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“Moving to the New Waivers” CAP-MR/DD Waivers Update 10-08

“Moving to the New Waivers” CAP-MR/DD Waivers Update 10-08. Rose Burnette, Sandy Ellsworth, Cheryl Smith Division of Mental Health-Developmental Disabilities-Substance Abuse Services. New Waivers.

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“Moving to the New Waivers” CAP-MR/DD Waivers Update 10-08

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  1. “Moving to the New Waivers”CAP-MR/DD Waivers Update10-08 Rose Burnette, Sandy Ellsworth, Cheryl Smith Division of Mental Health-Developmental Disabilities-Substance Abuse Services

  2. New Waivers • Two new waiver applications were submitted to the Centers for Medicaid and Medicare Services (CMS) on August 1, 2008 • Implementation date is November 1, 2008 • Since they are considered new waivers by CMS, initial approval will be for a maximum of 3 years.

  3. New Waivers • Supports Waiver-maximum annual benefit at $17,500 • Comprehensive Waiver-replacement for the current waiver with maximum annual benefit at $135,000

  4. Objectives of the Supports Waiver and the Comprehensive Waiver • Enhancing the focus on person-centered planning and the alignment of services and supports with person-centered plans.

  5. Objectives of the Supports Waiver and the Comprehensive Waiver • Modified day supports, supported employment, and long term vocational supports • To ensure that participants are progressing towards their employment goals, • AND have meaningful daily activities.

  6. Objectives of the Supports Waiver and the Comprehensive Waiver • Modifying residential services to facilitate smaller community congregate living situations; • Facilitate living and working in the Most Integrated Setting; and • Improving outcome-based quality assurance systems.

  7. Supports Waiver • For individuals who live in their own home or reside with their family with some support; • and individuals who live in licensed residential facilities. • Self-direction is an option in this waiver for individuals living in their own home or with their family. • The Supports Waiver contains an annual maximum cost limit of $17, 500.

  8. Comprehensive Waiver • Intended for individuals who reside in their own home; reside with their family; or receive residential services in community congregate settings in the community. • The Comprehensive Waiver contains an maximum annual cost limit of $135,000.

  9. Moving to the New Waivers CORE VALUES

  10. What are Core Values? The Core Values: • a set of ideas and norms • established to express the foundation • in which services are to be created, implemented and delivered • to all participants of Developmental Disabilities and CAP-MR/DD waiver services and supports

  11. What are the Core Values? The Core Values are: • Empowerment • Community • Partnership • Integrity • Commitment • Quality

  12. Empowerment Empowerment is: • a process that challenges our assumptions about the way things are and can be. • challenges our basic assumptions about power, helping, achieving, and succeeding. • The process which enables one to gain power, authority and influence over others, institutions or society.

  13. Community Communities share • intent, belief, resources, preferences, needs, risks, • and a number of other conditions that may be present and common, • affecting the identity of participants and their degree of cohesiveness.

  14. Partnership • A relationship between individuals or groups, • characterized by mutual cooperation and responsibility, • for the achievement of a specified goal.

  15. Integrity:   • It is the concept of basing of one's actions on an internally consistent framework of principles. • Integrity can be expressed as personal honesty: acting according to one's beliefs and values at all times.

  16. Commitment: • The means to duty or pledge to something or someone, the state of being bound emotionally or intellectually to a course of action or to another person or persons. • We use this word “commitment” or “committed” to express why we do what we do. We must realize that commitment is not just a word but it is an action.

  17. Quality The totality of features and characteristics of a product or service that bear on its ability to satisfy stated or implied needs.

  18. Quality Measures Rose Burnette DMH/DD/SAS

  19. Quality Improvement System Development • New waiver applications required enhanced attention to the states’ quality improvement/management system • Quality Improvement Strategy is evidence based and is a continuous Quality Improvement process

  20. Quality Improvement System Development • Quality Improvement Strategies; • Waiver Administration and operation • Qualified Providers • Health and Safety • Level of Care • Service Planning • Financial Accountability

  21. Quality Improvement System Development • Waiver Administration and operation • DMA-DMH-DD-SAS formal agreement • DMA monitoring of DMH-DD-SAS compliance to requirements

  22. Quality Improvement System Development • Level of Care • Ensuring participants meet LOC criteria • Ensuring LOC process is completed per requirements • CNR completion per required timelines and

  23. Quality Improvement System Development • Qualified Providers • Licensure and/or certification standards • Completion of criminal records checks • Health Care Personnel Registry Checks • Non-licensed AFL providers • LME monitoring

