Tuesday, September 29, 2009

Renewal of DD Medicaid waiver

Family Voices seeks to ensure families have access to information regarding the services they may use. The following is an excerpt from the DDRS bulletin regarding the renewal of the DD Medicaid waiver. If you have questions, you should speak with your IPMG case manager or use the resources included at the end of this post. DDRS is pleased to announce that on Friday, September 25, 2009, DDRS received a letter from CMS stating that the request to renew the Indiana HCBS DD Waiver, authorized under §1915(c) of the Social Security Act, has been approved. Effective October 1, 2009, this renewed waiver will continue to serve individuals of all ages with developmental disabilities who meet an Intermediate Care Facility for the Mentally Retarded (ICF-MR) level of care. The complete 253-page document is available for review online at http://www.in.gov/fssa/files/1DD_Waiver_Renewal_100109.pdf. Significant changes from the current (expiring) DD waiver document and the proposed renewal are listed below along with the location of those changes. The online waiver application is organized in multiple sections beginning with the Main section [Application (Module 1)], followed by Appendices A through J. While Quality improvement strategies primarily appear in Appendix H., Quality improvement assurances, sub-assurances and performance measures unique to each Appendix are now addressed throughout the document. The most significant changes between the expiring DD Waiver and the renewal are the move to using a uniform rate methodology and the unbundling of Day Services. (Appendices C, I and J) APPENDIX A: Waiver Administration and Operation • A-3 Use of Contracted Entities – The operating agency now contracts with another entity for the various functions previously performed by the Bureau of Quality Improvement Services (BQIS). These functions include components of utilization management (ensuring services are properly authorized, monitored and delivered), discovery and remediation activities. In addition, the mechanisms for overall systems improvement are contracted out. Oversight of the contractor remains in the hands of the BQIS Central Office. APPENDIX B: Participant Access and Eligibility • NUMBER OF PARTICIPANTS SERVED: (Appendices B-3-a, I and J) Indiana had projected to be serving 8118 participants by the end of waiver year 5 , largely due to the addition of reserved capacity (priority) criteria enabling participants with parents or guardians age 80 or older to receive priority waiver slots. Projections obtained with the help of advocacy groups were over-estimated, leaving reserved slots underutilized. Projections for the total number of active participants receiving DD Waiver services at the end of each waiver year follow: o Year 1—7133 o Year 2—7392 o Year 3—7644 o Year 4—7884 o Year 5—8118 • Reserved Waiver Capacity modifications include the expansion of reserved capacity (priority) criteria for individuals with aging caregivers. Additional priority criteria have been added for persons wishing to leave a facility but whose normal caregiver would no longer be able to provide their care, as well as for individuals being served in facilities but with a history of unexplained injuries or documented abuse that has been substantiated by DDRS and threatens the person’s health and welfare. (Appendix B-3-c) • Selection of Entrants to the Waiver (Appendix B-3-f) is modified to reflect that targeting, acceptance of the slot, and established eligibility for the waiver will result in removal of the participant from other waiver waiting lists. • Appendix B-4: Medicaid Eligibility Groups Served in the Waiver is modified to include the following additional Medicaid Aid Categories: o Children receiving Adoption Assistance or Children receiving Federal o Foster Care Payments under Title IV E - Sec. 1902(a)(10)(A)(i)(I) of the Act o Children receiving adoption assistance under a state adoption agreement - Sec 1902(a)(10)(A)(ii)(VIII) o Independent Foster Care Adolescents – Sec 1902(a)(10)(A)(ii)(XVII) o Children Under Age 1 – Sec 1902(a)(10)(A)(i)(IV) o Children Age 1-5 - Sec 1902(a)(10)(A)(i)(VI) o Children Age 1 through 18 - Sec 1902(a)(10)(A)(i)(VII) o Transitional Medical Assistance – Sec 1925 of the Act • Appendix B-6-a ii: Frequency of Services is modified to reflect that a need for services is now required quarterly rather than monthly, providing services are monitored monthly. • Appendix B-7-a. Procedures under Freedom of Choice has been changed to specify that in Indiana, participation in a Risk-Based Managed Care program (former statement included all “Managed Care” programs) and HCBS Waiver programs are mutually exclusive. APPENDIX C: Participant Services  Day Services were unbundled and replaced by the following: o Community Based Habilitation – Group o Community Based Habilitation – Individual o Facility Based Habilitation – Group o Facility Based Habilitation – Individual o Prevocational o Supported Employment Follow Along o Transportation Services  As a component of the bundled Day Services under the prior (expiring) DD Waiver, no limit previously existed for the amount or duration of Prevocational Services or Supported Employment Follow-Along (SEFA). Under the DD Waiver renewal, a participant may only utilize Prevocational Services for a time period of up to 12 months and may only utilize SEFA for a time period of up to 18 months in the same employment setting. The time limit clock for both of these services begins at the Start Date of the service as it first appears on any approved Initial, Annual or Update Plan of Care/Cost Comparison Budget (CCB) (and subsequent Notice of Action) having an Initial or Annual Start Date falling on or after the October 1, 2009 effective date of this waiver renewal.  New services added include the following: o Electronic Monitoring o Facility Based Support o Intensive Behavioral Intervention o Transportation o Workplace Assistance Each comprehensive service definition is included in the waiver document which will be available to the public once the waiver application is approved by CMS and posted to the DDRS website.  Service definition modifications were made to: o Adult Day Services to enable use of the new Transportation Service in conjunction with Adult Day Services; o Respite Care to clarify activities allowed and not allowed; o Residential Habilitation and Support enabling each parent, step-parent or legal guardian to provide the service for up to 40 hours per week; o all therapy services to clarify that service delivery to the participant is not appropriate within their educational setting; and o Behavioral Support Services to remove the never utilized Crisis Assistance component of the service.  Documentation Standards for the components of day services and Respite have been revised.  Provider qualifications across all waiver services were made more consistent while qualifications for Family and Caregiver Training Supports in particular were modified, enabling other than Residential Habilitation and Support providers to be approved for service delivery. APPENDIX D: Participant-Centered Planning and Service Delivery  The service plan development process has been enhanced by an improved Person Centered Planning process and use of a Health and Safety Indicator.  To improve Risk Assessment and Mitigation, Outreach Services now offer additional training opportunities and Health Assurance Reviews to providers. APPENDIX F: Participant Rights  The BQIS grievance/complaint system has been modified due to restructuring of the Bureau. APPENDIX G: Participant Safeguards  Participant Safeguards section revised to reflect contracting of most major functions of BQIS.  The expiring DD Waiver indicated the operating agency’s intent to eliminate use of the National Core Indicator Project with replacement by the Participant Experience Survey (PES). However, rather than the PES, the BQIS now utilizes the Comprehensive Survey Tool (CST), reviewing a sample of DD Waiver service plans to assure consistency of waiver the Plan of Care/Cost Comparison Budget with the Individualized Support Plan.  Rather than conducting agency and standards surveys for paper compliance, BQIS is focused on participant satisfaction with service delivery. APPENDIX H: Quality Improvement Strategy  BQIS has revamped the responsibilities of the Quality Improvement Executive Council and now uses a contractor to lead the Mortality Review Committee. APPENDIX I: Financial Accountability  Changed to a uniform rate methodology Please direct any questions or concerns you may have to our Help Line Resources:  DDRS Website: www.ddrs.IN.gov  DDRS Bulletin Archive: http://www.in.gov/fssa/ddrs/3350.htm  BDDS Help Line, E-mail: BDDSHelp@fssa.in.gov  BDDS Help Lines, Phone: (317) 234-5222 or 1-(888)-545-7763

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