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1 Department of Medical Assistance Services 1 Department of Medical Assistance Services.

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Presentation on theme: "1 Department of Medical Assistance Services 1 Department of Medical Assistance Services."— Presentation transcript:

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2 http://dmasva.dmas.virginia.gov/ 1 Department of Medical Assistance Services http://dmasva.dmas.virginia.gov 1 Department of Medical Assistance Services

3 http://dmasva.dmas.virginia.gov/ 2 Department of Medical Assistance Services 2 Objectives of Training Train in-home and day support providers on the associated requirements for Individual and Family Developmental Disabilities Support (DD) Waiver.

4 http://dmasva.dmas.virginia.gov/ 3 Department of Medical Assistance Services 3 Development of the DD waiver

5 http://dmasva.dmas.virginia.gov/ 4 Department of Medical Assistance Services 4 Development of the (DD) Waiver DMAS was directed by the 1999 General Assembly session to develop a new waiver for persons with developmental disabilities. DMAS formed a work group consisting of consumers, advocates, providers and state agencies that met nine times from May 10, 1999 through May 18, 2000 to discuss waiver development issues.

6 http://dmasva.dmas.virginia.gov/ 5 Department of Medical Assistance Services 5 Work Group Goals Option to institutionalization Consumer-directed whenever possible Services in the workplace when possible Individually tailored services Coordinate with schools and other training areas Maximize other financial resources Minimize duplication of resources

7 http://dmasva.dmas.virginia.gov/ 6 Department of Medical Assistance Services 6 Development of the (DD) Waiver DMAS submitted a report to the 2000 General Assembly session proposing the development of a new waiver. DMAS requested and received approval from the Centers for Medicare and Medicaid services (CMS) in May 2000 to begin implementation of the DD waiver on July 1, 2000. This waiver would be more consumer- driven and provide additional supports to families.

8 http://dmasva.dmas.virginia.gov/ 7 Department of Medical Assistance Services 7 Development of DD Waiver In order to get waiver approval from CMS, there must be an alternative institutional placement. For the DD waiver the alternative placement must be an Intermediate Care Facility for the Mentally Retarded (ICF/MR).

9 http://dmasva.dmas.virginia.gov/ 8 Department of Medical Assistance Services 8 Eligible for (DD) Waiver The individual must be 6 years of age and older and meet the related conditions requirements of C.F.R. § 435.1009, including autism; May not have a diagnosis of intellectual disability (ID) as defined by the American Association on Developmental Disabilities (AAIDD)

10 http://dmasva.dmas.virginia.gov/ 9 Department of Medical Assistance Services 9 Individual and Family Developmental Disabilities Support (DD) Waiver Meet the level of care for admission to an Intermediate Care Facility for the Mentally Retarded (ICF/MR).

11 http://dmasva.dmas.virginia.gov/ 10 Department of Medical Assistance Services 10 Covered Services Adult Companion Services Assistive Technology Crisis Stabilization Crisis Supervision Environmental Modifications In-home Residential Support Day Support Skilled Nursing Supported Employment Therapeutic Consultation Personal Emergency Response System Family/Caregiver Training Respite Care Personal Attendant Services Prevocational Services Transition services- MFP Case Management (State Plan Option)

12 http://dmasva.dmas.virginia.gov/ 11 Department of Medical Assistance Services 11 In-home Residential Support Services Service Definition

13 http://dmasva.dmas.virginia.gov/ 12 Department of Medical Assistance Services 12 In-home Residential Support Service Definition Training and assistance or specialized supervision Most training occurs in an individuals home or residence considered to be his/her home In-home support does not include room and board Enables an individual to acquire, improve, or maintain: –Activities of daily living (ADLs) –Access community resources –Adapt to the community/daily environment –Safety skills and health status

14 http://dmasva.dmas.virginia.gov/ 13 Department of Medical Assistance Services 13 In-home Residential Support Services Supplemental to the care provided by a parent or similar caregiver May support an individual whose level of independence does not require a primary caregiver

