Currently enrolled Medicaid HBCS waiver providers- add CHRPspecialty 619

• New providers (not currently enrolled as Medicaid provider)-complete DXC enrollment process, provider type 36, andCHRP specialty 619

Information on provider enrollment, rates, billing manual: www.colorado.gov/hcpf/our-providers

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Provider Enrollment

https://www.colorado.gov/hcpf/our-providers

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Coordination with Other Systems

• Partner with County Case Worker- include in all teammeetings

• Involvement of Child Welfare does not mitigate or change therequirements of the CMA case manager

• Consult County Case Worker to identify the decision makerfor child/youth

• Any suspected or alleged abuse must be reported to ChildProtective Services

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Child Welfare

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Regional Accountable Entity (RAE)

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Contacts

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Justine MiracleDevelopment Specialist

[email protected]

Nancy HarrisHCBS Benefits Specialist

[email protected]

Michele CraigComplex Needs Program Development & Evaluation Unit

[email protected]

Thank You!

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Documents

Home and Community Based Children’s Habilitation ... Waiver Training for...tension including WATSU • Must be a treatment strategy for an identified medical or behavior need and