1. The DMH Division of Developmental Disabilities Difference Wanda Russell Division Provider Relations Lead

2. Purpose Provide prospective agencies with knowledge of Division of DD processes and provide information essential to a successful partnership with Division of DD, individuals, families, and stakeholders.

3. Overview Division Mission Division Structure Eligibility Utilization Review Division Funding Sources Home and Community Based Services Final Rule Services Certification Provider Staff and P&P Applying for a contract Contract Implementation

4. Priorities

5. Division Structure Central Office 5 Regional Offices and 6 Satellite Offices Individual and Family Supports Intake/Eligibility Utilization Review Coordinator Behavior Resource Team Quality Enhancement Provider Relations Inquiry Coordinator Business Office

6. Eligibility Regional Office determines eligibility (9 CSR 45- 2.010) Individual must have a developmental disability Developmental disability must have occurred prior to age 22 To be eligible for services from the Division, persons with these disabilities must be substantially limited in their ability to function independently. If found eligible, the individual is assigned a Support Coordinator (SC).

7. Eligibility for Waiver Individual found eligible for DD services Developmental disability is likely to continue indefinitely Results in substantial limitations in 3 or more areas Self-Care Communication Learning, Mobility Self-Direction Capacity for independent living plus need for the level of care provided in an ICF/ID In addition, a determination must be made that the individual is at risk of needing ICF/ID institutional services if unable to access waiver services. Individual may not reside in ICFs/ID or other MO HealthNet-funded nursing facilities (ICF’s) unless person has a transition plan to move into the community

8. Utilization Review 9 CSR 45-2.017 A formal committee established at each regional office or at an SB40 Board to review PON assessments, proposed service plans and budgets. Makes recommendations utilizing the PON and attached documentation before services are approved and authorized. Review of new services or increasing the dollar amount of services. Applicable Medicaid State Plan services shall be accessed first when the individual is Medicaid-eligible and the services will meet the individual’s needs. Service may be approved, denied, or placed on a wait list. No service may start until UR approval and authorization is received.

9. Division Funding Sources Purchase of Service Shared Unit Waiver Comprehensive Support Partnership Autism Missouri Children with DD (MOCDD or Sarah Jian Lopez)

10. Home and Community Based Services CMS has published a final rule that supports what we have learned over time about individuals served in the HCB waivers The final rule includes where and how services are to be provided offering definitions and descriptions in detail for the first time. States are required to develop a plan for how they will make sure the definitions and descriptions in their waivers match the definitions in the final rule. Effective March 17, 2014

11. Final HCBS Rule Setting Requirements 42 CFR 441.30(c)(4) and 441.710 HCBS Rule requires that an HCB Waiver Service setting: Is fully integrated in and supports access to the greater community Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources Ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid home and community based services Is selected by the individual from more than one setting option, including non- disability specific settings and an option for a private room in a residential setting

12. Final HCBS Rule Setting Requirements 42 CFR 441.30(c)(4) and 441.710 Supports individual choice of services and supports Ensures privacy, dignity, respect, and freedom from coercion and restraint Optimizes individual initiative, autonomy, and independence in making life choices Facilitates individual choice regarding services and supports and who provides them

13. Final HCBS Rule Settings Requirements Settings presumed not to be HCB (Heightened Scrutiny) Settings in a publicly or privately-owned facility providing inpatient treatment Settings on the grounds of, or adjacent to, a public institution Settings with the effect of isolating individuals from the broader community of individuals not receiving Medicaid HCB services

14. Transition Plan Assessment Component Determines whether transition actions are needed for compliance, states must determine their current level of compliance with the settings requirements Provider surveys Settings analysis Crosswalk of final rule to waiver A description of the state’s oversight process to ensure continuous compliance Assess individual settings/types of settings to further document compliance

15. Services Assistive Technology Behavior Analysis Service Communication Skills Instruction Community Employment Community Specialist Community Transition Counseling Crisis Intervention Dental Environmental Accessibility Adapt. Group Home Host Home In Home Respite Independent Living Skills Dvlpmnt Day Hab, CI, In Home Individualized Supported Living Job Discovery Job Preparation Occupational Therapy Out of Home Respite Personal Assistant Physical Therapy Professional Assessment & Monitoring Specialized Medical & Supplies Speech Therapy Support Broker (Self-Directed Service) Transportation

16. Certification The following services require Certification or Accreditation Independent Living Skills Development Community Employment, Job Preparation and Discovery All residential services Provisional initially for 6 months, full Certification occurs every two years Certification is provided by the State at no cost to the agency and is based on health and safety

17. Provider Staff and P&P Must have a Professional Manager A four year degree or relevant field experience Each service definition lines out required qualifications and trainings for staff Direct Care staff typical training 18 years old, High School Diploma or GED CPR, First Aide, Medication Administration, MANDT, Abuse and Neglect, PCS, ISP Policies and Procedures DHSS policies and expectations do not equal to Division of DD policies

18. Why Apply for a Contract? Many individuals and families receive services from state plan and from the Division Dual contracted providers have the opportunity to offer continuity of staff over services to the entire family

19. Applying for a Contract Provider Enrollment Review Division Directive http://dmh.mo.gov/docs/dd/directives/5060.pdf Review standardized statewide application and frequently asked questions http://dmh.mo.gov/docs/dd/faqpursuingcontract.pdf Contact your local Regional Office Provider Relations Team Complete application and all requirements, submit to the Regional Office Provider Relations Team

20. Contract Implementation Support Coordination (SC) entities will be notified that the agency contract is available for use SC’s must provide individuals with choice Having a contract does not guarantee authorization of services Use of Referral Database for residential services Subsequent to providing services, all staff must be trained according to service definitions

21. Contract Implementation TCM Monitoring Provider Relations Review every three years http://dmh.mo.gov/docs/dd/directives/4090.pdf Quality Enhancement Review every three years http://dmh.mo.gov/docs/dd/directives/3100.pdf Certification every 2 years or Accreditation visit based on granted years Fiscal Reviews from the Regional Office for POS Funding MMAC Reviews

22. Contract Implementation As a result of any single or combined reviews on the previous slide, or from other information sources, Integrating Quality Functions Directive may be implemented Proscribes the systematic process for integrating and synthesizing information from all Quality Functions. The information is used to evaluate the performance of the service delivery system, remediate identified issues, and develop systems improvements in partnership with contracted providers. http://dmh.mo.gov/docs/dd/directives/4080.pdf

23. Review Division Mission Division Structure Eligibility Utilization Review Division Funding Sources Home and Community Based Services Rule Services Certification Provider Staff and P&P Applying for a contract Contract Implementation