Monday, October 11, 2010

Further explanation of upcoming changes to the DD/Autism waiver budgets

DDRS recently released a bulletin outlining changes to the DD/Autism waiver budgets. If you have questions or concerns, you should contact DDRS at BDDSHelp@fssa.in.gov or speak with your IPMG case manager. However, in an attempt to assist families in better understanding this change, Family Voices has created a more user friendly version of the announcement:

In the past, individuals receiving the DD or Autism waivers would meet yearly to determine an individual’s budget for the next year. The team would develop a weekly schedule and what services would be needed to support the individual. The budget would then be submitted by the IPMG case manager to the waiver unit for approval. If it was approved, the individual would receive the chosen services and amounts. If it was denied, the team would need to adjust the services and amounts and resubmit it until it was approved.

The state believes this is a subjective system that creates varied budgets for individuals with similar needs. So, they are implementing what they consider to be a more objective approach to allocating budgets. Rather than submitting a budget for approval AFTER the services are chosen, the individual will receive a certain budget based on a math equation (algorithm) and will then have certain services they MUST purchase before spending the remainder of the budget.

All DD/Autism waiver initial budgets (including those leaving a State Operated Facility (SOF) and Supervised Group Living (SGL) placement), all expiring transitional budgets and all budget renewals after January 1, 2011 will be developed with objective based allocations. The individual’s ICAP score, living arrangements (home or supported living), behavior needs, and/or medical needs will be scored to create a budget amount. Once that amount is determined, it will be released as the individual’s budget, or allocation. Some allocations will go to the PARS (personal allocation review) unit, if requested, to make sure it is appropriate.

Individuals will be assigned a score depending on those factors: Level 0 being very minimal supports needed up to Level 6 which is the highest level of need. An individual living at home, regardless of age, is also considered to have less needs than an individual living in a waiver supported living home.

In addition to using this formula to determine the individual’s budget, DDRS will also be requiring a reserve amount of the budget be used for day services. Those day services include: Community Habilitation, Adult Day Services, Pre-vocational services, Supported Employment Follow Along, Facility Habilitation, Music/Recreational/Other Therapies, and Transportation.

The Day Service reserve for most individuals who have exited school will be $10,500 ,except those with the highest level of need. Those with a Level 6 designation and have exited school, may have a day reserve of $18,000. Those individuals still attending school (0-22 years old) will have a day reserve of $5,500.

These day services must be purchased with the reserve amount of the budget or else that money is lost. Depending on the individual’s behavioral needs, they may have an additional budget reserve that must be spent on Behavior Management Services. Only AFTER those services are purchased may the remaining amount of the budget, if any, be used to purchase other services including residential habilitation, respite, etc.

It will be very important for families to work with their IPMG case manager to ensure person centered planning is being used to purchase services that meet the individual’s wants and needs for a safe and meaningful day. Since the emphasis is now on community participation, individuals need to ask about appropriate transportation services, especially if an individual needs it to be wheelchair accessible. The other question families should ask is if the individual might be eligible for Medicaid covered services such as home health and/or nursing, which would not be part of the individual’s waiver budget.

It is unclear at this time which items are eligible for appeal. There is typically some information on the appeal process when you receive the NOA (notice of action). Families should look for additional information from DDRS and discuss options with an IPMG case manager. If you feel you need more assistance than your case manager can provide, you can ask to speak with an IPMG supervisor or the BDDS ombudsman.

You can always also share your concerns with your state legislators. That information is available at:http://www.in.gov/legislative/legislators

Family Voices will continue to share information as it becomes available. Again, if you have questions or concerns, you should contact DDRS at BDDSHelp@fssa.in.gov
or speak with your IPMG case manager.

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