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OVERVIEW OF DDS ACS HCBS MEDICAID WAIVER. Medicaid Regular state plan Medicaid pays for doctor appointments, hospital expenses, medicine, therapy and.

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Presentation on theme: "OVERVIEW OF DDS ACS HCBS MEDICAID WAIVER. Medicaid Regular state plan Medicaid pays for doctor appointments, hospital expenses, medicine, therapy and."— Presentation transcript:

1 OVERVIEW OF DDS ACS HCBS MEDICAID WAIVER

2 Medicaid Regular state plan Medicaid pays for doctor appointments, hospital expenses, medicine, therapy and some adaptive equipment Waiver allows Medicaid to be used to pay for additional services If person is waiver eligible, they can obtain regular state plan Medicaid services as well as waiver services

3 Medicaid Waiver Facts Implemented September 1, 1989 Alternative to institutionalization Not an entitlement program Voluntary program Services and supports to live and work in the community Administrative authority and responsibility for waiver including application by DMS Approval of application by CMS Day to day operation by DDS with oversight by DMS

4 Application Contact DDS Intake and Referral staff (Adults) or DDS Children’s Services (Child) Informed choice of ACS Waiver and/or ICF (HDC) Complete application packet DDS review of application packet for eligibility Notification of placement on waiting list or ineligibility for waiver

5 Eligibility Requirements Developmentally Disabled (onset prior to age 22) ICF Level of Care limitations in 3 of 6 major life activities (self care, language, learning, mobility, self direction or independent living) Medicaid Eligible - $1911 (3 x SSI) monthly income limit, $2,000 resource limit and meet disability criteria

6 Case Management Locating, coordinating and monitoring of waiver services, state plan services, publicly funded services and informal community supports Development and timely submission of MAPS Assistance with Medicaid income eligibility and ICF level of care documents

7 Supportive Living Array Individually tailored services and supports that assist individual in acquiring, retaining and improving targeted skills necessary to reside in the community Direct care staff person works with person in waiver recipient’s home and community on identified goals and objectives

8 Supportive Living Array (cont) Community Experience - activities in a natural setting such as shopping at a grocery store Respite Non – Medical Transportation

9 Levels of Support Pervasive – constant support 24 hours a day, 7 days a week Extensive – schedule of daily or weekly supports less than 24 hours a day, 7 days a week Limited – intermittent in nature

10 Supported Employment Competitive employment Minimum wage Integrated work site On-going support

11 Adaptive Equipment Purchase, lease or repair of equipment required to enable individual to perform daily tasks Personal emergency response system

12 Environmental Modifications Adaptations to waiver participant’s place of residence Necessary to ensure health, welfare and safety

13 Specialized Medical Supplies Disposable undergarments Ostomy and colostomy supplies Nutritional supplements Non – prescription medications Drug and alcohol screening

14 Supplemental Supports Emergency medical costs including prescription co- pay Transitional expenses for moving from ICF/SNF Ancillary support to assure health and safety in crisis situation Fees for activities to reinforce specific habilitation needs (like Camps)

15 Consultation Psychological or adaptive behavior testing Screening, assessing, developing therapeutic treatment plans Training of direct care staff or family members Development of behavior management plan Determining appropriateness of equipment

16 Crisis Center/Intervention Short term out of home placement for intervention of crisis situation In-home or community services provided by mobile team during crisis situation to assist and/or train in dealing with behavior

17 Multi-Agency Plan of Service Individualized Services provided in least restrictive environment Monitored and adjusted based on needs Safeguards individuals rights Assures individuals health and safety Approved by physician Prior approval by DDS

18 Waiver Assurances Level of Care (LOC) for all applicants and annually for persons on waiver using processes and instruments described in the waiver Person centered planning where individual has choice of waiver, waiver services and providers, plan is updated annually/as needed and addresses all assessed needs (including health and safety risk factors) and personal goals and services are delivered based on plan

19 Waiver Assurances, continued Qualified Providers who meet certification standards including provider training Health and Welfare is monitored continuously with remediation when appropriate Administrative Authority with Medicaid agency retaining authority and responsibility for waiver Financial Accountability billing for authorized services delivered by qualified providers in accordance with approved waiver

20 Contacts for Application For CHILDREN (those up to age 21 and still in school): For ADULTS: or


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