15 http://dmasva.dmas.virginia.gov/ 14 Department of Medical Assistance Services 14 In-home Residential Support Service Definition May not be provided for a continuous 24-hour period Training is provided in the home or community Supports are delivered on a 1:1 staff to individual ratio

16 http://dmasva.dmas.virginia.gov/ 15 Department of Medical Assistance Services 15 Person Centered Approach This service should provide empowerment and support to the individual so that he or she may develop his or her own individual lifestyle

17 http://dmasva.dmas.virginia.gov/ 16 Department of Medical Assistance Services 16 In-home Residential Support Training and Assistance Activities

18 http://dmasva.dmas.virginia.gov/ 17 Department of Medical Assistance Services 17 In-home Residential Support Activities Functional skills training in personal care activities such as: –Toileting, Bathing, Grooming, Dressing, Eating, Mobility, Communication, Household Chores, Food Preparation, Money Management, Shopping etc. Functional skills training in use of community resources such as: –Transportation, Shopping, Social/Recreational Activities Training to help the individual adapt his behavior to home and community environments

19 http://dmasva.dmas.virginia.gov/ 18 Department of Medical Assistance Services 18 In-home Residential Support Activities Continued Assistance with personal care tasks, e.g. ADLs and community resources, if the individual is physically unable to learn these tasks Monitoring health, physical condition and medical needs Ensure completion of hygiene, nutrition and other tasks essential to health and welfare. Support with shopping, banking, laundry, arranging transportation etc. There must be documentation on the schedule for the type of assistance being provided.

20 http://dmasva.dmas.virginia.gov/ 19 Department of Medical Assistance Services 19 In-home Residential Support Criteria May not be provided simultaneously with personal care, respite care, attendant care or CD respite care services Must be prior-authorized Should be provided at frequency allowing for systematic training and maintenance of functional supports Individual must be present

21 http://dmasva.dmas.virginia.gov/ 20 Department of Medical Assistance Services 20 In-home Residential Support Criteria Functional Assessment must be conducted by the provider to evaluate each individual in his home environment and community settings. 12VAC30-120-750 (B) (2)

22 http://dmasva.dmas.virginia.gov/ 21 Department of Medical Assistance Services 21 In-home Residential Support hours and limitations Total billing can not exceed total hours approved by DMAS on the individuals POC Documentation of dates, times, and services provided Any circumstances that prevented the individual from receiving all scheduled hours If fewer than all the hours scheduled on the POC are delivered on a regular basis, over a 60-day period, the provider should determine if there is a need to request a revised POC reducing the hours

23 http://dmasva.dmas.virginia.gov/ 22 Department of Medical Assistance Services 22 In-home Residential Support hours and limitations General Supervision is non-billable Examples of General Supervision: –Awake staff coverage at night if the individual generally sleeps throughout the night –Oversight of leisure activities –Routine bed checks –Asleep staff at night on the premises for security and/or safety reasons –Staff on call during the day while the individual is participates in work/day support/school activities

24 http://dmasva.dmas.virginia.gov/ 23 Department of Medical Assistance Services 23 In-home Residential Support Specialized Supervision

25 http://dmasva.dmas.virginia.gov/ 24 Department of Medical Assistance Services 24 In-home Residential Support Specialized Supervision Provides staff presence for ongoing or intermittent intervention to ensure the individuals health and safety. DMAS 457 must clearly document the individuals need for this support. Provider DMAS 457 form must contain a specialized supervision objective outlining the staffs activities and specific times that these activities will occur Activities must relate to the assessed health and safety needs of the individual

26 http://dmasva.dmas.virginia.gov/ 25 Department of Medical Assistance Services 25 In-home Residential Support Specialized Supervision May include hours throughout the entire night, but only if documentation supports the request Ongoing need for this service should be documented in semi-annual reviews –If, over a 60-day period, the hours of Specialized Supervision actually provided are consistently less than the scheduled-upon, approved, and determined amount, the provider is expected to revise the DMAS-457 form, the weekly schedule, and amount to reflect this reduction.

