changes in the dd system lake county board of dd/deepwood service and support administration...

CHANGES IN THE DD SYSTEM

Lake County Board of DD/Deepwood

Service and Support Administration

6/3/2015

Transition TDD Waiver to I.O. Waiver

• DODD has submitted a proposed plan for the transition of TDD Waiver to I.O. Waiver to the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicaid‐funded waivers.

• After everyone has transitioned, the TDD Waiver will no longer exist.

Why

• DODD has heard from individuals and families that the Transitions DD (TDD) Waiver isn’t meeting their needs– TDD has a lack of employment supports– Minimal access to services that help people

become more involved in their communities– Limited Providers

What

• Individuals currently enrolled on the TDD Waiver will be able to enroll on the Individual Options (I.O.) Waiver – Offers a broader array of services than TDD– Includes day and employment options– Designed to help individuals become more

involved in community activities– Nursing services will be added to the I.O.

Waiver beginning July 1, 2016

When

• Beginning July 1, 2015, County Boards of DD through SSA will begin transitioning individuals currently enrolled on the TDD Waiver to the Individual Options (I.O.) Waiver.

• SSAs will assist you with the enrollment process and in most cases, if not all, will do so at the time of your annual Level of Care (LOC)

When– Phase I (July 1, 2015-June 30, 2016) will

include those individuals who do not require ongoing nursing services or whose nursing needs can be met under Delegated Nursing and/or Certified Medication Pass as a part of Homemaker Personal Care (HPC).

– Phase II (July 1, 2016-June 30, 2017) will include those individuals who require ongoing nursing services or whose nursing needs cannot be met under Delegated Nursing and/or Certified Medication Pass as a part of Homemaker Personal Care (HPC).

Do I Have a Choice in Waivers?

• If you believe another Waiver administered by DODD would better meet your needs, you can choose to enroll in one of DODD’s other two waivers – the Level One Waiver or the Self-Empowered Life Funding Waiver.

• You can discuss these options with your SSA and review information about all three waivers on DODD’s website – visit DODD.Ohio.gov and go to the individuals & families section, then the Waiver Types page.

INDIVIDUAL OPTIONS (IO) WAIVER OVERVIEW

Eligibility:• ICF/IID Level of Care• Annualized benefit amount is determined by the

completion of the Ohio Developmental Disabilities Profile. Upon completion and submission of the ODDP, a funding range is assigned to the enrollee based on his/her assessed needs and circumstances such as living arrangements and availability of natural supports.

• Per Rule, there is a total of 9 funding ranges starting at $5,001.


• Services included in the assigned funding ranges include:– Homemaker/Personal Care (HPC)– Adult Foster Care– Adult Family Living– Remote Monitoring– Remote Monitoring Equipment– Environmental Accessibility Adaptations– Specialized Medical Equipment and Supplies– Transportation– Residential Respite (limited to 90 days in a span year)– Community Respite (limited to 60 days in a span year)– Social Work– Home Delivered Meals– Nutrition– Interpreter Services


• Covered services under IO Waivers for day and/or vocational services that have separate annual budget limitations determined through the completion of an Acuity Assessment Instrument (AAI):– Adult Day Support– Vocational Habilitation– Supported Employment-Enclave– Supported Employment-Community

• Non-Medical Transportation with annualized benefit amount of $9,456.00

CMS Rule Change and Future Systems Redesign

• Effective March 17, 2014, CMS Rule change became effective– Identifies the characteristics of home and

community based services (HCBS) settings– Identifies settings that are not home and

community based– Outlines timelines for states to submit

transition plans to the Centers for Medicare and Medicaid Services (CMS) to ensure compliance

HCBS Characteristics

• Integrated in and supports full access to the greater community

• Selected by the individual among setting options including non-disability specific settings

• Ensures the rights of privacy, dignity and respect, and freedom of coercion/restraint

• Optimizes, but does not regiment, individual initiative, autonomy, and independence in life choices

• Facilitates choice in services and who provides them

Settings not HCBS

• Nursing Facilities

• Institutions for mental disease

• Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)

• Hospitals

• Any other setting with the qualities of an institutional setting

Institutional Qualities

• Located in a building that is also a publicly or privately operated facility that proivdes inpatient institutional treatment

• Located in a building on the grounds of or adjacent to a public institution

• Any other setting that has the effect of isolation individuals from the broader community UNLESS determined through heightened scrutiny that the setting does not have institutional qualities and does have home and community based qualities

