Spring 2009 - Rev 4/6/09 Navigating the New System …Community Care Waiver, Waiting List Changes, and Individualized Budgets The Arc of New Jersey &

Spring Rev 4/6/09 Navigating the New System …Community Care Waiver, Waiting List Changes, and Individualized Budgets The Arc of New Jersey & NJDHS-DDD

Overview of Presentation
Spring Rev 4/6/09 Overview of Presentation Who we are Three things you will know after tonight: What Medicaid is What the Community Care Waiver is How to get services Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

The Arc of New Jersey & NJDHS-DDD
Spring Rev 4/6/09 What is Medicaid? Government funded health insurance program for low income children and families, and adults who are aged, blind or disabled Pays for doctor visits, prescription drug coverage, other medical services Covers services other insurance often doesn’t: personal care, and long term services & supports Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

What is the Community Care Waiver…
Spring Rev 4/6/09 What is the Community Care Waiver… Funding mechanism for services Funds services in group homes, day programs, in-home supports Federal government contributes to the cost of services When services are not covered under waiver, the state pays the entire cost Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

…and Why is it Important?
Spring Rev 4/6/09 …and Why is it Important? It allows people to receive services in the community rather than in an institution It offers a wider variety/range of services & supports Because of the federal funds, it has potential to provide more money so the State can serve more people Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

…and Why is it Important?
Spring Rev 4/6/09 …and Why is it Important? And, it is the only way to access long term supports and ensure that your son/daughter will be properly supported throughout his/her lifetime Extensive waiting list Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 How Do You Get Services? Become DDD eligible Get on the Waiver Waiting List While you are waiting, you may be eligible for non-waiver-funded services Contact your DDD case manager to find out what services you can get while waiting for a waiver “slot” Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Overview of New System & Changes that are Coming
Spring Rev 4/6/09 Overview of New System & Changes that are Coming The only REAL/practical differences are: The vocabulary What you get when you reach the top of the waiting list You will have more choices in terms of what services you can get and from whom Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 New System Self-direction Option Based more on in-home supports Funding flows from DDD through Fiscal Intermediary Waiting list for “waiver slot” Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 New System Provider-Managed Option Individual chooses a provider agency Payment made directly to provider Waiting list for “waiver slot” Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 What We Know for Sure National Trend DDD has stated that this change is already being implemented Self advocates & families will need a new set of skills & new vocabulary Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

How does the Waiver System Work?
Spring Rev 4/6/09 How does the Waiver System Work? Determination of eligibility for waiver services Waiting list criteria Reserve capacity within the waiver Assessment Individual Budget – Decision to self-direct or not Plan Development If not eligible, then look at non-waiver & waiver services funded with state dollars Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

What does “Self-Direct” Mean?
Spring Rev 4/6/09 What does “Self-Direct” Mean? Support Coordinator assigned How do I find service providers? Who checks to see if services are being delivered? How does the money get paid to the provider? How much? Can I negotiate? What if my needs change? Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Waiver Waiting List All move to waiver waiting list if not currently enrolled on waiver When your name comes up on list, you will receive services you need at that time, and be removed from list If needs change, the changes will be accommodated Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