27 http://dmasva.dmas.virginia.gov/ 26 Department of Medical Assistance Services 26 In-home Residential Restrictions With Other Services In-Home Residential Support services will not be authorized for the primary purpose of supervision or personal care.

28 http://dmasva.dmas.virginia.gov/ 27 Department of Medical Assistance Services 27 In-home Residential Support Documentation

29 http://dmasva.dmas.virginia.gov/ 28 Department of Medical Assistance Services 28 In-home Residential Support Documentation Supporting Documentation (457) indicates: –Need for the service –Amount and type of activities (objectives and goals) Schedule of services –Total hours per day –Total hours per week

30 http://dmasva.dmas.virginia.gov/ 29 Department of Medical Assistance Services 29 In-home Residential Support Documentation In-home may not necessarily be required daily, but POC must reflect needs and appropriate allowable activities to be provided on a periodic basis Additional hours when clearly justified need to be requested through the case manager Reimbursed for hours of direct staff time with individual only

31 http://dmasva.dmas.virginia.gov/ 30 Department of Medical Assistance Services Must be authorized by DMAS Services explicitly detailed in Supporting Documentation In-home Residential Support Documentation

32 http://dmasva.dmas.virginia.gov/ 31 Department of Medical Assistance Services 31 In-home Residential Support Documentation A formal, written behavioral program is required to address behaviors, including self-injury, aggression or self stimulation. 12 VAC30-120-150(B)(4)

33 http://dmasva.dmas.virginia.gov/ 32 Department of Medical Assistance Services 32 In-home Residential Support Documentation Semi-annual Reviews: –Must be reviewed with individual General status of individual Significant events Individual/family satisfaction with services Any revision to Plan of Care (POC) and supporting documentation Submitted to case manager

34 http://dmasva.dmas.virginia.gov/ 33 Department of Medical Assistance Services 33 In-home Residential Support Documentation Supervision of direct care staff: –Monthly contacts/Semi-annual home visits –Signature of responsible supervisor –Date of contact/observation –Person contacted/observed –Staff performance and service delivery –Problems, concerns, individual satisfaction with services –Actions planned/taken to correct problems

35 http://dmasva.dmas.virginia.gov/ 34 Department of Medical Assistance Services 34 In home Residential Support Documentation Provider must maintain documentation of the date, times the services that were provided, and specific circumstances preventing the provision of any scheduled services. 12VAC30-120-750 ( C )

36 http://dmasva.dmas.virginia.gov/ 35 Department of Medical Assistance Services 35 In-home Supporting Documentation Overview

37 http://dmasva.dmas.virginia.gov/ 36 Department of Medical Assistance Services 36 Day Support Services

38 http://dmasva.dmas.virginia.gov/ 37 Department of Medical Assistance Services 37 Day Support Service Definitions Variety of training Assistance Support Specialized supervision (other than home or individual residence) Peer Interactions Specialized supervision for the acquisition Retention Improvement of self help Socialization Adaptive skills

39 http://dmasva.dmas.virginia.gov/ 38 Department of Medical Assistance Services 38 Day Support Service Definition Continued Providers are reimbursed only for the amount and type of day support services included in the individuals approved Plan of Care. This does not include prevocational services. 12VAC30-120-752(A)

40 http://dmasva.dmas.virginia.gov/ 39 Department of Medical Assistance Services 39 Day Support Activities Functional training in: –Self, social & environmental awareness –Sensory, gross and fine motor skills –Communication –Personal care –Problem-solving skills –Using community resources –Community safety –Peer interactions

41 http://dmasva.dmas.virginia.gov/ 40 Department of Medical Assistance Services 40 Day Support Criteria Must have demonstrated need for training, assistance and supervision –in settings outside of home –to access in-home residential services –to increase current level of independence –to sustain skills Individuals cannot benefit from Supported Employment

42 http://dmasva.dmas.virginia.gov/ 41 Department of Medical Assistance Services 41 Day Support Criteria Functional Assessment must be conducted by the provider to evaluate each individual in his home environment and community settings.