Coming into Compliance

• Free Choice of Provider Rule Revision – 5/1/2015– Describes the assistance individuals may receive

when selecting providers– Ensures county boards help recruit new providers,

where needed• New HCBS Waiver Administration Rule –

6/1/2015– Describes settings where services can/cannot be

provided– Emphasizes least restrictive services to meet

individuals’ needs


• Ongong compliance:– Develop new HCBS settings evaluation tool –

6/1/2015

• Waiver changes:– Phase-out of TDD Waiver – 7/1/2015-

6/30/2017• Add nursing to IO Waiver - 7/1/2016

• Revised Homemaker/Personal Care definition – 7/1/2016


• Revised Adult Day Waiver Services – 7/1/2016

– Supported Employment – Individual

– Integrated Prevocational Services

– Integrated Day Supports

Common Questions

• Does this mean that all current day programs have to close?– No. The Rule requires that all individuals,

regardless of where they receive services, must have the opportunity to participate in community-based activities to the greatest extent possible. As a result, existing providers of day services may need to change how services are offered in order to comply with the rule.

Common Questions

• Does participating in “community-based activities” mean that the existing facilities cannot be used and that everyone must spend the entire day in other community-based places?– No. Each person’s level of participation in

community based activities will be determined through the person-centered planning process.

Common Questions

• Does the new rule require everyone to work?– No. The new rule requires everyone to have

access to the broader community to the same extent as people without disabilities, including opportunities for employment.

• Some people don’t have enough information about working to know if they want to or not

• For some, work is not a priority

Common Questions

• The new services are being designed to give people who want to work the opportunity to do so and also to offer other services they may enjoy when not working.

Common Questions

• Will people get fewer hours of service than they do today if they don’t want to participate in community-based activities 100% of the time?– No. A fundamental principal of the

employment and day service redesign was that individuals will have the same level of service/support available under the new services as they do today.

Common Questions

• Will people be able to keep their current providers?– People who are currently receiving day

services from private providers will be able to continue working with those providers, as long as:

• the current Provider is also certified to provide adult day array services under the I.O. Waiver

• the setting in which the services are provided meets the rule requirements

Common Questions

• Conflict Free Case Management– DODD states that due to a provision in the

rule that prevents providers from also being responsible for case management activities, individuals will not be able to receive both SSA (case management) and day services from the county board.

– DODD has asked CMS for the ability to transition services from boards to private providers by March 2024.

Common Questions

– However, County Boards through the Ohio Association of County Boards continues to challenge this provision citing the fact that Free Choice of Provider needs to include all Providers, including County Boards

– Conflict Free Case Management is not a new issue and had successfully been addressed in the past with a “firewalls” document that ensures a separation of the case management services (SSA) from the services that are provided under HCBS Waivers.

– Work continues on this issue

What Will Look Different

• Enrollment Process– DODD has developed a simplified process to transfer

from the TDD Waiver to the I.O. Waiver – LOC assessments will be submitted on line effective

7/1/2015– Requires the completion of an Ohio Developmental

Disabilities Profile (ODDP) to determine funding range for services

– Requires the completion of an Acuity Assessment Instrument (AAI) to determine the group size with corresponding rates for day services

What Else Will Look Different

• Monitoring– Individualized monitoring tailored to current needs– Scope, type and frequency specified in the plan– Increased frequency based on intense behavioral,

medical needs, transitions in residential setting or at the request of the individual

• Person Centered Planning Process– Focus on gathering information that is important to

and for the individual– Risk Management– Keeping the plan relevant and outcome based

Person-Centered Planning

The goal is to provide guidance for achieving the individual’s desired outcomes utilizing the requested supports and services– Create a positive picture of who the person is – How to support the individual including challenges– Balance what is important to and important for– Create a shared understanding of effective support

between the individual, family and providers– To outline an action plan geared towards meeting the

individual’s desired outcomes

Focus is on supporting the person

ISP Development• Discovery

– Formerly known as assessment– Conversational approach focusing on abilities and

existing supports– Identify risks– Focus on relationships and capabilities– Creates a detailed description of the indivdual from

the individual’s perspective that outlines how providers can offer support

• Support planning– To provide guidance for achieving the indidal’s

desired outcomes – Outlines requested supports and services– Balances important to and important for

ISP Development• Resource management

– To identify, connect and provide methods or funding needed to accomplish desired outcomes

– Collaboration of families and community resources to enhance or build on the individual’s skills

– Focus is not to have paid supports over –run and individual’s own skills or naturally occurring resources in their lives

• Listening/Learning– Formerly known as monitoring– Ongoing formal and informal followup to learn and

witness evidence of progress– Outcomes are measured, compared and modified– Learn what is working and not working in a person’s

life

Waiver Nursing and State Plan Medicaid Services

• One thing the TDD Waiver has taught County Boards– Use of state plan Medicaid services to

enhance Waiver services

– Expectation to continue to utilize state plan Medicaid services while enrolled on IO Waiver

Waiver Nursing and State Plan Medicaid Services

• Authorization of State Plan Medicaid Services– Process will look similar for those receiving up

to 14 hours of Home Health Services• Assessment by a Medicare certified Home Health

Agency• Physician sign Plan of Care• SSA include on ISP

State Plan Medicaid Services – Private Duty Nursing

The plan for PDN authorization was for CBs to authorize private duty nursing (PDN) for all DD waivers. However, DODD was recently informed by Ohio Department of Medicaid (ODM) that this will not happen. The process will remain as it is currently under the other DD Waivers: SSA refers to ODM who will assess and approve or deny authorizations for PDN

What do TDD Waiver Providers need to do to continue providing services?