How Waiting List Will Work
Spring Rev 4/6/09 How Waiting List Will Work Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Changes in Need If needs change, an updated plan is completed Services change to fit the need Waiver eligibility is preserved regardless of residence Waiver is portable Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Review of Covered Services in CCW
Spring Rev 4/6/09 Review of Covered Services in CCW Case Management Day Habilitation Individual Supports Respite Supported Employment Community Transition Services Support Coordination Assistive Technology Devices Environmental and Vehicle Adaptations Personal Emergency Response System (PERS) Transportation Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Non-Medicaid Funded Services
Spring Rev 4/6/09 Non-Medicaid Funded Services Family Support Residential (room & board) after contribution to care received Start-up costs for residential placements, other than Transition services Discussion of what should be covered by state-only funds Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Questions Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Contact Start with your Case Manager Contact me by , if possible: Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Medicaid 101 What is Medicaid? Medical assistance to individuals who are aged, blind or disabled and TANF Income test Resource test TANF – Temporary Assistance to Needy Families (the old Aid to Families with Dependent Children) Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Medicaid 101 Services covered under Medicaid Mandatory services E.g., physician, hospitalization, pharmacy Optional services E.g., therapy, private duty nursing Each state determines scope, duration, and amount Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Waiver 101… or Why Have a Waiver?
Spring Rev 4/6/09 Waiver 101… or Why Have a Waiver? Institutional eligibility vs. in-home eligibility for Medicaid Non-traditional services needed Amendment to the Social Security Act in 1981 Created 1915 (c) option for states Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Waiver 101 Home and Community Based Services Allows state to limit number of individuals enrolled Allows state to refuse enrollment if individual cost is higher than institutional Standards for providers Additional “waivers” requested: Statewideness Amount, duration and scope Comparability Institutional income Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Waiver 101 Eligibility State specific Income Resources Level of care Service need Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 CMS Oversight Level of Care Services Plan Qualified Providers Financial Accountability Administrative Oversight by Medicaid Agency Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 New Jersey Waivers AIDS Community Care Alternatives Program (ACCAP) Community Resources for People with Disabilities (CRPD) combined three model waivers Acquired Traumatic Brain Injuries (TBI) Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 New Jersey Waivers Global Options (GO) – combined Community Care Program for the Elderly and Disabled (CCPED) and Enhanced Community Options (ECO) Community Care Waiver (CCW) Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Community Care Waiver Nationally, the second waiver approved by federal government Refinanced group home services Model used by many other states Changes needed to update model Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW Philosophical Changes Changed Services New Services Deleted Services Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW Services where you live With family Apartment Supportive living Group home Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW Self-direction added as option (includes Real Life Choices, Self-Determination, and Olmstead individuals who self-direct, and individuals served from Waiting List) Provider directed model still available Essential Life Plan added as alternate plan of care for individuals who self-direct or have an individual budget Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW Regional Monitor for Individuals who Self-direct (new administrative service) Assures that the following is completed: Assessment for waiver eligibility Level of care Assignment of budget amount Review & approve service plan Assure health & safety factors considered Approves expenditures Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW Retainer days paid for absences from day program and residential supports “Therapeutic” days Hospital days & related stays in other facilities Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 New Service Support Coordination For persons who self-direct Connects people to services Providers of Support Coordination are employed by agencies other than the Division Conflict of Interest provision Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW New individuals enrolled on waiver are assigned funding maximum based on the Developmental Disability Review Tool (DDRT) Remove Psychiatry & ITN as a covered service Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 New Services Transition Services For people being discharged from institutional settings Must be entering a non group home setting Pays for deposits, furniture, one time services (cleaning, extermination, etc.), moving Up to 180 days prior to move Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW Respite changes Clarify respite payment cannot be made to relative who lives with individual Expands eligible providers Camp (no out of state) ICF/MR Group respite at no more than 1:4 ratio Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW Day Habilitation Changed name Added hourly units (no more than 25/wk) Distance between individual’s residence & day habilitation site is not greater than 38 miles Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW Individual Supports Added hourly units (ratio cannot exceed 1:4) Requires drug & alcohol testing & orientation training Permits family member residing in home to provide services for a limited period (no more than 40 hours per week for no more than 30 days annually) during transition of staff Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring Rev 4/6/09 Revisions to CCW Environmental/Vehicle Modification Total expenditure of $11,000 every three years in conjunction with Assistive Technology Devices (new service) Transportation (new service) Rev 8/24/09 The Arc of New Jersey & NJDHS-DDD The Arc of New Jersey & NJDHS-DDD

Spring 2009 - Rev 4/6/09 Navigating the New System …Community Care Waiver, Waiting List Changes, and Individualized Budgets The Arc of New Jersey &

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Spring 2009 - Rev 4/6/09 Navigating the New System …Community Care Waiver, Waiting List Changes, and Individualized Budgets The Arc of New Jersey &

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Presentation on theme: "Spring 2009 - Rev 4/6/09 Navigating the New System …Community Care Waiver, Waiting List Changes, and Individualized Budgets The Arc of New Jersey &"— Presentation transcript:

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