43 http://dmasva.dmas.virginia.gov/ 42 Department of Medical Assistance Services 42 Day Support Types and Levels Types: –Center-Based –Non Center-Based Levels: –Regular –Intensive

44 http://dmasva.dmas.virginia.gov/ 43 Department of Medical Assistance Services 43 Day Support Intensive Level Criteria Must meet at least one of the following criteria: –Need for physical assistance for caring for personal needs –Extensive disability-related difficulties, requiring additional staff support –Extensive constant supervision to reduce or eliminate behaviors that preclude full participation in the program. Formal behavioral plan is required to address behaviors (Withdrawal, self injury, aggression or self stimulation)

45 http://dmasva.dmas.virginia.gov/ 44 Department of Medical Assistance Services 44 Day Support Services Documentation

46 http://dmasva.dmas.virginia.gov/ 45 Department of Medical Assistance Services 45 Day Support Services Documentation Supporting Documentation (457) indicates: –Need for the service –Amount and type of activities (objectives and goals) Schedule of services –Total hours per day –Total hours per week –Maximum not to exceed 780 units per plan year

47 http://dmasva.dmas.virginia.gov/ 46 Department of Medical Assistance Services 46 Day Support Services Documentation Services and documentation must be separate and distinguishable from In- Home Residential Support or Personal Care Service cannot be provided in individuals home without prior authorization from Kepro

48 http://dmasva.dmas.virginia.gov/ 47 Department of Medical Assistance Services 47 Day Support Services Documentation Documentation must confirm the following: Attendance Amount of individuals time in service Specific information regarding individuals response to various settings

49 http://dmasva.dmas.virginia.gov/ 48 Department of Medical Assistance Services Day Support Services Documentation Supports as agreed to in the supporting documentation objectives Assessment results must be available in at least a daily note or weekly summary

50 http://dmasva.dmas.virginia.gov/ 49 Department of Medical Assistance Services 49 Day Support Services Documentation Provider must review the supporting documentation with the individual or family/caregiver for annual review and revisions Submit to case manager at least semiannually

51 http://dmasva.dmas.virginia.gov/ 50 Department of Medical Assistance Services 50 Day Support Services Documentation Attendance log or similar document must be maintained indicating the following: Date Type of services rendered Number of Hours or Units provided (including specific time frame) Center-based or non center-based Regular or intensive level

52 http://dmasva.dmas.virginia.gov/ 51 Department of Medical Assistance Services 51 Day Support Service Blocks 1 - 3.99 hours =1 block 4 - 6.99 hours = 2 block 7 or more hours = 3 block

53 http://dmasva.dmas.virginia.gov/ 52 Department of Medical Assistance Services 52 Day Support Supporting Documentation Overview

54 http://dmasva.dmas.virginia.gov/ 53 Department of Medical Assistance Services 53 Questions

55 http://dmasva.dmas.virginia.gov/ 54 Department of Medical Assistance Services 54 Quality Management Review (QMR)

56 http://dmasva.dmas.virginia.gov/ 55 Department of Medical Assistance Services 55 Contact Information Long-Term Care Division Division of Long-Term Care Telephone 804-225-4222 Fax 804-612-0050 www.dmas.virginia.gov

57 http://dmasva.dmas.virginia.gov/ 56 Department of Medical Assistance Services 56 Supported Employment Services

58 http://dmasva.dmas.virginia.gov/ 57 Department of Medical Assistance Services 57 Supported Employment Service Description Paid employment Community worksites with people without disabilities Specialized supervision and training Ongoing support

