overview of dds acs hcbs medicaid waiver l.
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OVERVIEW OF DDS ACS HCBS MEDICAID WAIVER PowerPoint Presentation
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OVERVIEW OF DDS ACS HCBS MEDICAID WAIVER
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  1. OVERVIEW OF DDS ACS HCBS MEDICAID WAIVER

  2. Medicaid • Regular state plan Medicaid pays for doctor appointments, hospital expenses, medicine, therapy and some adaptive equipment   • Waiver allows Medicaid to be used to pay for additional services  • If person is waiver eligible, they can obtain regular state plan Medicaid services as well as waiver services

  3. Medicaid Waiver Facts • Implemented September 1, 1989 • Alternative to institutionalization • Not an entitlement program • Voluntary program • Services and supports to live and work in the community • Administrative authority and responsibility for waiver including application by DMS • Approval of application by CMS • Day to day operation by DDS with oversight by DMS

  4. Application • Contact DDS Intake and Referral staff (Adults) or DDS Children’s Services (Child) • Informed choice of ACS Waiver and/or ICF (HDC) • Complete application packet • DDS review of application packet for eligibility • Notification of placement on waiting list or ineligibility for waiver

  5. Eligibility Requirements • Developmentally Disabled (onset prior to age 22) • ICF Level of Care limitations in 3 of 6 major life activities (self care, language, learning, mobility, self direction or independent living) • Medicaid Eligible - $1911 (3 x SSI) monthly income limit, $2,000 resource limit and meet disability criteria

  6. Case Management • Locating, coordinating and monitoring of waiver services, state plan services, publicly funded services and informal community supports • Development and timely submission of MAPS • Assistance with Medicaid income eligibility and ICF level of care documents

  7. Supportive Living Array • Individually tailored services and supports that assist individual in acquiring, retaining and improving targeted skills necessary to reside in the community • Direct care staff person works with person in waiver recipient’s home and community on identified goals and objectives

  8. Supportive Living Array (cont) • Community Experience - activities in a natural setting such as shopping at a grocery store • Respite • Non – Medical Transportation

  9. Pervasive – constant support 24 hours a day, 7 days a week Extensive – schedule of daily or weekly supports less than 24 hours a day, 7 days a week Limited – intermittent in nature Levels of Support 24/7/365

  10. Supported Employment • Competitive employment • Minimum wage • Integrated work site • On-going support

  11. Adaptive Equipment • Purchase, lease or repair of equipment required to enable individual to perform daily tasks • Personal emergency response system

  12. Environmental Modifications • Adaptations to waiver participant’s place of residence • Necessary to ensure health, welfare and safety

  13. Specialized Medical Supplies • Disposable undergarments • Ostomy and colostomy supplies • Nutritional supplements • Non – prescription medications • Drug and alcohol screening

  14. Supplemental Supports • Emergency medical costs including prescription co-pay • Transitional expenses for moving from ICF/SNF • Ancillary support to assure health and safety in crisis situation • Fees for activities to reinforce specific habilitation needs (like Camps)

  15. Consultation • Psychological or adaptive behavior testing • Screening, assessing, developing therapeutic treatment plans • Training of direct care staff or family members • Development of behavior management plan • Determining appropriateness of equipment

  16. Crisis Center/Intervention • Short term out of home placement for intervention of crisis situation • In-home or community services provided by mobile team during crisis situation to assist and/or train in dealing with behavior

  17. Multi-Agency Plan of Service • Individualized • Services provided in least restrictive environment • Monitored and adjusted based on needs • Safeguards individuals rights • Assures individuals health and safety • Approved by physician • Prior approval by DDS

  18. Waiver Assurances • Level of Care (LOC) for all applicants and annually for persons on waiver using processes and instruments described in the waiver • Person centered planning where individual has choice of waiver, waiver services and providers, plan is updated annually/as needed and addresses all assessed needs (including health and safety risk factors) and personal goals and services are delivered based on plan

  19. Waiver Assurances, continued • Qualified Providers who meet certification standards including provider training • Health and Welfare is monitored continuously with remediation when appropriate • Administrative Authority with Medicaid agency retaining authority and responsibility for waiver • Financial Accountability billing for authorized services delivered by qualified providers in accordance with approved waiver

  20. Contacts for Application For CHILDREN (those up to age 21 and still in school): 501-682-2277 For ADULTS: 501-682-8678 or 501-683-5687