• Option 1: Provisional Certification– DODD will give all TDD providers, who are not

already certified under IO, Level One, or SELF, a one‐year provisional certification based upon the attached crosswalk.

– Each person enrolled in TDD has a date projected for when he/she will transfer from TDD to IO, Level One, or SELF. This information will be provided to service and support administrators to share with individuals and their teams.

– Provisional certification dates for existing TDD providers will follow the schedule below:

• Providers for individuals transferring 7/1/15 – 12/31/15 will receive provisional IO, Level One, and SELF certifications that are effective 7/1/15 – 6/30/16. These providers must submit a new application for certification prior to 6/30/16.


– Providers for individuals transferring 1/1/16 – 6/30/16 will receive provisional IO, Level One, and SELF certifications that are effective 1/1/16 – 12/31/16. These providers must submit a new application for certification prior to 12/31/16.




• Option 2: Initial Certification– Existing TDD providers, who are not already certified

under IO, Level One, or SELF, may skip the step of provisional certification and submit an initial application to add these services. This application must include verification that the provider meets all the standards for certification as specified in Ohio Administrative Code 5123:2‐2‐01.

– Any TDD providers who submit applications between 4/15/15 – 12/31/15 can request a waiver of the initial application fee by submitting an email to [email protected]

mailto:[email protected]


• Waiver services – Paid family caregivers that live with the individual will need to be authorized as Adult Family Living (AFL) instead of HPC – there will be no grandfathering. This is indicated on the “crosswalk of services” chart

• Waiver Nursing should be available 7/1/16 – TDD nurses will be granted provisional HPC certification. DODD anticipates that most TDD nursing can be covered under HPC. – If Waiver Nursing is needed, the CB will assess locally and

submit a recommendation to DODD, who will approve, partially approve, or deny the service once Waiver nursing is available under the I.O. Waiver

Other Changes for Providers• Billing Changes:

– As individuals transfer to other waivers, the only service for which claims will continue to be submitted through the Medicaid Information Technology System (MITS) is nursing.

– Claims for all other waiver services must be submitted through DODD’s Medicaid Billing System (MBS).

– In order to access MBS, all providers must create a user account through the Provider Certification Wizard (PCW), as described in the handout.

– Information about how to submit claims through MBS and upcoming billing training sessions is available at http://dodd.ohio.gov/Providers/Billing/Pages/default.aspx

– DODD will also be conducting billing training sessions specific to TDD providers in May and June. Notice of the trainings will be posted on our website (dodd.ohio.gov).

http://dodd.ohio.gov/Providers/Billing/Pages/default.aspx

Other Changes for Providers

• Medication Administration:– In accordance with chapter 5123:2‐6 of the Ohio

Administrative Code, unlicensed direct care workers serving people enrolled in IO, Level One, and SELF are able to administer medications and perform other health‐related activities upon completing required training.

– Information about the medication administration requirements is located at http://dodd.ohio.gov/HealthandSafety/Pages/Medication‐Administration.aspx

http://dodd.ohio.gov/HealthandSafety/Pages/

Governor’s Proposed Budget and Independent Providers

• Governor Kasich had proposed the phase out of Independent Providers as we know them in his proposed state budget. The House of Representatives removed this from the budget prior to the budget's move to the Ohio Senate. A counter proposal is now under discussion which would extend the timelines and allow individuals to continue selecting a qualified providing of their choosing.


• Original proposal - To eliminate or phase out Independent Providers statewide over a three year period beginning July 1, 2016, and go to an Agency only model. – The only exception to this would be if someone is

enrolled on a self-directed waiver and acts as the Employer Authority, then they can choose to hire an Independent Provider, as they are responsible for hiring/training/monitoring, etc. of staff. The only self-directed waiver that Ohio administers at this time is the Self Empowered Life Funding (SELF) Waiver


• DODD is proposing to add self-directed options under the IO and Level I Waivers in order to allow for individuals on these waivers to have the same opportunity to act as the Employer Authority and be able to hire/train/monitor staff.

• It is anticipated that DODD will continue to move forward with these self directed options in order to preserve the ability for individuals to continue receiving services from Independent Providers.

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