59 http://dmasva.dmas.virginia.gov/ 58 Department of Medical Assistance Services 58 Supported Employment Activities Training in specific job and related skills Ongoing or intermittent assistance Specialized supervision to ensure health and safety Contacts with employer, family members, other support services needed for initiating, maintaining and evaluating employment

60 http://dmasva.dmas.virginia.gov/ 59 Department of Medical Assistance Services 59 Supported Employment Criteria Service cannot be available from DRS or school system (must be documented) Generally follows DRS time-limited services Assessment must clearly reflect need for ongoing supports on the job Reimbursed only for services included in POC

61 http://dmasva.dmas.virginia.gov/ 60 Department of Medical Assistance Services 60 Supported Employment Individual Model –Regular community job –Job coach services –Usually one to one –Intermittent support –Reimbursement for specific interventions only, including collateral contacts, not time on the job

62 http://dmasva.dmas.virginia.gov/ 61 Department of Medical Assistance Services 61 Supported Employment Group Model –8 or fewer people with disabilities –Integration with people without disabilities –Enclave –Work Crew –Entrepreneurial –Benchwork/Electronics Assembly

63 http://dmasva.dmas.virginia.gov/ 62 Department of Medical Assistance Services 62 Supported Employment Service Limitations Transportation not included in service Case manager must determine and document supported employment services not available from DRS or school

64 http://dmasva.dmas.virginia.gov/ 63 Department of Medical Assistance Services 63 Supported Employment Documentation Supporting Documentation (457) indicates: –Need for the service –Amount and type of activities (objectives and goals) Schedule of services –Total hours per day –Total hours per week –Maximum not to exceed 780 units per plan year for SE enclave

65 http://dmasva.dmas.virginia.gov/ 64 Department of Medical Assistance Services 64 Supported Employment Documentation Attendance log or similar document must be maintained indicating the following: Date Type of services rendered Number of Hours or Units provided (including specific time frame) Center-based or non center-based Regular or intensive level

66 http://dmasva.dmas.virginia.gov/ 65 Department of Medical Assistance Services 65 Supported Employment Service Units Individual Supported Employment (SE) billed hourly Group Supported Employment billed at unit rate: 1 - 3.99 hours = 1 blocks 4 - 6.99 hours = 2 blocks 7 or more hours = 3 blocks

67 http://dmasva.dmas.virginia.gov/ 66 Department of Medical Assistance Services 66 Supported Employment Supporting Documentation Overview

68 http://dmasva.dmas.virginia.gov/ 67 Department of Medical Assistance Services 67 Therapeutic Consultation Services

69 http://dmasva.dmas.virginia.gov/ 68 Department of Medical Assistance Services 68 Therapeutic Consultation Service Definition Therapeutic consultation provides expertise, training, and technical assistance in any of the following specialty areas to assist family members, caregivers, and other service providers in supporting the individual.

70 http://dmasva.dmas.virginia.gov/ 69 Department of Medical Assistance Services 69 Specialty Areas for Therapeutic Consultation are: PsychologyRehabilitation Occupational Therapy Behavioral Consultation Psychiatry Social Work Therapeutic Recreation Psychiatric Clinical Nursing

71 http://dmasva.dmas.virginia.gov/ 70 Department of Medical Assistance Services 70 Therapeutic Consultation Activities 1. Interviewing the individual and relevant family members, caregivers, and other service providers to identify issues to be addressed and desired outcomes of consultation; 2. Observing the individual in natural and structured settings, or both; 3. Developing data collection mechanisms and direct collection of baseline data;

72 http://dmasva.dmas.virginia.gov/ 71 Department of Medical Assistance Services 71 Therapeutic Consultation Activities Continued 4. Assessing the individuals present and potential level of functioning, including the use of instruments to measure areas of adaptation or skills (but not to measure intelligence); 5. Observing and assessing current intervention or support strategies being used with the consumer; 6. Design and develop supporting documentation detailing interventions and support strategies to address identified issues and desired outcomes;