  24. Quality Improvement System Development • Service Planning • PCP address needs and personal outcomes • Participant satisfaction • Risk assessment • PCP completion per requirements

  25. Quality Improvement System Development • Health and Welfare • Risk assessment • Incident Reporting • Reports of abuse and neglect • Review of Level II and III Incidents • Use of restraints • Routine dental and health care

  26. Quality Improvement System Development • Next steps; • Development of a System wide data base • Implementation of processes • Training

  27. National Accreditation Requirements for CAP-MR/DD

  28. National Accreditation • Providers will have one year from the date of enrollment with DMA or the implementation date of the waiver, whichever is later, to earn National Accreditation. • Requirement is based on legislation

  29. Provider Endorsement and Compliance to Staff Training/Core Competencies • Endorsement of new services • LME review of providers for compliance of additional staff training/core competencies

  30. Endorsement of New Services • Home Supports • Long Term Vocational Service • Crisis Respite

  31. Endorsement of New Services • Behavioral Consultant • Revisions based on public comment • Revision will be posted on DMA web site for public comment • After the public comment period endorsement can be initiated and completed.

  32. Endorsement of New Services • Home Supports • written and designed to contain the elements and requirements of Residential Supports. • Home Supports is the only service that can be rendered by parents who live with their adult child. • Currently parents may provide Home and Community Supports and Personal Care services to their adult child living in the home.

  33. Endorsement of New Services • Home Supports • Existing providers of Residential Support services, who intend to provide the new service, Home Supports, endorsement is not required. • Existing providers of Residential Support services are required to sign the attestation letter indicating compliance to the Home Supports service definition.

  34. Endorsement of New Services • Endorsement completed per the DHHS Policy and Procedures for Endorsement of Providers of Medicaid Reimbursable MH/DD/SA Services. • Statewide enrollment, of the services provided, with DMA, and a signed MOA with each LME indicating which services they will deliver within the LME catchment area.

  35. Modifications to Existing Service Definitions • Modifications include additional staff qualifications and training/core competencies requirements • Adult Day Health, Crisis Services, Day Supports, Home and Community Support, Personal Care, Residential Supports, Respite, and Supported Employment.

  36. Modifications to Existing Service Definitions • Providers are required to sign the Attestation Letter, indicating; • their understanding of the new staff training/core competency requirements, AND • compliance to the added requirements prior to delivering the services, AND • acknowledgement of the LME’s monitoring of compliance to the requirements within 60 days of implementation of the waivers.

  37. Modifications to Existing Definitions • Providers submit the signed Attestation letter to DMA Provider Services with their completed Addendum Application • Copy to the LME

  38. Modifications to Existing Definitions • LMEs MUST monitor providers within 60 days of implementation of the waivers or provider delivery of the service. • To ensure compliance to the new requirements. • DMH-DD-SAS will verify the LME monitoring.

  39. CAP-MR/DD Waivers Service Definitions October 2008

  40. Opportunity

  41. Opportunity • What do people want • What’s working • What needs to be fixed

  42. GOAL Develop quality services that give the opportunity for to: • have real lives • have real jobs • have real choices • make decisions about their lives

  43. Changes • Created Two Separate Waivers • Staff Training • Staff Qualifications • Services Added 4 new services Clarified Definitions Clarified UR Guidelines

  44. Staff Training Requirements • Added Staff Training/Competencies to all definitions for direct service staff • Added Requirement for First Aid and CPR to all definitions for direct service staff

  45. Staff Training -Competencies • Elements for Core Values • Elements for Person Centered Thinking • Elements for Role/Purpose/Philosophy of Services • Elements for Participant Rights • Elements for Overview of Developmental Disabilities

  46. Staff Training -Competencies • Elements for Interaction and Communication • Elements for Service and Documentation • Elements for Incident/Accident and Other Reportable Events • Participant Specific Competencies

  47. Staff Qualifications Direct Care Staff, providing services, MUST have a High School Diploma or GED.

  48. Personal Care and Respite • Requirement for High School Diploma or GED. • Existing staff will have 18 months to obtain their High School Diploma or GED. • All new staff must have proof of High School Diploma or GED upon hire/prior to delivering services.

  49. New Services • Home Supports • Crisis Respite • Behavior Consultant • Long Term Vocational Supports

  50. Participants Living with their Family • Person Centered Planning • Participant chooses what services/supports and who provides services/supports • Choices • Home Supports – Family or Guardian of the Person living with the participant • Home and Communityand/orPersonal Care- Person Not Living with Participant

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