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ODMRDD Waivers. What is a Waiver?  A waiver is another way that Medicaid can pay for services to keep people with disabilities in their homes so they.

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Presentation on theme: "ODMRDD Waivers. What is a Waiver?  A waiver is another way that Medicaid can pay for services to keep people with disabilities in their homes so they."— Presentation transcript:

1 ODMRDD Waivers

2 What is a Waiver?  A waiver is another way that Medicaid can pay for services to keep people with disabilities in their homes so they do not have to move to a long-term care facility or nursing home. The local county board is required to pay 40% of the cost of waiver services and Medicaid pays the remainder

3 Types of Waivers  There are two waivers that ODMRDD oversees: Individual Options Waiver Level One Waiver  Both of these waivers are administered at the local county board level

4 Individual Options  Services available with the IOW include: Homemaker Personal Care Transportation Environmental accessibility modifications Adaptive & Assistive equipment Social work* Interpreter* Home delivered meals* Nutritional services* Adult Day Waiver Services *exclusive to the individual options waiver

5 Level One  Services available with LV1 waiver include: Homemaker/Personal Care Respite* Transportation Personal Emergency Response Systems Specialized Medical Equipment and Supplies Environmental Accessibility Adaptations Emergency Assistance* Adult Day Waiver Services *exclusive to the level one waiver

6 Assessments  Assessments are required to determine: Level of Care (ICF/MR LOC is required)  Qualifying Diagnosis (indefinite) or Areas of Delay  Functional Limitations  Need for Skill Acquisition Budget Range for Waiver Services  Individual Options only Prescreen for Level One  Level One relies heavily on natural support

7 Developmental Delays  To meet ICF/MR Level of Care, those birth thru 5 must have at least 3 areas of delay: Adaptive behavior Physical development or maturation, fine and gross motor skills, growth Cognition Communication Social or emotional development Sensory Development

8 Functional Limitations  To meet the ICF/MR Level of Care, those 6 years and older must have functional limitations in at least 3 areas: Self Care Understanding/Use of Language Learning Mobility Self Direction Capacity for Independent Living Economic Self-Sufficiency (Age 16+ only) **Assessments can be found at Click on forms at the bottom of the page

9 Medicaid  A Medicaid Card is included with the Waiver service package and may cover therapies, hospital services, nursing services, home health aides, doctor & dental appointments and medical equipment  A person must receive and continue Medicaid eligibility to receive waiver services  Medicaid eligibility is determined by the local Job & Family Services office and takes into consideration: Income Assets Disability and age

10 Waiting Lists in Delaware County  Delaware County Board of DD currently has waiting lists for funding for both waivers  Placement on the waiting list is determined by priority scoring which gives points for: Refinancing of supported living and/or adult services Those who are 22 years and older Those with a caregiver over the age of 60 Those with intensive behavioral needs, medical needs and/or at risk of institutionalization

11 Waiting Lists in Franklin County  Franklin County Board of MRDD currently has waiting lists for funding for both waivers Priority status is determined by an assessment tool based on the waiting list rule Sorted by priority group and then date and time

12 Adult Services  Both MRDD waivers include adult services, called Adult Day Waiver Services, in the service package  These services include: Adult Day Support Vocational Habilitation Supported Employment-Enclave Supported Employment-Community Non-Medical Transportation Limited Supported Employment Equipment and Modifications

13 Adult Services  The Adult Day Waiver Services are available to all waiver recipients who are no longer eligible for educational services  An Acuity Assessment Instrument is utilized to determine the service need for each individual and assigns each participant one of four acuity groups Acuity groups are separated by staff to participant ratio and funding limits Providers have the option of billing a daily rate or 15 minute unit rate depending on the length of participation

14 Any Questions?  Ohio Department of MR/DD  Delaware County Board of DD  Franklin County Board of MRDD  Ohio Department of Job & Family Services

15 Ohio Developmental Disabilities Profile

16 What is the ODDP?  The Ohio Developmental Disabilities Profile is an assessment tool for individuals enrolled on the Individual Options Waiver. The ODDP contains a series of questions created and designed to determine an individual’s service needs. The answers to these questions provide information about an individual’s needs and circumstances. The answers to the questions are scored by the Ohio Department of MR/DD  The purpose of the ODDP is to ensure that individuals across the State of Ohio who have similar needs and circumstances receive services at levels of funding through the IO waiver that are comparable

17 When to do an ODDP?  When a person enrolls on Individual Options waiver, the assessment will be completed as part of the enrollment process. Service & Support Administrators (SSAs) complete the assessment with the entire team. Individuals have the right to know the funding range that resulted from the ODDP assessment  There are 9 funding ranges associated with the ODDP allowing annual budgets from $5001 to $500,000

18 ODDP Questions  There are 40 questions on the ODDP  These questions cover 10 areas of life: Identifying Information Residential Disability Description Medical Information Sensory/Motor Information Cognitive/Communication Information Behavior Self Care and Daily Living Skills Routine Voluntary Caregivers Clinical Services

19 Revisions to the ODDP  Any time there is a substantial change in the way services are provided, the team needs to update the ODDP to reflect the change in need: Change in routine voluntary care being provided Change in residential setting, including a change in the number of persons living together who share waiver services Changes in behavior issues Changes in medical conditions

20 Prior Authorization  If the service needs addressed in the ISP cost more than the assigned ODDP range, a process called Prior Authorization may be requested  Prior Authorization allows a person to receive waiver services that result in an individual funding level above his/her funding range  Reasons to request Prior Authorization: Behavioral Issues Medical Issues Changes in ability of unpaid caregivers Changes in staffing ratio outside of a person’s control Emergency situations

21 Due Process  DCBDD Due Process Procedure  FCBMRDD Due Process Procedure  Once a person receives Medicaid services, they have a right to a State Hearing ODJFS State Hearings 30E Broad Street, 32 nd Floor Columbus, OH Fax

22 Questions? Melinda DraperKarin Crabbe Waiver Coordinator SSA Supervisor ext


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