Overview of the Intellectual Disability and Day Support Waivers Provider Training Module 1 Division of Developmental Services Department of Behavioral Health and Developmental Services 2013

ID Waiver Provider Modules 1. Overview of the ID and DS Waivers 2. Becoming an ID Waiver Provider 3. Supporting People in the ID and DS Waivers 4. Introduction to Planning 5. Residential Services 6 PA, Respite and Companion - DBHDS-licensed 7. Employment and other Day Services (Agency Directed) 8. Crisis Stabilization and Supervision 9. Assistive Technology, Environmental Modifications and Transition Services 10. Skilled Nursing 11. Personal Emergency Response System 12. Consumer Directed Services and Services Facilitation 13. Therapeutic Consultation 14. Preauthorization and Reimbursement 15.Monitoring and Oversight 2

About the ID & DS Home & Community Based Waivers 3 States apply to CMS/Medicaid match For individuals with intellectual disability Pays for long-term in-home and community services Waives certain Federal Medicaid requirements Two of 6 Home & Community Based Waivers Virginia offers

4 Waiver Highlights Began ID Waiver in 1991 Expanded services in 1994 Added Consumer-Directed Services in 2001 Added Day Support Waiver in 2005 Added MFP in 2008 Added PC Practices and the SIS in 2009 Just the Facts ID Waiver

5 Key Agencies Department of Medical Assistance Services (DMAS) Department of Behavioral Health and Developmental Services (DBHDS) Community Services Boards (CSBs) or Behavioral Health Authority (BHAs) Waiver Service Providers

6 CMS (Federal) Virginia General Assembly (State) DMAS DBHDS CSB Support Coordinator CSBs/BHAs (Local) Waiver Services Providers The Big Picture

7 Key Agencies Single point of entry Support Coordination Community Services Boards (CSBs) or Behavioral Health Authority (BHAs)

8 Key Agencies Community-based Selected by the individual Person-centered supports Waiver Service Providers

9 Key Agencies Department of Behavioral Health & Developmental Services (DBHDS) Pre-Authorization Technical Assistance Training Daily Operations Licensing Human Rights

10 Key Agencies Single state agency for Medicaid Payment to providers Service audits and fraud Quality reviews Appeals Department of Medical Assistance Services (DMAS)

11 Other Key Agencies DSS Public Schools DARS

12 ID and DS Waiver Eligibility Diagnostic Functional Financial

13 Diagnostic Eligibility 6 years or older: psychological evaluation stating diagnosis of intellectual disability 6 years or older: psychological evaluation stating diagnosis of intellectual disability Under age 6: psychological or standardized developmental evaluation stating diagnosis of intellectual disability or “at developmental risk” Under age 6: psychological or standardized developmental evaluation stating diagnosis of intellectual disability or “at developmental risk” Psychological Evaluation Guidance

ID as demonstrated by evidence of cognitive and adaptive delay OR presence of a syndrome typically associated with ID 14 Developmental risk: “presence before, during or after birth of conditions related to the occurrence of a developmental disability and for which no specific developmental disability is identifiable through available diagnostic and evaluative criteria.” For children under age 6: At Risk or ID Diagnostic Eligibility

15 CSB Support Coordinator (SC) confirms functional eligibility by completing: Within 45 days of date of request for services Level Of Functioning (LOF) Survey Functional Eligibility

16 Functional Eligibility LOF Survey Must meet ICF-ID level of care in 2 or more categories Completed within 6 months prior to start date Completed annually Applies to children under 6, too

17 Financial Eligibility DSS-determined Different financial limits for Medicaid Waivers Based upon the individual’s income only Possible patient-pay obligation

18 About the Waivers Each person requires a slot Each CSB has an allocation of slots Waiver Slots Just the Facts ID Waiver

19 Day Support Waiver Facts Day Support Waiver ID Waiver Based on urgency Annual allocations Based on urgency Annual allocations Slots Awarded… Based on date of need Limited to 300 slots Based on date of need Limited to 300 slots About the Waivers

20 If no slot, name placed on a Statewide Waiting List (WL) About the Waivers CSB submits to DBHDS Urgent and Non-urgent DBHDS maintains Statewide WL All Urgent in state served first

21 ID Waiver Services About the Waivers

22 Residential -Congregate -In-Home Personal Assistance RespiteCompanion Day Support Pre- Vocational Supported Employment Skilled Nursing Therapeutic Consultation Assistive Technology Environmental Modification Crisis Stabilization P ersonal E mergency R esponse S ystem Transition Services Service Facilitation Respite Companion Personal Assistance Self Directed ID Waiver Services ID Waiver Overview

23 DS Waiver Services About the Waivers

24 Residential -Congregate -In-Home Personal Assistance RespiteCompanion Day Support Pre- Vocational Supported Employment Skilled Nursing Therapeutic Consultation Assistive Technology Environmental Modification Crisis Stabilization P ersonal E mergency R esponse S ystem Transition Services Service Facilitation Respite Companion Personal Assistance Consumer Directed DS Waiver Services

25 Self-Directed Services Agency-Directed Services A Combination of Both Individual selects... or About the Waivers

26 Allowable support activities Criteria and limitations Individual Support Plans About the Waivers

27 Team Approach Individual Substitute Decision Maker Support Coordinator Waiver service providers Other providers, as needed Others, as requested by the individual Just the Facts ID Waiver About the Waivers

28 Based upon individual choice: Providers Services Outcomes Activities Staff S upports Places Peo ple

29 Available Resources: Department of Behavioral Health and Developmental Services Division of Developmental Services Offices of Licensing and Human Rights