73 http://dmasva.dmas.virginia.gov/ 72 Department of Medical Assistance Services 72 Therapeutic Consultation Activities Continued 7. Demonstrate specialized, therapeutic interventions or supports; 8. Train relevant persons to implement specific interventions or support techniques; 9. Train relevant persons to observe individual, record data, and monitor implementation of therapeutic interventions or support strategies; 10. Review documentation and evaluate activities conducted by family members, caregivers, or program staff; and

74 http://dmasva.dmas.virginia.gov/ 73 Department of Medical Assistance Services 73 Therapeutic Consultation Activities Continued 11. Train and provide technical assistance to family members, caregivers and other individual primarily responsible for carrying out the Individuals Service Plan

75 http://dmasva.dmas.virginia.gov/ 74 Department of Medical Assistance Services 74 Therapeutic Consultation Criteria Continued The Plan of Care (POC) must clearly reflect individuals needs, for specialized consultation provided to caregivers in order to implement the plan of care effectively.

76 http://dmasva.dmas.virginia.gov/ 75 Department of Medical Assistance Services 75 Therapeutic Consultation Criteria Continued Therapeutic Consultation services may not include direct therapy, nor duplicate the activities of other services available to the individual through the State Plan for Medical Assistance.

77 http://dmasva.dmas.virginia.gov/ 76 Department of Medical Assistance Services 76 Therapeutic Consultation Criteria Continued Behavioral Consultation may be provided in absence of other DD Waiver services when consultation provided to informal caregivers is necessary to prevent institutionalization TC services, other than behavior consultation, may be provided in In-Home Residential or Day Support settings or in office settings in conjunction with another Waiver service.

78 http://dmasva.dmas.virginia.gov/ 77 Department of Medical Assistance Services 77 Therapeutic Consultation Documentation The following information is required in the supporting documentation: Identifying information Targeted objectives, timeframes, expected outcomes Specific consultation activities Written support plan detailing interventions or support strategies

79 http://dmasva.dmas.virginia.gov/ 78 Department of Medical Assistance Services 78 Therapeutic Consultation Documentation continued Summary of consultative activities for the month Dates, locations, times of service delivery Supporting documentation objectives addressed Specific details of the activities conducted Services delivered as planned or modified Effectiveness of the strategies and satisfaction of services Monthly and contact notes:

80 http://dmasva.dmas.virginia.gov/ 79 Department of Medical Assistance Services 79 Therapeutic Consultation Documentation continued Semi-annual Reviews are required if provider extends three months longer should be forwarded to case manager Activities related to therapeutic consultation supporting documentation Individual status and satisfaction with services Consultation outcomes and effectiveness

81 http://dmasva.dmas.virginia.gov/ 80 Department of Medical Assistance Services 80 Therapeutic Consultation Documentation continued If consultation services extend less than three months: Forward a copy of monthly contact notes or a summary to case manager for semi annual review

82 http://dmasva.dmas.virginia.gov/ 81 Department of Medical Assistance Services 81 Therapeutic Consultation Documentation continued A final disposition summary must be forwarded to the case manager within 30 days following the end of this service must include: Strategies utilized Objectives met Unresolved issues Consultant recommendations 12VAC30-120-756 (6)

83 http://dmasva.dmas.virginia.gov/ 82 Department of Medical Assistance Services 82 Service Units and Limitations Unit of service is one hour Services must be explicitly detailed in supporting documentation Case managers must submit prior authorization to Kepro

84 http://dmasva.dmas.virginia.gov/ 83 Department of Medical Assistance Services 83 Therapeutic Consultation Supporting Documentation

85 http://dmasva.dmas.virginia.gov/ 84 Department of Medical Assistance Services 84 Questions? This is your time to ask questions. How may we help you?

86 http://dmasva.dmas.virginia.gov/ 85 Department of Medical Assistance Services 85 Contact Information Long-Term Care Division Division of Long-Term Care Telephone 804-225-4222 Fax 804-612-0050 www.dmas.virginia.gov


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