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 Modules1. Overview of the ID and DS Waivers

2. Becoming an ID Waiver Provider3. Supporting People in the ID and DS Waivers4. Introduction to Planning5. Residential Services6 PA, Respite and Companion - DBHDS-licensed7. Employment and other Day Services (Agency Directed)8. Crisis Stabilization and Supervision9. Assistive Technology, Environmental Modifications and Transition Services10. Skilled Nursing11. Personal Emergency Response System12. Consumer Directed Services and Services Facilitation13. Therapeutic Consultation14. Preauthorization and Reimbursement15.Monitoring and Oversight

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About the ID & DS Home & Community Based Waivers

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• 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

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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

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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

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CMS (Federal)

Virginia General Assembly (State)

DMAS

DBHDS

CSB Support Coordinator

CSBs/BHAs (Local)

Waiver Services Providers

The Big Picture

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Key Agencies

• Single point of entry• Support Coordination

Community Services Boards (CSBs) or Behavioral Health Authority

(BHAs)

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Key Agencies

• Community-based• Selected by the individual• Person-centered supports

Waiver Service Providers

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Key Agencies

Department of Behavioral Health & Developmental Services (DBHDS)

• Pre-Authorization• Technical Assistance

• Training

• Daily Operations• Licensing• Human Rights

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Key Agencies

• Single state agency for Medicaid• Payment to providers• Service audits and fraud• Quality reviews• Appeals

Department of Medical Assistance Services (DMAS)

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Other Key Agencies

• DSS• Public Schools • DARS

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ID and DS Waiver Eligibility

DiagnosticFunctionalFinancial

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Diagnostic Eligibility

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”Psychological Evaluation Guidance

ID as demonstrated by evidence of cognitive and adaptive delay OR presence of a syndrome typically associated with ID

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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

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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

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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

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Financial Eligibility

• DSS-determined• Different financial limits for

Medicaid Waivers• Based upon the individual’s

income only• Possible patient-pay obligation

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About the Waivers

• Each person requires a slot• Each CSB has an allocation of slots

Waiver Slots

Just the Facts ID Waiver

19Day Support Waiver Facts

Day Support WaiverID Waiver

• Based on urgency• Annual allocations

Slots Awarded…

• Based on date of need• Limited to 300 slots

About the Waivers

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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

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ID Waiver Services

About the Waivers

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Residential -Congregate -In-Home

PersonalAssistance

Respite Companion

Day Support

Pre-Vocational

SupportedEmployment

Skilled Nursing

Therapeutic Consultation

AssistiveTechnology

EnvironmentalModification

CrisisStabilization

P ersonal E mergency R esponse S ystem

Transition Services

ServiceFacilitation

•Respite •Companion• Personal Assistance

Self Directed

ID Waiver Services

ID Waiver Overview

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DS Waiver Services

About the Waivers

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Residential -Congregate -In-Home

PersonalAssistance

Respite Companion

Day Support

Pre-Vocational

SupportedEmployment

Skilled Nursing

Therapeutic Consultation

AssistiveTechnology

EnvironmentalModification

CrisisStabilization

P ersonal E mergency R esponse S ystem

Transition Services

ServiceFacilitation

•Respite •Companion• Personal Assistance

Consumer Directed

DS Waiver Services

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Self-Directed Services

Agency-Directed Services

A Combination of Both

Individual selects . . .

or

or

About the Waivers

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• Allowable support activities

• Criteria and limitations

• Individual Support Plans

About the Waivers

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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

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Based upon individual choice:

Providers

ServicesOutcomes

ActivitiesStaff Supports

Places

People

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Available Resources:Department of Behavioral Health and

Developmental Services• Division of Developmental Services

• Offices of Licensing and Human Rights

http://www.dbhds.virginia.gov