Wednesday, May 21, 2008

OASIS moving forward: a guide for consumers

The following information is from The Arc of Indiana ( regarding OASIS implementation plans. FV Indiana will also be posting the Home and Community Based Services manual as a featured resource so families, especially in the pilot district, can become better educated about what services they can "buy" with their allocation through the budget tool.

On July 1, Indiana's Family and Social Services Administration (FSSA) will begin phasing-in the statewide implementation of OASIS, a new way of allocating funds for people on the Developmental Disabilities, Support Services and Autism Medicaid waivers. The phase-in will begin in Bureau of Developmental Disabilities (BDDS) District 4, which includes the counties of Benton, Carroll, Clay, Clinton, Fountain, Monroe, Montgomery, Owen, Parke, Putnam, Sullivan, Tippecanoe, Vermillion, Vigo, Warren and White. FSSA expects to implement OASIS statewide in January 2009.

The following guide is a first step to provide information on OASIS. Because OASIS is not yet ready to be fully implemented, changes will continue to occur.

What is OASIS?

OASIS, Objective Assessment System for Individual Supports, is a new system to determine resources available to waiver recipients and reimbursement rates for services providers.

Under OASIS a formula that includes several factors will determine a specific resource allocation that is available to Medicaid waiver recipients to be used for services and supports from Medicaid waiver providers.

How is the resource allocation under OASIS determined?

The resource allocation, which represents a dollar amount that is available for an individual's Medicaid waiver service, is based on a formula. This formula includes:

1. ICAP score. Several months ago, FSSA hired Arbitre Consulting to conduct an assessment of people receiving Medicaid waiver services. The assessment is called ICAP. Inventory for Clients and Agency Planning. It is also known as the Objective Assessment (OS). ICAP is an assessment of a person's skills. The assessment produces a service score, which helps determine how much care a person needs.
2. Age of Medicaid waiver recipient.
3. Residence of recipient: living at home or in residential placement.
4. If living in a residential placement: housemate arrangement.
5. Need for specialized medical or behavior supports.

These factors are run through a formula, and, based on the end result, a resource allocation amount is determined.
For example, an older person might receive more funding than a younger person. A person living with family might receive more funding than a person living in a residential placement.
It is important to note that recipients of the Support Services Medicaid Waiver will not go through the resource allocation formula process. They are eligible to receive up to $13,500 for programs and services.

What happens after you receive your resource allocation?

1. Your IPMG case manager will inform you what your resource allocation is.
2. You will have an opportunity to use a computer-based program, known as a budget allocation tool, that helps you develop a preliminary budget
for the services you want to utilize with that allocation.
3. You will meet with a team (which can include your case manager, providers, advocates, etc.) to discuss and determine a plan of care (POC) based on the new resource allocation.
4. Based on the new plan of care, your case manager will develop and submit a Cost Comparison Budget (CCB) to FSSA for approval.
5. If approved, your new plan of care will be implemented. If not approved, your team will need to meet again, make changes, and resubmit the budget.

When and where will OASIS be implemented?

Individuals currently receiving Medicaid DD waiver services will be phased into the new OASIS system.

Phase One: BDDS District
May 2008: People who live in BDDS District 4 who receive services through the Developmental Disabilities or Autism Medicaid waiver will be notified by their case manager of their resource allocation. If this information is not provided, the case manager should be contacted by the Medicaid waiver recipient. Providers will not
receive information about resource allocations unless Medicaid waiver recipients provide authorization for them to receive this information.

July 2008: People who live in BDDS District 4 with a July anniversary date to renew their plan of care will begin receiving services based on their new
plan of care, if the Cost Comparison Budget has been approved.

Continued Phase-in of BDDS District 4: Each month, people living in BDDS District 4 will continue to be phased in, based on their anniversary date to renew
their plan of care. A new plan of care will be developed based on their resource allocation, and a Cost Comparison Budget will be submitted to FSSA
for approval.

Phase Two: Statewide Implementation October 2008: People throughout the state with a January anniversary date to renew their plan of care will receive
their new resource allocation. Their new plan of care, based on this resource allocation, will be implemented in January 2009, when the Cost Comparison
Budget has been approved.

November, 2008 and following: Each month, people receiving Medicaid waiver services will receive their new resource allocation approximately three
months before their anniversary date to renew their plan of care.

What if you are new to Medicaid waivers?

If you have not received a Medicaid waiver in the past, the following is what must happen before you can receive services under a Medicaid waiver:
1. You will be notified by the Bureau of Developmental Disabilities (BDDS) that you have been targeted to receive a Medicaid waiver.
2. A BDDS Service Coordinator will schedule a time to meet with you to determine if you are in fact eligible to receive services from the Medicaid
3. Once it is determined that you are eligible for the Medicaid waiver:
A case manager from IPMG will contact you to schedule a time to meet to complete a Person Centered Plan (PCP) and Individual Support Plan (ISP).
• if you do not already have Medicaid, the IPMG case manager will also assist you with applying for Medicaid.
• The Inventory for Clients and Agency Planning (ICAP) will be conducted by an independent company called Arbitre Consulting.
The assessment will produce the service score that will be used in the formula to determine your resource allocation.
4. You will be able to use a computer based program called an "interactive budget tool" to determine how you want to use your resource allocation
for services. The Person Centered Plan and Individual Support Plan can be used as a guide for how to use your resource allocation.
5. You will meet with your case manager to develop a plan of care, based on the resources available to you, and ideas generated from the interactive
budget tool. Your case manager will submit a Cost Comparison Budget to FSSA.
6. Your case manager will help you select providers to deliver the services.
7. Once your cost Comparison Budget is approved and providers have agreed to deliver services, you will begin receiving services.

Appeals Process
The ICAP score cannot be appealed. However, the state administrative appeals process can be used to appeal services that will be provided under the
plan of care.
The state is refining a new policy on how it will address people who have a significant change in the services they will receive.

To appeal, you may request an appeal within 30 days of the date you receive notice. The time limit is extended 3 days if the notice is received by mail.
To file an appeal, sign, date and return the Hearings and Appeals copy of the form that you should receive with a notice to:
MS 04, Hearings and Appeals
Indiana Family & Social Services Administration
402 W. Washington St., Room E034
Indianapolis, IN 46204

You will be notified in writing by FSSA of the date, time and location of the hearing. Prior to the hearing, you have the right to examine the entire contents of your case record maintained by your Case Manager. Ask for a copy of all assessments, completed forms and questionnaires that were used in determining your plan of care. You may represent yourself at the hearing, or you may authorize a person to represent you.

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