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About the ID & DS Home & Community Based Waivers 3 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
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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 Modules1. Overview of the ID and DS Waivers
2. Becoming an ID Waiver Provider3. Supporting People in the ID and DS Waivers4. Introduction to Planning5. Residential Services6 PA, Respite and Companion - DBHDS-licensed7. Employment and other Day Services (Agency Directed)8. Crisis Stabilization and Supervision9. Assistive Technology, Environmental Modifications and Transition Services10. Skilled Nursing11. Personal Emergency Response System12. Consumer Directed Services and Services Facilitation13. Therapeutic Consultation14. Preauthorization and Reimbursement15.Monitoring and Oversight
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About the ID & DS Home & Community Based Waivers
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• 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
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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
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Key Agencies
Department of Medical Assistance Services (DMAS)
Department of Behavioral Health and Developmental Services
(DBHDS)
Community Services Boards (CSBs) or Behavioral Health Authority (BHAs)
Waiver Service Providers
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CMS (Federal)
Virginia General Assembly (State)
DMAS
DBHDS
CSB Support Coordinator
CSBs/BHAs (Local)
Waiver Services Providers
The Big Picture
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Key Agencies
• Single point of entry• Support Coordination
Community Services Boards (CSBs) or Behavioral Health Authority
(BHAs)
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Key Agencies
• Community-based• Selected by the individual• Person-centered supports
Waiver Service Providers
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Key Agencies
Department of Behavioral Health & Developmental Services (DBHDS)
• Pre-Authorization• Technical Assistance
• Training
• Daily Operations• Licensing• Human Rights
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Key Agencies
• Single state agency for Medicaid• Payment to providers• Service audits and fraud• Quality reviews• Appeals
Department of Medical Assistance Services (DMAS)
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Other Key Agencies
• DSS• Public Schools • DARS
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ID and DS Waiver Eligibility
DiagnosticFunctionalFinancial
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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
ID as demonstrated by evidence of cognitive and adaptive delay OR presence of a syndrome typically associated with ID
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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.”
For children under age 6: At Risk or ID
Diagnostic Eligibility
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CSB Support Coordinator (SC) confirms functional eligibility by completing:
Within 45 days of date of request for services
Level Of Functioning (LOF) Survey
Functional Eligibility
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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
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Financial Eligibility
• DSS-determined• Different financial limits for
Medicaid Waivers• Based upon the individual’s
income only• Possible patient-pay obligation
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About the Waivers
• Each person requires a slot• Each CSB has an allocation of slots
Waiver Slots
Just the Facts ID Waiver
19Day Support Waiver Facts
Day Support WaiverID Waiver
• Based on urgency• Annual allocations
Slots Awarded…
• Based on date of need• Limited to 300 slots
About the Waivers
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If no slot, name placed on a Statewide Waiting List (WL)
About the Waivers
• CSB submits to DBHDS• Urgent and Non-urgent
• DBHDS maintains Statewide WL• All Urgent in state served first
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ID Waiver Services
About the Waivers
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Residential -Congregate -In-Home
PersonalAssistance
Respite Companion
Day Support
Pre-Vocational
SupportedEmployment
Skilled Nursing
Therapeutic Consultation
AssistiveTechnology
EnvironmentalModification
CrisisStabilization
P ersonal E mergency R esponse S ystem
Transition Services
ServiceFacilitation
•Respite •Companion• Personal Assistance
Self Directed
ID Waiver Services
ID Waiver Overview
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DS Waiver Services
About the Waivers
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Residential -Congregate -In-Home
PersonalAssistance
Respite Companion
Day Support
Pre-Vocational
SupportedEmployment
Skilled Nursing
Therapeutic Consultation
AssistiveTechnology
EnvironmentalModification
CrisisStabilization
P ersonal E mergency R esponse S ystem
Transition Services
ServiceFacilitation
•Respite •Companion• Personal Assistance
Consumer Directed
DS Waiver Services
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Self-Directed Services
Agency-Directed Services
A Combination of Both
Individual selects . . .
or
or
About the Waivers
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• Allowable support activities
• Criteria and limitations
• Individual Support Plans
About the Waivers
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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
About the Waivers
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Based upon individual choice:
Providers
ServicesOutcomes
ActivitiesStaff Supports
Places
People
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Available Resources:Department of Behavioral Health and
Developmental Services• Division of Developmental Services
• Offices of Licensing and Human Rights
http://www.dbhds.virginia.gov